Medicare Reimbursement Essay Example | Topics and Well Written Essays - 1000 words

Medicare Reimbursement - Essay Example Part A will cover the inpatient expenditures of Mrs. Zwick since she was in SNF a whole of 40 days. Part A covers full expenses for SNF for the first 20 days and after that it requires the policy holder to pay $148/ day up to 100 days. Part B will cover the equipment charges for the patient. Under the DME (Durable Medical Equipment), the walker that has been prescribed for Mrs. Zwick, will be paid for by Medicare. Mrs. Zwick will have to pay 20% of the amount that has been approved by Medicare, whether she chooses to rent it or purchase it. Part D will cover the drugs that have been prescribed by the doctor under the Medicare Prescription Drug Plan (PDPs). Mrs. Zwick has authorization that these drugs are medically necessary for her, but she will need to ascertain the quantity of the drugs. Step therapy will be applied to see if similar low cost drugs will be effective in the treatment, only then will Plan D cover the prescription drugs. The actual cost will depend n the type of drug used. Since Mrs. Zwick developed a Catheter Associated Urinary Tract Infection which was an HAI (Hospital Acquired Infection), and which could have been avoided by following infection control steps recommended by the CDC, Centers for Disease Control and Prevention (Medicare, 2013), thus the hospital will have to cover all the inpatient and SNF costs that have occurred after the acquired condition. In 2008, Medicare centres started to adopt a â€Å"no pay† policy for infections and complications acquired from the hospitals (O’Rielly, 2012). These hospital acquired conditions can be prevented and should be paid more attention to. CAUTI is one of the 10 conditions that are targeted by the CMS (Centres for Medicare & Medicaid Services) policy. CAUTI is the most preventable hospital acquired infection, a research â€Å"Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs†, revealed that 65% - 70% cases of CAUTI are preventable by adopting certain practices (Umscheid, Mitchell, Doshi, Agarwal, Williams & Brennan, 2011). 80% of Infection control professionals are of the opinion that such a policy from CMS has led to a greater focus on healthy practices and prevention of such acquired conditions (O’Rielly, 2012). Under the Deficit Reduction Act (DRA), hospitals will have to report secondary diagnosis, which will not be subjected to payment by Medicare unless they were present on admission of the patient (Paddock, 2007). But the medication and walker prescribed by the doctor will be covered by Medicare. After being admitted to the hospital, Mrs. Zwick developed an HAI, which could have been prevented by following control steps by the hospital. Ethical implications of such hospital acquired infections can be great. Mrs. Zwick suffered from pain tremendously due to the infection and had to stay in the SNF for an extra 19 days. Due to the carelessness of the hospital, the infection was caused, which led to taking of HIV antibiotics for Mrs. Zwick. Taking so many high potency medications at the age of 77 can be extremely harmful for the patient, as it can lead to further complications. The new rule may force the hospital or centre to compensate for the financial aspect but by all means the implications of such infection in terms of pain, time and extra high potency medication have to be borne by the patient him/herself. Scenario 2 COBRA (Consolidated

Environmental effects of oil spills Essay Example | Topics and Well Written Essays - 750 words

Environmental effects of oil spills - Essay Example ics (1997), an oil spill is â€Å"oil, discharged accidentally or intentionally, that floats on the surface of water bodies as a discrete mass and is carried by the wind, currents and tides. Oil spills can be partially controlled by chemical dispersion, combustion, mechanical containment and absorption. They have destructive effects on coastal ecosystems† (par. 1). The ecological crisis brought about by oil spills displaces a global equilibrium pattern based on the dwindling supply of marine resources. As an environmentally ethical dilemma, oil spills need to be closely evaluated and addressed to take drastic actions to restore balance and prevent further damage to the marine ecosystem. According to Oracle ThinkQuest, oil spills are actually classified into two groups: accidental and from operations (n.d., par. 1). Accidental oil spills are generally caused by collusions, fires and explosions, hull failures, and groundings (ibid.). On the other hand, oil spills from operations â€Å"occur when ships are carrying out routine operations at ports or oil terminals, but the majority of such spills are small, with 93% of them producing a spillage of less than 7 tonnes† (Oracle, n.d., par. 3). As indicated, two specific activities are encompassed within the scope of oil spills from operations, to wit: â€Å"loading/discharging: commonest cause of oil spillages (either during routine operations or resulting from accidents), with 3070 occurring between 1974-1999; and bunkering: the least common operational oil loss with only 566 occurring between 1974-1999† (ibid.). Whatever the causes are, the fact remains that the oil spilled in bodies of water pose dangers to marine life and to the environment. The International Tanker Owners Pollution Federation Limited (ITOPF) is â€Å"a not-for-profit organization established on behalf of the worlds ship owners to promote an effective response to marine spills of oil, chemicals and other hazardous substances† (ITOPF: About, 2010, par.

Persuasive Writing Essay Example for Free

Persuasive Writing Essay The next type of writing we will do is the persuasive essay. In this essay, you will be working to convince your reader of the rightness of your point of view on a specific topic. As I have already said, in some ways every type of writing is a form of persuasion: you are always trying to make your reader see the correctness of your opinion. In this assignment, however, you will stake out your position on a particular topic and argue forcefully and explicitly in favor of it. As always, you want to state your opinion explicitly in your thesis statement (of course, without saying, â€Å"I think that. . . .†). As always, you also want to pick a topic that is fairly focused, narrow, and specific: pick a topic that you can adequately discuss in four to five paragraphs. I will say it again: it is always better to say a lot about a small topic than to try to say a little bit about many aspects of a large topic. (For those who are counting, that is the 3,248th time I have said that this year.) Use the first paragraph to state and fully explain your thesis. The rest of your essay should then be the marshalling of evidence in support of your thesis statement and an explanation of and commentary on your evidence. Facts are necessary to support your thesis, but by themselves facts are not enough. You need to explain and comment on them fully; show how these facts support your view and not the view of the opposing side. Try to find three or four really strong pieces of evidence to support your opinion. There is no way you can say everything or think of every point; choose the strongest evidence you can. While arguing in favor of your position, you should also include arguments against the opposing view. For example, if I am writing about the wrongness of capital punishment, I should also include arguments showing the wrongness of arguments made in favor capital punishment. Try to anticipate the other side’s arguments. That will show you are thinking and will also strengthen your argument. In general, it is best to work from your weakest to your strongest argument. As usual, conclusions are difficult. End with a strong, powerful concluding paragraph that brings together your various ideas but does not merely restate them. Certainly do not end by saying something like, â€Å"For all these reasons . . . .† I have listed below a few sample thesis statements and a number of possible topics. Please do not be  limited by my suggestions. As with any piece of writing, you will do the best job if you write about something you care about. I will give you a sample essay. Your essay should be 1-2 pages typed or 4-5 sides handwritten, double-spaced either way. The essay is due Tuesday, 30 January. It is worth 100 points. We will work on the essay in class; you can always show me drafts. Do your best. SAMPLE TOPICS the dress code (or, better yet, some more significant and meaningful issue at school!) your allowance or curfew or some other family issue gun control, abortion, capital punishment (or any other political issue) your view on dating or relationships advocating for a particular religious or spiritual practice: for example, meditate everyday the need for more late-night activities for teenagers the war in Iraq of course, anything else you feel strongly about SAMPLE THESIS STATEMENTS Limiting civil liberties is not an appropriate way to keep this country safe from terrorism. Capital punishment is an unjust and immoral way to punish criminals. A vegetarian diet is a sensible and meaningful response to world starvation and environmental destruction. The dress code provides a meaningful way to minimize the economic competition between students and unite them in their common academic purpose. A vegetarian diet is a sensible and meaningful response to world starvation and environmental destruction. So many Americans are often caught up with finding the â€Å"perfect† diet. While such a diet does not exist, a vegetarian diet provides significant health, environmental, and political benefits. Choosing such a diet is a simple but significant way to make a real difference in one’s own life and the world. First of all, a vegetarian diet is far more healthful than the traditional  American diet that emphasizes meat. A meat-free diet is higher in fiber, lower in saturated fat, and richer in a wide range of vitamins and minerals than a meat-based one. While we do hear conflicting evidence about the various health claims of different diets, nutritionists and scientists seem to agree that a diet rich in fruits and vegetables provides the greatest health benefits. Some people might say that a vegetarian diet is boring: quite the contrary. Compared to the relatively few kinds of meats and ways to prepare them, there are scores of vegetables, fruits, grains, and legumes and almost countless ways to prepare them. A meat-based diet also puts far too much protein into the body, taxing the kidneys and wasting expensive food. As it is, Americans eat too much protein; eating a vegetarian diet is one way to reduce our intake of excessive and expensive protein. Eating a diet based on fruits and vegetables also creates less environmental havoc than a meat-based diet. Raising the animals necessary for the traditional meat-laden diet requires large amounts of land, mountains of processed feed, and the disposal of tons of waste. But a family of four could, if necessary, live for a year off the fruits, grains, and vegetables produced from a few acres of land. And, once the crop is taken, there are few or no ill effects. If the agriculture is done organically, vegetarian eating has even fewer harmful effects upon the land. In an age of diminishing arable land and resources and increasing populations, we need to find ways to get the most nutrition from our land use. A vegetarian diet provides such efficiency. Finally, a meat-rich diet consumes many more scarce resources than a vegetarian diet. It takes about 800 pounds of cattle feed to produce one pound of beef. In a world in which nearly one-fourth of the planet’s population is malnourished or starving, a meat-based diet is simply a luxury we can no longer afford (if we ever could have). In good conscience, it only makes sense to eat lower on the food chain – as we do with a plant-based diet. If everyone in the world ate a vegetarian diet, there would be an immediate surplus of food available to feed people at far lower cost and with wiser use of precious resources. In this way, vegetarianism becomes a moral choice. For reasons of politics, environment, health, and justice, vegetarianism is the only intelligent and compassionate choice in a world of scarce resources and increasing population. It may take some getting used to, but the benefits and rewards of a vegetarian diet – for the planet, the self, and the human race – far outweigh whatever minimal sacrifice may be involved. sentence in bold: thesis statement underlined sentences: topic sentences for each paragraph

Depression and Suicidal Ideation: Mental Health Case Study

Depression and Suicidal Ideation: Mental Health Case Study Introduction Mental health nursing is a complex healthcare practice, because it aims to meet the needs of clients with mental health needs, which are usually also complex and require more than a single therapeutic approach. Mental health nurses usually provide supportive and therapeutic care adhering to nursing and healthcare principles of beneficence and non-maleficence, and adhere to the principles published in the national guidance, of client-centred care focused on service user need, as enshrined in the National Service Framework for Mental Health (Department of Health, 1999). Mental health nursing usually involves the provision of ongoing, supportive therapeutic interventions and ‘talking’ therapies, which can include counselling based on established principles. This role of the mental health nurse involves the formation of a therapeutic relationship with the client, in order to support the client to development self-management and coping strategies for the ongoing control of th eir condition and its symptoms, in conjunction with pharmacological treatments. This critical essay will explore the mental health nursing care of a particular, identified patient encountered in clinical practice, in whose care the author was directly involved. It explores the provision of Cognitive Behavioural Therapy (CBT) to a single client who had complex health needs and challenging symptoms, reviewing the usefulness and appropriateness of the therapy, the effects or projected effects on the client’s wellbeing and symptoms, and the issues surrounding such care for the client in relation to rehabilitation and recovery as part of their mental health journey. The essay will focus on the care of one client with depression and suicidal ideation, looking not at the acute phase of mental health care, but the rehabilitation phase where the client is being supported into ways of managing symptoms and returning to a useful, active social life where they can function effectively within society. The essay focuses on the goals and principles enshrined in the NSF for Mental Health (DoH, 1999), that of achieving the best possible standards of health and wellbeing for the client and the best possible control of their symptoms. It will explore the rationales and process of the therapeutic intervention, and use this intervention within a person-centred model of counselling, support and care. Client Background and History The client, who for the purposes of this essay will be called Lisa (this being a pseudonym used to ensure client confidentiality), is a 19 year old young woman with a history of depression and suicidal ideation. Lisa first presented to the local mental health services at the age of 16, after an acute episode of physical self harm and attempted suicide. Lisa’s self-harming behaviour takes the form of cutting, usually to the arms, legs and abdomen, although she has been known at times to also cut her face and neck. During her first admission, Lisa was diagnosed as having Depression with Psychotic symptoms. She has been managed with a combination of Fluoexetine and a range of other medications, but is known to have frequent relapse due to medication non-compliance. Lisa has a complex personal and social history which goes some way to explaining her current state of mental ill health. She was abandoned by her single parent mother at the age of 11, from which time until the age of 16 she spent in local authority care, a mixture of foster homes and care facilities. At age 16 she left care and went on the streets, but at 17 after her third hospital admission was able to get into a social support programme, secure accommodation for herself, and start to attend college. Lisa is still at college, studying beauty therapy. She has a history of sexual abuse, but for the past year and a half has been living a relatively stable life, with a good social life and a busy college life. Lisa has presented this time with a relapse in her Depression, and has demonstrated a strong suicidal ideation, low mood and being very withdrawn and apathetic. She has, this time, attempted suicide through overdose of a friend’s prescribed medication accompanied by severe cutting to the arms, legs and breasts. After being medically stabilised, she was admitted to the mental health ward, and after two weeks on the ward, fully compliant with her medication, was making some progress towards rehabilitation. Discussion Norman and Ryrie (2004) describe mental health nursing as a process of working with clients to allow them to develop the skills to regain control over their lives through managing their mental health. Ultimately, mental health nursing supports clients into a phase of recovery (Tschudin, 1995), which means that they are not overwhelmed by their symptoms and can manage them through a combination of medication, personal supportive therapies, and other support, in order to lead ‘normal’ lives within society and achieve personal goals. Mental health nursing is based upon a range of principles, some of which are scientific, some of which are more holistic (Norman and Ryrie, 2004). Mental health nursing supports clients through the acute phases of their illness, via crisis management, and through the chronic stages of their illness, through longer-term processes of rehabilitation (Perkins and Repper, 2004). Quite often, mental health service users are viewed in terms of their d isease and its treatment, but the provision of true client-centred care should start off with a good understanding of the client and their condition, their particular needs, and then be followed by a judgement about how best to help them towards recovery along the spectrum of mental health and illness (Perkins and Repper, 2004; Foreyt and Poston, 1999). Recovery cannot be considered as a finite point in time, but as an ongoing balance between the client and their illness, wherein the client aims to achieve the ability to function at the level they desire, through accessing appropriate support (Perkins and Repper, 2004; Greenberger and Padesky, 1995)). The judgement about what kind of support is best is based upon a number of factors, but most often, the decision about which of the many approaches to supportive therapies and counselling will be used is based upon both the client need, and the mental health nurse’s own knowledge about, experience of, and preference for, a parti cular form of therapy (Puentes, 2004). Mental health nurses, therefore, must have a good understanding of themselves, their philosophical orientation in relation to counselling, and the therapies on offer, and are most likely to provide those with which they have the most familiarity. In this case, the author is describing their own philosophical approach as matching that of their clinical practice mentor, who, as an experienced mental health nurse, is a strong advocate of client centred approaches to counselling. Gamble and Curthouys (2004) describe these approaches as being founded on Rogerian principles that include empathy, genuineness and unconditional positive regard. Rogers (1957 in Gamble and Curthouys, 2004) suggest that within a therapeutic relationship, which is a supportive relationship between client and nurse, with the express goal of attaining rehabilitation or recovery, there should be certain features which support the client towards ‘functionality’. Thus, there needs to be contact between tw o people, nurse and client, in which the client is in a condition of incongruence, and the nurse a state of congruence, and in which the nurse displays unconditional positive regard, and empathetic understanding, towards the client (Rogers, 1957 in Gamble and Curthouys, 2004). The nurse must be able to communicate these factors to the client, within the client’s frame of reference (Rogers, 1957 in Gamble and Curthouys, 2004 Bryant-Jefferies (2006) argues that the therapeutic relationship must be founded on empathy, and that in order to achieve empathy the nurse must employ active listening, and must attend to all the signs and the kinds of communication which the client displays, providing a sense of being ‘present’ with the client in whatever experience they are retelling or currently experiencing. One of the more challenging aspects of developing such a relationship with the client is the provision of unconditional positive regard, which Bozarth and Wilkins (2001 in Bryant-Jefferies, 2006) describe as an ongoing, unceasing and unflagging ‘warm acceptance’ of the individual, regardless of what they might say. Some authors describe this as the element of the therapeutic relationship that is most likely to support the client towards recovery (Bozarth and Wilkins, 2001 in Bryant-Jefferies, 2006). In this case, the mental health nurse (the author’s mentor) who was the prima ry support person for the client, fully aspired to such principles and to the concept of developing the best possible therapeutic relationship with the client. The literature consistently demonstrates that the quality of the therapeutic relationship is fundamental to the client achieving a state of mental health and wellbeing (DoH, 2001; DoH, 2006; Nice, 2004). The author agreed with this and felt that their own therapeutic philosophy was founded upon similar principles, making it appropriate to get involved in the case. The client was also happy to have the author present, as they were involved in there are from admission, and had spent some time observing the client during the acute phase to prevent further self harm. Depression is a surprisingly common, yet often serious mental illness, which can present in a variety of ways, with features such as â€Å"low mood, lack of enjoyment and interest, reduced energy, sleep disturbance,appetite disturbance, reduced confidence and self-esteem, and pessimistic thinking† (Embling, 2002; p 33). According to Embling (2002), these symptoms can have a significant effect on people’s ability to take part in normal daily life or social activities, and in particular, the low mood and predisposition towards pessimistic thoughts can have a negative impact on thought processes, leading to suicidal ideation (Rollman et al, 2003).. There are a number of individual and social issues which have been shown to have an association with depression, including physical illness (acute and chronic), poverty or low socioeconomic status and deprivation, divorce, bereavement or relationship breakdown, loss of a job or sudden, negative change in circumstances, ethnic minority status, and concomitant mental illness (Embling, 2002). It is a chronic condition which can manifest in acute episodes which are often successfully managed with pharmacological and non-pharmacological support, but the relapse rate is high for many patients (Embling, 2002). It can range from mild depression to severe depression or anywhere along a spectrum in between (Rollman et al, 2003). A wide variety of therapeutic approaches have been used in treating this illness, and in Lisa’s case, she had had some success previously with solution-focused brief therapy, but had found herself relapsing once regular, close contact with a mental health nurse had lapsed. Lisa admitted that she felt the time was right to take control of her life and find ways of coping with her illness more independently, and was keen for strategies which would allow her to avoid having such serious relapses, because they themselves had a negative effect on her life and potential career. Therefore, it was agreed that CBT might be the optimal approach. Luty et al (2007) argue that CBT is not always the most efficacious therapeutic choice for severe depression, but in Lisa’s case, it seemed worth trying, particularly as her worst symptoms were related to not maintaining her medication, and once she was on her medication, the focus had to be on keeping her well enough to keep taking the tablets. Other literature suggests that CBT is effective in patients who have had a history of sexual abuse (Price et al, 2001) This seemed to imply that the focused approach to support that CBT offered would the right way, particularly as it is so focused on relapse p revention. According to NACBT (2007) cognitive behavioural therapy is the term used to describe a variety of therapeutic or interpersonal interventions, all of which are characterised by a focus on the importance of how clients think, and how this thinking impacts upon their feelings, their responses to stimuli and stressors, and their actions. Its value lies in the fact that it is structured, directive, and also time-limited, strong focusing client and nurse on the current problem, on how the client feels and thinks at the single point in time that therapy is taking place (Embling, 2002). CBT is based on â€Å"the theory that the way an individual behaves is determined by his or her idiosyncratic view of a particular situation, thus the way we think determines the way we feel and behave †(Embling, 2002p 34). According to Embling (2002), Beck et al (1979) introduced CBT , suggesting that â€Å"CBT can treat depression as it helps the client to evaluate and modify distorted thought processes and dysfunctional behaviours† (Embling, 2002) p 38). According to NACBT (2007) CBT has expanded within the therapeutic domain to include a range of approaches based upon the sample principles, including, Rational Behaviour Therapy, Rational Emotive Behaviour Therapy , Rational Living Therapy, Cognitive Therapy, and Dialectic Behaviour Therapy, all of which are based on what are described as â€Å"cognitive models of social response†. These in turn have been based on philosophical principles derived from Socratic thought, wherein individuals aim to attain a state of calm and tranquillity when challenged by stressful or difficult situations and experiences (NACBT, 2007). Thus the idea is to modulate the responses to life and experiences which precipitate symptoms of mental illness. The coun sellor directs the client to use inductive methods combined with principles of rational thinking and educative approaches, to support behavioural self-managed over the longer term , (NACBT, 2007; Sensky et al, 2000) and to prevent relapses (Bruce et al, 1999). Therefore, in CBT, the nurse provides the client with the ability to explore their behaviours, their responses and their typical symptomatic responses in particular in certain situations, and assists them in developing ways of mediating such responses so that they do not relapse into behaviours characteristic of their illness (Sensky et al, 2000; RCP, 2007; BABCP, 2007). Management of Lisa’s Care To begin with, it was really important to ensure that Lisa’s counselling and therapy was truly person-centred, in order to develop a good relationship between Lisa, the primary nurse and the author (NELMH, 2007; Moyle, 2003). The author hoped that Lisa would respond well to this approach because it would allow for the demonstration of empathy and a good understanding of how her life, previous mental illness and personal circumstances were contributing to her current illness, and therefore would support congruence in provision of support to meet her needs and address her specific concerns. However, the difficulty in achieving congruence here was that the author could not really claim to fully understand the effects of Lisa’s previous experience of sexual abuse or really relate to her experiences, and in particular, the author found some elements of her history, including the stories she told relating the sexual abuse, as very disturbing. The author discussed this with th e nurse mentor prior to the counselling sessions, and discussed how to achieve that true sense of congruence and presence, without communication their own abhorrence of the experiences that Lisa was relating. It was decided that it would be acceptable to tell Lisa that the author was appalled by these experiences, because this would underline the fact that she should not have had to suffer this abuse and that she was right to seek help in dealing with the effects on her mental health. Therefore, the author was able to enter into this counselling in supportive frame of mind, and able to achieve empathy without communicating negative feelings to the client. The focus of Lisa’s CBT was on the suicidal ideation/self-harming and the low mood and self-abhorrence that were the main manifestations of her depression. Collins and Cutcliffe (2003) show that one of the most common features displayed by mental health service users with suicidal ideation is hopelessness. This was certainly the case for Lisa, who displayed a sever pessimism about life and her ability to achieve anything like lasting recovery. Her goals to become a beauty therapist seemed unobtainable, and she felt she had no hope of making a new life for herself that was not ‘ruined’ by her previous life. However, Collins and Cutcliffe (2003) recommend CBT for this kind of pessimistic thinking because it focuses the client on establishing ‘hopefulness’ within their thought patterns. Other research shows that suicide risk can be reduced if individuals can experience others showing concern for them (Casey et al, 2006). This was supported by the author’s and the mentor’s firm belief in the efficacy of CBT for clients such as Lisa (Joyce et al, 2007). Thus, it was possible to establish an initial level of trust, and through the therapeutic relationship, the author was able to support Lisa in exploring her conditional assumptions (Curran et al, 2006) which led to the ongoing, spiralling pessimism, and then using CBT, we were able to set goals for each counselling session, set ‘homework’ which focused on self-management, and then reflect on progress as each session followed the previous one (Curran et al, 2006). The sessions focused on relapse prevent ion through changing cognitive patterns and schema, rehearsing relapse drills, and ensuring ongoing compliance with medication (Papakostas et al, 2003. While some authors argue for the need for inclusion of family or carers in therapeutic interventions such as (Chiocca, 2007), this was not possible with Lisa because she had no family and although she had a number of good friends made through her college course, none of them knew of her mental illness. The focus was therefore on health education, developing personal skills, and helping Lisa to cope with issues such as her current socioeconomic status (Jackson et al, 2006; Cutler et al, 2004). . Conclusion If, as Calloway (2007 p 106) suggests â€Å"nursing is defined as a profession that protects, promotes, and restores health and that which prevents illness and injury†, then using such a client-empowering form of therapy, one which is based on the development of realistic coping mechanisms (Salkovskis, 1995; Deakin, 1993), was the right approach with Lisa. Discussion with her revealed that focusing on relapse prevention, within an honest therapeutic relationship which addressed the factors affecting her mental health, and addressed the ways of thinking and behaviours which led to relapse, was the right approach, because these were, fundamentally, her primary needs. The person-centred approach, in particular, seemed to give her the positive, ongoing interpersonal contact she needed, such that she did demonstrate signs of moving into a state of rehabilitation and recovery. References BABCP (2007) CBT Today36 (3) Available form www.babcp.com Accessed 5-1-09 Bozarth, J. and Wilkins, P. (eds) (2001) Rogers’ Therapeutic Conditions: evolution, theory and practice Ross-on-Wye: PCCS Books. In: Bryant-Jeffries, R. (2006) Counselling for Eating Disorders in Women: Person-centred dialogues Oxford: Radcliffe. Bruce, T.J., Spiegel, D.A. and Hegel, M.T. (1999) Cognitive-behavioural therapy helps prevent relapse and recurrence of panic disorder following alprazolam discontinuation. Journal of Consulting and Clinical Psychology 67 (1) 151-156. Bryant-Jeffries, R. (2006) Counselling for Eating Disorders in Women: Person-centred dialogues Oxford: Radcliffe. Calloway, S. (2007) Mental Health Promotion: Is Nursing Dropping the Ball?. Journal of Professional Nursing 23 (2) 105-109. Casey, P.R., Dunn, G., Kelly, B. et al (2006) Factors associated with suicidal ideation in the general population: Five-centre analysis from the ODIN study. The British Journal of Psychiatry 189(5) 410-415. Chiocca, E. (2007) Suicidal ideation Nursing 37(5) 72. Collins, S. and Cutcliffe, J.R. (2003) Addressing hopelessness in people with suicidal ideation: building upon the therapeutic relationship utilizing a cognitive behavioural approach. Journal of Psychiatric and Mental Health Nursing 10 (2) , 175–185 Curran, J., Machin, C. and Gournay, K. (2006) Cognitive behavioural therapy for patients with anxiety and depression. Nursing Standard 21(7) 44-52. Cutler, J.L, Goldyne, A., Markowitz, J.C. et al (2004) Comparing cognitive behaviour therapy, interpersonal psychotherapy and psychodynamic psychotherapy. American Journal of Psychiatry 161 (9) 1569-1578. Deakin, H. G. (1993) Behavioural and Cognitive-Behavioural Approaches. Ch21 pp251-292. In Wright, H and Giddey, M. (1993) Mental Health nursing: From First principles to professional practice London: Chapman and Hall Department of Health (2006) From Values to Action. The Chief Nursing Office’rs Review of Mental Health Nursing London: DOH. Department of Health (2001) Treatment Choice in Psychological Therapies and Counselling: Evidence Based Clinical Practice Guideline London: HMSO. Department of Health (1999) The National Service Framework For Mental Health. Modern Standards and Service Models London: DOH. Diaz-Granados, N. and Steward, D.E. (2007) Using a gender lens to monitor mental health. International Journal of Public Health 52 (4) 197-198. Embling, S. (2002) The effectiveness of cognitive behavioural therapy in depression. Nursing Standard 17(14-15) 33-41. Foreyt, J.P. and Poston, W.S. (1999) What is the role of cognitive-behavior therapy in patient management? Obesity Research 6 18S-22S. Gamble, C. and Curthoys, J. (2004) Psychosocial interventions. In: Norman, I. Ryrie, I. (eds.) (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice Maidenhead: Open University Press. Gelso, C.J. Carter, J.A. (1985) The Relationship in Counseling and Psychotherapy. The Counselling Psychologist, 13 (2) 155-243 Greenberger, D and Padesky, C.A. (1995) Mind over mood. A cognitive therapy treatment manual for clients. New York: Guilford Press. Jackson, S.F., Perkins, F., Khandor, E. et al (2006) Integrated health promotion strategies: a contribution to tackling current and future health challenges. Health Promotion International 21 (Supplement 1) 75-83. Joyce, O., McKenzie, J.M., Cartern, J.D., et al (2007) Temperament, character and personality disorders as predictors of response to interpersonal psychotherapy and cognitive-behavioural therapy for depression. The British Journal of Psychiatry 190(6) 503-508. Luty, S., Cartern, J., McKenzie, J. et al (2007) Randomised controlled trial of interpersonal psychotherapy and cognitive-behavioural therapy for depression The British Journal of Psychiatry 190(6) 496-502 Moyle, W. (2003) Nurse-patient relationship: A dichotomy of expectations International Journal of Mental Health Nursing 12 (2) 103–109. NACBT (2007) Cognitive Behavioural Therapy http://www.nacbt.org/whatiscbt.htm Accessed 5-1-09 NELMH (2007) Relapse Prevention http://nelmh.org/page_view.asp?c=10did=820fc=001003005. Accessed 5-1-09. NICE (2004) Depression: Management of Primary and Secondary Care Clinical guideline 23 www.nice.org.uk Accessed 5-1-09 Norman, I. Ryrie, I. (eds.) (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice Maidenhead: Open University Press. Norman, I. Ryrie, I. (2004) Mental health nursing: origins and orientations. In Norman, I. Ryrie, I. (eds.) (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice Maidenhead: Open University Press. Ormel, J., Koeter, W., Van den Brink, G. and Van de Willige, G. (1991) Recognition, management, and course of anxiety and depression in general practice. Archives of General Psychiatry. 48 (8). Papakostas, G.I., Petersen, T., Pava, J. et al (2003) Hopelessness and suicidal ideation in outpatients with treatment-resistant Depression: prevalence and impact on treatment outcome The Journal of Nervous and Mental Disease 191(7) 444-449 Paykel, E.S., Scott, J., Cornwall, P.L. et al (2005) Duration of relapse prevention after cognitive therapy in residual depression: follow-up of controlled trial. Psychological Medicine 35 59-68. Peplau, H. (1989) Interpersonal constructs for nursing practice in: O’Toole, A.,Welt, S. 9eds) )1989) Interpersonal Theory in Nursing Practice. New York: Springer. Perkins, R. Repper, J. (2004). Rehabilitation and recovery. In: Norman, I. 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Rainman Essay -- essays research papers

Barry Levinson brings us a Raymond, very moving character in the movie Raymond Babbitt. Raymond is a grown man that is Autistic. Raymond may be grown up but he lacks certain sociable skills, making communication very difficult. He has a hard time understanding and answer questions. Because of Raymond’s handicap he is unable to progress into a new person. Raymond’s limitations give the movie boundaries. Levinson uses the idea of not allowing this character to change to affect the other characters in this story. The character that is most affected is Raymond’s brother, Charlie. At the beginning Charlie is frustrated and short on cash, his father has died and Charlie received no inheritance, his father had left it all to Charlie’s unknown brother, Raymond. When Charlie first meets Raymond he thinks it is a big joke, the way Raymond acts. Although, all he can seem to think about is why no one ever told him that he had a brother. Charlie makes it out to seem li ke he really wants to take Raymond in with him and take care of him, at this point Charlie is taking Raymond from the institute where he is being taken care of in hopes of trading Raymond back for part of his inheritance. When he is refused, Charlie runs off with Raymond beginning a cross-country journey that would change Charlie completely. The beginning of the movie shows Charlie as a money motivated guy. He was only in it for the quick buck, you soon find out that his business is suffering and is having many problems. T...

Personal Narrative - Knee Injury Essay -- Personal Narrative Essays

Personal Narrative- Knee Injury I was always an active person from being in sports to hanging out with friends. I always had something planned, or came up with something on the fly. My junior year in high school was a very tough time for me. I was involved in a lot of activities, organizations, and clubs. I was very active in one organization where I had to be up at school every morning at 7:15 for that meeting. Meaning I would not leave school sometimes until 6:45 to 7:00 in the evening. On the weekends I would have something to do either with friends or family. I would never go a weekend with nothing to do. Either I was out running errands or at the mall buying some new clothes. The problem came in on November 22, 2000 at an away game at North Side High. It was the third quarter ...

Occurrence Of Malnutrition In Children Health And Social Care Essay

The childhood period is the most of import phase for the overall development during the lifetime. Brain and biological development takes topographic point at this phase Muller and Jahn, 2009. These developments are influenced by sufficient of stimulation and nutrition, and this development affects of build, the immune system, knowledge, every bit good as societal and emotional growing ( Handal et al. 2007 ) . Such development helps to guarantee that each kid reaches his or her possible and is a productive member of society ( Uthman, 2009 ) . When kids waste their early old ages with a decreased sum of motivation, or a less emotionally and physically encouraging environment encephalon development is affected and leads to cognitive, societal and behavioural holds. Many factors can disrupt early kid development such as malnutrition ( WHO, 2009 ) . The nutritionary position of kids is a important presentation of wellness and development ; it is non merely a representation of past wellnes s but an of import index of future wellness ( Subramanyam et al. 2010 ) . Malnutrition is one of the of import wellness jobs throughout the universe, peculiarly in developing states ( Sarifzadeh et al. 2010 ; Hioui et Al. 2010 ) . Malnutrition is an of import public wellness job because it leads to increased hazard of decease from infective diseases, more terrible infections and a high cause of mortality, and making extra psychosocial loads ( Jesminet al. 2011 ) . Malnutrition is a status doing scrawny growing, scraggy, and blowing ( Faber et al. 2010 ; Subramanyam et Al. 2010 ; Uthman, 2009 ; Kandala et Al. 2011 ; Janevic et al.2010 ) , inadequacy of protein, energy and other foods and instability between the foods the organic structure needs and the foods it receives ( Muller and Jahn, 2009 ) . Malnutrition can be detected by anthropometric measurings were height-for-age ( HAZ ) , weight-for-age ( WAZ ) and weight-for-height ( WHZ ) is measured against a set of WHO child and growing criterions and NCHS/WHO mention ( Hioui et al. 2010 ; Lesiapeto et Al. 2010 ) . Malnutrition degrees are still high in developing states around the universe ( Sunil, 2009 ) , an estimated cachexia 9.8 % , scraggy 17.9 % and stunting 29.2 % ( WHO, 2009 ) , included Indonesia. Harmonizing to the WHO ‘s reported prevalence of malnutrition in kids under five old ages of age during the twelvemonth 2007 in Indonesia 19.6 % are scraggy, 40.1 % stunted, 14.8 % showed cachexia and 11.2 % were overweight. Many factors can be associated with the happening of malnutrition in kids. For illustration, inadequate wellness services and an unhealthy environment ( Schoeman et al. 2010 ; Hioui et Al. 2010 ) , socio-cultural environments ( Mashalet al.2008 ; Noughani & A ; Bagheri, 2010 ) , socioeconomic, maternal, and child factors ( Lesiapeto et al.2010 ; Hasselman et al.2006 ) , and socio-demographic factors ( Phengxay et al. 2007 ; Handal et al. 2007 ) . An apprehension of the most of import causes of malnutrition is imperative to be identified and an analysis would so bespeak more specii ¬?cally the type of policies, wellness plans and where resources should be directed to right the root causes of inequality in childhood malnutrition ( Lesiapetoet al. 2010 ; Uthman, 2009 ) .Statement of the jobThere are many factors that can act upon the happening of malnutrition in kids under five old ages of age are child factors, female parent factors, and family factors.Research aimThe chief aim in this research is to happen out the major factors act uponing the happening of malnutrition in kids under five old ages of age.Chapter IIReview of Relevant LiteratureDefinitionMalnutrition is a status manifested by stunting, being scraggy, and blowing if his/her tallness for age ( HAZ ) , weight for age ( WAZ ) and weight for tallness ( WHZ ) z-score was more than two standard divergences ( SDs ) below the mention median ( Lesiapeto et al. 2010 ; Sub ramanyam et Al. 2010 ; Uthman, 2009 ; Kandala et Al. 2011 ; Janevic et Al. 2010 ) , inadequacy of protein, energy and other foods and instability between the foods the organic structure needs and the foods it receives ( Muller, 2009 ) . Stunting is characterized by shortness-for-age or step of additive growing deceleration, an index of chronic malnutrition and calculated by comparing the height-for-age of a kid with a mention population of well-fed and healthy kids ( Muller and Jahn, 2009 ; Sunil, 2009 ) . Wasting is a contemplation of a recent and terrible procedure that has led to significant weight loss, normally associated with famishment and/or disease ; calculated by comparing weight-for-height of a kid with a mention population of well-fed and healthy kids ; indicates the acute degree of malnutrition or the current nutritionary position of kids and frequently used to measure the badness of the exigencies because it is strongly related to mortality ( Muller and Jahn, 2009 ; Sunil, 2009 ) . Underweight is measured by comparing the weight-for-age of a kid with a mention population of well-fed, composite step that indicates both acute and chronic malnutrition in kids ( Muller and Jahn, 2009 ; Sunil, 2009 ) .Factors act uponing the happening of malnutritionBase on the literature reexamine the factors act uponing the happening malnutrition in kids under five old ages of age are ; Child factors The kid factors are act uponing the happening of malnutrition are suckling, age of the kid, size at birth, sex of kid, hazardous birth interval ( Uthman, 2009 ) . Mother factors The female parent factors act uponing the happening of malnutrition are female parent ‘s age, female parent ‘s business, female parent ‘s instruction, and matrimonial position ( Uthman, 2009 ) . Family factors The family factors act uponing the happening of malnutrition are topographic point of abode, part, house sanitation, H2O beginning, and figure of kids in the house ( Uthman, 2009 ) .Research hypothesisIs there any relationship between, kid factors, female parent factors, and family factors with happening of malnutrition in kids under five old ages of age.Research inquiryWhat is the most dominant factor act uponing the happening of malnutrition in kids under five old ages of age?Conceptual ModelChild factors:AgeSexual activityBreastfeedingMothers Factors:AgeEducationOccupationFamily Factors:RearingHouse sanitationChild malnutrition:StuntingWastingUnderweightFigure 1. Thesis program conceptual model adopted from UNICEF ( 1997 )Operational definitionMalnutrition in kids is the kid under five old ages of age who has diagnosed malnutrition by Department of Health in West Nusa Tenggara Province. Child factors are the factor in a kids related to age, sex and chest eating of the kids. Mother factors are the factors related to age, instruction, and business of the female parents in the household. Family factors are the factors related to house sanitation and rearing theoretical account in the household.Chapter IIIMethods and ProceduresMethodologyResearch design Research design in this survey is cross-sectional. A cross-sectional survey is one of the most common and well-known survey designs. In this type of research survey, either the full population or a subset thereof is selected, and from these persons, informations are collected to assist reply the research inquiries. The information that is gathered represents what is traveling on at merely one point in clip ( Ollsen and George, 2004 ) . Population and sample Population in this research is households who have kids under five old ages of age in West Nusa Tenggara Province of Indonesia. The focal point samples are households who have kids under five old ages of age with diagnosed malnutrition in West Nusa Tenggara Province of Indonesia. Sampling technique in this research is utilizing a purposive sample. The sample choice is based on these features: Inclusion Standards Children under five old ages old who live with their household Family who willing to take portion in the survey Family in West Nusa Tenggara Province Sample Size Puting This research will be take topographic point in households at West Nusa Tenggara Province Measurement The anthropometric information of the kids were assessed utilizing the WHO Anthro package version 3.2.2. , to mensurate the informations about kid factors, female parents factors, and family factors will be utilizing inquirers. Because of this instrument used English linguistic communication, the research worker will interpret and so formalize by transcribers who were expert in both the English and Indonesia languages to guarantee equivalence the instrument in Indonesia linguistic communication. The instrument will be test dependability by utilizing with the similar samples, and guarantee that it is applicable with Indonesian people before roll uping informations. Ethical Consideration Ethical blessing should be granted by KU foremost. Then, a permission to make the research at the provincial and territory wellness offices, community wellness centres and voluntary are required. Participant information sheet ( PIS ) , namelessness, confidentiality, and informed concsent will be used to protect sample and the research worker.Plan for informations aggregationThe information about households who have kids under five old ages of age with malnutrition collected from section of wellness in West Nusa Tenggara Province of Indonesia. The anthropometric information of the kids were assessed utilizing the WHO Anthro package version 3.2.2, and expressed as z-scores for each of the anthropometric indices of malnutrition against both the new WHO child growing criterions and the older NCHS/WHO mention. A kid was defined as stunted, scraggy or wasted if his/her height-for-age ( HAZ ) , weight-for-age ( WAZ ) or weight-for-height ( WHZ ) z-score was more than two standard divergence s ( SDs ) below the mention median. Direct interview with a set of questionnaires will be used to roll up informations from the households related with child factors, female parent ‘s factors, and family factors.Plan for informations analysisTo measure factors of malnutrition in kids under five old ages of age utilizing multivariate analysis and was performed utilizing Eview 4.0. Eview provide sophisticated information analysis, arrested development, and prediction tools on a Windows base computing machine. The multivariate analysis will take into history the hierarchal relationships between kid factors, female parent ‘s factors, and family factors with kids malnutrition. There will be calculated utilizing logistic arrested development.A survey budgetNo Items Amount/ figure Estimation Price ( in Rupiah ) 1 Paper A4 70 GSM 5 ream @ 50.000 = 250.000 2 Transcript of inquirer 5 @ 100 @ 100 = 50.000 3 Printer ink 4 colourss @ 40,000 = 160.000 4 Transportation fee 2.500.000 5 Small gift for participant 100 @ 10.000 = 1.000.000 Entire 3.960.000 rupiahTimetableActivity 2012 2013 jun July August September October November December January February March April jun July August September Identify the job Find the relevan literature reappraisal Sum up an analyze the literature Start composing proposal Defense proposal Ask for ethical issues Roll uping informations Analyzing informations Write chapter 4 and 5 Thesis defence Prepare for publication