Sunday, January 26, 2020

Principles of Motivational Interviewing

Principles of Motivational Interviewing Motivational Interviewing Assignment Introduction: For the purpose of this assignement this student will identify 4 principles of Motivational Interviewing (MI) based on Miller and Rollnick’s (2002a) skilful clinical method of communication, comparing and contrasting these principles with the Digial Recording from my Laboratory work, concluding with the contribution that MI has made to the provision of nursing practice. What is Motivational Interviewing: The World Health Organisation (WHO) clearly identified Health Promotion as â€Å"†¦ the process of enabling people to increase control over, and to improve, their health†¦Ã¢â‚¬  (WHO 1986), however, there have been â€Å"feelings of frustration† recorded from primary health care workers (HCW) when interacting with patients in relation to making healthy lifestyle changes. This has been attributed in part, due to a lack of motivation in patients and therefore the patient may be adverse to change (Percival, 2013). Miller Rollnick (2002b) hope that HCW by using a collaboration of MI techniques may bring about positive change within a patient, by promoting their hopes and aspirations for the future, drawing on their tangible strengths and using motivation as the mechanism to achieve this change. Indeed, Miller and Rollnick (2002c) defined MI as: â€Å"It is a collaborative, not a prescriptive, approach, in which the counsellor evokes the person’s own intrinsic motivation and resources for change.† Principles of Motivational Interviewing: Miller Rollnick in 2002 identified a number of guiding principles for MI; expressing empathy, develop discrepancy, roll with resistance and support self-efficacy, further reviewed by Rollnick et al. (2008) and expressed using the acronym RULE: Resist the righting reflex, Understanding person’s motivation, Listen with empathy and Empower the person. To achieve success in MI using these principles, there are certain skills that must be utilised in a positive and effective outcome, for instance asking open questions, affirming the strengths of the patient and reflecting back or summing up what you have heard. Assess and critique of digital recording using identified principles: Resist the Righting Reflex: A natural and automatic reaction of the HCP is to make things â€Å"right† by fixing a problem, this stems from their training and experience in healthcare. Through the role play I feel that I spent too long trying to redirect the patient back to the topic of smoking, wanted to right the situation and I wouldn’t take verbal and nonverbal cues that the patient did not want to talk about smoking at that given time, it seemed to me that she had a greater desire to vent her feelings about her current marital situation including the recent infidelity, from a biopsychosocial perspective this was central to her recovery, and yet I returned on a number of occasions to the question of smoking albeit in a covert manner. The patient was in a state of pre-contemplation (Prochaska and DiClemente 1986), whereby she didn’t want to engage in any confrontational situation, believing that she did not need to change her habits regarding smoking, upon reflection the patient appeared pressured to into accepting change which further exacerbated her lack of desire to change. It appears that there was an increase in persistent resistance from the patient, which was as a direct outcome of me reverting back to the issue of smoking, therefore it is probable to say that in this scenario as a result of my desire to â€Å"right† the situation, I in fact made it worse, creating an underlying tension which was not beneficial for the patient’s recovery. I feel that a better approach would have been to gently broach the subject, with an understanding and acceptance that this was not the right time to discuss smoking cessation as the patient had other ongoing stressors. If by looking at and talking with the patient about her current biopsychosocial and socioecological stressors, I may have developed greater insight into what exactly may motivate this patient, therefore giving me clearer collateral to help develop my objective of discussing smoking cessation. Exploring and understanding the individual’s motivation: The patients own motives for change are more often than not prone to initiating change, however, in this scenario there was no indication that the patient was voicing any indicators that they wanted to change their smoking habbit, yes, she had mentioned that she had given up in the past and though I tried to develop that area it was met with resistence. Instead of trying to reason why this person isn’t motivated, I should have looked at what it is exactly that motivates her, irrespective of her current situation. There was scope to develop this as the patient showed great concern for her children, a key discrepancy in her concerns and her current smoking habit, this is a focal point that I should and could have developed further. In her current situation the patients confidence appeared to be extremely low, however I could have measured a true subjective rating in her confidence level by asking her a simple rating question â€Å"to rate from 0-10 how ready are you†¦Ã¢â‚¬ . This would have given me a springboard on which to probe for further motivational factors. Again by asking simple open ended questions such as: â€Å"what do you want to achieve? or how important is this for you?† it would have given greater insight into what motivates the patient by denoting what their goals are. As such, my focus was to talk about smoking cessation and unfortunately I didn’t pay much attention to signals; identifying what interests and concerns the patient was currently experiencing. There were small marked areas of ambivalence, which some (Mill Red 2008) regard as normal in MI and it was apparent at this time that the cons to giving up smoking outweighed the pros thus the patient appears to be somewhat unmotivated. Listening with empathy Empathy entails the HCP to listen to and engage with the patient in a non-judgmental manner. I expressed an understanding of how personal this experience was for the patient asking them to focus on their own issues and recovery, it could have been very easy for me to have been blasà © about the circumstances leading up to the admission, accepting what the patient was telling me in a non judgmental way. Giving a summary reflection, I paraphrased what the patient had told be asking for affirmation that I had an understanding of the current situation, which helped me to contextualise and use the patients own frame of reference. I listened for ‘change talk†, but couldn’t identify any desire, ability, reasons, need, commitment or taking steps towards instigating change, therefore the patient may not have been ready to engage in MI, however, it was a brief encounter of 5 minutes, giving me good insight into the patients current situation. The patient may not have been able to articulate their true convictions because of fear, lack of cognizance or increased anx iety due to her physical ill health and also the far reaching impact of her partner’s infidelity. Upon reflection my opening of â€Å"tell me about your problem† was poor and should have been more open and empathetic could have been more, I should have used â€Å"tell me about it† I felt that I displayed some very good attributes to listening empathetically; my body language and posture were open, engaging and receptive. I was non-confrontational or judgemental and verbally exhibited this through an appropriate use of tone and pitch, however, as mentioned earlier, I missed some important cues and felt that I didn’t ‘roll with resistance’, though it must be noted that working in a psychiatric environment there are less time constraints and more opportunities to develop an augmented MI working relationship with a patient. Empower the patient: Erickson et al. (2005) deemed that a person can increase their belief in the probability of change based on their ‘past successes’, so by focusing on the patient’s strengths and allowing them to achieve their own goal(s) the HCP can give the responsibility, ownership and control of choices back to the patient. It is within this stage that the HCP has to be a facilitator and motivator to the patient. Again the use of ‘scale questions’ can be very beneficial to the patient allowing them to rate how they perceive their situation allowing them to focus on their skills and strengths. As with all interventions in nursing, the skillset is with the clinician and MI can only work effectively if used correctly. Throughout the role play there were a number of positive example of where I was empowering the patient, starting with â€Å"I am not hear to lecture or preach to you, just to talk to you†¦Ã¢â‚¬  this I felt set expectations with the patient though it could have been more specific to smoking cessation. Focusing on strengths and positives; I asked â€Å"what did you do before to give†¦Ã¢â‚¬  showing the patient that they have succeeded in stopping smoking in the past. The patient expressed concerns about intrinsic family issues, though acknowledging that these are important, I advised the patient to focus and ‘concentrate on themselves in the here and now’. There were a number of pitfalls that I should have avoided such as using technical terms ‘psychosocial/biopsychosocial’ as the patient may not have understood what I meant, I should have kept it short and simple, mirroring the language used by the patient. Another area that should have been avoided was when I asked â€Å"when did you start smoking again? I know you don’t want to talk about it but..† as I feel that this reaffirmed a negative with the patient, contrasting strongly with the strengths and positives previously identified. Patients’ own arguments for change can be more persuasive than any arguments that an HCP may put forward, but it must be noted. Concentrate on the here and now†¦ It is fundamental that the HCP engages with the client in an open, non-confrontational manner with the HCP not falling into the trap of being the expert trying to assess the patient, apportioning blame or having preconceived ideas/beliefs regarding the patient. Conclusion: The Contribution that MI has mad to Nursing Practice. MI by the virtue of its patient centredness, MI affords itself to be used in a wide array of clinical settings through the use of interpersonal relationship (Rollnick and Miller 1995) allowing healthcare providers to be at one with the patient (Sobell Sobell 1993). There have been, in excess of 200 Randomised clinical trials validating the efficacy of MI in a wider cohort of nursing interventions (REF). It appears from the research that there are more studies needed to validate the true clinical efficacy of MI, however, MI has been used successfully in a multiplicity of settings from from smoking/alcohol cessation, improved efficacy in medication adherence, clients with Cancer (Thomas et al. 2012) HIV, weight management, indeed MI could and should be used all encounters between HCP and patients. The UK’s National Health Servce is rolling out a programme through all sectors about making every encounter count† which has its basis in MI. The WHO actively encourages the use of MI for those working on a quit lines when used in combination with theoretical approaches (WHO, 2014). Talking therapies have been complimented by the symbiotic use of MI in the promotion of health and as such must be embraced across all segments of the health sector, affording self-efficacy in positive outcomes for the patient. References: Mill Red 2008) Erickson, S. J.,Gerstle, M., Feldstein, S.W. (2005). Brief interventions and motivational interviewing with children, adolescents and their parents in paediatric health care settings. Archives of Paediatric and Adolescent Medicine, 159, 1173–1180 Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11, 147–172. Miller W.R. (1995) Motivational Enhancement Therapy with Drug Abusers http://motivationalinterview.org/Documents/METDrugAbuse.PDF(Accessed 13/10/2014) Miller W, Rollnick S (2010) What’s New Since MI-2, 2’nd International Conference on Motivational Interviewing, Stockholm, Sweden. (Last accessed: 14/10/2014) http://www.motivationalinterview.org/Documents/Miller-and-Rollnick-june6-pre-conference-workshop.pdf Miller, W. Rollnick S. (2002a pg. 41) Motivational Interviewing: Preparing People for Change, 2nd edn. Guilford Press, New York Miller, W. and Rollnick, S. (2002b) Motivational Interviewing: Preparing People for Change, 2nd edn. Pg 22 New York; The Guilford Press Miller, W. and Rollnick, S. (2002c pg.41) Motivational Interviewing: Preparing People for Change, 2nd edn. New York; The Guilford Press. Moyers, T. Rollnick S. (2002) A motivational interviewing perspective on resistance in psychotherapy. Psychotherapy in Practice 58, 185–193. Percival, J. (2013) Healthy lifestyle changes – getting beyond the ‘difficult’ conversationNovember 2013 | Volume 23 | Number 9 RCN London Prochaska J.O, DiClemente C.C (1986) Towards a comprehensive model of change. In Miller WR, Heather N (Eds) Treating Addictive Behaviors: Processes of Change. Plenum Press, New York NY, 3-27. Rogers C. (1951) Client-Centered Therapy. Houghton-Mifflin, Boston, MA. Rollnick, S. Miller, W. and Butler, C. (2008) Motivational Interviewing in Health Care. London; The Guilford Press. Sobell M.B. Sobell L.C. (1993) ProblemDrinkers. Guilford Press, New York. Thomas, M.L. (2012), Elliott, J.L., Rao, S.M. Fahey, K.F. Paul, S.P Miaskowski, C. A Randomized, Clinical Trial of Education or Motivational-Interviewing–Based Coaching Compared to Usual Care to Improve Cancer Pain Management: Vol. 39, No. 1, January 2012 Oncology Nursing Forum White, W.L. Miller, W.R. (2007) The use of confrontation in addiction treatment: history, sciences and time for change. Counsellor 8, 12–30. WHO (2009) Milestones in Health Promotion, Statements from Global Conferences. Accessed 17/10/2014 /http://www.who.int/healthpromotion/Milestones_Health_Promotion_05022010.pdf?ua=1 WHO (2014) Training for tobacco quit line counsellors: telephone counselling. WHO, Geneva. 1

Saturday, January 18, 2020

The Philippine Educational System

Two major subsystems – formal and non-formal. The Philippine educational system is composed of two major subsystems: the formal and the non-formal. The formal subsystem consists of sequential academic schooling at three levels. The first two levels are referred to as the basic education level, consisting of six years of primary or elementary education and four years of high school or secondary education. Basic education is intended to provide functional, scientific and social literacy. The Philippine government, through its public schools and the voucher system, provides free education for children up to the secondary level.The post-secondary and tertiary levels include one to three years of technical/vocational education and degree courses requiring a minimum of four years of college/university education. The three levels of schooling just described focus for the most part on providing academic training and scholastic competence. Any organized and systematic learning conducte d outside the formal educational system, whether providing certification or not, is referred to in the Philippines as non-formal education.Non-formal education addresses the needs of those who are not able to participate in the formal subsystem, most of whom may have dropped out of the formal system due to poverty. The organization, specific activities, and delivery methods associated with non-formal education are usually designed to meet the expressed needs of distinct clientele, such as primary and high school drop-outs, unemployed adults, and other marginal, dislocated, or disabled groups.Institutionalized in 1977 with the creation of the Office of the Undersecretary for Non-Formal Education under the former Ministry of Education, Culture and Sports, the non-formal education program is still provided separately and apart from the formal system. Efforts are being made to provide clear entry points to higher levels of formal education through a system of equivalency and certificati on.However, since the system is not yet fully operational, the non-formal education program appears to mainly concentrate on providing participants with skills necessary for employability and competitiveness in the labor market. The availability of non-formal education, however, is useful in that it expands a window of opportunities for education to more citizens from a variety of demographic characteristics, socio-economic origins, and general interests (DECS, 1994).The non-formal system makes education available to a larger number of Filipinos who cannot participate in formal educational programs. Government's support for and involvement in non-formal education notwithstanding, it must be recognized that the stronger advocacy for and more active implementation of the program in the Philippines could be attributed to private schools, churches, civic organizations, and foundations (Congressional Commission on Education, 1991).Private groups conduct activities ranging from providing basic-level skills training to values formation. The delivery vehicles of these activities include seminars and workshops, community assemblies, television and radio programs, correspondence courses, home visits, self-directed learning modules, and practical work. The curricular designs of the various programs vary from one implementing agency to another, and are tailor-fit to the needs of specific clientele (Gonzales and Pijano, 1997).At present, non-formal education in the Philippines has four main thrusts: develop family life skills, including health, nutrition, childcare, household management, and family planning; promote vocational skills; enhance functional literacy; and cultivate livelihood skills. Gonzales and Pijano (1997) note that given the dichotomy of the Philippine educational system, a subsystem of lifelong learning must perforce lean heavily on and draw services from both the formal and informal sub-systems.They add, however, that the current subsystems still do not reflect the significant and important â€Å"informal† attributes of lifelong learning. Recent developments in the national educational system. In 1994, the Philippine educational system was restructured in an attempt to rationalize and improve the provision of learning opportunities. The system currently has three subdivisions, namely: basic education; technical-vocational education and training; and higher education.

Friday, January 10, 2020

Only Child or With Siblings Essay

Being an only child or living with siblings†¦ what’s better? Let’s talk about the positive and negative aspects. Being an only child can be positive because you have all the attention of your parents only for you, parents do everything for you. You get the best education, the best toys, trips and parents have more money to spend on you. You don’t have to share anything. Likewise, you don’t have to fight for your room, food, gifts and for your parents love. There is nothing to feel jealous about or to compete for. Not only that, but you have more friends and become more resourceful and creative at the time of playing. In spite of, being an only child can make you selfish and feel you are the most important person because you are used to all the attention at home. When you are an only child parents tend to be overprotective and expect the best from you always. Moreover, only child can sometimes feel lonely and bored. On the other hand having siblings has some advantages. First of all, there are many members in the family to be around with, play, eat and at the end of the day there is always someone to talk with. In addition, whenever you have a difficulty there is always a sibling who would defend you. Besides when you live with siblings you can borrow things and learn to get along with others in a better way, practice the values of sharing, tolerance, love and caring. In contrast to this, there are also disadvantages in having siblings; most of the time there is no privacy for you. You must share your room, toys, clothes and food because it is very expensive to raise many children at the same time. Furthermore, child with other siblings spend most of the time fighting and arguing. Besides, when parents have more than one child the responsibility is bigger and they are always tired. However, being and only child or not as long as you have a family that takes care of you and loves you is what matters the most. Krizia Gomez

Thursday, January 2, 2020

Business Plan on Ethics Program

Introduction Because of the increased scrutiny on the actions of corporations and those who act on behalf of organizations, there has been increased attention placed on the ethical actions within organizations. Many organizations have responded to this increased scrutiny by establishing formal ethics programs to address what are appropriate actions for those working for the company. There are several components of an ethical program; they include code of ethics, code of conduct, statement of values etc. this article will explore an ethical program with a bias on code of ethics. A code of ethics is the most comprehensive of all ethical programs. It consists of general statements that are an inspiration and serve as the basis of rules of conduct. It specifies modes of reporting violations, disciplinary action and the structure of the due process. It may also be defined as a statement of the values adopted by the company, its employees and its directors. It is also a part of a broader, ongoing program to provide guidance for ethical decision making and to prevent misconduct. These broader programs must be actively managed and should include training for employees and directors, monitoring of compliance and regular report to the board. There are many formats and approaches in developing a code of ethics. It requires one to take an examination to help determine the key purpose you would like your code of ethics to fulfill, either you want it to focus on specific conduct concerning certain individuals or more general standards and also how the code will operate amid the existing policies for board members and staff. It is also important to determine who will participate in drafting the code. Ethics taskforce or committee that includes primary staff representatives is one of the approaches to consider. Key areas to include in creating a code of ethics One of the key areas to include when creating a code of ethics is the purpose and the values of the business. This includes the service being offered, the group of products or set of services, financial goal of the business and the role in society as the company see s it. The key area in this company will be to provide consultancy services to nongovernmental organizations. Employees are another very sensitive area that should be included in the code of ethics pertaining the business. The company should value employees, their working conditions, recruitment, health, rewards, training and development, equal opportunities, retirement, diversity harassment and discrimination as indicated in the company’s policies ( Peter,1997) Customers’ relation is something else to include in the creation of the code of ethics. The importance of satisfying customers and having good faith in all agreements, fair pricing, and quality and after sales services should be encouraged and maintained in the company. Shareholders and other providers of money in the company should be aware of all activities being undertaken by the company. The company should protect investment made and advance good returns on money lent. Also communicating on time and committing to accuracy of prospects and achievements is a key area of ethics. Other players that must also be considered in developing the ethics program are the supplier .Efforts should be made to ensure that suppliers are paid in time, for the company to achieve quality and efficiency. Excess hospitality and bribery should not be given. It should be the aim of the company to protect and preserve the environment. The company should also consider implementation of codes issued, assurance and reporting reviews. Basically, a code of ethics should attempt to achieve the following; trustworthiness, respect, responsibility, fairness, care and citizenship. Codes of ethics may not be effective if the distribution, training and support of management is not incorporated into the corporate culture. Developing an appropriate ethics training program In this challenging business environment of the 21st century, ethics in business is widely discussed but misunderstood in most cases. News on corruptions scandals in the corporate world have permeated the internet and television news, creating amazing headlines and sending heads wagging at the high degree of dishonest of business executives. This has been as a result of the lack of an appropriate ethics program. Business ethics training for employees has to include all aspects of conducting ourselves ethically in a business environment. The first and the most effective way of training business ethics is to lead by example. Training won’t mean formal classroom learning but also can be conducted in the conference rooms and in the hallways while employees go on with their duties. Leaders in the company have to show their employees that it is possible to be successful in maintaining high standards of ethics (Brakel, 2007). When a leader in a company sets an appropriate example, the employees are more willing to participate in training. Employees that witness their managers, supervisors or company owners conducting themselves in an unethical manner will not see the relevance of training and may brand it hypocritical. Business training shouldn’t cover the obvious such as concealing products flaws or falsifying records but should also touch everyday seemingly mundane topics such as inappropriate conversation about offensive emails and workers. It should be conducted over a period of a couple weeks or months and repeated throughout the year. It should not be a one hour topic and then forgotten until recruitment of new workers but should be an everyday activity all year round. An ethics training program should address a number of factors as explained below. it should help employees identify the ethical dimensions in business decisions. This means that the ethical training program should be geared towards assisting employees to understand the ethical aspects of the business decisions that they make. This is important in improving ethics in an organization. An ethical training program should also be geared towards addressing the complexity of ethical issues. A training program should assist employees to understand that ethics are very much intertwined with the success of the business in general and thus ethics should be taken very seriously in the conduct of everyday business. Dag asserts that an ethics training program should stress the fact that no unethical behavior is justifiable by emphasizing that; Whether discovered or not, unethical behavior cannot be justified; Unethical behavior is never for the best interest of the company; The firm is responsible for all the unethical behavior displayed by its employees and this calls for high standards of ethics in the organization; A system of monitoring, assessment, audit and reporting of misconduct; Auditors are very good for the assessment of control activities-the procedure, policies and aggregation of duties that exist. Auditors are very reluctant in assessing the control environment including criticizing management philosophy, attitude, styles of operational and competency when necessary. Most of the major frauds can be traced to the lack of efficient control environment but not the lack of control activities. Organizations fall when management overrides the system of control. Auditor’s ethics are quite as important as the management ethics. The basics of our profession should not be forgotten which is a serious problem affecting the credibility and accountability of any profession. It is quite easy to think of asset in terms of bits and bytes on a computer failing to verify the existence of an asset that has been at the heart of many frauds that auditors missed. In today’s business environment with color copiers, scanners, color printers and access to corporate logos on the net, it is even easier for the manufacture of a document. Companies external auditors should conduct an annual review in accordance with the audit plan of the companies material internal control effectiveness and management. Any failure in internal control or material non-compliance and recommendations for any improvement should be reported to the management. The auditor should review the effectiveness of the taken action by management and the recommendation made by the external auditors in this respect. Risk management and processes and management systems of internal controls in the company should be designed to manage rather than eliminate the risk of failure to achieve the company’s strategic objective. Developing a plan to review and improve the ethics program overtime Ethical behavior, integrity and honesty are issues that senior executives mostly identify as top priorities on their companies agenda. However the mere presence of codes of conducts, publicized reporting systems ensure a company has eliminated an environment that allows or encourages unethical misconduct. This is absolutely true when one is in constant pressure to perform and meet objectives for short term obligations are driving the employee’s behavior. Depending on the size of the company, it faces different compliances risk .It is very possible to identify which compliance risk are of greater concern by reviewing training courses which employers are most frequently required to complete. The company should explore all aspects of a decision and weigh the option surrounding the courses of action. To make everyone’s performance as individual or teams much easier sharing of business ethics and values should be practiced. Employees actually should know what they can do and what they can’t. Communicating business ethics within the vales statement is the first place to begin.Commmiting business ethics and values to writing and making sure that everybody is actively engaged in modeling the desired behavior. Procedures should be analyzed and policies reviewed to ensure that these same policies. Conclusion Ethics are critical to the success of an organization in modern times. An ethics program outlines the major ethical issues facing an organization and the organizational efforts to maintain a good ethical relationship with other stakeholders. An effective ethics program should thus be geared towards the attainment of fruitful results for the organizations long term survival. References Brakel, A (2007). The Moral Standard of a Company: Performing the Norms of Corporate Codes. International Journal of Business Governance and Ethics 3 (1):95-10 Dag G. A (2004). Ethics behind â€Å"Business Ethics†. Journal of Business Ethics 53 (1-2):3-8. Peter W. D. (1997) Issues in business ethics: Rutledge