Critical incidents and our behaviours.

Critical incidents and our behaviours. What is critical incident? Critical incident has been defined in different ways depending on the nature of the incident and the environment or setting where it took place. Tripp (1993) defines critical incidents as a commonplace events that occur in routine professional practice Incidents may relate to range of issues amongst which issues of communication, relationships, moral beliefs and ethical values, knowledge, culture or emotions. The definition I like best is that a critical incident need not be a dramatic event, but it is an incident which has significance for us. It is often an event which made us stop and think, or one that raised questions for us. One that may have made us question an aspect of our beliefs, values, attitude or behaviour. It is an incident which in some way has had a significant impact on our personal and professional experience and learning (MU). Curiosity is a basic human emotion. The psychologist William McDougall states that The instinct of curiosity is at the base of many of mans most splendid achievements . As humans we all have the drive to find rational explanation of lived events and our surrounding. We do that though trying to examine or reflect on our experiences. According David A. Kolb (1984) reflection is an inseparable part of the learning process. This is the part during which by analysing given event we enhance our knowledge, enrich our practical experience and prepare for new and challenging situations. Different frameworks have been developed to aid the development of critical reflection. Most prominent are the models of Kolb (1984), Gibbs (1988), Atkins and Murphy (1994), Johns (2000), Rolfe et al (2001) and Lister and Crisp (2007). Lister and Crisp explain that critical incident analysis has developed as a tool to aid critical reflection in practice, in health and social work. It has been used to enable students to describe and explore issues from their practice (Nygren and Blom 2001), (Montalvo 1999). PoDAIT describes that Critical Incident Analysis is an approach to dealing with challenges in everyday practice. and that As reflective practitioners we need to pose problems about our practice, refusing to accept what is. We need to explore incidents which occur in day-to-day work in order to understand them better and find alternative ways of reacting and responding to them. Therefore it is safe to conclude that critical incident analysis can enable professionals to reflect on their practice and to explain and justify it. Account: During my placement at a south London CMHT I had short period of working with the duty team. This was when I and the MH nurses Q met Miss X for an initial assessment. Several days following Miss Xs assessment her case was discussed at a clinical review with one of the team consultants DR G and it was decided that the dosage of her medications is to be altered. When I informed her GP of the above I was told that her medications have already been adjusted and that the dosage is different from the one given on her referral. This created the need for reviewing Miss Xs case second time. In the meanwhile Dr G left the team and was replaced by Dr V. By that time I had finished my period of duty work and despite the fact that I had recorded all information on the internal database and that Miss X was still a duty client I was asked to present her case at Dr Vs next clinical review. I had no objections as I had knowledge of the client, and especially as Q was not present. At the review was decided that Dr. V will offer Miss X another appointment. I recorded the outcome on the internal database and also reported to Q who happened to be on duty shift. I also informed him of the need for Miss X to be notified of her appointment. On the agreed appointment date Miss X did not attend and when contacted by phone she stated that she was not notified of it. Dr V asked me to offer her a new appointment for the following week. I had no obligation to liaise with the Miss X or do any work on the case as she was a duty client and I no longer had formal involvement with her. Nevertheless, I notified her of the new appointment did both over the phone and in writing. When the second appointment came Dr. V asked me to attend the assessment with her. I was not required to, however I accepted. I decided that while Miss X would be more comfortable with a familiar person during the meeting, I would have good learning opportunity attending an assessment conducted by one of the team consultants. When Miss X arrived I introduced Dr V to her. During the assessment Miss X said that her medications have not helped and that she cannot cope. During the assessment she was wringing her hands and became tearful. Dr. V identified that Miss X had not been taking her medications at the appropriate time and that sleeping in the afternoons could be contributing to Miss Xs difficult night sleep. During the assessment Dr. V suggested that she can prescribe Miss X a number of different sleeping aid medications. However, at the end Miss Xs medications were not changed and she was told to continue with her current ones, but to take them at the prescribed times. Dr V informed Miss X that she will offer her a follow up appointment in two weeks time, in order to assess her progress and to change her medications as and if necessary. Following the assessment I went to the duty workers and asked them to come for an update from Dr. V. Two of them were busy and the third one Z who is a MH nurse was dismissive. As I could not get anyone from the duty team to come I went to the doctors office for final discussion and planned to record the outcome of the assessment and any decisions on the internal database. While we were discussing Miss Xs action plan Z entered the office. It was jointly agreed that Miss X will be offered follow up appointment in two weeks time. Later in the day Z came to me and asked me whether I have recorded the appointment in the duty diary. I informed her that I have not as my understanding was that this is consultants appointment rather than a duty one, which is normally not recorded in the duty diary. Nevertheless, she insisted that I do so. As I recorded the appointment in the diary, which I found on Zs desk, Z came and asked me not to make the appointment for the agreed date but for the day after. She explained that the appointment fell on a day which should be free of duty appointments. I was obviously confused as the date was chosen by Dr V and the other 2 previous appointments were both booked for the same day of the week without that being a problem. Z said that she has spoken to Dr. V regarding the appointment already. While trying to be helpful, having been given ambiguous information and the fact that Miss X was not my client to start with, I decided to step back and asked Z to clear any confusion with Dr. V. On the following day during Dr. Vs clinical review meeting Z presented Miss Xs case with suggestion for her to be discharged back to GP. To my big surprise Dr. V agreed with the suggestion. The rest of the team approved her decision silently. As the team had moved onto discussing other client I did not want to interrupt and did not speak out until the end. Having considered the distressed and tearful state in which Miss X presented, during the two assessments, her reports of feeling hopeless and without support, and her previous suicidal ideation, I asked if we could have another look at her case and perhaps offer her one more appointment before discharging her from the team. Dr. V said that she had reconsidered her yesterdays decision and assert that Miss X presented low risk; therefore she did not require further input from a consultant. In principle I agreed that Miss X may not have to be seen by a consultant. Nonetheless, I still felt that it would have been appropriate and an example of good practice for a member of the team to see Miss X before discharging her, especially after she was told to expect further support. Z suggested that I should take the case on. I explained that without my placement tutors permission I am unable to accept any new clients. Z suggested that keeping her as a client for an extra week or two puts strain on the duty team and suggested that as alternative to face to face appointment I can call the client. I agreed to that, but highlighted that due to my student capacity I would still have to be supervised by a team member. One of the senior social workers commented that I will be given credit towards my competencies, for adv ocating for the client. My request was left unanswered and Z said that she would deal with the case. Following the meeting another member of the team also a MH nurse spoke to me and said that I should not have brought up this question and contested the decision made by the consultant. I provided my practice assessor with a report of the situation however, it never went any further. I tried to look at the whole process and the outcome from Miss Xs perspective and tried to explore her feelings. Removal of formal and informal power barriers between the su and s providers Did not feel like I could change the decision and speaking to the cons. Would not have been benefitial. I was surprised if not even shocked by the consultants decision. Earlier I had observed (noticed) a certain level of indecisiveness as whether to prescribe different medication s or not have offered a range of different meds however did not stick to any of her own suggestions. Reflecting on that I tried to justify her behaviour accepting the fact that along the assessment different new information came to light. (reflected on her actions and decisions made) Power dynamics, my student and consultant Being familiar with the details ot the case I felt it was morally and ethically unjust to remain silent and not bring the matter up Being assertive but not argumentative (being diplomatic) in this situation my believes and values clashed with the decision taken What was the right thing to do. Keeping in mind my status in the team as student on placement, without extensive social work experience and not familiar with the power dynamics within the team I was double minded as to whether to Express my disagreement by suggesting an alternative approach to the situation and in this way challenge the decision taken by the consultant or to remain silent. In this situation the final decision about the care of the patient was being made. I (felt) was aware that once the decision was made speaking in private with any of the participants would not be constructive or bring positive results. Learning No one likes being challenged and when this happen some people may become self-protective and resistant to accept others views which may also impair future joint working. It is important to highlight that by challenging certain decision it is only the decision being challenged and not the person. After all the joint goal is the wellbeing of the client and not proving who is right or wrong. Be aware of office power dynamics and be mindful that some professionals may be strongly opinionated and confronting their views on a particular matter has to be made with care and in non confrontational approach. Sensitively approach and challenge others opinions try to (prevent from happening) diffuse charged emotionaly situations (to be diplomatic) When analysing a critical incident, it is useful to ask yourself questions such as: Why do I view the situation like that? What assumptions have I made about the client or problem or situation? How else could I interpret the situation? What other action could I have taken that might have been more helpful? What will I do if I am faced with a similar situation in the future? Refs: Atkins, S Murphy, K (1994) Reflective Practice Nursing Standard 8 (39) pp49-54 Evans, D. (1999) Practice Learning in the Caring Professions, Aldershot, Ashgate. Gibbs G (1988) Learning by doing: A guide to teaching and learning methods. Oxford Further Education Unit, Oxford. Johns C. (1995)Framing learning through reflection within Carpers fundamental ways of knowing in nursing. Journal of Advanced Nursing 22 p. 226-234 McDougall W. (2003), An Introduction to Social Psychology, Courier Dover Publications Rolfe G., Freshwater D., Jasper M. (2001), Critical Reflection in Nursing and the Helping Professions: a Users Guide. Basingstoke: Palgrave Macmillan (M.U.)(http://www.monash.edu.au/lls/llonline/writing/medicine/reflective/2.xml) KOLB D A (1984) Experiential Learning: experience as the source of learning and development New Jersey: Prentice-Hall ProDAIT http://www.prodait.org/approaches/cia/ [accesedà ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦.]

Location: Rome, Italy :: essays papers

Location: Rome, Italy Architect: Giacomo Barozzi da Vignola; born 1507, died 1573. His career illustrates the rigidity of Mannerist art in the later half of 16th century. His design of Il Gesu meant that Jesuit missionaries carried copies of his design all over the world. His first major work was the villa (Rome) built for Pope Julius III, but Il Gesu was the most influential, although considered architecturally less adventurous. Vignola published his own treatise, Regola delli Clinque Ordini d'Architettura in 1562. It became the standard textbook for architectural students, mainly in France, for about three centuries and nearly two hundred editions of it are known. Towards the end of his life, he built a gateway for the Farnese Gardens in Rome. The gateway was demolished in 1880, but stones were preserved and it has been rebuilt. Builder: Giovanni Tristano Construction Date: began 1958 (factual). Resource type: Church Style/Culture: Italian Renaissance Description and Features: Il Gesu displays a tunnel-vaulted nave (about 60 feet wide) and has four chapels on each side. The end walls are aligned with the outer walls of the chapels. The tunnel vault rises above the cornice that runs from the faà §ade to the piers of the crossing. Due to the faà §ade windows and the lunettes of the tunnel-vault, the nave is brightly lit, but in contrast, the chapels are dim. The diameter of the dome is equal to the width of the nave. Vignola accomplished this by having the chapels in the form of a continuous row into the piers of the crossing. The dome seemed to rest on surrounding walls, not on the three dimensional piers. The small chapels formed a passage in-between the nave and the transept. Original Use: Il Gesu is the Roman mother-church of the Jesuit Order Construction History: On June 26, 1568 the foundation stone was laid out, although it took years to finally decide on its situation, shape and size. Nanni di Baccio Bigi had submitted a design for the church in 1550, and Michealangelo was called in to design it in 1554, but Vignola's designs were approved. The construction finally started when Cardinal Alessandro Farnese made a large financial contribution in 1586. Giovanni Tristano, a Jesuit father, and an architectural expert, who worked on other Jesuit churches prior to Il Gesu, directed the building. It is assumed that by 1571, Vignola's plans did not satisfy Tristano, because Giacomo della Porta was called to design the faà §ade.

Childhood Obesity Essay

Childhood obesity is a growing health concern nationwide. Obesity is a disorder in which the body fat content has become so high that it creates health problems and increased risk of health problems (Childhood Obesity: An Overview. Children & Society, 21(5), 390-396). Doctors agree that there are two primary factors in creating obese children. First, the children and teenagers are not eating the right kinds of foods. Second, America’s children are getting less and less exercise on a daily basis. The effects of childhood obesity can be very serious and often include both physical and psychological effects on the lives of the children who are affected. Children that are obese go through a lot of different situations that allow them to become more prone to a mental illness. There are several causes for childhood obesity. Technology plays a big role in childhood obesity in today’s society. The biggest cause of childhood obesity is the lack of parenting. Childhood obesity can be prevented. It is best to prevent it from happening than to have to obtain a treatment for it. Childhood obesity plays a major impact on children up into adulthood and even has a role in the decisions an individual makes. Children that are obese have physical limitations. Most children usually take a liking into some type of physical activity whether it is playing a sport or just running around the yard for fun. Those actions are the normal expected actions of any child by both society and most of all parents. It is very difficult for a child when he or she is excluded from or limited to a certain amount of a physical activity due to weight related issues. Some children do not take rejection very well in any way, shape, or form. Obese children fall subject to a variety of physical and perceived physical barriers. Living an active lifestyle is difficult for an obese child. Obese children often go through a cycle of inactivity and poor health which creates more and more of a problem. Some of these problems that inactivity and poor health cause include asthma, joint pain and increased musculoskeletal stress, orthopedic problems, and psychosocial morbidity. When it comes to physical activity it is common in obese people to have the feeling of being too heavy in order to perform any physical activities. It is almost impossible for an obese child to just jump into heavy doses of high intensity physical activity. It is preferred that an obese child take a slow approach with light low-intensity physical activities in order to reach a better health. Obesity is associated with early mortality and has overtaken smoking as the health problem with the greatest impact on quality of life, mortality, and morbidity (Canadian Journal Of Psychiatry, 57(1), 13-20). The physical effects are often similar to the effects that are faced by adults who are obese, the psychological effects can sometimes be much, much worse because of the negative impact these issues can place on a still developing child. Mental illness is a significant factor that associates with obesity. Most people hear the term obese and mainly think of it as a physical condition. Obesity can be both physical and mental. From a behavioral perspective, mental illness is often characterized by a symptom profile that impacts energy, appetite, and motivation, and is more likely to be associated with unhealthy lifestyle factors, such as smoking, alcohol, and drug use. This makes exercise and healthy nutritional choices more difficult to implement (Canadian Journal Of Psychiatry, 57(1), 13-20). There is on individual on the face of this earth that smokes, drinks, or uses any recreational drugs that can still perform heavy doses of high intensity activities on a regular basis. The most common mental condition that is found it obese children is low self-esteem. Most people do not realize how much detrimental comments affect these children. The majority of children who are obese are faced with constant and persistent ridicule. The sad part about this situation is that the ridicule does not come from just other children but adults as well. The results of constant ridicule may lead a child to believe that they are worth anything which makes them feel as if there is no reason for them to even try to amount to anything. When anyone has that belief in their head it blocks that person from not caring about their life as a whole. This leads to a variety of problems all on its own. Success is something that may never be strived for by a child or adult that loses the mental battle that comes along with obesity. Studies show that children that are obese are at a higher risk of emotional problems that often carry over into adulthood. The study also reported that obese boys and girls with low self-esteem had higher rates of loneliness, sadness and nervousness. These children were more likely to smoke and drink alcohol compared with obese children with normal self-esteem. Depression, often an outcome of low self-esteem, affects as many as 750,000 teens in the U. S. (Source: Pediatrics, â€Å"Childhood Obesity and Self-Esteem,† January 2000. ) Untreated depression is recently passed upon but is a cause and effect of childhood obesity. Technology is at an all-time high. The technological age has resulted in children spending prolonged hours in front of television (TV) and computer screens. Lots of children are more interested in the technology than the usual interest of physical activity. Television shows, the internet, mobile phones, and video games occupy most children’s attention for great amounts of time every day. The rapid growth of technology is grasping the attention of the youth. The new lifestyle that has taken over the lives’ of the youth leaves little time for them to exercise. This lifestyle reduces the amount of physical activity and it is far from the lifestyle that their parents may have enjoyed many years ago. Parks are not as used as they often were and playgrounds are not as busy as they used to be. All of that is replaced with computers, laptops, handheld games, and anything that involves little or no physical movement. Health researchers suggest no television at all for children aged less than two years and not more than two hours of viewing for children aged more than two years. Most importantly it’s unhealthy to provide your child a separate television or computer in his room. More time spent on television and computer playing video games or computer games means less time spent on healthy physical activities. Nintendo did have one breakthrough when they the WII system to the world. This games forces children to get up out of their seats and move in order to play the game. Children are limited to the use of certain technology while at school, but at home the use of technology is at the discretion of the parent. Most children would rather sit inside all day with technology and constantly intake major calories without burning any. On a daily basis this can add some major pounds and create bad habits. Technology is great to have but it must not be abused by any individual. More than 25 million students use the National School Lunch Program (NSLP) daily, while approximately 7 million utilize the National School Breakfast Program (NSBP) daily. The public school systems have started programs that assure that each child is being fed healthy foods and that each child has the required physical activity to go along with an education. School programs that encourage physical activity are important for increasing children’s energy expenditure; because children are less likely to participate in physical activity in the absence of adult supervision (Am J Public Health. 001;91:618-620). The education and health of children are prominent considerations in the 21st century. Schools have always had a traditional focus on increasing literacy and numeracy proficiency in children, but now they are increasingly being tasked with preventing obesity as well. Regular physical activity is directly implicated in the prevention of childhood obesity; there is evidence, however, that it may also benefit cognitive development(American Journal Of Public Health, 102). Physical education (PE) in schools is an ideal vehicle by which to promote physical activity in children because it is available to all children, and teachers have the opportunity to integrate it into the overall education process (American Journal Of Public Health, 102). The public school system has a major impact on the determination of what children are exposed to. Starting the concern for kid’s health at an early age is a head start for the future. The impact on the lives of kids early may be the influence each child needs in order to make healthy decisions in the run of life. Parenting is the best prevention method that exists today for childhood obesity. Parents may miss or just don’t ever think about the actions that they perform around their kids. Children are followers, so most kids are reflections of their parents. Parents can help prevent obesity by having the knowledge of nutritional facts, by the food available in the household, by the parents’ eating habits, encouragement of activity, parents’ activity pattern, the current weight of the parent and by monitoring the time spent with the new age technology that requires little or no physical movement. Old sayings often make people believe that obesity is genetic. This is not a true statement. Every adult has control over what their physical appearance would be. Children need a good role model physically. Parents are the perfect role models for this job. Parents have the biggest and most effect on the lives of their children. Parents should be very concerned with the health of their children at a very early age. Some of the schools are now offering to the parents a few courses that are very direct about proper nutrition and exercise. Also the lunch menu for the week is sent home in advance to inform the parents of what type of foods and snacks that their children are consuming on a daily basis. People are still in belief when it comes to kids that it is ok for them to eat anything. Proper nutrition plays a very big role in the development of a child , both physical and mental. Keeping the kids in the habit of eating healthy has very great benefits in the long run. The mixture of fast food diets along with sedentary lifestyles is creating a generation of children who are facing very adult health issues like high cholesterol, diabetes and heart disease. Preventing obesity, or even slowing the dramatic rate of increase in obesity prevalence, will probably require societal changes which facilitate the modification of diet and physical activity by children and their families (Childhood Obesity: An Overview. Children & Society, 21(5), 390-396). Technology will continue to rise rapidly. Most children are more attracted to prolonged hours of sitting with some type of technology rather than to get up and be active. The society revolves around the use of technology, both mobile and stationary. Public schools are implementing new programs that will reflect the proper nutrition and exercise required for each child. Schools also have the potential to influence students’ beliefs and attitudes regarding nutrition and weight control. Parents are the best prevention method against obesity. Parents have the control over each and every cause of childhood obesity. Every child looks up to their parent and someday may want to follow in their footsteps. The result of the footsteps each child takes is heavily depended upon the parent.

Cyp3.2 1.1 - 1444 Words

It is an important part of a practitioner’s job to observe and assess children in order to establish where a child is at with regards to their development, health and well being and if they require extra support. The factors that need to be taken into account when assessing development are: * Confidentiality – Parents/carers must give consent for information to be collected and stored about their child and they should be able to access this freely. If information needed to be shared with other professionals, signed consent needs to be gained from the parent/carer with the exception of cases where it is believed a child is in immediate and significant harm. All information recorded must be securely stored so it is not freely accessible†¦show more content†¦It is important to make judgements on a child’s development in order to see if they require additional help or support. Practitioners must ensure judgements are based on actual information recorded and should also bear in mind opinions from parents/carers, colleagues, and other professionals. Practitioners may need to explain why they have formed an opinion but must be prepared to have an open mind if others disagree. For my observations I chose a child who was 14 months old. See attached appendix 1 for the observation notes. Before doing my observations I decided that I would use the narrative technique. A narrative assessment involves recording things as and when they happen in detail, over a period of between 10 and 20 minutes. I decided to use this technique as they can be used frequently without the children noticing too much. The only disadvantage could be that you may miss key observations as you are busy writing things down. From my observations I have developed a development plan. See attached appendix 2. The plan I devised was implemented straightaway. When the child next came into the setting I decided to set up a sticking activity after breakfast as I thought it would be better if the child had been fed so they would be more likely to concentrate. After breakfast the child was sat in the home