Monday, January 27, 2020

Preparation For Providing Effective And Efficient Mentorship Nursing Essay

Preparation For Providing Effective And Efficient Mentorship Nursing Essay In preparation for this assignment searches have been conducted using the following databases: Cinahl, Pubmed and Medline search terms Learning theories, Learning styles, Mentorship and Practice Education Facilitator were used singularly or in combination. Manual searching of relevant nursing journals and publications have been performed. Articles published in English in the last 10 years were reviewed. This assignment will examine the issues and processes that need to be considered whilst facilitating and supporting a student to meet their learning outcomes in a practice placement, there will be discussion regarding the assessment strategies available as a mentor, which contribute to the overall assessment of students. Furthermore learning styles and theories will be discussed, along with the clinical setting as an environment to facilitate the learning needs required to achieve success in completing the practice placement learning outcomes. A brief overview of the clinical setting will be provided to capture the ambiance of the learning environment. The setting for this location is an Elective Orthopaedic Unit within the Northwest and in conforming to the Nursing and Midwifery Council (NMC (2008); any names used will be pseudonyms to protect identification, confidentiality and dignity will be maintained at all times. NMC (2008) states that a mentor is a registered nurse who has completed the approved mentorship programme and meets the criteria set out in NMC (2008) standards for mentors, practice teachers and teachers. Whereas Gopee (2008) argues the term mentor is frequently used to mean trusted friend, guide and advisor. There is also identified the eight mandatory standards that must be achieved to become a mentor, the author will be referring to these standards to support learning and development in practice. To ensure the student who will be named as Lucy for the purpose of this assignment has a positive learning experience it is paramount that learning environment is supportive for Lucy and for those who work alongside her. An orientation pack and welcoming letter are provided with useful information and an introduction to the allocated mentor is provided when ever possible on attendance the first shift. Kenworthy and Nicklin (2000) support the view that the more comfortable and welcome a student feels within the working environment, the more likely it is that effective learning will take place which is a key factor in successful learning. Pearcy and Elliot (2004) found that students who have had negative experiences with their mentor and placements, tend to leave the course before qualifying however Beskine (2009) advocates that starting off with a positive approach promotes the students experience as well as the quality of the placement. Adhering to the mandatory standards set by the NMC (2008) Standards to Support Learning and Assessment in Practice; and in order to establish the stage of Lucys training and her learning needs and style a mutually agreed time and location is identified for the initial meeting to take place. This meeting provides the opportunity to co-ordinate off duty and to identify another team member who will be available to support Lucys learning needs in the absence of her mentor. Once Lucys learning style had been established, then negotiating the best way forward to facilitate the learning experiences relevant to the placement can take place This provides the opportunities for Lucy to meet all of the learning outcomes and needs. Direction towards self-management of learning should be encouraged to help promote professional development, and to instil the importance of responsibility and accountability. At the half way point Lucy and her mentor will have a formative assessment, evaluation of her progress this will determine any action plans or adjustments necessary to enable Lucy to meet her learning outcomes. NMC standards for mentors (2008) state that a mentor must contribute to evaluation of student learning and assessment experiences, suggesting aspects for change resulting from such evaluation. A summative assessment would usually take place when completing student documents whilst focusing on the whole of the placement. In a study by Hart and Rotem (1994) it is indicated that the qualities of a mentor are a vital factor in providing and achieving a positive and valuable learning environment; moreover the study found that stressful events for nursing students during clinical practice have shown the initial clinical experience was the most anxiety producing part of clinical experience Cahill (1996) acknowledges that the single most crucial factor in creating a positive learning environment is the relationship between staff and the student nurse; it is also discussed that a common problem that arises for a student is that they are regularly unable to work with their mentor. Many nurses and nursing students in the past found themselves to be autonomous practitioners, learning their skills within the situations they found themselves in without adequate guidance or support (Bray Nettleton, 2008). Whereas Higgins et al (2009) suggest the success of any nursing student in any program in any clinical setting is complex, enhancing the complicated nature of education and the perception of competencies whether student or mentor. This is an important concept to be sensitive to, as the process of moving forward with the knowledge and skills needs to be supported and nurtured in order to facilitate the standard of care that is safe, accountable, and competent. Honey and Mumford (1992) Identified If mentors are to teach students effectively they must be aware of different learning styles and the importance of them; furthermore Honey and Mumford explore four different styles of learning and is a variation on Kolbs learning cycle, which was originally adapted from Kolb and Fry (1975). It is thought whenever possible, it is essential to allow the students individual style of learning determine the choice of teaching. Within Kolbs model there are four different styles of learning they describe, activist, theorist, pragmatist, and reflector. They also propose that although many people can be a mixture of the four styles, they primarily have a preference for only one. However Clark (2007) suggests that labelling such as activist versus reflector has no scientific justification. Downie and Basford (2003) believe, that to identify the learning outcomes at the beginning of the placement is of great benefit to the student, knowing the stage of training that the student is currently at helps to support a student effectively within the clinical setting; moreover they suggest that most students prefer the traditional learning method described as pedagogy which is where the mentor or teacher has full responsibility for what the student learns. Andragogy is described by Knowles (1990) as adult learning where the student is motivated and applies life experiences to learning, therefore this suggests the use of andragogy teaching method would be beneficial to Lucy as she is very motivated in learning outside if the learning outcomes. When establishing Lucys learning style, formal teaching sessions were introduced to demonstrate how theory is applied in practice. A taxonomy frequently used in nursing is the framework by Benner (1984) in which there are five levels; novice, beginner, competent, proficient and expert. According to Benners stages of clinical competence, which shows the journey of a novice to an expert then Lucy appears to be an advanced beginner as signs of understanding NMC The code: standards of conduct, performance and ethics for nurses and midwifes have been identified along with previous experience in other clinical areas. As required By NMC (2008) Standards to Support Learning and Assessment in Practice along with fostering professional growth, the mentor encourages Lucy to reflect on her practice and empowered Lucy to be autonomous within the limitations of the supervised role, whilst being fair and accurate in the assessment of the student. Validity is the most crucial aspect of any assessment; it shows the extent to which the assessment measures and what it is expected to measure. A valid assessment is one that assesses learning outcome; it is set out to assess and not to target other outcomes that may not have been learnt adequately at that point. Reliability is also a key factor to be considered in assessments, the term reliability is used to indicate the consistency of which an assessment measures and what it is designed to measure. However Goding (1997) suggests that reliability and validity are inappropriate indicators of nursing practice and that they reduce practice to a list of objectives, which holds very little relation to the intricacy of practice. The NMC (2006) advocate that assessment is said to be reliable, if it gives similar results when used on different occasions, and with different assessors. It is suggested by Hand (2006) that continuous assessment allows the student to achieve their target through progressive goal setting. Whereas Clifford (1994) explains continual assessment of practice, implies the students performance is monitored on a daily basis during clinical practice, which would be done on a day-to-day basis. Regular meetings between Lucy and her mentor allow discussions with mutual respect to evaluate the progress she is or may not be making, enabling action plans to be implemented if necessary. According to NMC (2008) the mentor should provide the student with constructive feedback and assist them in identifying future learning needs and actions. Employing evidence-based practice, observation and communication equips the mentor with some of the necessary tools to identify the strengths and weaknesses and provide feedback; remaining objective when assessing the student to meet the required outcomes also means being objective when completing student documentation. It could be tempting when assessing Lucy to overeat her performance causing the halo effect, although by underrating her performance could cause the horn effect; this could happen if there is a clash of personalities between a student and a mentor. Krech et al (1962) document that human tendencies can influence a manager or mentors point of view causing stereotyping and the halo and horn effect Research by Watson Harris (1999) that examines support of students in practice placement established that some student nurses are being allowed to pass clinical assessments without having demonstrated sufficient competence; the study revealed that some Practioners did not feel it was their responsibility to fail students. Moreover Duffy (2003) reports that it is inevitable that some students will not be able to meet the required level of practice and it is essential that mentors do not avoid the difficult issue of having to fail these students. Duffy (2003) identified that weak students tend to have poor interpersonal skills, are disinterested in practice learning and are frequently late, and that they also lack personal insight and the awareness of professional boundaries. Duffy goes on to recommend that early intervention is essential if mentors or the clinical team notice an issue or concern about students, time must be made to discuss the issues. There may be other factors affecting performance and these mitigating circumstances may need to be considered, however performance must meet the required standard. The NMC (2008) Standards to support learning and assessment in practice state the mentor is accountable and responsible for assessing the total performance of the student including attitude, skills and behaviour. There are fundamental individuals that can offer support and guidance to the mentor. The mentor can access support in assessing a student by way of the links to the Practice Education Facilitator (PEF), whose multidimensional role includes; according to Salvoni (2001) helping to support and enhance clinical practice and teach student nurses practical skills within the academic setting, in recognition of the theory-practice relationship. In addition to this Rowan Barber (2000) and Richards et al (2001) support the view that the PEF furthers staff in the development of their teaching and assessment skills. The PEF, University Link Lecturer and The Academic Adviser are pivotal in supporting and guiding both the mentor and the student if there have been concerns expressed in a students progress within the placement. There is a potential that a mentor could be mentoring a student who is not able to achieve within the placement, if a mentor has concerns it is essential that this concerns be acted upon in the appropriate and in a timely manner. Duffy (2003) recognised mentors do not always identify and deal with problems early enough in students placement, they find it difficult to fail a student, in order to prepare a mentor for their role and the responsibilities in failing the student it is vital that they are supported and backed up by the PEF. The NMC (2008) states mentors should manage failing students to enable them to enhance their performance and capabilities for safe and effective practice. The student should also understand their failure and the implications of this for their future. NMC (2006) states students must evaluate their placement as part of the educational audit process. Also as the named mentor you are responsible for making the final assessment and are accountable for passing or failing the student. It is inescapable that some students will not be able to achieve the required level of competence whilst in the practice placement and it is essential that mentors do not evade the difficult issue of having to fail a student. In conclusion this assignment has examined a plethora of evidence, research, reviews and studies to elicit discussions and reflection surrounding what issues and processes have to be considered whilst supporting a student in a practice placement along with comparing the range of assessment strategies accessible to mentors which, contributes to the overall assessment of students. Wilkinson (1999) argues liasing between clinicians and educationalist enhances the quality of assessment and promotes a practice based learning culture. Learning styles and learning theories have been investigated. It is important to assess each student as an individual in the context of their learning needs to strengthen the integration of theory and practice within the clinical setting likewise it is imperative that the mentor has an understanding of the learning outcomes. The mentor was able to pass Lucy in her practice placement and maintained professional boundaries throughout the experience.

Saturday, January 18, 2020

The baby boomer in the midst of the economic crisis

Most of the baby boomer generation were imbibed with the stereotype perception on the facets of work, employment and success. In a typical scenario, that â€Å"best† schedule would connote that a baby boomer would go to work on a regular schedule, 8-5, working from Monday to Friday schedule. Most of the time would be spent in the office, taking a daily commute to and from the office, with some time being taken by overtime, some work to be done on the weekends, and some other tasks to be accomplished at home.Success was also easily defined, with the person attaining the highest position in the corporate ladder becoming the epitome of that standard of success (Brad Harrington, Douglas Hall 98). Many of the people, baby boomer and others, believe that the current recession is about to end and that more prosperous times are about to return are, what observers state, is sadly suffering from a near sighted view of the present economic crisis.In reality, since the peaking of the 2005 United States housing crisis, the continuing barrage of the sub-prime financial crisis in 2007,and the resulting economic slowdown in the American economy in December of the same year, its has been observed that the United States economy, and to a certain degree the global market, has entered into an era of prolonged adjustments, with expected periods of growth, but the severe economic restructuring currently being put in place is believed to continue for the next years. What is believed to be the main driver of these developments is the baby boomer generation.It is assumed that the previously mentioned financial crisis is also contributory to the current financial morass, but the imperative reasons is that what is considered as the largest demographic in the history of mankind, the baby boomer generation born after the Second World War, has overreached its spending power (Professor Rodrigue Tremblay). What is seen to be the immediate effect of this development is that there must b e a realization that the exhaustion of the spending power of the baby boomer generation is irreversible.In this regard, the solutions cannot be found overnight; the remedy will be decades of readjusting of corporate spending, reduced spending and increased savings, and liquidating massive mountains of debt. The ramifications of this development will be seen to reverberate through the entire economic structure, as seen in the downturn of the automobile industry, and the increases in the health care sector, as the baby boomer continue to age (Tremblay).What is considered as a significant public policy issue is the potential load that a society that is reaching its twilight years will place on the nation's health provider system and the government expenditures. The â€Å"2030† issue is about addressing the challenge that by that time, there will be adequate and an efficacious system will be in place in three decades time, when the elderly sector in society will be double the pre sent population. By the year 2030, it is expected that many of the baby boomer generation will be between the ages of 66 to 84 years, and they will comprise 61 million individuals.Apart from these, the number of the older baby boomers, will be more than 9 million by 2030 (James Knickman, Emily Snell). The present structure of the long term care sector is constructed around the provision of the service by private providers, which can be categorized as non-profit and some for profit outfits. When the available resources increase, the development of new services can accelerate at a faster pace. Inversely, when available resources decrease, it is also expected that the capacity of the sector will diminish.Taking the example of home health care as a point of reference, the growth in the yearly expenditure rate increase went from ten percent in the period of the 1980's reaching into the 1990's, plummeting to a negative three percent in just two years, from 1998 to 1999 (Knickman, Snell). The Congressional Budget Office (CBO), in a 1999 report, calculates that expenditures related to long term care needs was approximately $120 billion in 2000, more than half (59 percent) addressed by the private sector.The balance of the expenditures were covered by individual expenses, with the private long term sector just covering one percent of the long term health care expenditures. In the conservative estimation of the CBO, the total amount for long term health care will rise an average of 2. 6 percent above inflationary levels annually over a span of three decades, totaling more than $150 billion in 2010, close to $200 billion in 2020, and a colossal $ 230 billion by the year 2030 (Knickman, Snell). In the composition of the Federal budgetary outlay, three government dominate the bulk of Federal spending; Medicaid, Medicare and Social Security.Federal outlays for these programs in 2004 reached more than $960 billion, exclusive of receipt offsetting of Medicare premiums. In tot al, these three programs totaled more than 40 percent of the entire Federal budget. It is be noted that the Federal government is contemplating on implementing sweeping changes in the mechanism of the Social Security system. The changes in the Social Security structure is inclusive of proposals to divert a portion of their tax payments to private investment tools (United States Congressional Budget Office 9).One piece of advice that the boomers might give serious contemplation to is the fact that there exists now a need to increase levels of savings rather than increased spending. All the events the last few years have sent a clear signal to the aging sector to turn to savings and restrain spending binges; but these acts of saving on the part of the boomers would mean a decrease in the levels of consumption and reduced spending, so that they can liquidate their liabilities, and that will increase the personal net income of the boomers.But what does that spell for the economy, if the largest spending sector considers more saving and reducing their consumption? It will translate to a comprehensive deceleration in economic growth and some excruciating adjustments in broad sectors in the economy (Tremblay) . In this light, it is expected that the effects of the current financial crisis hounding the global economies will be magnified and increase in its intensity, and the magnified effects of the crisis will continue to be felt in the decades to come.The economic doldrums will not be continuous, as there will be some short lived gains and increases, but will quickly return to the state of economic stagnation. To cite an example, in the last decade, Japan suffered a period of stagnation induced by the elderly demographic buffeted the nation's economy for the entire nineties. Even to this day, Japan is still trying to finds its way out of the economic morass it suffered during that time (Tremblay). Many of the countries whose population practices a very high standard of savings patterns will be able to export much of that capital to other countries.During the baseline year for model simulations, 1997, it was seen that many industrial states were exporting more than $60 billion in net investments to some low and middle level nations, amounting to 1. 1 percent of the gross domestic product of the nations that receive these outflows of capital. In that year, only nations in East Asia region were seen to be net exporters of capital. But in the year 2015, the recipients of the outflows of the industrial nations will be the ones exporting capital, and the industrial nations currently exporting the capital will be the ones importing the capital (World Bank 40).In the years not covered by the data released by the Congressional Budget Office (CBO), the continued aging of the baby boomers, compounded with increasing costs related to health care, will create a significant shift in the financial situation of the Unite States. It is expected that in the nex t three decades, the population of Americans at or over the age of 65 will jump 100 percent, while the number of people that are under the age of 65 will only increase by 15 percent. What is more alarming is the rate for the increase for health care expenditures is expected to outstrip the pace of economic growth during the same period.If the costs continue at a pace of 2. 5 percent, the Federal government will increase its budgetary allocations for Medicare and Medicaid, from 4. 2 percent at present more than 11 percent by the year 2030 (Congressional 10). Budgetary allocations for Social Security is expected to increase in the next thirty years by an average of 40 percent under the operation of the present laws. The share of the allocations for Social Security will rise from the 4. 2 figure at present to at least 6 percent in 2030.By comparison, the revenue projections for Social Security is expected to be static during the period, hovering at around 5 percent of gross domestic pr oduct (GDP). All combined, these pressures will exert significant amounts of stress on the budget that growth in the economy is unlikely to fully satiate (Congressional 11). Works Cited Harrington, Brad, Hall, Douglas T. Career Management and work life integration: using self assessment to navigate contemporary careers. Los Angeles, USA: Sage Publications 2007. Knickman, James R. , Snell, Emily K. â€Å"The 2030 Problem: Caring for Aging Baby Boomers†.Health Research and Education Trust 2002 August, 37(4), pp. 849-884 Tremblay, Rodrigue. â€Å"The Great Baby-Boomers Economic Stagnation of 2007-2017†. United States Congressional Budget Office. The US Budget and Economic Outlook 2006- 2015. P. O. Box 416, Old Chelsea Station New York NY: Cosimo, Inc. 2005 World Bank. Global economic prospects and the Developing countries, Volume 13. 1818 H Street, NW, Washington, DC: World Bank Publications 2003.

Friday, January 10, 2020

Advanced Counselling Skills Essay

1. Understand the process of a series of counselling sessions. 1.1 Identify the stages of a series of counselling sessions. A well-structured counselling session provides an essential framework for both counsellor and client. Many authors describe the structure of a counselling work in terms of a beginning, middle phase and end Jacobs (2004). Gray (2004) likens the structure to an artist’s frame encapsulating a picture stating â€Å"Just as the frame around a picture serves to enhance and contain the material within it, so the structure erected around a counselling arrangement supports the work the participants are engaged in†. The beginning session is crucial for establishing trust, initial rapport and boundary settings. This is described in more detail in 1.2. The middle phase of the session is the working part where the exploration and the work takes place. It involves some or all of the key counselling skills. The main aims are ensuring using skills that support the client to feel secure enabling them to recognise their emotions, thought processes and behaviours and reflect on these. It gives space enabling clients to establish their own change. The ending is the third stage and is an action phase. It is result of the enhancement of the client’s self-acceptance and the associated internalising of his locus of evaluation. It contains elements of review and importantly effective closure for both client and counsellor. 1.2 Evaluate the importance of an appropriate opening of a series of sessions. The beginning of a session is important to establish trust, rapport and set boundaries. The contract occurs to help establish a  professional relationship. It includes confidentiality, time, money, complaints and client expectations of the counselling environment. Day and Sparacio (1988) describe this as â€Å"a joint understanding between the counsellor and client regarding the characteristics, conditions, procedures and parameters of counselling†. Establishing a solid professional relationship which is clearly boundaries reduces the chance of conflict in the future sessions. It empowers the client to feel secure and valued and protects the counsellor from possible issues such as over money or time keeping. Opening sessions allow for the first positive and professional impression to be made. The client may feel unsure of the process and the opening session(s) allows for trust to develop alongside the client’s willingness to open up. At the beginning the power is on the side of the counsellor due to knowledge this shifts towards the client through explanation of the process as there are no hidden agendas. 1.5 Explain the importance of working towards the ending of a series of sessions. In person centred counselling the client generally dictates the end point although a counsellor may still initiate an ‘endings’ discussion inviting the clients opinion on this. There are three areas that can be defined in preparing for an ending of sessions. Reviews and restarts and preparation for ending This is to explain to the client that although the current counselling process counselling is coming to an end it is not necessarily a cure all one-time event. It may be entered into again later in life or the client may not feel the need for future intervention. Reviewing the counselling process This is to develop and check a client’s cognitive understanding of what has transpired. Practical questions posed by Bayne (2008) could take the form of How does the client feel about the ending? What has this counselling relationship been like? What has been achieved? What has the client learned to help in the future? What might happen in the future? Unfinished business This is a chance for a client to voice questions or uncertainties that may have gone unsaid and focus on short work that still needs to be achieved. Both client and counsellor need to be able reflect on the ending for themselves, on what has been achieved, and what are their own reactions to an ending. In counselling endings may not go to plan and some clients may end sessions without notice. This could leave the counsellor feeling unsettled that the relationship has not been ended well for either of them. Clients may decide in the middle of a series of sessions the counselling is not for them because it’s not working or what it brings up is too difficult at that time. Financial or life demands may also stop the client from coming. Some clients may not realise they are ready for the ending and feel rejected by the suggestion this could come from rejections in previous life events and needs careful handling. This is similar to Egan’s (1986) model the â€Å"Three stage f ramework† which lists exploration, understanding and action in sessions. 1.3 Explain the purpose and importance of a working agreement for a series of sessions. A working agreement is important as the counselling relationship is a contract either as a private personal therapist or as part of an agency. There are guidelines and procedures from the British Association of Counselors and Physcotherapists (BACP) and the agency that need to be followed in order to protect the agency, client and counsellor. It is important that a contract is agreed and this includes practical considerations such as (money, time, location and frequency of sessions). It can also include the model and style of work that the counsellor and client wish to work within. Within the contract confidentiality is essential to help secure the client and build a sense of trust and professional relationship. This can be explaining how records are kept, supervision and permission to share certain information with G.P with or without prior consent from the client. Other practical arrangements may be such as what procedure to follow if the client or counsellor cannot make a session or how they can contact each other or holidays. It is useful to set out what will and won’t happen in counselling is so there is a baseline of understanding. This may include issues such as physical proximity and touching. It may  relate to chance meetings outside of the room and how they could be handled. It can include other sign posting and emergencies contacts if the counsellor is not available. The counsellor can explain his or her role and the expectations of this alongside the role and expectation of the clients such as time keeping and commitment to the process. It can involve the difficulty of endings and developing an agreement with the client if they chose to end the sessions early calls the c ounsellor for closure on both sides. In conclusion the counselling relationship is based on the counsellor’s ability to identify the client’s expectations and anxiety about the service. To be able to clarify the clients and counsellors ability and limitations of the relationship. Laying the foundations of the contact protects the counsellor and client physically and emotionally and reduces the chances of conflict that could derail the therapeutic relationship. For example payments could affect the power relationship between counsellor and client. Without an agreement the client is less likely to feel secure and valued by the counsellor and be more likely to not commit fully to the therapeutic process. 1.4 Explain the purpose and importance of reviewing progress with the client (assessment). Traditionally assessment is not generally emphasised in the person centred counselling approach as it disrupts the clients from focusing on themselves and working with their feelings, shifting the focus of attention from the client to the counsellor. However, given the nature of the counselling work and contract based work counsellor’s work within it is often necessary and required by an agency. I personally see assessment as key to gaining insight in to the client and building a plan of work. Counselling is a contractual relationship as part of this there needs to be regular review of the work being undertaken to ensure the goals or conditions established are being met and progress is being made. Assessment according to Gladding (2009) entails â€Å"the collection of information in order to identify, analyse, evaluate and address the problems, issues and circumstances of clients in the counselling relationship†. This is then used to identify potential work needed, planning interventions and evaluation clients. Assessment is a process in counselling not just a beginning and end event. Brammer (1989) writes on assessment saying â€Å"the integration of assessment information  requires a process of developing a description and explanation of the client’s problems that will be used as a basis for a therapeutic plan. The therapist is interested in linking the client presenting problems to the client personalised meaning of the problem, unique developmental history, family system interactions and formulate explanations that hypothesise about why the client has become symptomatic at this particular time† At the beginning of a series of sessions time needs to be given over to an initial assessment it can use a number or practical tools such as assessment questionnaires. This, as stated above, can help identify possible areas of work. It can inform to the counsellor that their client requires more specialist help such as complex trauma work and a referral needed. Alongside this an initial assessment may take the following structure and can look for information on: Current problems Previous counselling experience Occupation, relationship and children Medical and health Why choosing counselling now What to gain form counselling Historical information school, upbringing, memories and diversity issues Support networks Discussion on if counselling is suitable or referral made. Some counsellors add a review into the end of every session this is particularly relevant with short focused based counselling. Evaluation sheets may be used every week as part of NHS contracted work to establish progress or value added for the organisation to justify funding. Reviewing of work may be just once in the middle of a series of sessions for less focus based work as around 8 to 10 sessions. With longer open ended contract whole sessions maybe given over to reviewing. These may use formal evaluation forms such as Clinical Outcome Routine Evaluation forms (CORE) or other methods such as Primary Health Evaluation of Mental Disorders Patient Questionnaire (PHQ-9). It may simply be a session dedicated to discussion over the clients progress overall. Evaluation or assessment, as a process, can be useful to show the client the progress they are making. It is essential to relate back to the initial question as although counselling may  have been useful, and the client feel better, but has it redressed the clients presenting problem? 1.6 Explain the importance of ensuring the environment is suitable and safe. The space in which the session takes place is important; it should be quiet, safe and above all confidential. All distractions such as mobile phones or interruptions should be minimised. It should remain consistent, comfortable and neutral in design. Both client and counsellor safety in terms of health and safety and lone working arrangements should be catered for. Green (2010) describes the importance of the room and lack of personal or religious aspects saying â€Å"the room is a kind of metaphor for what will take place between you. You the counsellor are going to be fully present, warm and available to the client but you are not going to being other aspects of yourself into the equation†. 2. be able to conduct a counselling session with a client in an ethical, effective and safe way. 2.1 Open the session, explaining the working agreement including 2.2 Develop the session using the following skills and interventions appropriate for the session and the model used. 2.3 End a session appropriately, usually the following where applicable See recording 3. Be able to reflect on the counselling session 3.1 Evaluate the effectiveness of the opening of the session This session was a continuation of previous sessions the need to open the session effectively and invite the client in still remains. In this session the contract was reviewed including the essentials of time boundaries, confidentiality, student status and ethical framework. In addition to this contract permission was sought to record the session. The contract was shorter than normal and on reflection could have been delivered slower and given invitation for the client throughout to ask questions. In the opening of the session I invited the client in and to do this briefly reflected and offered a summary of work that had taken place in the previous sessions. This was to show my attentiveness and show the client they had been heard previously and my attention was firmly on them from the outset of the session. 3.2 Justify the use of skills used during the session Attentiveness and rapport building The rapport with the client had been set in previous sessions and continued through this one. This was shown by a short summary at the beginning reflecting on topics from these previous sessions. The client was given an opportunity to bring one of these prior topics or something new to the session with the question â€Å"I was wondering which avenue you would like to go down today?† [3.45] Active listening Active listening is to show the client they are being heard. This is not only through verbal ques and reflecting but also in non-verbal ways. Throughout the session there were nonverbal examples of my attentiveness with nodding and smiling where appropriate and also the â€Å"Um† and â€Å"Okay† comments to encourage the client to continue with their story. Examples of this are at [10.52] after the client â€Å"I feel like I have to step in and get **** to see it from his perspective†. I use them â€Å"Um† instead of questioning as I sensed there was more to come from the client about this point. They start to question themselves so the nonverbal action was affective. Empathic listening Empathy is a way of being not just a professional role or communication skill it is attending to both the physical and psychological and listens to the clients view point. Empathy builds self-confidence and positive regard alongside promotes professionalism. Listening to the client and them feeling held in the session is crucial to allow them the space and security to open up. In this session there were several examples where I show the client they are being heard. This is around [13.30] minutes into the session where I ask the client â€Å"I wonder what you are left feeling?† At [16.10] I ask â€Å"Where do you see yourself?† The client throughout is focusing on their partner and their children but not on their own feelings. Effective questioning Open ended questions allow for the free flow of information, understanding the problem better and allows for rapport building. Closed questions that only elicit a yes or no elicit the opposite response of closing down the conversation. In the session there are a few open questions such as â€Å"I wonder what you mean by you know† [5.25]. This is to try and elicit what the client means in the context. Another example is â€Å"What does it feel like for you when the tensions going on?† The aim is to open up the clients feelings more at that point in their life and gain better understanding. Summarising My summary occurs 4 minutes from the end of the session. The client is made aware of this by the statement â€Å"If I could summarise†. The idea being to check the client felt heard and that there was no bits that I had missed from the session as the client should leave feeling heard and valued. The summary went over the salient points of the session allowing chance for reflection on the positives that came out of the conversation. The aim being to leave the client with a positive feeling relating to the work that have done. The client then reflects themselves back about something they have discovered about their relationship and how they may look at it differently. At the end the client is thanked and given an invitation to continue this exploration next session. Thus allowing the client time to think before the next session on what they would like to bring. This is to leave the session’s client centred. Focusing and challenging At [25.29] the client begins to bring in another aspect to the topic. Although potentially relevant there is little time to explore this topic. Focusing allowed for this session to stay on the track it I said â€Å"We only have a few minutes left of the session. Your Mum has been mentioned in several sessions but I’m wondering if we can stay focused on that moment†. By focusing the aim was to explore the feeling in more detail and not allow avoidance alongside not bringing a new topic when there was no time to fully explore this being so close to the end of a session. Immediacy There is a good example of immediacy in the session. It is important as a counsellor to not only hear what the client is saying but also be aware of their body language. At [10.42] I say to the client â€Å"You gestured with your hands that sense of balance† then I reflect on the balance between the children and partner that the client has been talking about. Working at an appropriate pace Pacing in this session was good. As a counsellor mine matched that of the clients throughout. This had already been established in the previous sessions although the contract could have been slowed down. The idea is to match the clients pace, pitch, tone and speed. A counsellor can use their own tone of pitch to slow the client down if they are running away with their story rather than taking the time to pause and think. Checking understanding with the client There were several examples of checking understanding with the client. The first occurred at [3.00] where I asked â€Å"Would you mind briefly going through†¦Ã¢â‚¬ ¦.† This was seeking clarity of a historical event. The second occurred at [9.00] with the question â€Å"Remind me how long †¦Ã¢â‚¬ ¦..† Although covered in a previous session it was important that the time frames being worked with were accurate. The aim being to also focus the client on the actual length of time they have been with their new partner. 3.3 Explain why other skills were not used during the session Managing silence There was no silence in the session this was due to my need to develop this skill. The spaces still feel unnatural and there were several chances where it could have been used. At [23.15] after the client responds they pose their own question â€Å"What will happen if I don’t?† I respond â€Å"Good question what will happen if you don’t†. At this moment the client should have been given time to think. Instead of this I looked to direct the conversation instead of holding the client in that moment and giving them the space. A second example was when the client comments â€Å"Why am I doing it†. I jumped in instead of leaving the space. If the silence had continued beyond the client’s reflection then I could have paraphrased this back to them to  highlight their thinking at that time. These interruptions potentially could cause the client to get nervous, stop the flow of information or feel intimidated. They could lose confidence in the proce ss and by not feeling heard could prevent communication in the future. Challenging During this session there was a very poor example of challenging where I asked the client â€Å"You’ve spoken about protecting the teenagers I was wondering if it was about protecting your relationship as well†. This was about my addenda to find out if there was a link and did not add value to the conversation at that point instead it detracted from the clients work. An example of missed challenging occurred at [6.39] the client uses the word â€Å"worried† four times in a minute. I could have challenged them on what the word worried meant to them as each of us carries our own perception. Working with diversity as it impacts on the session Within this session I sis not bring in diversity. Although working with this client there is normally an element as they are not British born and moved to the UK as an adult. So culturally in terms of relationships and family dynamics there is a possibility of needing to understand the difference. Language has in previous sessions been a barrier with needing to clarify my understanding of how Evaluate the effectiveness of closing the session This session was closed well the client was given a warning that was near the end of time with me saying â€Å"We only have a few minutes left†. They were then offered â€Å"If I could summarise†. The summary covered the main points from the session and allowed the client to affirm these. It gave opportunity to leave a positive point for the client to think upon to leave them secure after the session. It also opened up the possibility for the topic for the next session allowing them homework of reflection. The client by responding and affirming the summary gave rise to the fact they felt heard in the session. The session was within the time boundaries and the client was thanked for the session. Recognition was given to the next meeting with the client. Bibliography Brammer, L. Shostrom E and Abrego, P. (1989) Therapeutic Psychology Fundamentals in Counselling and Psychotherapy. 5th Ed. New Jersey: Prenice Hall. Bayne, R. (2008). The counsellor’s handbook. Cheltenham, U.K.: Nelson Thornes. Day, R.W and Sparacio (1988) Structuring the counselling process in Dryden (2008) Key Issues for Counselling in Action. London: SAGE Egan, G (1986) The skilled helper. Pacific Grove, Calif: Brooks/Cole Gray, A (2004) An introduction to the Therapeutic frame, London: Routledge Green, J and Claringbull, N. 2010 Creating the therapeutic relationship in counselling and psychotherapy. Exeter: Learning Matters Gladding, S.T (2009) Counselling: A Comprehensive profession (6th Ed.). Upper Saddle River, NJ: Pearson Education. Jacobs M (2004) Psychodynamic Counselling in Action (3rd Edition) London: Sage

Thursday, January 2, 2020

The Economic Costs Of Adhd - 1472 Words

EXECUTIVE SUMMARY The purpose of this paper is to examine and summarize available literature on the economic costs of ADHD, as well as possible economic benefits of treating this condition. INTRODUCTION ADHD is a very common neurodevelopment disorder of childhood. It is usually first diagnosed in childhood around the age of seven with symptoms typical during ages 3-6 and often lasts into adulthood. Children with ADHD may have trouble paying attention, staying organized and controlling impulsive behaviors. It is very difficult to diagnose and when undiagnosed the children can grow to be mislabeled as trouble makers in their adulthood. PREVELANCE OF ADHD IN THE UNITED STATES Children Adolescents Analysis of parent-reported data from the†¦show more content†¦2015). The US Census Bureau estimates 1,795,734,009 people were aged 5-19 worldwide in 2013. Thus, 7.2% of this total population is 129 million—a rough estimate of the number of children worldwide who have ADHD. Based on DSM-IV screening of 11,422 adults for ADHD in 10 countries in the Americas, Europe and the Middle East, the estimates of worldwide adult ADHD prevalence averaged 3.4% (Fayyad et al. 2007) Costs Of ADHD It is estimated that the cost of Illness (COI) of ADHD in the United States for children and adults is between $143 billion to $266 billion (adjusted to 2010 U.S. dollars) every year for the nation (Doshi 2012). Direct Costs in Children: Of the total annual cost of ADHD, 26%–27% were incurred by children that account to $38 billion–$72 billion (Pastor 2015). It was also noticed that Children with ADHD incurred significantly greater per capita total costs ($1465 vs $690) than children without ADHD. Children with co-existing co-morbid conditions lead to use of more health resources and incur high health care expenditure than children without ADHD or other significant conditions such as Asthma or other pediatric conditions. Children with ADHD had 10 times more outpatient mental health visits (1.35/year vs 0.14/year), 4 times more pharmacy fills (11.25/year vs 3.30/year), and 2 times more primary care visits (3.84/year vs 2.36/year) than children without ADHD. The incremental costs were estimated to be $375 for children with ADHD