Medication Errors Research Paper Example | Topics and Well Written Essays - 500 words - 1

Medication Errors - Research Paper Example Nurses make errors when giving medications in any of these stages with most of the errors being done at the prescribing stage. Most errors that nurses do however are the administering errors that make up 26-32% of total medication errors (Unver et al, 2012). The most unfortunate thing about these errors is that they have not been intercepted by anyone but recent technological advancements focus on reducing them. It can be argued that most nurses do not conduct these errors knowingly as there are many factors that contribute to the medication errors. One factor that makes nurses make errors in administering medication is having wrong patient details. It is essential for a nurse to have all the information about a patient as it determines things like the dosage he or he is given. A patient can conceal to a nurse that he or she is allergic to various medication and in the event the nurse prescribes to the patient a medicine that would trigger an allergic reaction, a case of medication errors arises (Lan et al, 2014). Environmental factors also make nurses make medication errors. A nurse is likely to make a mistake in administering medication in working environments that are not conducive. There are high chances that a nurse working in a cluttered environment will make a medication error when administering or preparing drugs. If a nurse is preparing a drug in a poorly lit place, he or she will certainly make a mistake. The extensive learning that nursing students go through when learning does not make them be in a position where they can recognize and differentiate every drug in the market and this makes them confuse some drugs. There are incidents where nurses mistake certain drugs that have the same packaging and recommend them to innocent patient (Cheragi et al, 2013). To help reduce this confusion, the companies making these medicines should differentiate the drugs as much as

Innovation course PowerPoint Presentation Example | Topics and Well Written Essays - 1750 words

Innovation course - PowerPoint Presentation Example ter is to improve the delivery of quality health care conforming to the strict standards of the Joint Accreditation Commission of Health Organizations (JACHO). It basic strategy to attain its vision and mission is to manage innovation through governance and leadership skills. The first strategy is to employ non-nurse managers to head their nursing units. It is strategic move to enable nurses to focus on patient care and not be bogged down with administrative work. This move paved the way to increase morale and productivity in the units, and increased patients’ satisfaction with regard to the delivery of efficient and effective healthcare. The second strategy was an innovative structure necessitating building a two-tower structure which stands on a 1.6-hectare property. This move would capture a more extensive clientele thereby improving their market share. The third move was to institute actions which are â€Å"firsts† in the industry. First to invest in advanced medical equipments to cater to more patients not only in the local market but in the neighboring Asian nations. Further, this strategy puts SLMC in the top spot among the medical institutions in the Philippines. Innovative companies have well defined goals, vision and mission. The vision defined 2010 as the year to achieve its being one of the top 5 hospitals in Asia and would be achieved through highly competent and caring professionals and with the use of world class technology and research. Leadership is essential in managing innovation. The appropriate leadership skills are matched with personalities, characteristics and behavior of its human resources to motivate them into achieving organizational goals. Company’s resources must be maximized. Human resources are acknowledged as their most important asset. Property, equipment, and processes are continuously updated. And management has made a commitment to invest in technologically advanced medical equipments to compete with other top health

People Suffering Mental Disorder Auditory Hallucinations

People Suffering Mental Disorder Auditory Hallucinations Auditory hallucinations for some people suffering mental disorder are frequently experienced as alien and under the influence of some external force. These are often experienced as voices that are distressing to the individual and can cause social withdrawal and isolation. Although auditory hallucinations are associated with major mental illnesses such as schizophrenia, they also occur in the general population (Coffey and Hewitt 2008). The annual incidence is estimated between 4-5 percent (Tien 1991), with those experiencing voices at least once, estimated between 10-25 percent (Slade Bentall 1988).The standard professional response to voice hearing has been to label it as symptomatic of illness and to prescribe anti-psychotic medication (Leudar Thomas 2000). An alternative is suggested by Romme and Escher (1993), who view the hearing of voices as not simply an individuals psychological experience, but as an interaction, reflecting the nature of the individuals relationship with h is or her own social environment. In this way, voices are interpreted as being linked to past or present experiences and the emphasis is on accepting the existence of the voices. Romme and Escher (1993) see hallucinatory voices as responsive to enhanced coping and found that those who coped well with voices had more supportive social environments than those who found it difficult to cope. This dissertation will aim to discuss the experience and management of auditory hallucinations in schizophrenia looking into therapeutic relationship, helping approaches, and working towards the ending of a therapeutic relationship discussing discharge. First chapter will aim to explain what schizophrenia is, the cause of schizophrenia, its symptoms and types with particular focus on auditory hallucinations. The chapter will then discuss what auditory hallucinations are in the diagnosis. Therapeutic relationship between service user and the nurse is paramount in mental health nursing and is seen to prove long term outcome such as social functioning (Svensson and Hansson 1999). Chapter two will aim to discuss the building of therapeutic relationship in the management of auditory hallucinations using Peplaus interpersonal relations model (1952). The importance of holistic assessment using a variety of tools, scales and questionnaires that will identify symptoms, risks, management of risk and address the service users needs will be discuss in chapter three. Chapter four of this dissertation will discuss helping approaches. Gray et al (2003) states that pharmacological and psychosocial interventions have been heavily researched to find the most up to date literature and recommendations for the management of auditory hallucinations in schizophrenia with medication and Cognitive Behavioural Therapy (CBT).. The final chapter will aim to discuss the ending of the therapeutic relationship between the nurse and the service user looking into discharge planning process and conclusion. Chapter one What is Schizophrenia and Auditory Hallucinations? Introduction to chosen topic Schizophrenia is one of the terms used to describe a major psychiatric disorder (or cluster of disorders) that alters an individuals perception, thoughts, affect and behaviour. Individuals who develop schizophrenia will each have their own unique combination of symptoms and experiences, the precise pattern of which will be influenced by their particular circumstances (NICE 2010). Allen et al (2010) define schizophrenia as a chronic and seriously disabling brain disorder that produces significant residual cognitive, functional and social deficits. Schizophrenia is considered the most disabling of all mental disorders (Mueser and McGurk, 2004), it occurs in about 1% of the world population, or more than 20 million people worldwide (Silverstein et al., 2006). The DSM -IV TR (APA 2000) defines schizophrenia as a persistent, often chronic and usually serious mental disorder affecting a variety of aspects of behaviour, thinking, and emotion. Patients with delusions or hallucinations may be described as psychotic. However, Tucker (1998) argues that the system of classification developed by the DSM-IV does not actually fit many patients as a whole; the syndromes outlined in DSM-IV are free standing descriptions of symptoms. He said unlike diagnoses of diseases in the rest of medicine, psychiatric diagnoses still have no proven link to causes and cures; Tucker argues that there is no identified etiological agents for psychiatric disorders. Schizophrenia is characterized by clusters of positive symptoms (e.g. hallucinations, delusions, and/or catatonia), negative symptoms (e.g. apathy, flat feet, social withdrawal, loss of feelings, lack of motivation and/or poverty of speech), and disorganized symptoms (e.g. formal thought disorder and/or bizarre behaviours). In addition, individuals with schizophrenia often experience substantial cognitive deficits including loss of executive function, as well as social dysfunction (Allen et al., 2010). It is estimated that nearly 75% of people with schizophrenia suffer with auditory hallucinations (Ford et al., 2009). Positive and negative symptoms are mentioned briefly because the dissertation is primarily focused on auditory hallucinations. Auditory hallucinations in diagnosis Auditory hallucinations are often considered symptomatic of people diagnosed as suffering from schizophrenia (Millham and Easton, 1998). APA (1994, p.767) defines hallucinations as a sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ. Auditory hallucinations range from muffled sounds to complete conversations and can be experienced as coming either from within or from outside ones self (Nayani David, 1996). However, Stanghellini and Cutting (2003) argue that APA definition of hallucinations is false, they believe an auditory hallucination is not a false perception of sound but is a disorder of self consciousness that becomes conscious. Hearing voices is not only linked to a persons inner experience but can reflect a persons relationship with their own past and present experiences (Romme and Escher, 1996). Beyerstein (1996) suggests that voices are anything that prompts a move fro m word based thinking to imagistic or pictorial thinking predisposes a person to hallucinating. Auditory hallucinations, or hearing sounds or voices are the most common and occur in nearly 75 percent of individuals diagnosed with schizophrenia (Ford et al., 2009). Auditory hallucinations are often derogatory or persecutory in nature, and can be heard in the third person, as a running commentary, or as audible thoughts. Some individuals with schizophrenia also experience useful or positive voices that give advice, encourage, remind, and help make decisions, or assist the person in their daily activities (Jenner et al., 2008). Voice hearer can work with their voices and either choose what to listen to or can completely ignore them (Romme et al., 1992). Sorrell et al (2009) states that some individuals experience positive voices which do not affect the way they function or go about their daily living, these hearers also find that their voices may offer advice and guidance. The hearers voice can be reported as a little distressful or some go on to report no distress at all (Honig et al., 1998). However Nayani and David (1996) argues that individuals who experience a constant negative voice found them less difficult to control, they found the voice more powerful and attempt to ignore the voice. Chadwick et al (2005) said that those who resist voices or feel the need to argue or shout back are termed malevolent, those who think voices are good and engage with them are benevolent, they see voices are helping them so they tend to listen and follow advice. Swanson et al (2008) suggests that people who hear voices are more likely to be victims of violence than be violent themselves. However Soppitt and Birchwood (1997) argue that voices are more commonly linked to depression, voice hearers can also have a history of suicidal thoughts, paranoia and abuse. Not all auditory hallucinations are associated with mental illness, and studies show that 10 to 40 percent of people without a psychiatric illness report hallucinatory experiences in the auditory modality (Ohayon, 2000). A range of organic brain disorders is also associated with hallucinations, including temporal lobe epilepsy; delirium; dementia; focal brain lesions; neuro- infections, such as viral encephalitis; and cerebral tumours intoxication or withdrawal from substances such alcohol, cocaine, and amphetamines is also associated with auditory hallucinations (Fricchione et al., 1995) The phenomenological characteristics of auditory hallucinations differ on the basis of their etiology, and this can have diagnostic implications. People without mental illness tend to report a greater proportion of positive voices, a higher level of control over the voices, less frequent hallucinatory experiences, and less interference with activities than people who have a psychiatric illness (Lowe, 1973). There is also evidence that delusion formation may distinguish psychotic disorders from non clinical hallucinatory experiences. In other words, the development of delusions in people with auditory hallucinations significantly increases the risk of psychosis when compared with individuals who have hallucinations but not delusions. Auditory hallucinations may be experienced as coming through the ears, in the mind, on the surface of the body, or anywhere in external space. The frequency can range from low (once a month or less) to continuously all day long. Loudness also varies, from whispers to shouts. The intensity and frequency of symptoms fluctuate during the illness, but the factor that determines whether auditory hallucinations are a central feature of the clinical picture is the degree of interference with activities and mental functions (Waters, 2010) The most common type of auditory hallucinations in psychiatric illness consists of voices. Voices may be male or female, and with intonations and accents that typically differ from those of the patient. Persons who have auditory hallucinations usually hear more than one voice, and these are sometimes recognized as belonging to someone who is familiar (such as a neighbour, family member or TV personality) or to an imaginary character (God, the devil, an angel). Verbal hallucinations may comprise full sentences, but single words are more often reported. Voices that comment on or discuss the individuals behaviour and that refer to the patient in the third person were thought to be first-rank symptoms and of diagnostic significance for schizophrenia (Schneider, 1959). Studies show that approximately half of patients with schizophrenia experience these symptoms (Waters, 2010). Waters (2010) says a significant proportion of patients also experience non verbal hallucinations, such as music, tapping, or animal sounds, although these experiences are frequently overlooked in auditory hallucinations research. Another type of hallucination includes the experience of functional hallucinations, in which the person experiences auditory hallucinations simultaneously through another real noise (e.g., a person may perceive auditory hallucinations only when he hears a car engine). The content of voices varies between individuals. Often the voices have a negative and malicious content. They might speak to the patient in a derogatory or insulting manner or give commands to perform an unacceptable behaviour. The experience of negative voices causes considerable distress. However, a significant proportion of voices are pleasant and positive, and some individuals report feelings of loss when the treatment causes the voices to disappear (Copolov et al., 2004). The exact processes that underlie auditory hallucinations remain largely unknown. There are two principal avenues of research: one focuses on neuro anatomical networks using techniques such as positron emission tomography and functional Magnetic Resonance Imaging (MRI). The other focuses on cognitive and psychological processes and the exploration of mental events involved in auditory hallucinations. A common formulation suggests that auditory verbal hallucinations represent an impairment in language processing and, particularly, inner speech processes, whereby the internal and silent dialogue that healthy people engage in is no longer interpreted as coming from the self but instead as having an external alien origin. There is support for this language hypothesis of auditory hallucinations from neuro imaging studies. These show that the experience of auditory hallucinations engages brain regions, such as the primary auditory cortex and broca area, which are associated with language c omprehension and production. This suggests that hallucinatory experiences are associated with listening to external speech in the absence of external sounds (Waters, 2010) An explanation of why these experiences are not perceived as self-generated posits that auditory hallucinations arise because persons who have the hallucinations fail to distinguish between internal and external events. This arises because of deficits in internal self-monitoring mechanisms that compare the expected with the actual sensations that arise from the patients intentions. This abnormality also applies to inner speech processes and leads to the misclassification of internal events as external and misattribution to an external agent (Frith, 2005).However, Bentall and Slade (1985) suggest that individuals with hallucinations use a different set of judgment criteria from healthy people when deciding whether an event is real, and they are more willing to accept that a perceptual experience is true. This bias essentially involves a greater willingness to believe that an event is real on the basis of less evidence. According to the context memory hypothesis of auditory hallucinations, the failure to identify events as self-generated arises because of specific deficits in episodic memory for remembering the details associated with particular past memory events. These specific deficits in memory cause confusion about the origins of the experience (Nayani and David, 1996). Patients with auditory hallucinations tend to misidentify the origins and source of stimuli during ongoing events and during memory events (Waters et al., 2006). The lack of voluntary control over the experience is a key feature of auditory hallucinations, which might explain why self-generated inner speech is classified as external in origin (Copolov et al., 2003). Hallucinations are experienced when verbal thoughts are unintended and unwanted. Because deficits in cognitive processes, such as inhibitory control, are thought to render people more susceptible to intrusive and recurrent unwanted thoughts, studies have linked audit ory hallucinations with deficits in cognitive inhibition (Waters et al., 2006). Recent advances in the neurosciences provide clues to why patients report an auditory experience in the absence of any perceptual input. Spontaneous activity in the early sensory cortices may in fact form the basis for the original signal. Early neuronal computation systems are known to interpret this activity and engage in decision-making processes to determine whether a percept has been detected. A brain system that is abnormally tuned in to internal acoustic experiences may therefore report an auditory perception in the absence of any external sound (Deco and Romo, 2008). Ford et al., (2009) suggested that patients with auditory hallucinations may have excessive attentional focus toward internally generated events: the brains of persons who have auditory hallucinations may therefore be over interpreting spontaneous sensory activity that is largely ignored in healthy brains. Cognitive impairments are not the only factors responsible for auditory hallucinations. Psychological factors such as meta-cognitive biases, beliefs, and attributions concerning the origins and intent of voices also play a critical modulatory role in shaping the experience of hallucinations. The role of environmental cues and reinforcement factors through avoidance strategies must also be incorporated in any explanations of auditory hallucinations. These factors do not explain how hallucinations occur in the first place, but they have strong explanatory power when accounting for individual differences in how the voices are experienced (Baker and Morrison, 1998). Patients suffering from auditory hallucinations sometimes can not distinguish between what is real and what is not real, it is very important to build a trusting therapeutic relationship with the sufferer. This dissertation will go on to explore the importance of building a therapeutic relationship with a patient; To explore the extent of auditory hallucinations a patient may be experiencing it is important that an appropriate assessment and risk management are carried out, exploring the need for assessment and risk management in auditory hallucinations, It will also look into helping approaches discussing pharmacological and psychosocial approaches in the management of auditory hallucinations and how to end the therapeutic relationship between a service user and the nurse, looking into discharge planning. CHAPTER TWO DEVELOPMENT OF THERAPEUTIC RELATIONSHIP Development of the Therapeutic Relationship Peplaus theories laid the ground for ascendancy of the relationship as the key context for all subsequent interventions with patients (Ryan Brooks, 2000). Although the idea of the relationship endures as the paradigm for psychiatric nursing (Barker, Jackson, Stevenson, 1999a; 1999b; Krauss, 2000; Raingruber, 2003), it does not appear there is any universal consensus on exactly how to frame this relationship. The nurse-patient relationship can be defined as an ongoing, meaningful communication that fosters honesty, humility, and mutual respect and is based on a negotiated partnership between the patient and the practitioner (Krauss, 2000, p. 49). Peplau describes nursing as a therapeutic interpersonal process that aims to identify problems and how to relate to them (Peterson and Bredow 2009). Forster (2001) defines therapeutic relationship as a trusting relationship developed by two or more individuals. However, Jukes and Aldridge (2006) says at first sight therapeutic nursing and the therapeutic relationship may seem relatively easy to define, but once we scrape the surface we find a complex range of ideas and concepts that stem from philosophies, ideologies and individual therapies. Sometimes there are difficulties in applying these definitions to our own work. Not least of these difficulties is the relevance of the concept of therapy as healing to nursing. This begs the question of whether a therapeutic relationship always entails the use of a therapy, or whether there is something more universal and fundamental in therapeutic relationships. It seems important therefore to attempt a workable definition of the therapeutic r elationship that has currency within nursing as a whole. Additionally, it seems that therapeutic nursing has two facets. The first of these, and probably the most apparent, is the emotional and interpersonal aspect, which we might call therapeutic nursing as an art. The second is the more logical and objective aspect, which we might call The therapeutic nursing as a science. Arguably, there is a synergy between the two that leads to a gestalt, and therefore a need to address both aspects if our nursing is to be truly therapeutic in a holistic sense. Peplaus theory focuses on the nurse, the patient and the relationship between them and is aimed at using interpersonal skills to develop trust and security within the nurse-patient relationship. Therapeutic relationships are the corner stone of nursing practice with people who are experiencing threats to their health, including but not restricted to those people with mental illness (Reynolds 2003). The relationship of one to one of nurse patient has potential to influence positive outcome for patients. Hildegard Peplau interpersonal relations overlap over four phases namely: Orientation, Identification, Exploitation and Resolution. Peplau also identify that during the four overlapping phases nurses adopts many roles such as- Resource person: giving specific needed information that aids the patient to understand his/her problem and their new situation. A nurse may function in a counselling relationship, listening to the patient as he/she reviews events that led up to hospitalization and feeling connected with them. The patient may cast the nurse into roles such as surrogate for mother, father, sibling, in which the nurse aids the patient by permitting him/her to re-enact and examine generically older feelings generated in prior relationships. The nurse also functions as a technical expert who understands various professional devices and can manipulate them with skill and discrimination in the interest of the patient (Clay 1988). The orientation phase is the initial phase of the relationship where the nurse and the patient get to know each other. The patient begins to trust the nurse. This phase is sometimes called the stranger phase because the nurse and the patient are strangers to each other (Reynolds 2003). Peplaus (1952) suggest that during this phase early levels of trust are developed and roles and expectation begin to be understood. It is important that during this time that the nurse builds a relationship with the patient by gaining their trust, establishing a therapeutic environment, developing rapport and a level of communication expectable to both the patient and the nurse. During the orientation phase trust and security is supposed to be developed between the nurse and the patient. Co-ordination of care and treatment of patient while using an effective communication between the MDT is a nurse role. The nurse also acts as an advocate/surrogate for a patient and promotes recovery and self belief. Essential communication skills are deemed to be listening and attending, empathy, information giving and support in the context of a therapeutic relationship (Bach and Grant 2009). Building a therapeutic relationship needs to focus on patient -centred rather than nurse-task focus. Bach and Grant (2009) say interpersonal relationship describes the connection between two or more people or groups and their involvement with one another, especially as regards the way they behave towards and feels about one another. Communication is to exchange information between people by means of speaking, writing or using a common system of signs or behaviour. Faulkner (1998) suggested that Rogers (1961) client centred approach conditions can be seen as important factors that contributes to a therapeutic relationship. Rogers (1961) three core conditions are: congruence, empathy and unconditional positive regards. Congruence means that the nurse should be open and genuine about feelings towards their patient. Having the ability to empathise with the patient would show that the nurse has the ability to understand the patients thoughts and feelings about their current problem. Unconditional positive regards is viewing them as a person and focusing on positive attributes and behaviour (Forster 2001). The orientation phase also gives the nurse the chance to asses the patients current health and once the assessment has been carried out the can then move the relationship forward to the identification phase. The identification phase is where the patients needs are identified through various assessment tools. Assessment will be discussed in detail in the next chapter. Butterworth (1994; DH 1994a; DH 2006a) says that during the identification phase the nurse and the patient will both work together discussing the patients identified needs, needs that can be met and those that cannot be met. They will al so identify risks and how to manage the risks and aim to formulate a care plan. Butterworth said the care plan should focused on the patients individual needs, long and short term goals and their wishes, whilst being empowered at all times to make informed decisions and choices that matter in their care. Collaborative working between multi-agencies ensures the needs of the patient are being met through appropriate assessment and treatment under the Care and Treatment Plan (CTP). The Care and Treatment Plan is one of a number of new rights delivered by the Mental Health (Wales) Measure (2010). The Measure also gives people who have been discharged from secondary mental health services the right to make a self referral back for assessment and it extends the right to an Independent Mental Health Advocate to all in-patients. A care co-ordinator must ensure that a care and treatment plan which records all of the outcomes which the provision of mental health services are designed to achieve for a relevant patient is completed in writing in the form set out (Hafal, 2012). The Sainsbury Centre for Mental Health (Rose 2001) found that patients are often not involved in the care planning process and many service users were not even aware of having a care plan. The exploitation phase is where interventions are implemented from the needs and goals set out in the identification phase which enables the service user to move forward, these interventions will assist in managing auditory hallucinations, whilst educating the patient and family members about the illness. Helping approaches will be discussed in detail in the next chapter looking at various up to date interventions available for the management of auditory hallucinations. A trusting relationship can help with recovery and during these interlocking phases is what the nurse and the patient are aiming for (Hewitt and Coffey, 2005). Building of a trusting therapeutic relationship is essential for nursing interventions to work (Lynch and Trenoweth, 2008). Nurses need to be sensitive, show compassion at all times and understanding to a patients needs. Nursing interventions needs to address physical, psychological and social needs; this involves having holistic approach (Coleman and Jenkins, 1998). Nurses need to work with the best evidence based therapeutic treatment available, this then being a positive approach to care (NMC 2008). The Chief Nursing Officer (CNO) review of the Mental Health Nursing (2006) noted that to improve quality of life, service users risks need to be managed properly, whilst promoting health, physical care and well being. However, Hall et al., (2008) argues that the CNO review does not take into consideration the great pressure nurs es are under and also the complex needs of the service user. Therapeutic interventions are an important aspect of recovery (Gourney 2005). Recovery can be described as a set of values about the service users right to build a meaning life for themselves without the continuous presence of mental health symptoms (Shepherd et al., 2008). The purpose of recovery is to work towards self determination and self confidence (Rethink 2005). National Institute for Mental Health in England (NIMHE, 2005) described recovery as a state of wellness after period of illness. Nurse need to provide a holistic view of mental illness with a person centred approach that can work towards the identification of goals and offer the patient appropriate support through interventions like CBT, family therapy and coping skills, this will enable the patient to be at the centre of their own care, thus taking responsibility for their own illness and improve quality of life. Service user who have a full understanding and accept their illness can engage more with therapies and in terventions with the necessary support from professionals, this then leads to self determination and better quality of life (Cunningham et al., 2005). However, Took (2002) says it is important to remember that with a service user experiencing auditory hallucinations, their mood and engagement can fluctuate and also the side effect of prescribed medication can affect this which may slow down the recovery process. Early intervention is also recognised to improve long term outcomes of auditory hallucinations in schizophrenia (McGorry et al., 2005: NICE 2009). However, not all service users will seek advice when first experiencing symptoms, due to stigma attached to mental illness and fear of admission to hospital (French and Morrison 2004). Some service users have also complained that the hospital has a non therapeutic environment and that they also feel unsafe and in an orison like setting (SCMH 1998, 2005; DoH 2004b). Drury (2006) says that service users felt that some professionals lacked compassion. Mental health nurses are encouraged to adopt a client centre approach, some research suggests nurses lack empathy and have general uncaring attitude (Herdman 2004). The final phase of Peplaus theory is the resolution phase. This is where the nurse and the service user will end their professional relationship. The relationship can end either through discharge or death. For the purpose of this dissertation the ending of the relationship that will be discussed at a later chapter will be discharge. Therapeutic relationship is seen as paramount during these interlocking phases of peplaus interpersonal relations theory, nurses needs to promote the service users independence whilst treating them with respect, privacy and dignity. By identifying treatment goals, implementing and evaluating treatment plans the service user can move on to interventions that will help them manage and cope with auditory hallucinations. Chapter 3 Assessment of a patient with Auditory Hallucinations Assessment of Auditory Hallucinations Assessment is the decision making process, based upon the collection of relevant information, using a formal set of ethical criteria, that contributes to an overall estimation of a person and his circumstances (Barker 2004). Hall et al (2008) described assessment as one of the first steps to the nursing process; it is also part of care planning and a positive foundation for building a relationship and forming therapeutic alliance. It is an ongoing process that enables professional to gather information that allows them to understand a persons experience. Most assessments have similar aims. However, how assessments are conducted can vary enormously. Such differences are very important and can influence greatly the value of the information produced (Barker 2004). In Wales CTP was introduced under the Mental Health (Wales) Measures 2010. CTP means a plan prepared for the purpose of achieving the outcomes which the provision of mental health services for a relevant patient is design to achieve and ensures service users have a care plan, risk assessment and a care co-ordinator to monitor and review their care (see appendix one). NICE (2010) suggest that assessment should contain the service users psychiatric, psychological and physical health needs and also include current living arrangements, ethnicity, quality of life, social links, relevant risk and other significant factors that may affect the service users quality of life. Assessment of a patient relies upon the collection of information through interviewing: the patient, member of their family, direct observation of the nurse, questionnaire, rating scales, and previous history (Previous records). However, Barker (2004) argues that despite the importance of the history, if relied upon as the sole method of assessment, not only may the final picture of the patient be of a doubtful accuracy but it may also lack the fine detail necessary for the planning o

Gothic Culture Essay -- Goths Renaissance History Essays

Gothic Culture You're walking down the street and all of a sudden you encounter a group of oddly dressed youngsters all in black, or perhaps wearing elaborate lace and brocade, looking strangely like they came out of eighteenth century. You immediately feel a bit of apprehensions as you clutch your child closer to and wonder what exactly it is that these kids are up to. Are they part of a Satan worshiping cult, or just a band of traveling actors? In either case their strange dress and pale likenesses took you aback and made you a bit prone to prejudge. What you were probably looking at were a group of Goths. What exactly is a Goth you may ask, and why the weird dress and affinity for black. This along with the origins, and some of the trials and tribulations faced by this extraordinary group of individuals, along with dispelling some common misconceptions is the objective of my writings. First lets take a look at what Goth is and where it began. Gage Canadian Dictionary defines "Goth." as "an uncivilized person, barbarian."( 1975:425) the origin of the word dates back to the third or fourth centuries when a Germanic tribe called the VisiGoths overran the Roman Empire and settled in what is now Sweden and the surrounding area (Shultz,1984:325). The word gained its modern meaning during the Italian Renaissance when the word was used to describe the architecture that was emerging at the time. The architecture was considered barbaric because of its pointed arches and steep roofs, along with the frequent use of the gargoyle, which was thought to ward of evil spirits. The modern Gothic movement and its origins are not as easily defined, and varies according to your source. I've combined the two to show an evolution of how it all... ...nformation has always been the key to help ease prejudices and discrimination, by introducing the ideology behind the Goth culture and explaining the reason behind the dress; I hope that it has brought about a better understanding of these people and their plight to a peaceful existence. Bibliography Fulton, Ben "Goths For Goodwill."City Beat (1998): 2p. Online. Internet. June 4,1998. www.slweekly.com/news/citybeat/cb 980604 a.html "Dictionary of Goth" 6/24/98 http:www.jesus.cam.ac.uk/~vkc20/goth/qzhtml Shultz, James.(1975) Germanic Tribes (3rd ED), Published by Weber and Van Syckle: Berlin Sangange, Eretica "Darkness Can be Felt"(1999): Online.Internet. June 30, 1999. http://pages.prodigy.com/Fifth Dream/goth.htm Yvain, Euphrosyne "Origins of Modern Gothic Culture"(1999) Online. Internet June 24,1999. http:www.blood-dance.net/goth/origins.html

Jeremy Lin

Chink in the Chain Webster’s Dictionary defines success as the favorable or prosperous termination of attempts or endeavors, or, successful performance or achievement. On February 4th 2012 Jeremy Lin made his NBA debut against the New Jersey Nets. Twelve minutes into the game, the non-starter Guard entered the game to make his debut as a New York Knick. To everyone’s surprise Lin came off the bench cold to put up big numbers against the Nets that would both change the pace of the game and give birth a new sensation in the NBA.In his debut game, Lin put up twenty-five points, seven assists, and two steals which was a team high in all three categories (NBA. com). Lin’s initial success was foreshadowing to what was soon to come. According to Webster’s Dictionary’s definition, Lin’s twenty-five point achievement in his first performance as a Knick can be deemed successful. Over the next three games of his career, Lin’s success continued. I n his first four NBA starts he had achieved a 27. 3-point per game average proving him to be an elite NBA player (NBA. om). Not only was his point per game average impressive it was also a new NBA record, surpassing players such as Allen Iverson and Michael Jordan, who are largely considered to be two of the best players to play the game. Along with Lin’s success in the NBA came a lot of attention in the media, a growth in Asian-American attendance at Knick games, and increase talk around the league. Jeremy Lin’s success in his initial performances as a Knick sparked a media hit, on Television, in Newspapers, and on the Internet as well.One of the most popular expressions about Lin’s success was â€Å"Linsanity†, which is a combination of the player’s last name, Lin, and the word insanity to describe the players up and coming success. Not all of the postings and expressions in the media were as warmhearted as the trending â€Å"Linsanity†. L in’s attention in the media quickly shifted from his success as a player to attention towards his Chinese heritage. For example, The New York Post, a very highly respected new paper in the Northeast released an article titled â€Å"Amasian! , which was not perceived to be offensive or racist by many peoples, because Asian is not by any means an offence term. As time progressed so did the offensive news articles and names given to the successful athlete. Lin was deemed ‘Super-Lintendo’ and ‘The Yellow Mamba’. Super-Lintendo was in reference to Super Nintendo, and Chinese manufactured video game, while The Yellow Mamba is a spin on Kobe Byrant, and African American NBA player’s nickname. The Yellow Mamba was given to Lin because of his success in the NBA comparable to Bryant’s and his Chinese skin often associated with a yellowish hue.As Lin’s success in the NBA continued his attention in the media and Chinese association grew. Fe bruary 18th 2012 at 2:30 am ET, Anthony Federico posted his article titled â€Å"A Chink in the Armor: Jeremy Lin’s 9 Turnovers Cost Knicks In Streak-Snapping Loss to Hornets† on ESPN. com. Shortly after the article was posted, at 3:05 am the article was removed from the website. Though the article was only online for a brief thirty-five minutes, the article was viewed by many, received a lot of attention and was exceedingly controversial.Shortly after its publish, many different new sources and individuals debated whether the article was racist or not. In addition to removing the article from the website, ESPN decided to suspend the articles publisher, Anthony Federico for a thirty day work period and then later that month fire him. ESPN received a great deal of negative attention and many people both agreed and disagreed with Federico’s article being deemed racist. Fererico’s article received a significantly more attention than New York Post’s ar ticle â€Å"Amasian! because ‘Chink’ is a often considered to be an offensive term to Chinese-Americans. Federico’s article went under great scrutiny from members of the Chinese American Community. U. S Representative and Chinese-American, Judy Chu was appalled by ESPN. com’s article. â€Å" I think the use of the term is appalling and offensive,† said Judy Chu to MSNBC, one of the world’s most successful new networks. The word ‘Chink’ is a very offensive word to the Chinese-American community.Chink is a negative ethnic slur towards Chinese people and other Asian Americans because they are commonly assumed to be Chinese because of their appearance and the large Chinese population. â€Å"The ‘c’ word is for Asian Americans like the ‘n’ word is for African Americans,† Said Chu. Judy was highly offended by the Federico’s use of the ‘c’ word. To compare the Chinese slur chink, to the African slur nigger, a word that is perceived to be highly racist and has been taken out of American Literature n some schools, gives a good sense of how offensive it really is. The slur nigger is the most offensive word you could ever call an African American person and is frowned upon due to its negative association dating back to times of slavery in America. If Chu is able to associate chink in the same regard as nigger, it is obvious that its use is highly offensive to Chinese-Americans, because the word nigger is not something that is said in the media, on radio or on basic television because of its so highly offensive.Judy Chu speaks passionately about the vulgar word chink because it’s hateful and is used to so similarly to the word nigger. â€Å"While no one would claim that racism against black people is no longer a problem in America, it is unthinkable that any news network or even half-brained TV presenter would use racial slurs against a black player equivale nt to the Asian ones that have been used against Lin,† stated Hadley Freeman in â€Å"The Guardian† a well-respected Newspaper in London.Freeman compares the Chinese racism to be equivalent to using racism towards black people, where she says that no one would ever think to you use a racist word towards black people because it is so out-casted or restricted, especially in the media. The phrase â€Å"Chink in the Armor† is a reference to a chink, or crack in medieval armor, which would lead to vulnerability and potential injury. Today, this expression is used to describe a weak spot in an object or even a weak member of a group or a team.Anthony Federico used the expression â€Å"Chink in the Armor† in one of his article’s titles to describe Jeremy Lin’s multiple turnovers in The New York Knicks loss to the New Orleans hours before the article publication. Federico used the expression the correct way being that Lin performed poorly in the game leading to a loss for the Knicks; thus, making a Lin a weak link or Chink in the Armor for the team. â€Å" †¦Had nothing to do with me being cute or punny,† Said Anthony Federico. In his claim given to Politico. om, a popular Internet news source, Federico claims that he was not intentionally racist towards Lin. Federico said that the use of the expression â€Å"Chink in the Armor, had nothing to with Lin being Chinese, and that wasn’t used to be interpreted as pun, or sneaky way to include racism towards Lin and Chinese peoples. † (Freeman 1) Federico’s defense in The Guardian gives his claim that he simply used the expression correctly and did not intentionally use the word chink in its popular meaning describing Chinese people.He believes that the reason why the article’s titles receive so much negative attention was not because of his wrong action, being that he used the phrase the way that it is intended to be used, but because individu als and the media misinterpreted his intentions and accused him of racist intentions. Lin’s success has been turned into many different puns in the media like his nickname ‘Super Lintendo’, where the pun is very blunt, but Federico’s use of the word chink in his own opinion was strictly used to in its obvious expression and a reflection of Lin’s performance in the night before and did not pertain to his ethnicity.Federico went on to apologize to Lin in his statement; â€Å"I’m so sorry that I offended people. I’m so sorry if I offended Jeremy. †(Freeman 1) In Federico’s apology he is saying that he is sorry for offending both the Asian American community and Jeremy, and that his remarks were accidently racist, because he did not mean for his title to be interpreted to be racist. Federico claims that his article’s title containing the expression â€Å"chink in the chain†, was not using the word in a negative manner.He also claimed that if the title was in fact racist that it was strictly because of poor word choice and therefore accidental. Federico’s past use of the word does not support his claim that he did not use the word with an ethnic connotation. â€Å"Federico told the Daily News he had used the phrase hundreds of times in headlines over the year,† taken from an article written by Mackenzie Weigner on Politico. com, a well respected online news source. Federico has used word chink in his publications hundreds of times in his career.Because he has used the word so many times throughout his career he is very aware of its negative and racist denotation. By claiming that he has used the word hundreds of times, Federico should have known the potential risk of publishing an article containing the word chink when talking about a Chinese American. â€Å"And if he was using it all those times, that is extremely sad. The word was used since the 1880s to demean Chinese Amer icans and to deprive them of rights, and it is used on playgrounds specifically to humiliate and to offend Asian Americans. So I don’t know where he’s been all this time. (Weigner 1) Judy Chu is disgusted by the fact that Federico has used the word so many times over the course of his career and not sees a problem with it. Chu finds it to be sad that Federico has used the word so many times in his career as a journalist and still cannot grasp the hateful meaning the word takes towards Chinese Americans. Judy the goes on to give a history of the word chink and how it has been used all along to intentionally be offensive towards Asians and more specifically Chinese Americans. Racism is something that Jeremy Lin has experienced his entire lifetime as a collegiate basketball player.During his time at Harvard University, Lin was a successful basketball player and often the members of the opposing team’s student fan section often chanted racist remarks as he played. F or example, when Lin played University of Connecticut the fans chanted â€Å"wonton soup† as he took his foul shots. When asked about the publication on ESPN. com Lin said, â€Å"Have to learn to forgive and I don’t even think that was intentional. Or hopefully not. † (Weigner 1) Federico had apologized to Lin about the incident, and Lin was very quick to accept the apology, forgive him and move on.Lin states that he thinks that Federico’s article could have potentially been unintentionally racist as Federico claims. In the end of Lin’s statement he says â€Å"Or hopefully not† meaning that if the article was intended to be seen as punny, by slipping in the word Chink while talking about him, he would have found it to be offensive. Racism has been surrounded by racism for a long time and has learned to put it past him and focus on what was important to him, his successful basketball career. Following Lin’s impressive and record-breaki ng start in the NBA came a large amount of media about both his accomplishments and his Chinese heritage.Many of the publications during this times period were warm-hearted and highlighted Lin’s numbers and quick climb to the rank of an elite NBA player, while unfortunately many other publications keened in on Lin’s race and at times were demeaning. Federico’s article received an excess of attention and proved to be controversial as it was highly debated. Though Federico claimed that his article was not intentionally racist, many people were offended, particularly Asian Americans and as a result Federico was highly scrutinized.

Objections Arising from Evil in the World Essay

The word evil is a word which can be used very loosely, usually used to describe something we think to be morally wrong, something that when in inflicted on a person causes pain and suffering. However, if an ‘evil’ act is committed by someone who has been in all other aspects good, does this act make this person ‘evil’? There are many different situations where evil acts could be done all with different circumstances and consequences. For example; at Auschwitz, so many guards were involved in the slaughter of massive amounts of Jews but it seems unlikely that all of them were evil. The actions may be considered evil but they were normalised by the sense of responsibility felt by the guards. In their eyes, they were carrying out a duty so the question of whether they are to be labelled evil is indefinite. There are two recognised categories which evil can fall under: Moral evil and Natural evil. Richard Swimburne, a modern day philosopher describes moral evil as ‘including all evil caused deliberately by humans doing what they ought not to do, and also the evil constituted by such deliberate acts or negligent failure’. It is the result of a human action which is morally wrong, such as murder or war. Natural evil is the result of apparent malfunctioning in the natural world, it is according to John Hick ‘the evil that originates independently of human actions. It is in disease, in bacilli, in earthquakes, in storms, and in droughts.’ The fact that evil, or suffering is an undeniable factor in our lives presents an array of problems in today’s world where there is a strong belief by many of a higher power which should in theory, be able to eradicate it from the world or in fact never have let it come to exist in the first place. For believers in the God of Classical Theism, this ‘problem of evil’ as it is often referred to, creates a serious dilemma. Moral evil is an easier problem to tackle for a theist than that of Natural evil, as it can be said that it occurs from the misuse of freewill, but they are still faced with justifying the existence of Natural evil. If God created the world from nothing, then there is nothing beyond His control so for whatever reason, God must be the creator of evil and suffering. A theist can sometimes be faced with justifying both types of evil as natural evils like tsunamis and hurricanes are often the cause of people committing moral evils like looting. The problem is not easily justifiable and is illustrated in ‘The Inconsistent Triad’, which states the points: God is omnipotent and omniscient (A), God is all-loving (B), and evil exists (C). These three statements cannot all be true so it would seem that one of them is false, but since we know evil and suffering exist the inconsistency must lie in one of the other 2 points. The conclusions drawn from this are that either God is not omnipotent and cannot stop evil from existing, or that God is not all-loving and chooses not to stop evil existing, or that in fact God does not exist. This can be used as an argument for the non-existence of God. A quote from Swimburne on the Problem of Evil, ‘There is a problem about why God allows evil, and if the theist doesn’t have (in a cool moment) a satisfactory answer to it, then his belief in God is less than rational and there is no reason why the atheist should share it.’ An example of the problem being used in this way is in Hume’s combat of Thomas Aquinas’ Design Argument (Summa Thelogica) where he labels the Problem of Evil as ‘The Rock of Atheism’. However, whilst being a problem for theists in that it challenges the nature of God, it also poses problems in other ways. It presents itself as a philosophical problem as it compels the believer to accept conflicting claims that are logically impossible to reconcile. It is also a diverse problem; evil manifests itself in many different ways, demanding separate explanations. The problem of evil has proved itself to be a challenging problem, as it is not just going to disappear, evil and suffering are objective realities which are almost impossible to deny. B) Unpack two theodicies and analyse which how successful these are As I said, the justification of God’s allowance for the existence of evil is not easy, but there are many theodicies which have developed that provide strong arguments. A theodicy is a theory that justifies why God allows evil without qualifying the attributes of the God of Classical Theism. Two of which are those of Augustine and Irenaeus. Augustine’s theodicy has had considerable influence over many scholars since it was developed and attempts to provide justification for both moral and natural evil. According to Augustine, the perfect God created a flawless world where evil and suffering did not exist, and that God is not responsible for the existence of evil as it is not a substance, but in fact a deprivation of good. He uses an analogy of blindness to illustrate his meaning, as blindness itself is not an entity but an absence of sight. Augustine claims that evil comes from angels and humans who have deliberately turned against God and abused his gift of freewill. He states that evil is necessary in a created world as only the uncreated creator can be perfect, his creations are susceptible to change. Augustine’s idea on the existence of Natural evil is that it exists as a punishment for the Original Sin, which we are all guilty of as we were all seminally present in Adam at the time it was committed. Natural evil punishes us for the destruction of the natural order by human action. For these reasons God is right not to intervene and the fact that he does save some through Christ emphasises His mercy. God would be justified in sending everyone to hell for being guilty of the Original Sin, the fact that some go to heaven shows God’s goodness. Augustine’s theodicy has some substantial strengths, as is proved by its popularity. Brian Davies is an example of a scholar who supports his claim that evil is only a deprivation of good rather than having a proper existence, he said it is ‘a gap between what there is and what there ought to be’. To criticise would be to say that God should have created more than he did which doesn’t make sense; how is anyone to know how much more should have been created. Augustine’s views on evil being a product of freewill have also been upheld. Despite it’s strengths, Augustine’s theodicy has many holes in it to be addressed, it contains logical, scientific, and moral difficulties. Augustine’s concept of Hell comes under scrutiny; Hell is part of God’s design of the universe, so it was created before the world’s flaws began to appear, which means that God must have anticipated and accepted that the world would go wrong. F.D.E Schleiermacher expresses his logical contradiction to Augustine’s views on the origin of evil and a perfect world going wrong, Schleiermacher informs us that whether evil is a deprivation or not it is still real and it is therefore logically impossible for it to just come out of nothing. This means that evil must be connected to God and he either never created the world perfect or he made it so it was able to falter. Another logical difficulty of this theodicy comes of the capacity to do evil in a ‘perfect’ world and disobey God, as in a perfect world no knowledge of good and evil should exist. The knowledge of them could only come from God. Scientific difficulties stem from the modern world’s concept of evolution; the idea of a perfect world being damaged by humans does not allow for evolution. Moreover, Augustine refers to the Garden of Eden in his theodicy, and this paradise is hard to accept on the basis of evolution. A final difficulty lies with the concept of us all being seminally present in Adam’s loins, this is biologically impossible so we cannot all be responsible for the Original Sin. From comparing the strengths with the criticisms we can see that Augustine’s theodicy ultimately fails. The theodicy of Irenaeus is another which provides a formidable answer to the question of why God allows evil’s existence. As said by Irenaeus, Gods aim when creating the world was to make humans in his likeness, but to do this, humans could not be made perfect but had to develop through free will. It was therefore necessary for God to give us free will and therefore necessary to give us the potential to turn against him. If he didn’t enable this, we could never attain God’s likeness as according to Ireneaus it requires willing co-operation. The natural order had to be designed in a way where humans could cause harm, which they did resulting in suffering, but God still cannot compromise our freedom by removing evil. Ireneaus claims that the evil and suffering will eventually be overcome and everyone will attain God’s likeness and reside in Heaven. This justifies temporary evil, which if complying with Ireneaus’ thought enables the understanding of good. Many philosophers have added to Ireneaus’ theodicy including John Hick (who claims that good developed from free will is better than ready-made goodness), and Peter Vardy who used an analogy of a king to illustrate this – where a king falls in love with a peasant girl but rather than imposing his power on her and forcing him to marry her, he wins her over. They both believe that without development our goodness would be without value, we would be automatons. According to this theodicy, humans had to be created imperfect to be able to go against God, and they had to be created at a distance from God so they could decide for themselves to believe in him. If we were sure he was there, there would be no free will, John Hick called this the ‘epistemic distance’. If God wasn’t separated from humans we would know he was real and would live a good, moral life because we would know that it is in our best interests, it wouldn’t be real goodness. Humans also couldn’t be created in a paradise or else qualities such as courage would not be attainable and there would be no development as good and evil would be indistinguishable. The theodicy justifies natural evil as it makes the world well adapted to ‘soul making’ (John Hick). The Modern Additions to this theodicy claim that heaven is the eventual goal for everyone for three reasons; a future in heaven is the only justification for the suffering of the world. Secondly, if life were to end in death God’s purpose would be unfulfilled since we would not be reaching our goal of becoming God’s likeness. Lastly, nobody can be overlooked as evil acts are carried out in different circumstances for different people. For example, someone who was abused while being raised is much more likely to be abusive as an adult, it is something they are used to and have become desensitised to. There are solid criticisms of Irenaeus’ theodicy as well as Augustine’s: For example, everyone going to heaven defies religious texts as well as making it pointless to live a moral life, why bother if you are going to heaven anyway? It also takes away the incentive to develop into God’s likeness which Irenaeus regarded of utmost importance. Another critique is of the level of suffering needed to make the world adapted for ‘soul making, e.g. Was the Holocaust really necessary? Finally, it can be said that love can never be expressed through suffering, supported by D.Z Philips who said it is not justifiable to hurt someone to help them. To conclude, neither of these theodicies can be considered perfect by any means, but Ireneaus is the stronger of the two. Where Augustine fails to provide room for belief in evolution, Ireneaus manages it and while Augustine cannot provide a logical explanation for the origin of evil, Irenaeus provides a stable reason for it. It is also popular, like Augustine’s for its views on free will.