Ensuring Effective Assessment In Psychiatry And Mental Health Nursing Essay

Ensuring Effective Assessment In Psychiatry And Mental Health Nursing Essay In the domain of psychiatry and specifically in the area of mental health nursing, it is essential that an early, quality assessment with accurate information is gathered about the patient. Psychotic, neurotic and depressed behaviours are all different. Sullivan (1990) makes it clear that poor assessment and/or misinterpretation of a patients presentation can be critical to their well-being and subsequent treatment or therapies. Bearing this in mind, it becomes vital that the mental health nurse is adept at conducting effective assessments. This account considers such exemplars through witnessing a one to one interview in an acute unit, will analyse and reflect on those skills employed to assess the bio-psycho-social needs of the patient and include references to clarify evidence-based practise. In keeping with the Code of Confidentiality as is required by (An Bord Altranais (ABA) 2000), relating to client confidentiality, names and locations involved have been changed. Thus, the client will be called Mary. The Gibbs cycle (1988), is used as a reflection tool to create a structured account of the discussion, and clearly show that true reflection in practise has occurred during its research. Mary is a 38-year-old married female depressive and more recently has had a secondary diagnosis of Anorexia. She has been a frequent patient over ten years to the acute ward where I was on placement. Mary was assigned a nurse whom I shadowed during this time to make my observations who was very helpful and pointed out pertinent features of mental health care practice to me. Mary refuses to eat and drinks only when her body demands it. When unfamiliar people are near, she gives distressed cries. She is on high protein fluids and is weighed every few days. I was shown how to observe her eating pattern and left to perform my task.  I was embarrassed and horrified that she wouldnt eat for me and as she wouldnt talk I had no idea whether she liked what was offered to her. I felt out of my depth and didn t know what to do. She would scream and shout out at me and Im not sure whether this was her way of trying to  communicate with me. I felt I should be doing more for her but not sure what. I informed my preceptor that she would not eat what was offered and was told not to worry he would try again, she turned her head. I felt totally useless as I could see this lady was fading away from lack of food but as she refused to eat there wasnt much I could do and as she would not talk  I didnt know how to communicate with her. Deliberate self-harm may refer to any act of non-accidental, self-inflicted injury.   It covers a broad spectrum of behaviour from successful suicides to non-fatal overdoses or self-inflicted wounding, which may have been previously classed as attempted suicide McAlaney ( 2004). Whilst Marys medical condition was not assessed as being immediately life-threatening her psychological presentation gave the nurse no other alternative than to contact the on call senior psychiatric house officer to conduct an assessment (bio/soc/psy evaluation) of her mental state. It must contain a detailed and precise record of what happened and any answers given to often very structured forms of psychological questioning. Thompson and Mathias (2000) likewise describe the process as acquiring information about a person or situation that may include a description of the persons wants and ambitions. Although I was not allowed to sit in with this interview I was fortunate to be present when Marys assigned nurse was talking to Mary on a one to one basis. Before entering the room where the assessment was to take place, I obtained the required consent from Mary (A.B.A. 2000) to be present. Control of the environment and assuring privacy can be central to successful assessment. Despite not being specifically designed for the assessment of distressed patients the nurse quickly checked for comfort, that chairs were the same height, distanced suitably from each other to avoid invasion of personal space yet allowing easy discussion. The nurse remained at the same level as his patient at all times and practised positive body language; leaning slightly forward in his chair, maintaining an open posture and remaining relaxed throughout. These characteristics have been well documented by Farley (1992). He further ensured that Mary had sufficient water and nutrition prior to the assessment- as far as she was willing that day considering her condition. The important thing was to have Mary at ease. Thompson and Mathias (2000) suggest that careful attention should be given to these points.   He then asked Mary how she would prefer to be addressed. Holland and Hogg (2001) reported that professionals must not assume that everyone wishes to be known by their listed name.   This clarification promotes affability as well as professionalism.  Ã‚   Brief periods of general chat opened the session to set an ambient atmosphere for the interview. This introductory phase is also referred to as the orientation or pre-helping phase. Forchuk (2002), states that Health professionals with well-honed listening skills, empathy and who display understanding allow patients to express their concerns, discuss options and build trust. The nurse interviewing Mary didnt rush the interview, let silence prevail for her to consider her answers and further supported Mary with encouraging statements to draw information such as, Tell me a little more what makes you feel this wayà ¢Ã¢â€š ¬Ã‚ ¦ Martin (1995), concludes silences actually maximise interaction with a patient. At this stage of the process Mary tentatively began disclosing some information to the nurse and it could be noticed that a therapeutic relationship was beginning to formulate. Actually engaging in conversation whether disclosure or otherwise was a big step for Mary.   The works of Burnard (1999) further promoted this observation. Mary seemed to be doing most of the talking while the nurse responded with active listening. Listening with attention and commitment is a caring response and forms the basis of all effective communication. Eye contact and continuation sounds, body language and gesture all gave safe non-verbal messages and encouraged continued conversation.   Brereton (1995) has identified that listening skills dominate talking skills; in the context of a psychiatric assessment this showed that a clients condition gives added value if the doctor is able to give time to the patient to express herself rather than give her (the doctor) interpretation of what she may have been trying to say. Mary was now helping herself and seemed a little relieved to be sharing her thoughts at this time.   Marys mood was important to the assessment. The nurse identified her presentation as familiar with that of depression and  her diagnosis was supported by her confirmation of not wanting to eat or drink and feeling uncomfortable around people. She became distressed and was unable to maintain eye contact. These symptoms are classic of the depressed patient Barker (1997). To support this diagnosis, both open and closed questions were necessary. A closed question directly requires a yes or no response but does not necessarily invite any elaboration. Barker (1997) suggests that closed questions are appropriate in the initial stages of the assessment to establish simple facts and clarification as they put fewer demands on the patient. In this assessment the nurse had managed to establish rapport quite quickly and asked more open questions (using how/why) like I am interested that you say you dont want to eat any more, can you tell me a little more why you feel like this? as opposed to, Are you eating well? but Mary began to withdraw. This cue told the experienced nurse to hold back and it began to identify the content of her thoughts and he noted the responses discreetly whilst attempting to retain eye contact with her as much as possible. The process of maintaining eye contact was further used to examine her ability to reciprocate. Nelson-Jones, (2002) mentions that the inability of patients to maintain prolonged eye contact would indicate he/she may be in a withdrawn state or feel uncomfortable in his/her condition. Barker (1997) further stated that over enthusiasm about eye contact might cause an aggressive or confrontational experience. The use of this method was appropriate as the assessment progressed. The nurse summarised in terms that Mary could understand, and identified key points discussed, gaining Marys affirmation that her interpretation was valid. Nelson-Jones (2002) said this process gives the patient a clear feeling of acknowledgement from another of their deepest feelings while  aiding the recovery process. The skills used in Mental Health  assessments emphasise the need for a holistic approach in the work of the Mental Health  Nurse. There is no standard format or panacea in the profession of Mental Health Nursing; the many tools and strategies used throughout the process depend fundamentally on the skill of treating each person as an individual, with their own set of needs and concerns as paramount. The assessment witnessed demonstrated that combining these skills promotes a good rapport with the patient and most importantly getting a full picture that can be interpreted and shared with the multi disciplinary team for the onward process of the care pathway approach. I have discovered that being objectively caring and non-judgmental in assessing the current situation at presentation is a key attribute in assessment skill. Often when interviewing known clients it can be difficult to avoid simply replicating their previous diagnosis or being frightened by the available evidence. I have further reflected on the necessity to question a patient using inter personal skills and effective non-verbal stimuli to encourage exploration and expression of their feelings, sometimes when they are particularly vulnerable, in order to help them. Academic research and observed practise-based experience can help the development of these skills. I have further learnt that people in crisis need continual support and assistance through their acute phase. This will make me more aware of my communication skills.

The Count Of Monte Cristo Essay -- essays research papers

The Count of Monte Cristo By: Alexandre Dumas Type of Literary Work: Historical Novel This book is an example of a historical Novel. It is historically accurate, and consists of characters that could have existed in the nineteenth century. Theme:Judgment Day comes to us all inevitably. We all pay for all evil and injustices of our life, yet sometimes there will be someone so viciously wronged, that he will return like a wrath of nature, with and unquenchable thirst for vengeance. Such a vendetta is the building block for the theme of this novel. The Count of Monte Cristo is that wrath of vengeance that crushes those who plotted his demise. Fernand Mondego and Danglars both wronged Dantes, and both were motivated by envy. Both men were filled with jealousy and never thought of the consequences of their actions. Villefort disposes of Dantes because of ambition. He would stop at nothing to climb the aristocratic ladder. Finally, Caderousse, a man that is simply ill natured, helped in the destruction of Dantes> None of these men could fathom how costly the price of these injustices would be. The actions and painful consequences exemplify the novel’s theme. Injustice toward the innocent for ignoble motives such as envy and jealousy will eventually be avenged severely. Live a life of virtue, not of vice, sot that one will not prosper in vain as did the villains of this novel. Setting:France in the nineteenth century is a nation teeming with turmoil. Those loyal to Napoleon feud with those loyal to the French monarchy and Kink Louis. We are moved across this nation in this novel, and begin in a small port city in southern France, Marseilles. Marseilles is where the characters are introduced, and where the conflict first. We quickly proceed to an island that harbors a prison infamous for nearly impossible escape, and sheer brutality, the Chateau d’If . The novel places the characters in the dungeon, giving a sense of hopeless despair, yet from there we move on. After a short stay in Rome at the time of the Carnival, we are settled in Paris. Here most of the plot is developed. The novel finally concludes in the Isle of Monte Cristo. Basic Plot:The Pharon, a three masted ship is docked by a young, skillful, promising young sailor by the name of Edmond Dantes. When the ships owner, Monsieur Morrel, learns that the ship’s admired captain passed away, ... ...fortune rewards his good will. Character most liked: In the novel, I grew especially fond of Monsieur Morrel. His heart was free from hate of thirst for vengeance. He was honest and thrived by helping others. He and his son were the only truly good-hearted men in the novel. He ran a firm with honest practices and persistently helped Dantes. When the Count repaid him for his kindness, the reward was truly deserved. Personal Evaluation: After reading this book, I can see why it has such and enduring popularity. The plot is exciting, and absorbs the reader into a romantic adventure. The characters are clearly described, and are put into situations causing the reader to grow emotions toward the characters. I would certainly recommend this novel for the sheer fact of how involved you become in the novel. I kept wanting to continue reading to see what twist would come up next. If I could change one thing in the novel, it would be the Count of Monte Cristo in one respect. He claimed to be God’s angle of vengeance, implying his actions were God’s will. I believe God is merciful, and punishment come about as consequence of our own sinful deeds, and not because God wishes to punish us.

Should Marty’s Company Embrace Open-Source Software?

ZAOZAO LIU MIS500 FALL 2012 Should Marty's company embrace open-source software in its hit product? Marty Dirwey, CEO of Kalley Music Software, is facing a crucial question that whether she should open Amp Up’s source code to users and developers. Undoubtedly, the new strategy which opens source software in KMS's hit product challenges the current highly successful strategy which prioritizes holding the intellectual property of Amp Up. However, if I were Marty, I would support the new strategy. There are four parts in this paper. 1) analyze a basic but essential issue that why Marty hesitates opening Amp Up's source code; (2) further explain the reasons why the company should accept the open-source strategy; (3)give some recommendations to KMS; (4) draw the conclusion. The reasons why Marty hesitates opening Amp Up's source code Essentially, there are three things Marty is worrying about: the feelings of the team, the churn of the customers, and the profit of the company. As w e can see from the case, Marty is in a dilemma.She resists opening the source code, because she is unwilling to give up the source code which is the fruit of painstaking labor of the whole team and she is worrying about how to make money if the company shared the source code of the software which currently is the main source of their revenue. However, on the other hand, if she won’t open the source code, undeniably, she is likely to be seen as the enemy of the users, maybe not the enemy of all users, but at least the enemy of the fanatics, which must lead to be alienated by the customers who play a significant role in the music game field. ZAOZAO LIU MIS500 FALL 2012 The reasons why the company should accept the open-source strategy Based on what's Marty worried I mentioned above, I will explain the reasons why the company should accept the open-source strategy from three perspectives. Considering the feelings of the team, especially the feelings of programmers, I believe the programmers must cheer for open-source software.Obvious is that confronting the current situation that inventing and executing dazzling upgrades are becoming harder and harder, programmers who Marty really cares about are fatigue so that they lose the passion in the software so that exhaust the creativity. At the moment, open source is a savior for all the programmers. They can integrate ideas from different developers and based on the basic innovative idea from developers, the programmers are more likely to create more stable and valuable upgrades than their opponents, because the programmers, the parents of Amp Up, must be more familiar with every detail of code.Another fact we should recognize is that a new generation of programmers has grown up with open source software, and is more skilled in finding out what they need with OSS than with closed and proprietary tools and systems. What mean by this is that with the open-source software, the programmers would work more effectivel y and efficiently. As to the customer churn, opening Amp Up's source code to the external developers doesn't necessarily lead to the customer churn, while closing the source code doesn't mean that similar and better software would never show up and the customers would be loyal to the company forever.Actually, infringers with strong competences have already shown up. Thus 2 ZAOZAO LIU MIS500 FALL 2012 open source becomes a must-to-do thing. From my perspective, as long as the programmer team of Amp Up doesn't give up the innovation of the software, the opponents can hardly take away the original customers. There are two reasons. One reason is that Amp Up has sound brand which has been generally accepted. In my opinion, the code of software is similar to the literature.Famous literature must be recreated several times, but the readers usually only can remember the original writer and prefer the original work. Thus, Marty doesn't need to worry about the KMG's position in the music game will be challenged easily, leading to a large number of customer loss. The other reason is the team of Amp Up, including the programmers, CEO, COO, is professional and visionary and more familiar with the software and mass market so that the team is more likely to have a better understanding of the customers' preference and cater to the needs of the market.The strategy of open-source software in KMS's hit product has a positive impact on enforcing the business transformation from a technology-oriented company to a serviceoriented company, which can bring KMS more opportunity to get more profit. If KMS wouldn't give away their proprietary IP and open the source, to keep technology advantages in the music game field, they must invest more money in Amp Up, such as maintenance fee of hardware, so the downward tendency of KMS's profit would be inevitable. Recommendations for KMS In short-term run, KMS should open the source and then integrate and utilize the ideas from different develop ers to mprove Amp Up quality and get potential customers to the 3 ZAOZAO LIU MIS500 FALL 2012 maximum extent. That is, KMS should utilize Amp Up to capture the last bucket of gold of the music software. After that, KMS should open the platform to third-party companies and provide technical support to those companies which still have the dream of surviving or even thriving in an increasingly competitive music game field. In long-term run, a business transformation of KMS is a must. Besides, I think KMS should still prioritize the innovation, because it has a potent technology team. However, the model of technology innovation should be changed.Innovation within ecosystem should be a long-term direction. Conclusion KMS should open the source, because Amp Up has already in the open-source community and open source software can bring more potential customers and more profit to KMS. Reference Coyle, Karen. â€Å"Open Source, Open Standards. † Information Technology and Libraries 21 . 1 (2002): 33-6. ABI/INFORM Complete. Web. 18 Sep. 2012. Jonathan Schwartz. †Should Marty’s Should Marty's company embrace open-source software in its hit product? † Simon, Phil. â€Å"Next Wave of Technologies† opportunities in chaos (03/01/2010) , Chapter 5 4

Global Warming And Its Effects On The Planet Essay

As Albert Einstein said â€Å"Look deep into nature and then you will understand everything better†. It can be hard, but not impossible to understand more about this ever changing universe. Without a doubt, our planet as we know was not the same a century ago and it will not be the same a decade from now. Due to this perpetual evolution of our planet’s natural cycles, its inhabitants are forced to choose between adaption or extinction. Meanwhile, an invasive species, or humans, has started a chain of disasters that are accelerating global changes and, in extension, the crucial selection of existence. Over the years, the field of natural science has increased human knowledge regarding our negative impact on the planet. Despite this, humans have taken minimal action towards addressing the problem that, considered a myth by some, is global warming. Many of us take our planet for granted, not realizing that, in of its own, it consist of one huge ecosystem relying on all of its parts to function properly. Because of this interdependence, action must be taken to minimize and raise awareness of global warming on the arctic region and its resulting effects on ecosystems around the world. Occurring on the entire planet, global warming affects individual regions at different intensity levels. Places covered in snow, like the Arctic, are being disturbed by the rising temperature, resulting in a decrease of ice and an increase of liquid water. To illustrate the immensity of this matter,Show MoreRelatedThe Effects of Global Warming on the Planet1158 Words   |  5 PagesGlobal warming can be defined as the increase in the earths sea level due to an increase in surface temperature. In decades past, there have been debates on what can be causing global warming. 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