Three Ideologies of Political Economy Essay - 974 Words

Mohammed Talukder ILRS504 February 14, 2010 Wk5 Essay Assignment- Three Ideologies of Political Economy Global power is understood to be both economic and political, which are interrelated in a complex manner. Thus the International Political Economy (IPE) has become a discipline within the social sciences that analyzes international relations in combination with political economy. IPE is considered flexible and contains epistemologies that are subject of robust debate. At the core of the debate are the three main philosophical ideologies (Realism, Liberalism and Marxism) which create conflicts revolving around the role and significance of the market in the organization of society and economic affairs. This paper will analyze these†¦show more content†¦The liberal named Becker believes that â€Å"a market economy is governed principally by the law of demand† (Gulpin, p 29). Becker explains that this law holds that people will buy more of a good if the relative price falls and less if it rises; people will also tend to buy more of a good as their relative income rises an d less as it falls. Thus the government intervention is not necessary to maneuver the market unless a market failure exists. And, in terms of IPE, they believe that there is no necessary connection between the process of economic growth and political developments such as war and imperialism. Therefore â€Å"these political evils affect and may be affected by economic activities, but they are essentially caused by political and not by economic factor† (Gulpin, p 30). The Marxism ideology of economy arose in reaction the Realism and Liberalism in the middle of the 19th century with the central idea that the economy drives politics. The political conflict arises from struggle among classes over the distribution of wealth. Thus they believe that political conflict will cease with the elimination of market and of a society of classes. The Marxist view believes that only robust application of strong public power can check innate tendencies for private power to benefit elites at the expense of population at large. The Marxism ideology of economy has beenShow MoreRelatedLiberalism and Mercantilism1287 Words   |  6 PagesLiberalism and Mercantilism International political economy is an important subdiscipline of international relation. It has three main ideologies, Liberalism, Mercantilism and Marxism. In this essay there will be three parts, first part is to demonstrate what the Liberalism and Mercantilism are on the perspective of international political economy and then the second part is to compare and contrast these two ideologies of political economy. 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Influences on Stephen Cranes The Red Badge of Courage

People tend to be greatly influenced by stories, news, and other contemporary sources of knowledge, which ultimately affects the impact they have on the world. Stephen Crane was greatly impacted by the time period in which he lived. One such influence was the popular literary style of Realism. Realism is the trend in which literature is based on the true nature of everyday occurrences devoid of any fantasy or romance. It is the raw depiction of what life and society is actually like. This literary style can be found in many of Stephen Crane’s novels. Religion also had a significant impact on the way Stephen Crane wrote his novels. He was an atheist which brought about the idea that humans are just part of nature and must solve their own problems without the intervention of a higher being. This notion is evident with the protagonist of The Red Badge of Courage. Henry Fleming, a young union soldier in the Civil War, must overcome the fear of putting his life at risk to achieve what he wants most which is honor. Honor comes from actively participating in battle and sacrificing his life for the cause. Honor is physically represented from a wound noted as the â€Å"Red Badge†. In the end Henry doesn’t consult in a higher being and achieves what he wants most by overcoming the mental obstacles and ultimately finding the strength within to realize what courage actually is. 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Reflective Essay on Learning Disabilities †Psychological Well-being Free Essays

string(151) " admitted to the mental health hospital due to her episodes of self-harming, which is a risk to herself and to other service users \(other patients\)\." Background The purpose of this reflective essay is to reflect on learning disabilities, focusing on mental health and psychological well-being. It provides a critical investigation of the assessment process; formal and informal assessments; application of legal, ethical, and socio-political factors to the process; and the role and function of the nursing profession to the theory and practice of assessment. The case of Janet, an epileptic patient, is the focus of the assessment in this essay. We will write a custom essay sample on Reflective Essay on Learning Disabilities – Psychological Well-being or any similar topic only for you Order Now 1. Process of Assessment Assessment is the first step to diagnosing mental disorders. A mental health assessment is a multifaceted intellectual activity involving the hypothesis formulation of a certain individual, which serves as the basis for deciding on data to be collected and interpreted, as well as for drawing conclusions. A full clinical assessment goes hand-in-hand with mental health assessment, which involves evaluating and measuring systematically such factors in an individual as psychological, biological, and social to assess a need for a possible psychological treatment (Elder, Evans, and Nizette 2013). Mental health nursing maintains its keystone in an accurate and methodical biopsychosocial and spiritual assessment. The initial process of assessment ascertains whether the individual has a mental health problem; identifies the problem; the most appropriate treatment; and whether there is coexisting health or social problems requiring attention or treatment. Thus, it is necessary to carry out a comprehensive assessment to determine the person’s diagnosis and develop a suitable treatment plan. According to mental professionals, mental disorders may be classified according to behavioural patterns as well as patterns of thought and emotion. By understanding classification systems, mental health nurses enable professional and effective communication with other health disciplines and contribute to research and in selecting effective interventions (Elder et al. 2013; Basavanthappa 2007). Assessment is crucial as the client must be assessed holistically, in which a relevant information about his/her life, behaviour, and feelings must become integrated. Attainment of optimum level of health for the client is the focus of such care (Shives 2008). Hopp and Rittenmeyer (2012) emphasised that it is important to do mental notes when doing an assessment since this would provide some clue as to how the person is feeling. Hence, one must look at the appearance, behaviour, speech, emotional state, and thinking of the person being assessed. However, looking into these areas is not enough since misinterpretation or erroneous assumptions may take place. Rather, it is necessary to take into account the context, setting, social norms, and beliefs for the individual being assessed (Pender, Murdaugh, and Parsons 2006). Needs-led assessment will allow the nurse to place more emphasis on finding solutions (Coffey and Hannigan 2003). 2. Risk Assessment A significant role is played by risk assessment and management in the practice of mental health nurses and multi-disciplinary teams. These risks include threat/danger to others as well as self-harm, amongst others. Despite the presence of risks however, a balance must be considered between the needs of each individual service user (client) and people’s safety and protection. A further emphasis is placed on paucity of information and lack of knowledge about such risks, thereby leading to ‘clinical gambling’ that can further result in mishaps (Cordall 2009). It is necessary to provide focus on improved consistency in applying risk assessment and management strategies, considering their central role in the practice of mental health. Admittedly, risk assessment and management went through certain developments, including the area/s to be understood about risk assessment; its clarity and what must be assessed; strategy developments in nursing risk; proposals; and leaned enquiry-based lessons. Hence, risk language must be standardised and simplified, which requires improving clarity in the vital roles of the concept (Cordall 2009). When one speaks of risk assessment in mental health services, he/she deals with the broader possibility (risk) of an event or behaviour (outcome). The outcome is the principal area of interest since it is commonly connected to an extent of severity, which could be associated with the indications of dangerousness/illness. Important regard is given to the impact of such severity because both a high outcome risk with low impact and a low outcome risk with high impact can take place (Kettles and Woods 2009). A useful way to consider the manner through which events take place is much the same as researchers’ predictive ability to test a number of risk assessments, which is also a useful way to evaluate the success of outcomes. Contingency tables allow an examination of correct predictions and error rates, and are hence an excellent means to present these results. On the other hand, the severity of behaviour refers to the level of intensity of risk occurring, and may be classified as mild, moderate, or severe (Kettles and Woods 2009). Clinical practice in a range of settings involves the core feature of violence risk assessment. The focus on risk to others in the mental nursing health practice is that ignoring or failing to acknowledge it can leave medical personnel unprepared and a lack of preparation results in situations where less willingness to work with aggressive and violent patients might be felt by clinical staff. Moreover, as there is a widely-held awareness of the relatio nship between mental illness and violence, an increasing basis of risk assessments will be taking place in clinical, correctional, and legal settings (Woods, 2009). On the other hand, risk to self, which may include suicidal behaviour, physical and social self-neglect, and vulnerability to risk from others, must also be considered. Worthy of note here are the biologic theories of suicide, which look into the link between physical illness, increased risk, and neuro-biological factors of suicide (Murray and Upshall 2009). 3.Case Study The Purpose of Assessment and its Potential Impact for Promoting Inclusion The person who is the focus of this case study is an epileptic patient named Janet. She is 48 years old, very fragile (small and short), and is within the care facility because her medication was not acting on her. She was admitted for her best interest. Janet was admitted to the mental health hospital due to her episodes of self-harming, which is a risk to herself and to other service users (other patients). You read "Reflective Essay on Learning Disabilities – Psychological Well-being" in category "Essay examples" Janet is on different psychotic tablets and mood stabilizers; she is unable to sleep despite having been prescribed with sleeping tablets. Her behaviour is very challenging: she bites, screams all day, and is out of control. She came to the hospital to be observed and to allow personnel to research on a suitable drug that could work for her. She came to the ward setting via a referral from both her General Practitioner (GP) and her Psychiatric consultant. In the ward, she was placed on a close observation at Level 3. She was also assessed by the speech and language therapist as well as the behavioural therapist because of her difficulty to swallow. Her mental health is very unstable and she is unable to communicat e verbally. However, she uses and understands gestures. She only makes sounds, noises, and screams as a way to communicate. She likes pulling and grabbing, and loves her meal, especially her cups of tea. Janet came from a low-income British family, never married, and never had children due to her apparent condition. She is second amongst four children and still has both of her parents. The above narrative shows an investigation of a patient with a mental and learning disability problem, who was admitted to a mental health setting expecting treatment. It is apparent that an assessment was done on the patient before any clinical personnel would have carried out a specific intervention procedure. The above has not only related the nature of the patient’s illness but also presented other information that may be gathered in order to conduct an accurate assessment that will aid a precise diagnosis. The diagnosis of learning disabilities/mental disorders requires assessment as the initial step, which was evidently carried out on Janet. Mental health assessment is conducted vis-a-vis a full clinical assessment, which is a systematic evaluation of the psychological, biological, and social factor of a person who is presented with a potential psychological disorder. Assessment begins with a process wherein a curative alliance occurs between the client and the mental health personnel, thereby forming the basis of a care plan. Empathy and compassion are necessarily involved in the process in order to support the development of trust between the client and the mental health personnel forming an alliance (Elder et al. 2013; Kettles and Collins 2002). The clinical personnel in charge of Janet were empathetic and compassionate of her condition. The health personnel took extra care to understand the client in crisis, taking into account her associated fear and distress level, especially if her prior service experience had been difficult and/or if she underwent compulsory treatment. The mental health nurse took the major role in the performance of an accurate and ongoing assessment on Janet. Assessment may be generally described as a complicated process since the diagnosis it performs ascertains the treatment for the client. The client’s needs and strengths are gauged by thorough assessment. It must be noted that assessment seldom includes one function; patients might be assessed to determine who they are, to describe and appraise particular problems of living as well as personal and social resources. All of these are embodied in a global assessment. Through assessment, the mental health nurse was able to obtain some understanding of the significance of Janet’s condition and problems (Elder et al. 2013; Morrison-Valfre 2013). The mental health nurse engaged in Janet’s condition acknowledged the different systems and levels of care for the person-in-care and ensured that she received treatment with dignity and respect so as to enable her to go back eventually to the highest possible level of self-care (Griffin, 2012). All patients must be treated with dignity and respect, giving careful considerations to the manner of communication with them (Hindle, Coates, and Kingston 2011). Thus, being aware of Janet’s systems and levels of care vis-a-vis her condition allowed the mental health nurse and care specialists to determine her treatment and receive it with respect and dignity. Types of assessment may be classified as global, focused, and ongoing. Global assessment enables the provision of baseline data, such as the client’s health history and current needs assessment. Focused assessment, on the other hand, has a limited scope in its aim to focus on a specific need or potential risk. Ongoing assessment pertains to systematic monitoring and observation related to certain problems (Elder et al. 2013). The case study adopts a global assessment. Prior to assessing the service user being referred to in crisis, it is necessary to find out if she experienced mental health services and consulted their crisis plan. It is also important to enquire of her preference for a male or female care professional to carry out the assessment. In this case, Janet’s family specified female care professionals. Moreover, crisis assessment needs to clarify the information and its potential outcomes, addressing the client’s individual needs. Assessment for mental health must involve the client’s relationships, social and economic circumstances, behaviour, symptoms, diagnosis, and current treatment (NHS 2011). It is evident that amongst these concerns, the assessment made on Janet was focused most on her behaviour, symptoms, diagnosis, and current treatment. Her family history, social and economic circumstances, and the like, were also mentioned in the assessment. It must be recognised that assessments and diagnoses performed must be evidence-based and need the use of accepted methods. Assessments are carried out by suitably qualified staff with training and experience to assess mental health problems, and where possible, in the client’s preferred setting, with respect to the safety of all concerned. Collecting information about the person can be performed by the person himself/herself, or by other people who have prior observation of the person’s behaviour, such as family or carers. In this regard, it was the latter which was applied to Janet due also to her inability to communicate effectively. What the mental health nurse needs to know about the patient determines how he/she gathers the information. Knowing about what the person feels or thinks necessitates asking him directly in order to gather the needed information. Hence, the mental health personnel oftentimes asked Janet about what she thought or felt about certain things , people, or food. If the mental health nurse needed to know the manner in which Janet might behave in certain circumstances, Janet must be asked to reflect on her behaviour, or someone may be asked to observe Janet’s behaviour, or both. Further, it is essential to understand the lived experiences of both Janet and her carers in the assessment. Necessary information for understanding such lived experience involves Janet’s or the carer’s manner of interpreting what is taking place with Janet besides knowledge about her life, including her interests, personality characteristics, social resources, and personal circumstances. Janet’s family was involved in the treatment in the earliest possible way because of their in-depth information about how the symptoms of mental illness have developed, including their knowledge of the social and emotional environments contributing to the flourishing of such symptoms in Janet. Interviews, diaries/personal records, questi onnaires, and direct observations are the major assessment methods that can be performed to obtain the needed information for the assessment (Wilkinson and Treas 2011). In Janet’s assessment, relevant information was collected through interviews, direct observations, and a referral from her GP and her psychiatric consultant. Interviews were performed with her family members and carers who observed her behaviour. Models of Assessment and How They Impact on Inclusive, Responsive and Responsible Practice The new model of care is exemplified by new care practices whereby best practices as advanced by research evidence present the new model of care (Kleinpell 2013). According to Freeman (2005), a biopsychosocial assessment of the patient is considered in an effective intervention, with a recommendation of a multi-method and multi-modal format. Moreover, these domains of information are used for assessment: biological, affective, behavioural, and cognitive domains, alongside the units of assessment, including the patient, his family, the health care process, and the socio-cultural setting in which the patient exists. The mental health personnel must understand the current status and history of the patient, and the assessment must identify problem areas and consider the patient’s assets and resources. This model can be employed in contemplating the patient’s change of behaviour to improve his quality of life, prevent illness, and promote well-being (Freeman 2005). The biopsychosocial assessment model also investigates the interrelatedness amongst the physical, psychological, behavioural, environmental, and social aspects of an individual’s life. The biological system focuses on the anatomical state of disease and its effect on the individual’s biological functioning. On the other hand, the effects of psychological factors, including personality and motivation, are emphasised in psychological system as the individual experiences mental illness. Further, the social system looks at the familial and cultural effects of the experience of illness. The causal ordering of biopsychosocial model is intrinsically biomedical, which means that rather than the causes, biochemical abnormalities can affect a person’s social environment. One criticism of this model is that it tends to rule out structural and social factors, but can however be considered as a useful framework for understanding the experience of mental illness (Freeman 2005) . The psychosocial model, on the other hand, is considered a holistic perspective to mental disorders and presents the interdependent areas of biological, psychological, and social factors in the assessment of mental health disorders (Boyd 2008). It is significant to note that standardised assessment methods promote inclusion in the mental health. The strategy of the European Union (EU) for mental health identifies best practice in the domain and in fostering social inclusion. A holistic approach is required in any effort to recognise best practice in social inclusion rather than to simply emphasise on aspects relating to mental health. Social exclusion cannot be addressed by just looking at the mental health problem of a person since one of the fundamental reasons for social exclusion of people with mental health illnesses is the propensity to take an exclusive emphasis on their medical symptoms rather than resolving the fundamental causes of their problems. Issues needing attention are equality and diversity, access to physical and mental health care and social networks, to name a few (House of Lords, 2007). The relevance of action to promote and improve social inclusion is embodied in mental health policy and is safeguarde d in the National Service Framework, which affirms that discrimination against people with mental health problems must be resisted and their social inclusion must be fostered. This signifies that mental health workers must regard the promotion of social inclusion a primary concern. The Effectiveness of Formal and Informal Assessments as Mechanisms to Develop a Shared Understanding of Need Either a formal or informal assessment may be carried out by the mental health nurse. A formal assessment involves an ordered interview plan and tools including questionnaires, checklists, etc. to acquire important information to aid the assessment interview. On the other hand, an informal assessment is less structured and the questions raised are those that the interviewer views to be relevant at the time he/she asks them. The formal interview has more benefits than the informal one since it is able to carry out a more or less similar assessment of people through the tools and structured interview plan thus devised. In addition, the individual’s biases and value judgments are less expected to influence the interview, as can take place in an informal assessment. The decision to use either formal or informal assessment methods is ascertained by the person in care as well as the adopted standardised assessment procedures (Pryjmachuk 2011). A formal assessment is emphasised on some form of structure and is commonly planned and studied with care, i.e. through some research. An informal assessment, on the other hand, involves information gathered through less structured methods. Despite the almost similarity in the appearance of both methods, such similarity is however superficial. In both cases, the care personnel (e.g. nurse) would ask the person-in-care certain questions relating to his condition, noting his replies. However, a formal interview will have the questions carefully prepared earlier and might even be worded in a certain way, whilst the informal interview lacks this feature. Instead, the nurse conducting an informal assessment would ask certain questions she thinks relevant at that time, phrasing them in such manner she considers appropriate. Albeit both kinds of assessment are commonly used in mental health settings, it is important to recognise the significant advantages of any formal system over the less structured ways of investigating the condition of persons-in-care. The guidelines and procedures embodied in a formal system allow various people-in-care to be examined in a relatively the same fashion. This results in reduction, if not total cancellation, of one’s own prejudices. Regardless of who completes the assessment, its outcome must be the same, and such cannot be said of informal methods (Barker 2004). The first point of information must be the patient’s basic demographics and condition/illness. An evaluation of physiological symptoms, history, risk factors, and treatment procedures must be considered vis-a-vis biological targets. His current moods, feelings about the illness/mental problem, support network, amongst others, constitute the patient’s affective targets. Crucial to his comprehensive evaluation is an assessment of his behavioral targets, which include self-care, functional capabilities, and occupational/recreational abilities (Freeman 2005 ). All of these must be embodied in the assessment made on Janet. Critical Application of Legal, Ethical and Socio-Political Factors to the Practice of Assessment The use of assessment and clinical procedures involve some ethical issues. Ethical dilemmas may occur when diagnosis is performed in such situations, whereby diagnosing a person arbitrarily is often entailed. However, health care personnel have the clinical, ethical, and legal obligation to screen patients for life-threatening problems such as bipolar disorder, suicidal depression, and the like. It is necessary to point out that exclusive reliance on standardised treatments for certain problems may invite ethical concerns because of the questionable nature of the reliability and validity of these empirically-based strategies. Along with this is the fact that human change is complex and that measuring beyond a simplistic level is a difficult task, thereby making the change meaningless (Corey 2013). Thorough reflections on ethical considerations relative to health technologies are involved in the assessment for health technologies and value-based decisions. Since methods of retrieving information for effectiveness assessment are not appropriate to retrieving information on ethical issues, it is important to adopt a specific methodological approach (Scholarly Editions 2012). In addition, ethical principles such as autonomy, fidelity, and justice, amongst others, are involved in the provision of mental nursing care. National professional organisations set the standards for professional nurses’ ethical behaviours (Boyd 2008). Likewise, the healthcare organisation must ascertain its training needs and design structures to enable its healthcare personnel to understand ethical values and principles and hence integrate them into daily practice. With the provision of training, ethical values might not be recognised by several staff personnel whenever they occur, and thus they might impair their ability to recognise a suitable course of action. A formal assessment process is viable in enhancing an ethical framework within the healthcare organisation (Corey 2013). A point to consider is that the mental health care system faces certain magnified legal issues. The legal aspects of the assessment process in the practice of assessment involve such example where the nurse is held responsible for her judgments as well as the safety and well-being of the person-in-care. Every nurse must be aware of the three legal concepts that might affect their practice of care: negligence, malpractice, and liability (Davies and Janosik, 1991). Negligence occurs when a person (e.g. nurse) has become careless or has failed to act prudently, or has acted in such a way that is contrary to the conduct of a reasonable person. Malpractice takes place when a person commits professional misconduct, or has discharged his professional duties improperly, or fails to meet the standard of care as a professional, thereby resulting in harm to another. Liability, on the other hand, occurs as an obligation for having failed to act on something (Davies and Janosik, 1991). Mental health care is also influenced by sociopolitical factors, whereby the power of social justice is emphasised in the rectification of socio-cultural insensitivities (James and O’Donohue 2009). Mental health issues necessitate increased understanding of the sociopolitical context. This would include increased emigration in various parts of the world, which presents greater attention to the manner in which mental health issues may be effectively addressed within a broader global context. Studies involving culturally diverse samples would enable researchers to assess the generalisability of the diagnostic classification of mental problems across cultures and would likewise determine culturally specific events that might be influential to prevalence rates. Not being able to recognise the significant cultural differences amongst peoples impliedly promotes the ‘one-size-fits-all’ approach that is often criticised in the current diagnostic system for mental problems . It has been emphasised that cultural and sociopolitical factors could indeed influence the assessment of certain mental illnesses, thereby enabling mental clinicians to consider cultural issues as necessary aspects of the assessment and diagnostic process (Chang 2012). Culturally able mental health care involves suitable treatments that take into account the client’s culture and social setting. The literature indicates that the primary objectives of mental health are to return to function, contribute to society, and maintain relationships (Markowitz and Weissman 2012). 4. Application to Practice How the Role and Function of the Nursing Profession Relates to the Theory and Practice of Assessment All mental health practitioners are responsible for developing certain strategies that allow people to maintain and build relationships, social roles, activities, etc. that are vital to social inclusion (Harrison, Howard and Mitchell 2004). The provision of high-quality mental health disqualifies biases and instead understands these biases at a range of levels, such as practitioner level, community level, and practice programme (Shieves 2008). It is recognised in this work that such biases can lead to social exclusion in the domain, which is not desired. Pondering on the provision of mental health care would necessitate its interpretation by psychodynamic theories, which looks at interpersonal concepts and examines the development of the mind within a lifetime (Dillion 2007). Behavioural theories provide emphasis on normal behaviour rather than the causes of mental problems/disorders. The objective is to effect behavioural change by means of conditioning, positive reinforcement, and so on (Dillion 2007). Meanwhile, cognitive theories involve understanding by focusing on behaviour and the individual’s cognition, including the way he processes his thoughts. The value of cognitive theory is seen in patient-therapist collaboration and the client’s active involvement in the occurrence of change (Dillion 2007). This is contrary to the situation where the client has learning disability and hence would find it difficult to pursue all these. Social Theories, on the other hand, involve socio-cultural perspectives and family dynamics, to name two, and convey that the development of a care plan for the patient necessitates certain socio-cultural aspects (Dillion 2007). This is suggestive of an inclusive care plan (Harrison et al., 2004). The importance of these theories to practice is that learning disabilities and mental problems as well as their causes can be more increasingly understood through their aid, thereby providing treatment to the patient with a consideration of their behaviour, cognition, socio-cultural context, and so on. These theories also aid in pursuing further the concept of inclusion in health care and in understanding further the relevance of the assessment process. Through theories that aid practice, mental illness can be more accurately understood using integrative approaches. The conceptual framework of psychiatric domain involves various theoretical perspectives, with the absence of a single best explanatory model explaining mental illness. As this conceptual framework takes its development towards an increasingly integrative viewpoint, more effective and efficient integrative assessments will be the result of an understanding of complex relationships amongst various processes associated with normal human functioning and mental illness (Lake 2007). The Effectiveness and Efficiency of Assessment Strategies within the Current Practice and Overall Service The extent of effectiveness and efficiency of assessment within the current practice of the mental health nurse are seen in the impact of assessment as a life-changing experience for many persons-in-care. The rapport that the mental health nurse is able to establish with the client with a learning disability/mental problem as a result of the ‘therapeutic alliance’ provides the client a holistic approach to care. It confirms the need for a multi-disciplinary and team approach to the mental health service provision. Through an assessment, the mental health nurse becomes aware of the need for a supportive environment whilst collecting necessary data. The assessment also enables the mental health nurse to liaise with appropriate professionals, such as in Jane’s case where her GP and psychiatric consultant submitted a referral to the mental health hospital in order to aid in her diagnosis. Various tools, such as Life Skills Questionnaire, are used to gather additional information, which assist in developing a relationship with the service user (Acquah 2012). The mental health nurse pays attention to the person’s feelings, thoughts, and behaviour, which are ways in which humans respond to life problems. If a person experiences increased detachment from one’s surroundings and the people in it, alongside the presence of distorted thought processes, the person can thus become problematic with satisfying to live a meaningful existence. The role of the nurse in this context is to identify how those behavioural changes hold back the person’s ability to pursue his own life and then design a specific care that will aid the person to address them. The utmost goal is certainly to help the person return to his usual normal activities and contribute to society. Through the nurse’s task to identify the effects of behavioural changes on the individual and to carry out a specific plan of care, the nurse thus considers the consequence s of the learning difficulty/problem the basis of intervention. Further consideration of the client’s needs and interests is the principal value embodied in the establishment and execution of nursing services. This value must be implied in a nursing approach for the care of patients having been diagnosed for learning disability/mental illness. Along with this claim, the notion of a disease in the mental care must be given up as the center of mental health care and instead look at the patient as a person (Barker, 2004). In general, information about the nature and the extent of the patient’s problems are considered in a nursing assessment; hence, the nurse finds out the problem of the patient and how big it is. These questions must be asked in the most detailed manner possible, especially if the focus is to evaluate the impact of various forms of care. However, the means through which such information is gathered usually depends on the problem involved, in which even the personality of the person-in-care can even influence such means of information collection. The things that the nurse must consider are accurate information about the biophysical needs of the person needing mental care; the reflection of the need for precision and reliability for the adopted method; and the influence of the attitude or mood of the person conducting the assessment (Barker 2004). There are similar aims for most assessments; however, the manner in which they are carried out can vary greatly. These differences are very important and can have enormous influences on the value of information being produced. The means through which an assessment is conducted can spell a worthwhile exercise or otherwise. The key differences between methods of assessment convey the way in which information is gathered (Barker 2004). Upon the assessment process, the nurse explains to the person-in-care such process and its contents, providing feedback for his collaboration with clients and healthcare team members to collect holistic assessments. Such assessments are conducted through interviews, observations, and examinations whilst being aware of confidential issues and relevant legal policies (Videbeck 2011). Additionally, policies and legal issues must be integrated in relation to ensuring the protection of other persons-in-care. Improvements in secondary care teams (e.g. mental health, learning disability, etc.) are necessary to ensure a consistent approach to care (Woods and Kettles 2009). The Nurse’s Role in the Assessment Process It must be noted that the mental health nurse takes the role of a coordinator as he/she interacts with other disciplines in the care delivery. A patient always receives a nursing care plan, but other disciplines are necessarily involved in such plan or individualised treatment plan (Boyd 2008). Further, the mental health nurse plays an important role in the assessment process where data are collected and organised, leading to the identification of diagnoses in which data are as well analysed. This would then lead to the planning phase, whereby prioritisation of problems is highlighted, along with identification of goals, selection of nursing intervention, and care plan documentation. The implementation features the nursing orders being carried out whilst documenting the nursing care and client responses. This leads to the evaluation phase, which involves monitoring the client outcomes and resolving, maintaining, and/or revising the current care plan (Timby 2009). Indeed, the mental h ealth nurse demonstrates a range of roles in the entire nursing process, as much as in the assessment practice. His/her performance in the assessment process determines the delivery of the next stage of the nursing process; hence it is required that such assessment is both precise and correct. For the nurse’s own future learning and development, there are perceived tremendous developments in his role, which are expected to take place within the managed care environment vis-a-vis his professional knowledge, skills, and attitude. Those who have carried out strong assessment and patient teaching abilities would be considered to have the most marketability. The nurse’s role in mental health assessment has radically evolved from merely using the client’s five senses to assessing his overall condition. Today, nurses use communication and physical assessment methods to come up with a clinical judgment relating to the client’s mental state. Additionally, technological advancements have developed the role of assessment, which correspondingly allowed managed care to develop the need for assessment skills (Weber and Kelley 2009). For example, the most broadly functioning measures used for people with learning disability/ mental problems are the Global Asse ssment Scale (GAS) and the Global Assessment of Functioning Scale (GAF), which is a modification of the GAS. The GAS is aimed for clinicians to decide on mental health along a single dimension on a scale of 100 points. The lowest functioning level of the individual during the previous week is the basis of GAS ratings (Thornicroft and Tansella, 2010). Furthermore, assessment helps the mental health nurse to decide the extent that the patient can do independently alongside the extent of help they need and the type of intervention necessary. A patient with a mental health problem for example, may need more encouragement for their hygiene needs, which means that their therapeutic care plan may include this aspect (Spouse, Cook and Cox 2008). This can be further considered in Jane’s case. Reflecting on Policy on Mental Health Capacity Implementation of mental health policy is an intricate process, including a number of different financial, technical, and political issues. Teaching programmes for mental health policy usually intend to develop the knowledge of the public on health professionals and other people playing a significant role in the development of mental health policy. Some programmes are specifically focused on issues of policy and service development; in particular, tackling the needs of those who are directly involved in the accomplishment of mental health policy, as well as in the development of research capacity (Patel, Minas, Cohen et al. 2013). Recommendations Recommendations for the nurse’s speciality include the following: Provide specialist skills and special therapeutic orientation to mental health nurses. This will train them to deliver research-based care and treatment to service users with learning disability/mental problems. Identify the need for the mental health nurse to develop skills in psychotherapy, which is resonant to interpersonal relations perspective to mental health nursing. This will highlight the nurse’s central role in mental health, which is his personal relationship with the patient (Norman and Ryrie 2013). Develop electronic health record systems for assessment. This will prepare professionals of health information management assess their situation in a more realistic manner. These record systems are necessary because of their use in storing patient data over time, such as test result data, diagnoses, problem lists, and so on. The client’s clinical information is necessarily retrieved by practitioners through their work station. Standard coding systems defining data consistently are suggested, specifying the capacity to pursue the outcomes of the health care process (Harman, 2001). How the Nurse Can Contribute to Best Practice and Actively Justify and Promote Quality Care The nurse can contribute to best practice by establishing an active participation in the mental health process via the integration of appropriate technology that can speed up the assessment process. Through evidence-based and person-centred intervention, the nurse will be able to help tackle several mental health needs, which can benefit clients like Jane. Evidence-based practice is now a current adoption in mental health care, which involves selecting the best interventions with a specific client and promoting specific interventions for definite problems/illness based on treatments that are supported empirically. Such evidence-based practice includes a consideration of the patient’s characteristics, preferences, and culture (Corey 2013), which the mental health nurse must take account of. These aspects had been mentioned in Jane’s case but needed further highlights to become more viable to the assessment process. The concept of social inclusion in mental health presents best practice to the mental health nurse, who has the primary role in conducting an inclusive assessment process. With the promotion of social inclusion, the mental health nurse becomes culturally competent in providing a service that harmonises with the client’s cultural and social background and value system. This is an area of best practice for the mental health nurse’s task in the assessment process. Further, looking at the cultural and social context of the patient needing care rather than merely focusing on his demographics as well as the historical development of the mental illness provide evidence-based considerations for future practice. Racial and ethnic differences in mental health care had been documented to demonstrate this point. Such factors as gaps in access, disputed diagnostic procedures, and limited specifications of competent treatments are reflective of what needs to be further emphasised in mental health care. In conclusion, the assessment process within the mental health care for patients with learning disabilities and mental problems needs procedures and strategies that are aligned to social inclusion and considers ethical, social, and political aspects of the process. Hence, a specialist assessment may be carried out in order to evaluate the patient’s strengths and difficulties alongside their current distress and potential replicable support. References Acquah, F. (2012) Utilising Untouched Mental Health Nursing Skills in Private Practice. Australian College of Mental Health Nurses: Mental Health Nursing in Primary Care: Putting the Pieces Together. Canberra. Barker, P. J. (2004) Assessment in Psychiatric and Mental Health Nursing: In Search of the Whole Person. Second Edition. UK: Nelson Thornes Ltd. Basavanthappa, B. T. (2007) Psychiatric Mental Health Nursing. India: Jaypee Brothers Medical Publishers (P) Ltd. Boyd, A. (2008) Psychiatric Nursing: Contemporary Practice. PA: Lippincott Williams Wilkins. Chang, E. C. (2012) Handbook of Adult Psychopathology in Asians: Theory, Diagnosis, and Treatment. London: Oxford University Press. Coffey, M. and Hannigan, B. (2003) The Handbook of Community Mental Health Nursing. First Edition. Oxon: Routledge. Cordall, J. (2009) ‘Risk Assessment and Management’. In Risk Assessment and Management in Mental Health Nursing. ed. by Woods, P. And Kettles, A. M. West Sussex: Blackwell Publishing Ltd. Corey, G. (2013) Theory and Practice of Counselling and Psychotherapy. Ninth Edition. Mason, OH: Cengage Learning. Davies, J. L. and Janosik, E. H. (1991) Mental Health and Psychiatric Nursing: A Caring Approach. Boston, MA: Jones and Bartlett Publishers, Inc. Dillion, P. M. (2007) Nursing Health Assessment: A Critical Thinking, Case Studies Approach. PA: F.A. Davis Company. Elder, R., Evans, K., and Nizette, D. (2013) Psychiatric and Mental Health Nursing. Third Edition. NY: Elsevier Health Sciences. Freeman, A. (2005) Encyclopedia of Cognitive Behavior Therapy. NY: Springer Science. Griffin, D. J. (2012) Hospitals: What They Are and How They Work. London: Jones Bartlett Learning, LLC. Harman, L. B. (2001) Ethical Challenges in the Management of Health Information. London: Aspen Publishers Inc. Harrison, M., Howard, D., and Mitchell, D. (2004) Acute Mental Health Nursing: From Acute Concerns to the Capable Practitioner. First Edition. London: SAGE Publications Ltd. Hindle, A., Coates, A., and Kingston, P. (2011) Nursing Care of Older People. London: Oxford University Press. House of Lords (2007) Improving the Mental Health of the Population: Can the European Union HelpVolume II: Evidence. London: The Stationery Office. Hopp, L. and Rittenmeyer, L. (2012) Introduction to Evidence-Based Practice: A Practical Guide for Nursing. PA: E.A. Davis Company. James, L. C. and O’Donohue, W. T. (2009) The Primary Care Toolkit: Practical Resources for the Integrated Behavioral Care Provider. New York: Springer. Kettles, A. M. and Collins, M. (2002) Therapeutic Interventions for Forensic Mental Health Nurses. England: Jessica Kingsley Publishers Ltd. Kettles, A. M. and Woods, P. (2009) ‘The Theory of Risk’. In Risk Assessment and Management in Mental Health Nursing. ed. by Woods, P. And Kettles, A. M. West Sussex: Blackwell Publishing Ltd. Kleinpell, R. M. (2013) Outcome Assessment in Advanced Practice Nursing. Third Edition. New York: Springer Publishing Company LLC. Lake, J. (2007) ‘Integrative Mental Health Care: From Theory to Practice, Part 1’. Alternative Therapy of Health Medicine, 13 (6), 50-56. Markowitz, J.C. and Weissman, M. M. (2012) Casebook of Interpersonal Psychotherapy. London: Oxford University Press. Morrison-Valfre, M. (2013) Foundations of Mental Health Care. Fifth Edition. London: Mosby, Inc. Murray, B. L. and Upshall, E. (2009) ‘Risk to Self’. In Risk Assessment and Management in Mental Health Nursing. ed. by Woods, P. And Kettles, A. M. West Sussex: Blackwell Publishing Ltd. [NHS] National Health Service (2011) Service User Experience in Adult Mental Health: Improving the Experience of Care for People Using Adult NHS Mental Health Services. Retrieved on November 7, 2013 from http://www.nice.org.uk/nicemedia/live/13629/57534/57534.pdf Norman, I. J. and Ryrie, I. (2013) The Art and Science of Mental Health Nursing: Principles and Practice. England: Open University Press. Patel, V., Minas, H., Cohen, A., and Prince, M. J. (2013) Global Mental Health: Principles and Practice. New York: Oxford University Press. Pender, N. J., Murdaugh, C. L., and Parsons, M. A. (2006) Health Promotion in Nursing Practice. PA: Lippincott Williams Wilkins. Pryjmachuk, S. (2011) Mental Health Nursing: An Evidence Based Introduction. First Edition. London: SAGE Publications Ltd. Scholarly Editions (2012) Issues in Healthcare Technology and Design. Atlanta, Georgia: Scholarly Editions. Shieves, R. (2008) Basic Concepts of Psychiatric-Mental Health Nursing. Seventh Edition. PA: Lippincott Williams Wilkins. Spouse, J., Cook, M. J., and Cox, C. (2008) Common Foundation Studies in Nursing. Fourth Edition. London: Churchill Livingstone. Thornicroft, G. and Tansella, M. (2010) Mental Health Outcome Measures. Third Edition. London: The Royal College of Psychiatrists. Timby, B. K. (2009) Fundamental Nursing Skills and Concepts. Ninth Edition. London: Lippincott Williams Wilkins. Videbeck, S. L. (2011) Psychiatric-Mental Health Nursing. London: Lippincott Williams Wilkins. Weber, J. and Kelley, J. (2009) Health Assessment in Nursing. London: Lippincott Williams Wilkins. Wilkinson, J. M. and Treas, L. S. (2011) Fundamentals of Nursing – Volume 1: Theory, Concepts, and Applications. US: F. A. Davis Company. Woods, P. (2009) ‘Risk to Others’. In Risk Assessment and Management in Mental Health Nursing. ed. by Woods, P. And Kettles, A. M. West Sussex: Blackwell Publishing Ltd. Woods, P. and Kettles, A. M. (2009) Risk Assessment and Management in Mental Health Nursing. London: Blackwell Publishing Ltd. How to cite Reflective Essay on Learning Disabilities – Psychological Well-being, Essay examples

The Defense of Marriage Act free essay sample

The law thoroughly states how conservative republicans thought that by passing this law they’d gain univeral American support to help them in elections. ttp://www. huffingtonpost. com/waymon-hudson/over-70-major-companies-f_b_1080485. html This website displays the companies that are against the DOMA act. The Defense of Marriage Act (DOMA) is a law that was formed in 1996 by Congress, and was signed into law by then president Bill Clinton sought to be enforced by the Supreme Court that defines marriage as a union between a man and a woman. Traditionally, marriage is defined as a lifelong union between a man and a woman at the pinnacle of their life’s down until their final years. And the purpose of DOMA is to protect that sense of unionship in the United States and rather preserve it than destroy it. DOMA is a tricky subject. What I would like to learn about this subject is who backs this clause with full support and effort and who is absolutely against it. We will write a custom essay sample on The Defense of Marriage Act or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Although, as I’ve researched and read about this topic I’ve learned that DOMA is against gay-marriage so almost naturally I know that american homosexuals would be against this, but it would serve me well to learn about and delve further into if any politicans or important figures ho’re against this as well as that demographic of people. I personally do not agree with the DOMA act because I believe that, whatever your sexual orientation may be that you should be able to marry and it should not be limited to just a union between a man and a woman. The final ruling for DOMA is not to be made until June of this year, one of the more recent Supreme Court cases that dealt with DOMA was Pedersen v. Office of Personal Management. When passed in 1996, the bill contained the following guidelines restricting same sex married couples from being able to do the following: 1. File their taxes jointly 2. Take unpaid leave to care for their spouse 3. Receive spousal benefits under Social Security 4. Receive equal family health and pension benefits as federal civilian employees. Along with DOMA being against same-sex rights, the Respect for Marriage Act (RMA) is for respecting the benefits of all married couples including same-sex married couples such as making those particular couples eligible for federal benefits and security those being family and medical leave, or Social Security spousal leave and survivor benefits although it cannot support grants at the state level.

Victorian England Essay Example

Victorian England Essay Charles Dickens the author of Great Expectations was born in 1812 in Portsmouth; he was the second child of six. His father was a clerk in the Navy pay office; he was often in debt and ended up in Marshabea prison. Charles was lucky enough in such difficult circumstances to have a few years of schooling before he was sent to work in a friend of the family. Charles worked in this Factory for seven shillings a week. It seems that it was from this background that Dickens drew from for most of his writings. It is evident that real people he had met during his life inspired the plots and characters in his novels. As Charles family wealth increased he again went back to school after finishing school he started work as a solicitors clerk, he then progressed as a court reporter it was at this stage in his life that he started supplementing his income by writing. This essay will focus on the settings in which this novel takes place and how they are described and depicted, it will also look at how these settings relate to the characters in the plot and their personality traits. The settings will also be examined in terms of the life and times of Victorian England. Dickens is famous for his use of language to describe people, places and features of the landscapes in which his novels take place. In this essay I will examine two major points about Dickens use of language to create characters, firstly through characternym and secondly through using descriptive language and imagery to convey the mood of particular scenes. The opening scene of Great Expectations is set in a graveyard on the Kent marshes; the main character Pip is visiting his mothers grave. Pip, is an orphan and is being raised by his abusive sister and her husband, Joe Gargery the kindly village Blacksmith. We will write a custom essay sample on Victorian England specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Victorian England specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Victorian England specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Suddenly in the fist scene Pip is grabbed by an escaped convict, Magwitch who is hiding in the graveyard, who cried out Keep still, you little devil, or Ill cut your throat! , the convict is trying to force Pip to aid him he pesters Pip about where he lives, demanding food and a file to break his chains. Pip is terrified and informs the convict that his Mother is nearby; the convict reacts by suddenly starting to run away from Pip, then he stops and looks over his shoulder realising there is nobody there he continue his aggressive line of questioning. The language that Dickens uses to describe the scene of the graveyard creates a bleak and eerie atmosphere to the setting; it is very bleak and depressing the way things are depicted. The convicts appearance is described in great detail, his poor and rough demeanour are emphasised over and over again using different examples of the way he has been afflicted by nettles, stones flints etc. Also Dickens uses lots of descriptive words to really put across the state of the man and to invoke a strong sense of his appearance.

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The Amendments of the Bill of Rights essays The Bill of Rights, consisting of ten amendments, was ratified into the constitution in the year 1791. The document's purpose was to spell out the liberties of the people that the government could not infringe upon. Considered necessary by many at the time of its development, the Bill of Rights was written to protect U.S. citizens from abuse of power that may be committed by the different areas of their government. It does this by expressing clear restrictions on the three branches of government laid out previously in the Constitution. Each amendment either states what the government cannot do or limits its powers by providing certain procedures that it must abide by. The Bill of Rights expresses civil liberties-liberties that are for the people and states that the government cannot take action that would go against or infringe upon on these rights. The First Amendment guarantees the people the freedom of expression, which includes the freedoms of religion, speech, press, and assembly, as well as the right "to petition the government for a redress of grievances." The original reason for adopting the First Amendment was that the first settlers who came to the Americas in search of religious toleration and political asylum wanted to make sure that injustices would never happen again. The Second Amendment is the right to bear arms. This amendment was added to the Bill of Rights so that Congress could not pass laws to disarm state militias. The Third Amendment is the prohibition against the quartering of troops in private homes. The Fourth, Fifth and Sixth amendments all protect a person who is a suspect in crime from being treated unfairly. The Fourth Amendment prevents against unlawful search and seizure. It prevents police and other government officials from searching people's homes, offices, and from seizing their property wit hout reasonable grounds to believe that a crime has been committed. The Fifth Amendment has five important p...

Investment opportunities and risks in stock markets Literature review

Investment opportunities and risks in stock markets - Literature review Example With the EPFs emerging as a vital source of capital inflow for the developing countries, an array of issues arises regarding this pattern of investment. It is of prime importance to understand the diversification benefits accruing to an investor from investing in the developing countries and the returns to stocks of these emerging markets. Investors and researchers are concerned about the level of integration of these markets with the financial markets of the industrially advanced countries. Several research works have been conducted in the past to investigate about the process of integration between these markets and to understand the changes appearing in the risk-return features of emerging markets. This helps in the understanding of the individual investor’s reaction to the changes in organization of financial markets and the changes in her behaviour in favourable and unfavourable economic conditions. Sufficient research papers are available, that present their findings rel ated to the developed industrial countries. It has been found that there is a lack in recent researches concerning the stock market scenario and market returns in the emerging economies. This essay focuses on reviewing the existing literature on the risks and benefits accruing from investment activities in the developing economies and comparing it with the risks and benefits associated with investing in the advanced stock markets of the world. The diversification benefits are investigated and the correlation between the advanced and emerging stock markets is studied through this literature review. Review There are several reasons that provoke investors to seek diversified and long-term exposure to the emerging financial markets. Social as well as demographic trends are fundamental to the growth of emerging economies and the development of investment prospects in those markets. Recent researches show that the influence of the financial crisis of the US and the Euro zone has been felt more severely in the developed nations rather than on the developing countries. As a matter of fact, a few emerging financial markets are demonstrating a high degree of stability that is historically associated with the mature economies. This is an outcome of rapid evolution, which shows that the investment conditions are also evolving at a fast pace. Many investors of the developed countries such as the United States consider the emerging economies, like, Brazil, India, Russia and China to offer good investment opportunities. In fact, some other smaller markets, such as, Philippines and Indonesia, are emerging that put forward noteworthy opportunities to equity investors. But while choosing the market in which to invest, the investor require the understanding of the differences and parity among the emerging markets, and must not group them together. The investors have to weigh the currency strength of the country in which they are deciding to invest along with the stability of the country’s government (TIAA CREF, 2013). Rationale behind investing in developing countries According to Henry and Kannan (2008), two rationales emerge out of conventional theories pertaining to investment in risky assets, such as stocks, in developing countries. Th

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Financial Crisis and Their Possible Solutions - Essay Example It is evidently clear from the discussion that financial crisis affected most parts of the world. It began in the US after the Difficulties in the US submarine market that had rapidly rocketed and spilled all over the world. Bordo et al find that the frequency of the financial crisis is higher than the previous one and can be comparable only to the Great Depression. It had detrimental impacts on different sectors of the economy in all countries. Reinhart, Reinhart and Rogoff have, in the past years documented the effects of the banking crisis that are typically proceeding by credit booms and asset price bubbles. They note that on average 35% real drop in housing prices stretch over a to almost six years. Equity prices fall over 55% over a period of 3 years, while output in those countries fall by 9% in two years, unemployment increases by 7% in four years while an 86% debt increase based on the pre-crisis level. Many models have documented the effects of the financial crisis. Adrian and Shin, Brunnermeier have documented a thorough review of the events preceding the financial crisis in late 2007 and early 2008. They note that the seeds of financial crisis can be traced back to the low interest rates policies adopted by the Federal Reserve and other world central banks after the collapse of the technology stock bubbles. The need for the debt securities by Asian banking institutions aided in fuelling the economic crisis. Acting as financial intermediaries, banks channel funds to potential investors. Through the process of borrowing and lending, they benefit from a diversified portfolio of risk sharing. They also act as monitors (Diamond, 1984) and streamline loans to well-organized customers (Gorton and Kahn, 1994) and other vital roles in maturity transformations. This implies that in crisis, every banking institution becomes concerned. For instance, Dell Aricia and Rajan (2008) provide that banks’ grief contributes to a decline in credit and low GDP .Fur ther evidence provides that those sectors, which heavily depend on external financing, perform relatively dismal during the banking crises. These effects are stronger and severe in developing countries. In addition, the report note that over the last two decades, banking sector continues to be complex in its modes of operations. For instance, banks use various instruments to hedge risks. However, despite the complexity banks have remained sensitive to the panics and runs. Gorton (2008) note that holders of short-term liabilities feared to fund banks as they the anticipated losses in the sector could have in their securities. The recent research proposes two theories to give a tentative explanation on the causes of the bank panics and runs. One argues that panics are undesirable events caused by random withdrawals unrelated to the changes in the real economy. Bryant (1980) and Diamond and Dybig (1983) note that agents have uncertain needs that relates to consumption. If other deposit ors believe and can even further establish the slightest of evidence, then all the agents will find it rational and imperative to redeem their claims from banking institutions and will cause the panics and banks’ runs. Another theory explains that banking crises are natural outgrowth of the business cycle. An economic slump will reduce the value of the bank resources, heightening the possibility that banks are unable to meet

Introduction To Dual Diagnosis Health And Social Care Essay

Introduction To Dual Diagnosis Health And Social Care Essay Over the last ten years in mental health, there has been a significant change and considerable debate about the definition of dual diagnosis, this terminology refers to a mental health disorder combined with substance misuse (Department of Health, 2002). This can cover a broad range of disorders from learning disabilities and substance abuse of legal or illegal drugs to severe mental illness such as schizophrenia and substance misuse of cannabis or alcohol (Department of Health, 2002). However in medicine dual diagnosis is an umbrella term, for a primary and secondary disorder for example diabetes and hypertension (Sowers Epstein, 1995) This research proposal will focus on the client group duality of psychosis and substance misuse of cannabis or alcohol. Psychosis can be defined as a severe mental health disorder in which thought and emotions are significantly impaired, whereby people can lose contact with reality. However the symptoms can vary between negative and positive, the negative symptoms can cause apathy, a reduction or absence of social skills, resulting in confused thoughts which impair their ability to concentrate or complete instructions. The positive symptoms can be defined as either visual or auditory hallucinations or delusional thoughts, where a person may have an undeniable belief in something false (National Institute for Clinical Excellence (NICE), 2011). However substance abuse can aggravate psychosis leading to further hallucinations, which is associated with a wide range of negative outcomes, such as higher rates of relapse, increased hospitalisation (revolving door clients), suicide, housing issues and poorer levels of social functioning, such as poverty, violence, criminality and social exclusion, less compliance with treatment, greater service costs to National Health Service (NHS) or the criminal justice system and government services (Department of Health, 2007). More significantly The World Health Organization (WHO) reported 51,353 admissions of drug-related mental health disorders in 2010/11. These admissions have increased year on year and are now nearly twice as high as they were ten years ago, therefore families are at greater risk of having a family member diagnosed with dual diagnosis (The World Health Organization , 2012). Significantly the impact of the dually diagnosed within families is drastic, family dynamics are altered by challenging and difficult situations within the home, by displaying disruptive and aggressive behaviours (Biegel et al, 2007). Clearly people with dual disorders have strained interactions with their families. However when relationships are strained families might be less willing to help, the relative with dual diagnosis which could contribute to higher rates of homelessness and social problems (Clarke, R E; Drake, R E, 1994). Yet family members may have differing amounts of contact and distancing, because of the negative impacts of their behaviour. However someone in the family takes the role of main caregiver, being the person most directly linked to the caring of the dually diagnosed whilst care giving not only affects their QOL, it also impacts on possible depressive symptoms and research has indicated that care giving burden has a risk factor for early mortality (Biegel et al, 2007), (Marcon et al, 2012) (Walton-Moss et al, 2005) Yet a lack of social support, and informal and formal care, has been found to be the most important source that predicts the burden of family caregivers (Biegel et al, 2007) although informal caring occurs naturally within family relationships, which is typically unpaid, this goes beyond the caring expected of these relationships in contrast to a paid formal carer (Chaffey Fossey, 2004) additionally being a carer can raise difficult personal issues about duty, responsibility, adequacy and guilt (Shah et al, 2010). Research into the impact of care giving shows that carers suffer significant psychological distress and experience higher rates of mental ill health than the general population, the triggers for distress are as follows; worry, anger, guilt, and shame; financial and emotional strain; marital dissatisfaction, physical effects of the stress of living with a substance abuser (Biegel, et al 2007). However without the contribution of the UKs 6.4 million unpaid carers health and social care services would collapse. In 2037 its anticipated that the number of carers will increase to 9 million (Carers UK, 2012). Worldwide several authors have argued for service systems to acknowledge and address family members need to ensure their own well-being, as well as to ensure effective community support for people living with mental illness (Chaffey Fossey, 2004) (Igberase et al 2012) (Carey Leggatt, 1987). The last ten years have seen major reform of the law as it relates to carers; consequently families have been forced to give up work to care for their relatives. Family carers need assistance to prevent becoming unwell themselves (Carers UK, 2012). Therefore supporting carers must be a central part of government reform, which acknowledges the family as associated clients who desperately need support. This is paramount because relatives often know little about how the interactions between mental illness and substance misuse are interchangeable. Therefore families need practical information about dual disorders, to help recognise the signs of substance abuse, and strategies for its management for example medication adherence and recognising relapse triggers. Addressing these factors would enable the improvement in the dually diagnosed directly related to greater outcomes in the well-being of the family (Mueser Fox, 2002). Overview, context and background information relevant to topic It costs the UK Â £1.3 billion a year in carers benefits and lost taxes whereby family members are becoming increasingly responsible for providing support, although in 2012 the British government submitted the Care and Support Bill which will guide future services for caregivers. Families will no longer be treated as an extension of the person they are caring for, they will have a right to an assessment, this will give carers much better access to support them balance their caring roles and responsibilities (Carers UK, 2012). Yet informal carers may experience less choice about the discontinuation of care in comparison to volunteer or paid carers, possibly due to love of the family member and a sense of duty, it is essential that the family understand the facts about dual diagnosis, to have every hope for recovery of the family (Department of Health, 2007) Additionally health services should acknowledge the families by assessing them as associated clients so that carers can learn to recognise the triggers of caregiver burden and moreover be given general education and health promotion (Rethink, 2007). However in 2006, the College of Occupational Therapists (COT) announced a 10 year vision for occupational therapy in mental health which included by 2013 for practitioners to have extended their scope of practice across a range of agencies to meet the occupational needs of mental health services (COT, 2006) Statement of the problem proposed to be investigated The proposed research intends to investigate, what are the experiences of people who are carers for people with dual diagnosis? General aim(s) of the proposed research To find out how families cope living with someone with dual diagnosis? What are their biggest challenges? To identify the current experiences from the perspective of the carer regarding the impact of dual diagnosis, the burden; grief and the loss of their relative. Relevance, significance or need for the study The relevance to occupational therapy and the health service; carers are associated clients and therefore need to be taken into consideration when assessing this client group. Furthermore the lacking of occupational therapy literature in this area makes a clear case for the proposed research. Chapter 2: Literature Review Introduction to the chapter Literatures in dual diagnosis are largely separate, mainly based in substance abuse or mental health fields. However over the past decade, family work in dual diagnosis has been mainly focused on client outcomes and not the families well-being or quality of life QOL. However occupational therapy literature is also limited, lacking investigation of occupational needs identified from the families perspective. However a considerable amount of literature has been published on descriptions of occupational therapists roles by defining and establishing what an occupational therapist does within the multi-disciplinary team in mental health services, but not specifically to dual diagnosis (Brown, 2011) (Hyde, 2001)(Lloyd et al, 2008). Therefore it is beneficial for occupational therapists to have a better understanding of the families perspectives, as associated clients to enable additional support for the caregiver thus improving outcomes for the whole family. There is a plethora of literatures, on outcomes associated with family support for the dually diagnosed, the majority of studies examined the relationship between family involvement and client outcomes such as reduction in mental health symptoms, engagement in treatment services, lower hospitalisation rates, improved decrease in substance abuse, sustained remission (Clark, 2001) (Mueser Fox, 2002) (Biegel et al, 2007). Although the high service costs of treating the substance abuser and the frequent involvement of relatives in the lives of dually diagnosed clients, there are few resources to help clinicians engage and collaborate with families (Mueser Fox, 2002). This implies that families or informal carers can easily become the main source of care when treatment fails, the family being the last resort (Clark 2001). On the other hand, some research has shown that individuals with dual diagnosis are less satisfied with their family relationships than those with a severe mental illn ess alone (Kashner et al. 1991) and that receiving family support may exacerbate difficulties by increasing conflict (e.g. supply of additional money may be used for drugs, existing poor family dynamics worsen carer-client relationship). Conversely research is lacking in the support of families caring for the dually diagnosed (Biegel, et al, 2007) (Townsend, et al, 2006). In contrast families are often the most significant people in the dually diagnosed life, this unique relationship puts families in the central position of being able to encourage the dually diagnosed to take the necessary steps towards recovery by providing direct care such as practical help, personal care, emotional support as well as financial support (Clarke, R E; Drake, R E, 1994) (Shah et al, 2010) (Mueser Fox, 2002). The impact of mental illness on families is usually conceived in terms of caregiver burden, this experience may help determine the quality of life QOL for family members, the most significant being, isolation, coping with behavioural problems, and relationship problems between family members (Clark, 2001). Mueser et al, (2009) study of 108 families conducted a randomised control trial utilising Lehmans QOL interview instrument with satisfactory reliability and validity (Lehman, 1998) for the diagnosed, the caregiver was assessed using the family experiences interview schedule (FEIS) with established reliability and validity which did not incorporate the QOL for the family this was not addressed. The findings from this study found that motivating relatives, to participate in family intervention can address the disruptive effects. These stressors that affect quality of life include; worry, anger, guilt, and shame; financial and emotional strain; marital dissatisfaction, physical effects of stress of living with a substance abuser (Biegel et al, 2007). Additionally Biegel et al (2007) exploratory, non-experimental cross-sectional survey design conducted interviews / surveys with 82 females with dual diagnosis and 82 family members and considered the caregivers experience as moderate, and found that behavioural problems contribute to the burden affecting their quality of life, the strength of this study is acknowledging how substance abuse impacts on the role of care giving which was also tested by applying FEIS. Many studies of family carers of persons with mental health and or substance abuse issues consider how families quality of life is affected, the main themes highlighted that emerges throughout the reviewed literatures are caregiver burden which is documented as worry, anger, guilt, isolation, stress which results in a diminishment of QOL of family members (Biegel et al, 2007) (Chaffey Fossey, 2004) (Shah, Wadoo, Latoo, 2010) (Chan, 2010). Behavioural problems have been found to be the strongest predictor of caregiver burden across chronic illnesses (Biegel et al, 2007). In contrast Jokinen Brown, (2005) conducted a focus group study which included 15 subjects would argue that there are positive aspects of lifelong care giving and quality of family life, the study acknowledged the concerns for the health of all family members (Jokinen Brown, 2005). Research in the QOL of care giving highlights that carers suffer significant psychological, distress and experience higher rates of mental ill health than the general population. Therefore by improving the QOL of carers will likely to reduce caregiver burden that requires further research to explore the lived experiences of families living with the dually diagnosed (Shah et al, 2010). However, literatures addressing the family as a collective unit and the impact of care giving on each family members role is lacking therefore this literature reviews the research. The majority of family caregivers, mostly women report experiencing moderate to high levels of depression as well as stress, this type of informal care giving is taken on in addition to existing roles and responsibilities (Chaffey Fossey, 2004) (Biegel et al, 2007) (St-Onge Lavoie, 1997). Traditionally, informal care was supplied by women but nowadays women are not only more likely to work, but also likely to be significant contributors to family finances. For women, this implies that earnings will be lost due to informal care increasing. However women play a central role in care-giving which may impact on their well-being more than other members of the family (St-Onge Lavoie, 1997). Although according to shah et al (2010) women have higher rates of depression than men in the care-giving role (Shah et al, 2010). However male carers tend to have more of a managerial style that allows them to distance themselves from the stressful situation to some degree by delegating tasks (Shah et al, 2010). Significantly (Mays Holden Lund, 1999) Interviewed 10 male caregivers and the findings, men expressed their means of coping by being realistic and action-oriented in response to their feelings. However the effect of care giving on children can be considered by the physical changes to normal growth, for example migraines, inflammation of the lining of the colon, and ulcers (Biegel et al, 2007) (Townsend et al, 2006). Tracy Martin, (2006) examined the effects of dual diagnosis via cross-sectional survey design which examined the types of support provided by minor children and the differences in support perceived by the child versus the support perceived by the adult. The findings that the role of children is often ignored or neglected, the effects are referred to as a role reversal parental child or parentification thus resulting in negative developmental outcomes for the child, although a weakness with this study is the support perceived by the child is not the views of the children but by the mothers reporting on both, these findings represent a design bias (Tracy Martin, 2006). Significantly Rupert et al (2012) aim to identify the issues when engaging children whose parents have a dual diagnosis explored the perspectives of 12 children via semi-structured interviews. A strength with this study is that the authors were able to elicit the sensitive data ethically by gathering information about secrecy issues around their parents substance abuse and remaining loyal to their parents, children experience negative times spent with their parents, with family arguments and the knowledge of when the parent abuses substances these findings represent the need to acknowledge childrens perspectives as associated clients (Reuper et al, 2012). The authors acknowledge that the study does not recognise the other family members within the household that could provide an exploratory view of their perspective. Although the effect of care giving on siblings is lacking, Sin et al (2012) studied the phenomena of understanding the experiences of siblings of individuals with first episode psychosis. Qualitative semi-structured interviews with 31 sibling participants researched that they had somehow lost their brother or sister as his or her character had changed since the onset of their diagnosis (Sin et al, 2012) Younger siblings were much more likely to cope by withdrawing and not getting involved, they often reported that they were not made aware of information and resources available to help with the situation and were also less likely to want to know about the illness (Sin et al, 2012). Strength of this study is the qualitative exploratory semi-structured interviews, and the themes that emerged although this study does not address the issues of substance abuse or the quality of life of the other family members. The gap in the literature is that quality of life does not consider the affects of mental health and substance abuse on the family. This paper has not been able to locate any studies that consider the qualitative exploratory lived perspectives of all family members living with the dually diagnosed, and the impact on their quality of life, therefore due to the lack of research on families living with the dually diagnosed this research seeks to explore their perspectives. To conclude Health professionals should focus on the familys environmental context, and their perceptions of their relative with mental illness, thus by assuming that each family is different, clinicians should evaluate how family dynamics can affect the families quality of life and how theses interactions impact in their plan of care (Walton-Moss et al, 2005). However, numerous studies have looked at the effects of family involvement on the outcomes of the dually diagnosed, current literatures are lacking on the quality of life of family members, and does not consider the effects of mental health and substance abuse on the family, this provided the focus for the present research. The relevance to occupational therapy The relevance to occupational therapy services is to lessen the burden on the carers so that they can continue in their caring role, being fully informed of diagnosis, relapse triggers, substance abuse, and the available services so that they can continue their caring role. Statement of aims To explore the perspectives of carers of clients with dual diagnosis To explore the perspectives of the carers regarding substance misuse To find out how carers cope, living with someone with dual diagnosis, what are their biggest challenges? Research question proposed to be investigated To explore the lived experiences of a family that lives with the dually diagnosed client. Chapter 3: Methodology Description and justification of research Design A qualitative semi-structured interview which utilises open ended questions, has been chosen because these methods lend themselves to exploring the familys perspective and meanings of living with the dually diagnosed, this will permit individual members of the family narrative to be acknowledged. Moreover the researcher will ask questions in similar ways to all participants, which will attempt to maximise the confidence in the research reliability and validity (Hicks, 2009). This method will attempt to understand a complex novel phenomenon, whereby the researcher needs to understand that the concepts and variables that emerge may be different from the aims, sought by the study (Pope Mays, 2006). In contrast focus groups were not chosen due to the consensus of a group of people rather than the individual perspectives from the family (Pope Mays, 2006). The research will be conducted in the participants home, due to purposive sampling methods in which sites are selected on the basis that they are typical of the phenomenon being investigated (Pope Mays, 2006: 115). This will attempt to justify the rationale for the research taking place in the home in environment (Pope Mays, 2006). Moreover purposeful sampling techniques will be used to obtain participants whereby the researcher identifies specific people to take part (Hicks, 2004). However an aspect which illustrates rigour can be identified through member checking, whereby cross-checking findings with participants, can help to refine explanations, and aims to reduce subjectivity in processing of data analysis (Pope Mays, 2006). Therefore Living with dual diagnosis through the families eyes, can be addressed by using semi-structured interviews whereby rigor can be associated with this type of approach, due to data collected from as many appropriate sources to provide in-depth information (Pope Mays, 2006). Indication and justification of required number of Participants The participants will be family members of the dually diagnosed client, that attend a community mental health daycentre. However this study acknowledges the stigma attached to mental health services, as recent studies have shown that public education campaigns on mental illness and the integration have done little to alter the stigma associated with mental health (Schulze Angermeyer, 2003). Conversely the recruitment of participants may rely upon their visit to the day centre or if not appropriate for them then the dually diagnosed participation at the centre and the passing on of the flyer or information about the study, requiring no attendance at the day centre is necessary, due to the research being conducted in the participants family home. However It is argued by Crouch McKenzie (2006) that for in-depth qualitative studies small numbers of cases facilitates the researchers association with the participants, and enhances the validity therefore a maximum of 20 participants in total will be recruited to allow sufficient time to analyse the collected data (Crouch McKenzie, 2006). However snowballing sampling, was not the chosen method of recruitment because recruited participants in the study, would refer and reccommend future participants (Patton, 2002). Organisation of access to and recruitment of possible participants Participants for this study will be obtained through voluntary participation advertised via flyers and posters at a community mental health daycentre (Appendix 7), the flyers will provide instructions for participants to contact the researcher, the purpose of the study; requirements to be a volunteer, and the time commitment of the volunteers will be listed on the flyer, once families (maximum total of 20 people) are recruited for the study, the researcher will remove the flyers and posters. When volunteers respond, a telephone screening interview, approximately 5 minutes per person, will be conducted to determine if the individual family members meet the inclusion criteria. Families that respond and meet the inclusion criteria will be consented and assented (if appropriate) and recruited to participate in the study. The researcher will speak with the families, and communicate with each family member to set up a meeting time and place that is convenient for all members (Pope Mays, 2006). Inclusion/exclusion criteria of participants The validation for the inclusion and exclusion criteria relies on the family homogeneity that they are composed of being related and living together, therefore similar participants may enable a more in-depth enquiry into their shared and distinctive experiences (Hicks, 2004) The inclusion criteria eligibility: a) Family member is living with the person diagnosed with dual diagnosis. b) Family member is capable of engaging in verbal communication pertaining to semi-structured interviews. c) Family member is above 16 d) A family consisting of two or more members (max 4) not including the dually diagnosed client. e) English speaking and capacity to reflect participate. The exclusion criteria: a) Family member is below the age of 16. b) The diagnosed family member with dual diagnosis. c) No mental disorders or substance misuse disorders. d) Non-English speaking or with a cognitive deficit disorder. The semi-structured interviews may discuss topics or issues which are sensitive to the participants, these difficulties can be averted by a procedure of gaining on-going consent and assent for the 16-18 year olds (appendix 2) (Wiles et al, 2007). If distress occurs then the researcher can either stop the activity or will move on to the next area. It will be made clear to participants that they can decline to answer any particular questions or discuss topics that they feel uncomfortable with and can leave the research at any time, additional support and information will be available (Wiles et al, 2007). Indication of Ethical issue relevant to the proposal The researcher should at all times respect the autonomy of the individual by allowing the participant the freedom from control or influence of the study. Additionally the researcher has a duty to uphold beneficence which is the obligation to maximise benefits and minimise harm (Domholdt, 2000). Justice should be maintained throughout which is the obligation to treat each person in accordance with what is morally right and proper, therefore informed consent and ascent will be obtained via the Participant Information Sheet (approximately 30 min) (Appendix 1). Once the inclusion criteria has been met and each of the participants agree to join the study, a meeting time and place for informed consent, form review and data collection can be scheduled. The researcher will review (1) the purpose of the study, (2) an explanation of the procedures including the interviews, and the interview process, (3) an explanation of possible benefits and/or risks or discomforts (4) Consent to audiotape semi-structured interview (amended consent form), and an explanation of the subjects rights and confidentiality, the subjects will be asked to repeat their understanding of the study and procedures in their own words. Once full understanding has been demonstrated of the purpose and procedures of the study, the researcher will ask the participants to sign the consent form. Research approval General approval to be sought from Brunel University Research Ethics committees. Ethical approval for the research study is to be obtained from Brunel University, additional permission to be sought from the community mental health day centre (gatekeepers) to recruit participants via flyers and posters (Brunel University West London, 2010). Discussion of ethical considerations related to participation and consent Due to possibility of participants being aged from 16-18 assent will be required which is a term for participants too young to give informed consent but who are old enough to understand the proposed research, including the expected risks and possible benefits, and the activities expected of them as subjects. Assent by itself is not adequate, however. If assent is given, informed consent must still be obtained from the subjects parents or guardian (Domholdt, 2000). Ethical issues will arise throughout the research process, from initial planning to writing up and data analysis, due to interviews concerning private experience (Kvale, 2007). The researchers will respect the privacy of the participants by making it clear to them that they are free to decide what information they wish to share with the researcher and that they should feel under no pressure or obligation to discuss matters that they do not wish too. Data regarding the patient, family or the community, which will have the potential to identify them, will be omitted, Indication of any risks and benefits to participants and/or researcher The possible risk to the participant is the discussion of sensitive issues, due to the nature of the research and the psychological aspect of discussing experiences. If distress occurs then the researcher can either stop the activity or will move on to the next area. It will be made clear to participants that they can decline to answer particular questions or discuss particular topics (Wiles et al, 2007). Moreover the non-therapeutic approach, whilst designed to advance knowledge and therefore be of collective benefit, it is not expected to give a direct benefit to the research subject (Wiles, Crow, Charles, Heath, 2007). The risk to the researcher is conducting the study in the participants home, the researcher will have to abide by the Suzy Lamplugh Trust lone worker policy (Suzy Lamplugh Trust, 2012) (appendix 4 ) therefore a full risk assessment will need to be completed. Additionally the researcher will indemnifying against risk, to either the researcher or to participants, by taking out insurance for a period of time limited to the research process. Consideration of issues of confidentiality and data security In order to protect confidentiality, the researcher will identify the subjects for this study by the role that the participants fulfil in the family for example mother, son or daughter. Once all data is collected and analysed the interviews will be transcribed, and the audio tapes will be stored in a locked, secure location until the study is completed, after completion, the primary data will be destroyed and all other data will be destroyed and discarded according to data protocol up to two years (Brunel University West London, 2010). Materials or equipment The interviewer is the instrument in this type of evaluation; the instrument can be affected by factors like fatigue, personality, and knowledge, as well as levels of skill, training, and experience. According to (McNamara, 2009), the strength of the general interview guide approach is the ability of the researcher to ensure that the same general areas of information are collected from each interviewee. The equipment required to analyse the data is software for qualitative data analysis which is ATLAS.ti 7, as a tool for enhancing rigour this software is available at Brunel University (Atlas.ti Qualitative Data Analysis, 2012). The training implications required is a one hour training session. Additionally an audio tape recorder is required for the semi-structured interview; a limitation is that the interviewees may be unable to put their thoughts into words and difficulties of analysing data from semi-structured interviews (Atlas.ti Qualitative Data Analysis, 2012). Comprehensive description of Procedures The study will consist of 45 weeks part-time work (appendix 9) the research will be advertised through flyers and posters at the mental health day centre after seeking approval from the day centre (gatekeepers), The recruitment drive will be for two months via dually diagnosed participation at mental health day centre which the researchers have no affiliation too