Monday, January 27, 2020

Anorexia Nervosa Patient Case Study

Anorexia Nervosa Patient Case Study For my six week clinical practice placement in an adolescent mental health unit I chose to focus my project on a 15-year-old anorexia nervosa patient. This disorder largely affects young women and is an extremely challenging problem to treat. I felt that working with an anorexia nervosa patient in this controlled environment, under the guidance and supervision of a mentor, would be a particularly good application of action learning because â€Å"action learning†¦ can rapidly develop critical skills.†[1] In particular I wanted to develop interpersonal skills necessary to communicate well with patients and colleagues, and learn to relate to any issues raised by my patient being a teenager. As I learn better from hands-on training than through just reading and discussion I felt this would a valuable use of my clinical placement. Anorexia nervosa patients often have low self-esteem and â€Å"a desire for achieving perfection in all the things they do†[2] – this was something I had to be aware of during the placement because it raises the problems with goal setting. With anorexia it is difficult to agree on goals with a patient because the main goal, from a health perspective, is weight gain, which they want to avoid.[3] The other issue is that the patient is 15-years-old. This fits the common case that many patients â€Å"seek therapy at the insistence of parents†¦ [so] the patient arrives at for the consultation poised to resist, anticipating the same pressures for change.†[4] These factors combine to make treatment extremely difficult: first, the patient is resistant to change; second, the patient specifically wants to avoid weight gain, which is the main goal; third, if you can get the patient to agree on a goal they might feel anxiety because of their perfectionism, leading to mo re controlling behaviour – i.e. trying to lose weight. My mentor was especially helpful in highlighting some of these points to me with regards to the patient, and helping me think about ways we could deal with them clinically. In my last placement I did a training course in cognitive behavioural therapy (CBT) and my mentor and I felt this could be useful. There is extensive clinical evidence supporting the use of CBT in treating anorexia nervosa[5] and â€Å"once the disorder is initiated, it is the cognitive self-reinforcement that becomes the key factor in regulating it.†[6] We agreed that since cognitive behaviour is key to the illness it has potential to break the negative thought cycle. I used clinical guidelines to understand more about the possible benefits of CBT for anorexia nervosa. One item of interest is that: â€Å"The CB approach has two particularly valuable sources of flexibility and creativity applicable to the issue of engagement. These are structured assessment and models of resistance†¦ structured assessment can be very helpful in developing an in-depth understanding surrounding resistance to services.†[7] With the guidance of my mentor and other clinic staff I worked on my assessment skills with the aim of engaging this particular patient. Unfortunately, in the course of my six week placement the patient proved very difficult to engage with, perhaps because â€Å"change involves a patient giving up a cherished and valued state.†[8] If this had been in an unsupported setting I would have found this very discouraging and probably would have doubted my methods. However, through using the learning side of the process I found that â€Å"motivation and engagement are commonly poor or ambivalent in patients with eating disorders, particularly anorexia nervosa†[9] and that â€Å"patients with anorexia nervosa react to stress both in childhood and adulthood with a helpless style of coping and a tendency to use avoidance strategies.†[10] These findings showed that I was dealing with a widespread problem, not something specific to my patient. This insight, and the supportive atmosphere from the other clinical staff, helped me keep my focus on the patient, and not think of the challenges as personal failings. In the space of six weeks I didn’t have time to work through these issues with this particular patient, but the action learning process gave me the confidence that I would be able to address them in future. It also put in perspective that the patient continued to lose weight. That is obviously not the outcome desired but knowing that: â€Å"70 percent of the [eating disordered] subjects for CBT remained symptomatic†[11] assured me that this is also a common problem. During the placement my mentor and I discussed these problems and talked about different methods that might be useful to overcome them. One area I decided it was important for me to focus on is relational skills with patients. With anorexia nervosa, especially, â€Å"the interpersonal process†¦ needs to take this ambivalence or indeed resistance into account. The skills of motivational interviewing are invaluable.†[12] We also talked about the possibility of using other types of therapy along with CBT. Most of the clinical data supports CBT as effective, but there have been some studies that show family therapy can be beneficial[13], which we thought might be a useful avenue to explore since the patient is 15. However, my mentor cautioned me that family difficulties often lie at the root of eating disorders and suggested I check some literature. I found out that â€Å"women with anorexia nervosa typically describe both their parents negatively†¦ and women with eatin g disorders described their parents as typically unsupportive of their independence.†[14] This would suggest treating family therapy with caution. It could be that patients come from genuinely unhappy families, or it could also be that anorexia nervosa patients resent their parents’ perceived intrusion of trying to make them eat as an attack on their independence. I’m glad my mentor raised this issue, because it made me realise that before using additional therapies you need to consider patient history and resistance, and you also need to understand the reasons they might not want to do a particular therapy, to allow you to make the best decision about treatment options. During the placement there was a good mix of clinical work and theory. I found my relationship with my mentor was the most important element during my time working with the patient, as they modelled good patient care and helped me reflect on my own work. They emphasised to me that â€Å"reflection is important within formal professional courses†¦ and for demonstrating work-based learning,†[15] which is something I probably wouldn’t have really thought about without their guidance. One of the possible weaknesses of action learning, according to some practitioners, is that: â€Å"where real work and learning are explicitly associated, the excitement, significance and immediacy of the action element can often submerge the learning element.†[16] I can see how that could happen in a busy clinical setting – for example an AE department – but I felt that within the setting of the mental health clinic there was adequate time for learning and there was a chance to access books, clinical guidelines and advice from the staff. As a result of what I learned during my project my development goal is to practice my therapeutic communication skills and make an effort to get feedback on them. This placement made me see how important interpersonal skills are, as well as the different challenges. In working with my patient I felt lack of engagement was one of the biggest difficulties, and led to an unsuccessful outcome in the short term. Developing strong therapeutic communication skills is a way to overcome resistance to treatment. Using the listening skills of therapeutic communication will also help understand the patient’s needs and challenges related to treatment – such as possible family issues in anorexia nervosa. It was somewhat discouraging to not see a better result with this patient, but the placement taught me that: â€Å"in Action Learning the emphasis is on the courageous struggle to act and understand; not on short cuts and quick fixes†[17] and I think that knowledge will enhance my confidence as I approach the challenges of improving my communication skills and taking forward what I learned. Bibliography Bennett-Levy, J., Butler, G., et al., Oxford Guide to Behavioural Experiments in Cognitive Therapy, Oxford University Press, 2004 Bulman, C. and Shutz, S., Reflective Practice in Nursing: The Growth of the Professional Practitioner, Blackwell Publishing, 2004 Cassidy, J. and Shaver, P., Handbook of Attachment: Theory, Research, and Clinical Applications, Guilford Press, 2002 Costin, C., The Eating Disorder Sourcebook: A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders, McGraw-Hill Professional, 2006 Garner, D. and Garfinkel, P., Handbook of Treatment for Eating Disorders, Guilford Press, 1997 Grant, A., Mulhern, R., et al., Cognitive Behavioural Therapy in Mental Health Care, SAGE, 2004 Marquardt, M. and Callahan, M., Action Learning, American Society for Training and Development, 1997 Newell, R. and Gournay, K., Mental Health Nursing: An Evidence-based Approach, Elsevier Health Sciences, 2000 Norman, I. and Ryrie, I., The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice, McGraw-Hill International, 2004 Pedler, M., Action Learning in Practice, Gower Publishing, Ltd., 1997 Footnotes [1] Marquardt, M. and Callahan, M., Action Learning, American Society for Training and Development, 1997, p. 13 [2] Bennett-Levy, J., Butler, G., et al., Oxford Guide to Behavioural Experiments in Cognitive Therapy, Oxford University Press, 2004, p. 267 [3] Ibid, p. 95 [4] Garner, D. and Garfinkel, P., Handbook of Treatment for Eating Disorders, Guilford Press, 1997, p. 99 [5] Garner, D. and Garfinkel, P., Handbook of Treatment for Eating Disorders, p. 95 [6] Ibid, p. 106 [7] Grant, A., Mulhern, R., et al., Cognitive Behavioural Therapy in Mental Health Care, SAGE, 2004, p. 149 [8] Newell, R. and Gournay, K., Mental Health Nursing: An Evidence-based Approach, Elsevier Health Sciences, 2000, p. 253 [9] Bennett-Levy, J., Butler, G., et al., Oxford Guide to Behavioural Experiments in Cognitive Therapy, p. 282 [10] Newell, R. and Gournay, K., Mental Health Nursing: An Evidence-based Approach, p. 247 [11] Costin, C., The Eating Disorder Sourcebook: A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders, McGraw-Hill Professional, 2006, p. 118 [12] Norman, I. and Ryrie, I., The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice, McGraw-Hill International, 2004, p. 463 [13] Ibid, p. 467 [14] Cassidy, J. and Shaver, P., Handbook of Attachment: Theory, Research, and Clinical Applications, Guilford Press, 2002, p. 508 [15] Bulman, C. and Shutz, S., Reflective Practice in Nursing: The Growth of the Professional Practitioner, Blackwell Publishing, 2004, p. 30 [16] Pedler, M., Action Learning in Practice, Gower Publishing, Ltd., 1997, p. 229 [17] Ibid, p. 32

Sunday, January 19, 2020

My School Essay

Today if there is any institution which exerts the greatest influence on us after the family, it is the school. The years that we spend in school are not merely time spent in learning and filling our minds with knowledge, but also time spent in moulding our character, acquiring various attitudes and imbibing basic principles of life. The basic traits of our personality are formed during our school days. The name of my school is Don Bosco Secondary School. It is situated in a town called Tura, W.Garo hills, Meghalaya. It is considered to be one of the finest schools in the state, highly acclaimed for its excellent HSLC results. The school building is an impressive structure. It consists of four floors and has about 25 classrooms. Classrooms are spacious and airy. see more:speech on my school Two staircases at both ends lead to the floors. The school has a well equipped library, a well- established science laboratory and an excellent computer room, all of which are situated on the third floor. The schools auditorium situated on the top-most floor is said to be the finest hall in the region. The Principal’s office, clerk’s room and the Staff Room are on the ground floor, close to the entrance. The school canteen is another important part of the school complex. It is situated on a separate wing close to the ground floor. Two cemented basketball courts stand in front of the Principal’s office, while the school’s football field lies at the far end of the compound. A small garden full of flower plants surrounds the school building adding to the charm and beauty of the entire complex. My school has over 1500 children studying from nursery to class X and a staff of over 45. Our headmaster is an experienced and a very efficient person, who has been at his job for the last 15 years and more. Under his able direction, the school has been obtaining cent percent HSLC results over the last 10 years. The teachers are well experienced and well versed in their subjects. My school has also made a name for itself in the field of cultural pursuits and sports activities. The school band is considered to be one of the best bands in the whole region. The principal celebrations in my school are School Annual Sports Day, Parents’ Day, Teacher’s Day, Children’s Day, Anniversary Day, Founder’s Day, etc., which are celebrated in a grand manner. Co-curricular activities, such as, scouting, N.C.C., Eco- Club, School band, etc. have contributed in making my school an excellent educational institution of the region. What I like most in my school, is the discipline that exists there. The headmaster as well as the teachers are disciplined and men and women of character. They do not allow any untruly behaviour or any undisciplined activities by students. A lot of emphasis is given to character formation, moral education and acquiring good values of life. Although the school ambient is rather strict and time-table based, yet there is lot of fun and joy in the school. Matches, tournaments, cultural shows, competitions, outings, etc. make my school life lively, interesting and enjoyable. I am proud to be a student of Don Bosco Secondary School, Tura. As I glance back at the bygone school years, my heart swells up with gratitude and thanks giving for the twelve wonderful years that I spent in the school. My school has profoundly shaped and moulded me more than any other factors in my life. School is a temple of learning and a training ground for future citizens. The name of my school is JB High School. It was set up in 1943 by a land-lord in our area. He donated land and money for the school. The atmosphere in which our school is situated is very pleasant. It is surrounded by a play ground on one side and a garden with a small pond on the other. The school has two rows of big buildings. The name of the school is written on the front building. There are ten class rooms in the front building. Other ten rooms in the back building are used for different purposes such as the Head Master’s Office, Library, the Clerk’s Office, the Science Laboratory, the Teachers’ Common-room, the N.C.C. and Scout Room, etc. There is also a hostel in our school campus. There are twenty teachers, a PET, a librarian, a clerk and two peons in our school. All the teachers are qualified and experienced. The Head Master is a learned man. He teaches Science and Geography. He also teaches English. The total number of students of our school is about five hundred. We go to school in uniform. The uniform for boys consists of blue half-pant and white half shirt. For girls it consists of blue skirt and white blouse. The school functions from 10.30 A.M. to 4 P.M. classes begin after a mass prayer. During the recess hour we go to play ground. Some students also go to library and read newspaper there. In games period we play football, volley ball, etc. Girl students play ring ball too. The library of our school is a big one. There are about two thousand books on different subjects; we have a library period in our weekly routine. We borrow books from our library and refund them after a week. We observe the Republic Day, the Independence Day, the Teacher’s Day in our school. We also celebrate the Ganesh Puja and the Saraswati Puja in our school. We also hold debate competitions and games and sports every year. The school magazine named â€Å"the Shree† is published every year. In annual examinations the students from our school show brilliant performance. Many students from this school have occupied glorious position in our state. The District Science Exhibition is also held in our school. Two years ago a classical teacher from our school won the Governor’s Award. The discipline, the study atmosphere and the brilliant academic result of our school attract many meritorious students from distant parts of our state. It is an ideal school in all respects.

Friday, January 10, 2020

What is Wisdom?

I. Has your view of wisdom changed since the beginning of the course? Explain how and why. Since the beginning of the course, my view of wisdom remained the same. However, I was able to enrich my knowledge because of the definitions and discussion on the subject by the different philosophers whose ideas of wisdom greatly shaped the word. After taking the course I was able to come up with the conclusion that wisdom can be defined differently according to observations of a person towards how wisdom is being used or misused. Interestingly, even scholars and the learned have their respective sets of definition for wisdom. However, it will still be evident that in the bottom line, wisdom will still be one thing and this is how a person uses the capability of his mind to create or make decisions. There are things in my preliminary essay which I questioned throughout the course. One example is the thought that wisdom is the use of intellect. There were times in the course of study where wisdom is discussed in terms of emotion, or the heart. This made me wonder whether wisdom is purely the mind’s work, and assessing the different definitions I came into the conclusion that my preliminary thoughts were true. Still, there are parts in my former definition of wisdom that changed. I pointed out early on that wisdom amongst children and the younger adults may be lacking due to being inexperienced which I now proved otherwise. As Thoreau points out, the older a wise person becomes the less his wisdom becomes significant because of new things and developments that occur everyday. Thus, there are certain aspects where a child or a young adult may know more while an older, more experienced person know less or nothing about. In the same way, old knowledge may be more familiar to an older person when compared to a younger one. Yet I still remain faithful to the fact that the definitions pertinent to wisdom are numerous, as I pointed out in my preliminary essay. Wisdom can be identified with the current pre-occupation of the person defining it—whereas a scientist may define wisdom in a scientific way, a teacher may define it in an instructive way, and a student may define it in a learner’s way. The possibilities in which wisdom may be defined are endless. II. Whose view (Socrates, Thoreau, Huxley, Piper, or Frankl) seems to be most reasonable? Why? Of the views discussed in class, Thoreau’s is the most significant. He stated that a man’s wisdom and ignorance are results of his time, citing the yield of people to superstition of their time as an example. (Creating Minds, 2007) This is especially true even to this day and age. A person may be wise for his age, but new studies, inventions, and scholarly developments can tend to outdate his wisdom and in the process introduce other people who can seem wiser an fuller because their knowledge is far more updated that the wise people ahead of them. In hindsight, this is why a person would never cease learning, because once he does his wisdom will definitely deteriorate. Mencken states that the older he grows he realized that wisdom does not come of age. This is ratified by Van Buren, who likened wisdom coming from age with wine saying it a person will only be wise with age like wine if the grapes are good enough to begin with. (Moncur, 2007) True enough, knowledge does not come of age. Wisdom is brought about by a never-ending free-flow of knowledge despite age. Children and young adults can get a deep well of wisdom if they are motivated to learn, and adults will also improve on their wisdom if they do not stop learning. Continuous learning is an important aspect of sustaining wisdom, whereby new information consistently is being added up to one’s well of knowledge which he can process and use to make sound and wise decisions. To be wholly wise, it is important that a person gets out of his somfort zone and try things that are not normally done by someone his age, or someone whose occupation is similar to him. When a person is not open to learn new things, even if he has the age capability to learn them, he will be outdated with information and his well of wisdom gets short of this additional information. III. Whose view (Socrates, Thoreau, Huxley, Piper, or Frankl) seems to be the least reasonable? Why? Of the views discussed in class, Frankl’s is the least reasonable. To begin with, he insists that wisdom comes from the heart and that this can make wisdom more sensible than the wisdom wrought from the mind. Given that this is factual in its deepest sense, wisdom still goes back to being a function of the mind. Questioning everything, Lichtenberg said, is the first step to wisdom—and altogether accepting that everything is the last step to wisdom. (Moncur, 2007) Therefore, it is difficult to accept that wisdom from the heart, though claimed more sensible, is the real essence of wisdom. It is true that wisdom can be affected by what the heart feels, but the capability to be wise is exclusively spawned by the mind. There may be contentions to this. A charity worker, for example, may prove it wise to day that true wisdom comes from the heart because the nature of the work he is in touches more in emotion. On the other hand, a scholar whose preoccupation is more on knowledge and improving this knowledge will prove this otherwise. Again, definitions will vary according to who is defining the word. Yet it is still improbable to say that this is reasonable as compared to wisdom’s other definitions by other scholars and philosophers, especially those whose ideas were discussed in class. This sums up how the work of the mind breeds wisdom. It is not the heart which is wise. Emotions bred by the heart are also not acceptable, as scientifically it has been noted that it is the hypothalamus and not the heart that is capable of telling a person how to respond through emotions. In summation, this says that Frankl’s definition of wisdom can be misinterpreted in a lot of ways, and thus it is the least reasonable as compared to the definitions by other philosophers whose definitions were discussed in class.

Thursday, January 2, 2020

The Trinity Project Testing The Effects of a Nuclear Weapon

The Trinity Project was a project conducted to test the effects of a nuclear weapon. The Trinity nuclear device was detonated on a 100-foot tower on the Alamogordo Bombing Range in south-central New Mexico at 0530 hours on 16 July 1945. (Rohrer, 1995-2003). This project was organized by the Manhattan Engineer District (MED). This organization worked diligently planning and coordinating all of the logistics for the groundbreaking event. From 1945-1946 over 1000 personnel either worked or visited the test site. The United States was trying to gain nuclear proliferation throughout the world so this project was necessary for our enemies to see the devastation of a nuclear blast. One of the driving forces behind the trinity†¦show more content†¦General Groves, with his customary bluster and intensity, wished to make Kyoto, the ancient capital of Japan, the initial target for the atomic bomb to inflict the maximum psychological shock on the Japanese populace, but Stimson with T ruman’s eventual backing, overrode him. (C.S.C., 2011). The first test was made of the implosion type of fission atomic bomb. The scientist and the Generals did not drop the first bomb from a plane, but from a 100 foot steel tower. To assure the defeat of Japan Truman and Byrnes worried about the test that took place in the desert of New Mexico on July 16 in the city of Alamogordo. The code name for the Manhattan project was called â€Å"Trinity† people never knew why the project was named Trinity, but it was speculated that Oppenheimer picked it in reference of the divine Hindu trinity of Brahma (the Creator), Vishnu (the Preserver), and Shiva (the Destroyer). (http://nuclearweaponarchive.org/Usa/Tests/Trinity.html, 2003) General Groves and Robert Oppenheimer took the lead with a series of officials and scientist for the initial test. Scientists seemed to be elated at the project, because they expended so much energy on this project that even Oppenheimer, he climbed the tower to give the bomb its final inspection. Once the inspection was complete all of the personnel moved to a protected observationShow MoreRelatedThe Manhattan Project And How Did It Affect The World? Essay1528 Words   |  7 PagesWhat is the Manhattan Project? And how did it affect the world? The Manhattan Project was a secret project that was kept from public knowledge and even the vice president didn’t even know about the project until the completion of the project was nearly done. 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