Social Inclusion Via Social Skills Training Nursing Essay

Social Inclusion Via Social Skills Training Nursing Essay My patient was 59 year old lady suffering from schizophrenia since 25 years. According to patient she had a happy married life in London, her husband died and she was brought to Pakistan due to her abnormal behavior and her son was also separated from her. Medical file reveals that after her husbands death she had behavioral changes for which she was consulted to psychiatrist and diagnosed with schizophrenia. She was forcefully brought to Karwan-e-Hayat 3 years back due to violent behavior. Since then she is there, presently she is experiencing social isolation as she stayed in her room most of the time, refuses to participate is day care activities and verbalizes that I like to be alone, dont want to meet anyone I have nobody to share my feelings, people here cant help me, everybody think I am mad. I observed her hesitation with people around her weather they are patients, staff or doctors. However one typical observation was that when I forced her to participate in activity she ref uses twice but third time she participated by silently doing the task and went quietly. I noticed that she was facing difficulty in understanding but she didnt ask for any clarification and continued. Reflecting upon the scenario I was motivated to work on something that can help to manage her social isolation. Reviewing through literature I came across concept of social inclusion of patient via social skills training in patient with Schizophrenia. As we know that human is social animal and social interactions are crucial for regulating a successful functioning in the society. According to Mental Health Coordinating Council, MHCC (2007) .Social inclusion is about ability to engage in all aspects of a society that genuinely includes people living with mental illness that supports, intervenes without stigmatization. Further Ware, N.C et.al. (2008) Define it a process through which individuals with psychiatric disabilities develop an increasingly exercise capacities for interpersonal connectedness and citizenship. Social inclusion is essential in schizophrenia as due to cognitive deficits individual social and vocational abilities and hinders routine functionality of a person and make person uncomfortable in social situation. (Dickinson, D.et al.2007). To promote social inclusion in patient I choose social skills training (SST) as it is utilized as a tool to engage patient in routine life and feel as a part of society. SST consists of learning activities utilizing behavioral techniques that enable persons with schizophrenia and other disabling mental disorders to acquire interpersonal and independent living skills for improved functioning in their communities. (Kopelowicz, A. et al, 2006). Reason for selecting it for my patient is that her cognitive deficits have lead to social isolation that makes her uncomfortable in social situations. I have observed her uncomfort while talking with others, hesitating in marinating eye contact and also unable to share her emotions so SST will sever as a basic step in promoting socialization and also help her to feel confident. In Pakistan vast numbers of people are suffering from mild to moderate psychiatric illnesses and an estimated number of mentally disturbed people in Pakistan are even higher (Punjab Institute of Mental Health, PIMH 2009). Only few researches have been conducted on this issue due to low research priority, negative perception about mental illness and low priority of mental health training in the country. One of the study done on psychologists experience of cognitive behavior therapy in Pakistan suggests that despite significant number of psychologists in Pakistan yet psychological interventions play only a minor role in treatment plans in Pakistan. In addition psychotherapies need adjustments for use in Pakistan; they shared four major issues that are hurdles in therapy, its related issues, involvement of the family and modification in therapy service and resource issues. (Naeem et al.2010).However Department of Health Promotion Punjab(2009) is primarily concern to initiate appropriate mental health promotion strategies. They have developed manual to be used for the capacity building of health care providers thus bridging a gap between health care delivery system. They have integrated provision of supportive environment and development of personal skills in component of mental health promotion. They have also planned to facilitate social settings which enhance social network for mentally ill patients. Furthermore their approach towards mental health promotion represents social inclusion, participation, strengthening individuals, communities society to increase social support for sufferers. One of their goals is to encourage people with mental disorders to participate in normal life with their families and friends once treated and stable ,they also provide specialized training to doctors in the field of psychiatry especially for counseling and rehabilitation techniques as this is a weak element in our context .(PIMH 2009).Fortunately it seems that Pakistan has in itiated a step towards mental health promotion which is an achievement and its our responsibility to take this step ahead toward accomplishing goals. Social inclusion is necessary for mental health promotion and for the recovery from mental illness. A social connection is the key for including person in society which includes engaging person with its environment. In relation to my patient as she is an elderly woman, along with her disease process there are other factors that have contributed to social isolation for example: her early widowhood, separation from son due to her psychiatric illness, suspiciousness towards her family members all has lost her social role in her family. (CITRA 2007).Many studies have concluded that social inclusion in older people serve as a protective factor to overcome social isolation. These factors are defined as connection with friends, family members; neighbors children and community (Warburton.J, Lui.C.W.2007). Research done on preventing social isolation among older people suggests that and social activity and group interventions can alleviate social isolation among older people. Researchers agre e that a meaningful social network is a strong support against social isolation in later life. (Cattan.M, et al,2005).For my patient family support is difficult to establish as her son is abroad and she is suspicious to others due to her disease process, presently her community participation can be enhanced for her social inclusion. Here comes the role of SST, In my patient learning social skills will help her to achieve her own personal goals and enhance her communication of feelings and needs and improve the quality her relationships with others which she think is not good. An effective SST program is based on certain principles that include guidance, demonstration, practice and feedback. The amount of time needed to complete a SST program depends on patients performance (Stuart,G.W. 2009).Recent advance in SST by A. Kopelowicz et al. (2006) highlighted that in over 2000 patients with schizophrenia, there was a considerable association between characteristic that reflected social competence, good psychosocial functioning and having confidants as well as subjective reports of high levels of life satisfaction. Moreover research by Dickinson, D.et al. (2007) supports that competent use of social skills by people with schizophrenia is extensively related to actual role functioning in the community. In fact patient s with good social skills, as measured by the MASC (Maryland Assessment of Social Competence.), were more likely than others to have been competitively in employment. Which means that patients can prove themselves if they are well treated on time. According to A. Kopelowicz et al.(2006) The components of the SST procedure are derived from basic principles of human learning, I incorporated social learning theory(Bandura,1989) in relation to my patient scenario, as according to social learning theorist internal cognitive processes influence behavior ,as well as observation of the behaviors of others and the environment in which behavior occur Similarly it outlines three requirements for people to learn behavior include retention, reproduction and motivation to adopt the behavior. All these interactions help person to modify their behavior. (Smith, E. E, et al,2003).Considering my patient, this learning model will help her in learning and modifying her behavior in front of others and m ake her feel comfortable and confident to react in a particular situation. Ultimately this will boost her interaction with others comfortably and her antisocial behavior will be changed. Strategies to promote social inclusion via SST are multidimensional. It varies from individual to group, community and institutional level. At individual level interventions focuses pertinent needs of an individual, successful individual interventions progress to group therapy. At community level, psychological needs of the person should be recognized in adopting social skills by engaging family and creating supportive environment for patient in surroundings. According to A. Kopelowicz et al. (2006) the community-based interactions help them adjust their behaviors to their unique environments and practice and implement the skills that they have tailored. At government or institutional level, awareness session should be held for the provision of knowledge to people and should train personnel, to implement SST as a health promoting practice, for psychiatric patient to promote social inclusion and participation by them, in this way mental illness will not be stigmatized and together we can help theses patient. (MHCC 2007). I have incorporated Learning-Based Procedures Used in Social Skills Training (A. Kopelowicz et al.2006) within the nursing process which involve interventions from all levels. It focuses on needs identification, which was done thorough assessing patient by taking history, doing mental status examination followed by building trust relationship. Specific to socialization I asked patient to share her expectation from self and what changes would she like to make in her routine life? In which she highlighted that I want to be accepted by people. Then setting goals with specification of the social behavior was done by involving patient where patient would be able to participate in social gatherings on her willingness. It was accomplished to certain extend due to her short attention span. Planning was followed by interventions that includes helping her in promoting relationships wherever she can, taught her to begin and maintain conversation; by motivating her in initiating , help her to have voluntary interactions with others especially with her roommate and neighboring people by involving her in activity with others and take part in group. For this behavioral rehearsal approach was taken in which patient demonstrated skills that are needed for quality social interaction. In addition ongoing corrective feedback was given to modify the behavior like she was encouraged to sit throughout the session with other patients. Social modeling was done by observing behavior during OT activities and accordingly modified with the patient. Additionally positive reinforcement was given on improved social behaviors. Implementation process was integrated with social learning theory by considering patient ability to retain and focus on her attention span. I intervene gradually by monitoring patient ability to grab things, and by reinforcing positive behavior of patient. Reproducibility was assured and motivation was given on and off. Moreover, I first time saw patient laughing and involved with others during OT activity and her expression of I am enjoying this activity made me glad. Evaluation was based on asking question regarding her feelings of modified behaviors, Observed her ease in OT activities, able to express herself and less hesitated and maintain eye contact while talking.(A. Kopelowicz et al.2006) I always had a negative feeling towards mentally ill patient, while working with my patient I felt blessed because I was able to see her suffering. It was my prejudice that every person is capable to interact with others in the world with social skills and able to communicate in society .I had this understanding that mentally ill patient usually like to be socially isolated because they have their own world and will not be able to adjust themselves but now I understand that there are so many reasons to it. In fact before reading about SST I didnt know that it has profound benefit in promotion of mental health. This writing helped me to correct my attitude towards mental illness and enrich me with knowledge and importance of social inclusion in patients life. To summarize socialization is a lifetime process and it has great value in every aspects of life. Promoting social inclusion by helping patient to learn social skills will offer support, built confidence , enhance self-esteem in patients which eventually improve the quality of life, promote recovery and leads to successful functioning of individuals in society. As concluded by MHCC (2007) the social inclusion approach offers a valuable frame work to view both the individual and collective responsibility for good mental health. References: Cattan.M, White.M, Bond.J Learmouth.A (2005). Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Ageing Society 25 pp 41-67. Cambridge University Press Cornell Institute for Translational Research on Aging (CITRA). (2007) Social Isolation: Strategies for Connecting and Engaging Older People. Dickinson.D,Bellack.A.S Gold,J.M.(2007).Social/Communication Skills, Cognition, and Vocational Functioning in Schizophrenia: Schizophrenia Bulletin 33( 5). Kopelowicz, A; Liberman,R. P; Zarate, R. (2006). Recent Advances in Social Skills Training for Schizophrenia.Schizophrenia Bulletin, 32(1), S12-S23. Merton,R Bateman,J, (2007). Social Inclusion: Its Importance to mental health. Mental Health Coordinating Council (MHCC). Naeem,F; Gobbi,M; Ayub,M; Kingdon,D.(2010).Psychologists experience of cognitive behavior therapy in a developing country: a qualitative study from Pakistan. International Journal of Mental Health Systems.4 (2) Norma C. Ware,N.C;Hopper,K; Tugenberg,T;Dickey,B; Fisher,D. (2008).A Theory of Social Integration as Quality of Life. Psychiatric Services (59) pp 27-33 Rana, N.A. (2009).Mental Health in Primary Care. Punjab Institute of Mental Health. (PIMH). Smith, E. E; Hoeksema, S.N; Fredrickson. B; Loftus,G.R. (2003).Atkinson Hilgards Introduction to Psychology (14th ed.).Thomson:Wadsworth. Stuart,G.W.(2009).Principles and practice of psychiatric nursing(9thed.).St.Louis:Mosby. Warburton.J, Lui.C.W.(2007).Social isolation and loneliness in older people: A literature review. Australasian Centre on Ageing

Art of the United States

Art of the United States Out of all the works of art with in the Art of the United States exhibit in the San Diego Museum of Art in Balboa Park, Shipwreck by Thomas Doughty really made an impression on me. It is a 25 x 30 ? in. oil on canvas. The reason this painting caught my eye is because it has two especially unusual qualities. First, Doughty rarely painted seascapes, and his paintings usually focused on the lyrical aspects of nature rather than the threatening ones. Shipwreck was composed in the artists studio from elements borrowed from different locations. The painting is symmetrical with trees blowing in harsh winds on either side. The swaying trees seem to barely be holding on to the rocks on which they stand. Ominous clouds lurk in the distance that augment terror that the crashing waves bring to the viewer. Just beyond the vanishing point of the ocean, a horizontal line of reddish yellow breaks up the dark color of the ocean and the clouds. The gentle blended lines seem to celebrate the wilderness of the United States during the eighteen hundreds. The curved lines strengthen the movement of the ocean and the clouds. The color scheme seems to be unified and the overall dullness and darkness of the painting intensify the violent and even theatrical depiction of a storm. There is a tiny figure that stands both at the center of the storm and at the center of the painting. I think the artist painting this painting because wants viewers to be able to identify with the miniature central lone figure. He stands alone and helpless; watching the ship break against the rock just offshore. It appears he is watching the figure immediately to his right struggling in the rampant surf. During the 1800’s shipwrecks were very common and many people could easily have identified with the tiny figure standing in the midst of the raging storm. The painting evokes both awe and fear in me. The rash of mother nature seems to be unstoppable.

Patient Rights Essay

Patient rights are also human rights. Every patient deserves to be treated respectfully and with every intention of helping patients improve their health. Due to past historical events, there was a need for the creation of two documents that give patients protection and rights when it comes to clinical experiments. These events were experiments that were conducted unethically and violated human rights. The names of these documents are: The Nuremberg Code and The Belmont Report. The first one that was created in the 1940’s was The Nuremberg Code which relates to the events that happened during the holocaust. Nazi physicians were responsible for performing malicious experiments on prisoners in the concentration camps. The Belmont Report was created later after the discovery of the Tuskegee Syphilis Experiment. In this study, which was conducted from 1930-1972, African American men were deceived into thinking they were being treated for syphilis when they actually were not. Even after the discovery that penicillin was an effective treatment for this disease, many men were still left untreated and left to die unnecessarily. The â€Å"Doctors’ Trial† was one of the main trials conducted after World War II in Nuremberg, Germany. This was an international trial made up of judges from the United States, Britain, France, and the former Soviet Union. This trial involved 23 defendants, 20 of them being physicians, all accused of torturing and murdering prisoners in concentration camps with the use of medical experiments. Sixteen of the 23 defendants were found guilty and sentenced to death, life in prison, 25 years, fifteen years and ten years in prison. The remaining seven were acquitted. After conclusion of the trial, the judges felt a strong need for an additional way to protect human research subjects. This is when they created the ten research principles now known as The Nuremberg Code. As the Hippocratic ethics was great for physician-patient relationships, it did not fit so well with scientific research. Everything changes because the primary goal of the physician is no longer the patient, but instead the results of his or her experiment. The Nuremberg Code solves this conflict. The first and main principle of the Nuremberg Code makes the voluntary consent of human subjects absolutely essential. Experiments should not be random or unnecessary; they should be in search of beneficial results. It should be based on experimentation of animals and help prove positive effects are the result. Mental and physical suffering or injury should absolutely be avoided. No study shall be performed when there is a risk of death or severe injury involved. The potential risks should never exceed the potential benefits. Sufficient preparations must be made and acceptable facilities must be used in order to protect against injuries, disabilities, or death. Only qualified individuals may perform such studies and the highest possible skill and care shall be applied throughout the entire process. Subjects will always hold the power to end the experiment at any time they feel is necessary for their own well-being. And last of all the scientist in charge must end an experiment as soon as there might be any reason to believe that there is a possibility that continuation of the study could result in injury, disability, or death to any of the participating subjects. In Tuskegee Syphilis Experiment the Nuremberg Code was disregarded and still continued to be sponsored by the U. S. government. The reason for this may be because the code and principles were not regulated and could not be enforced by laws. In 1978 the Department of Health and Human Services (HHS) published the Belmont Report. The Belmont Report is made up of three basic ethical principles which are: respect for persons, beneficence, and justice. All persons asked to be in a study should have total autonomy and complete control of their decisions. For beneficence researcher should not only attempt to achieve maximum benefits for the subjects, but also minimize all risks. Justice states all people should be treated fairly and benefits and problems should be distributed fairly as well. These are now regulation guidelines and remain the main focus to protect humans as subjects. To this present day the Belmont Report continues to be used as a reference for institutional review boards (IRB) which ensure that human based research follow all ethical regulations and guidelines. Anytime experiments on humans are being conducted, ethical issues will always be involved. With the creation of these two documents it helps determine whether a clinical trial is ethical or not. First of all the experiment must have some kind of social or scientific value in which it may produce results that will benefit health and well-being or even increase knowledge on a certain subject. Only qualified scientists or physicians are allowed to perform such studies using methods and techniques that will produce reliable results. Subjects must be chosen fairly. The risks of the study must be minimized while the benefits maximized, or at the least benefits and risks should be proportionate. Informed consent means subjects will be informed on the purpose of the research, its risks, benefits, and alternatives. This helps to make informed decisions and also subject have the power to end the study at any time. Subjects will also be provided confidentiality, information on any new discoveries and results of the studies. These documents not only provide protection and safety for test subjects, but it also protects certain individuals from being participants in any studies. There are certain populations or groups of people that cannot be selected for studies for certain reasons. Adults are preferred subjects over children. Individuals must be competent in order to give informed consent, which would eliminate using mentally ill people as subjects for a study. Prisoners should also be excluded as test subjects as they are already in a forced position. There must be a certain criteria met in order to use any of these subjects in a research study. I find it to be a real shame that the Nuremberg Code was overlooked in many studies performed in the United States after its creation. It was not regulated and it was not against the law to not follow these codes of ethics on research. Although it took a series of unfortunate events to come up with the Belmont Report, it sure is nice to know there is protection now for human test subjects. The creation of Institutional Review Boards (IRB) to enforce that studies are being conducted under ethical guidelines and researchers are following these rules was essential in helping to improve the search for better health in this country. This will continue to guide our effort as well as change when other issues arise. The good thing is that I do not seeing it ever changing much more as all the most important ethical issues is covered by these documents when performing any research on human subjects.

Leadership Style And Leadership Theory - 807 Words

This paper explores five published empirical articles and report results from research conducted on traits, skills, and characters relationships to leadership and followers. The paper discusses the common themes and conclusions addressed in all studies. The articles penned with the intention of examining the impact leadership style and leadership theory in areas such as individual identity, culture, and worldview. Mahdi, Mohd, and Almsafir (2014) argue there is a significantly strong relationship between the leadership behavior and organizational commitment. Also, the paper synthesizes pool of knowledge on the empirical impact of leadership behaviors on follower’s perceptions. Various aspects of these variables questioned in these articles provide an extensive and extended comprehensive understanding of the factors that affect groups and employees in societies. First article: â€Å"Effects of Leader intelligence, personality and emotional intelligence on transformational leadership and managerial performance† by Cavazotte, F., Moreno, V., and Hickmann, M. (2012) share perspectives on emotional intelligence and leadership traits. Cavazotte et al. (2012) investigate impacts of personality traits and emotional intelligence on transformational leadership and performance of leaders in the context of the organization. The study reviewed and built upon the theory of both whole systems and complex systems, evaluating 134 middle-management teams from an enormous Brazilian Energy company.Show MoreRelatedLeadership Styles And Theories Of Leadership857 Words   |  4 Pagesproject shows that leadership is defined in many ways. Characteristics of a good leader are questionable. Leadership styles and theories, such as servant leadership, collective leadership, and dictatorship vastly differ but still share similar attributes. 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