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Term Papers Vs Research Papers

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The career fair and emerging pop stars The MIT Career Fair was last Thursday, when three hundred companies set-up booths in our athletic facility to try to recruit MIT students. While the fair was specifically tailored to graduating seniors looking for full-time jobs, underclassmen also attended to try to secure summer internships as well. It was quite a spectacle, as 3500 MIT students and alumni, armed with power suits, gold Brass Rats, and stellar resumes, made their way through the maze of prospective employers. Some were looking for a career; others had their sights on the free goodies (ranging from t-shirts to USB drives to hot-pepper sauce.) My favorite Career Fair activity has always been the dinner banquet, organized by the Society for Women Engineers (SWE). From 6 â€" 8 pm, some MIT undergrads had the opportunity to network with company representatives over a wonderful buffet dinner. It was a very intimate setting and an extraordinary opportunity to really get to know about a company. I was seated at a table with three other upperclassmen and five employees of Ethicon Endo-surgery, a medical devices company. We learned all about the structure of the company, previous intern’s projects, life in Cincinnati, the product design process, what life after MIT is like, and more! - Oh, and I must mention this… On Friday night, I had the pleasure of attending Zeta Beta Tau’s semi-annual dessert soiree. Not only did I get to consume dozens of scrumptious chocolate-covered bits of heaven, but I also had the privilege of watching Bryan’s stunning karaoke rendition of *NSYNC’s classic, “Bye Bye Bye.” Yes, the same Bryan that does tissue engineering research in the lab of a certified genius also serenades unsuspecting audience members.

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Personal Philosophy My Philosophy - 1257 Words

Personal Philosophy My nursing philosophy is helping people in terms of humanistic care, that I discovered it when I was a fourth year nursing student. From my philosophy, I desired to be a family and community health nurse. Since I became a nursing student, I never considered that I needed to have a nursing philosophy to navigate my career. I practiced in hospitals about three years, which I got both negative and positive experiences. In particular, I figured out that working in hospitals persuade me to be a robot. There are three reasons that I discovered that I should not work in the hospitals. Firstly, I spent all my working time to do merely routine jobs, without any creative activities or critical thinking. A large number of patients in my responsibilities and timetable controlled me. Secondly, when I saw patients pass away in front of me, I had no emotional response any longer. I felt that it is a normal phenomenon. Thirdly, it is worse when I imagine that I have to spend more than 50% of my life, holding crying people, ill people, and patients at the end stage of life. I ask myself repeatedly what I want to be. I found my answer that I want to be a nurse who cares people with humanistic care. Metaparadigm of Nursing My metaparadigm of nursing addresses four concepts: person, environment, health, and nursing. Concept definitions are as follows. Person A person in my philosophy is a client because some people are healthy one that should not call them asShow MoreRelatedMy Personal Philosophy Of Philosophy968 Words   |  4 Pagesway of thinking and reasoning. In my studies I have learned that philosophy is the study of knowledge, reality, and human existence. Socrates once said, â€Å"The unexamined life is not worth living.† I agree with this statement, because I believe any intellectual person must question the world around them. Questioning different aspects of life is a vital way to gain knowledge. During my search for knowledge, I began to develop my own personal philosophy. Our philosophies are largely based off of our perceptionsRead MoreMy Personal Philosophy Of Philosophy902 Words   |  4 PagesStatement of Philosophy My personal philosophy its important for me that I stay true to my personal, moral and ethical values that has followed me throughout my life. The American Nursing Association stats â€Å" The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence and to continue personal and professional growth†. (American Nurse Association, 2011, p. 7) Jean Watson says that nursing should be â€Å"concerned with theRead MoreMy Philosophy : My Personal Philosophy958 Words   |  4 Pagesâ€Æ' My philosophy is to do something I love. I realized that teaching was my passion by experiencing many other things that weren’t. I tried to immerse myself in other topics, such as business but it just did not feel right to me. By pursing education I can do something I love every day. I believe it is very important to have a strong passion and knowledge in the field you choose to follow. From my past experiences, to educate one another, one must have a strong backbone so the students know whatRead MoreMy Personal Philosophy : My Philosophy2538 Words   |  11 Pageswould treat all of my stuffed animals with various cuts or â€Å"boo boos†. However, this dream I had continued to stay with me as I grew older, but the complexity of my dream began to change. I still had the mentality of wanting to heal others, but the reasons behind it began to develop and this can be shown through my personal philosophy. Defining my personal philosophy begins with incorporating my prof essional philosophy. I believe that my personal and professional philosophy is congruent in thatRead MoreMy Philosophy : My Personal Philosophy929 Words   |  4 PagesMy Personal Philosophy My whole life I have wanted to teach. Ever since watching my kindergarten teacher write on the chalk board, create fun activities, and grade papers I knew I wanted to teach. My motives have changed since that time in my life. I want to teach because it brings me a sense of accomplishment and satisfaction when I know I am helping another person grow intellectually and as a person. Whether it s inside or outside of the classroom, I will try my best to help my students succeedRead MoreMy Personal Philosophy : My Philosophy Of Philosophy1339 Words   |  6 PagesI am a philosopher: always have been, always will be. The moment I stop questioning the world that we currently reside in, I would cease to follow my inquisitive qualities. While there are moments when I accept things for what they truly are, I’m often caught in the act of trying to piece together the world and its elements. Christ has called me to live a unique life. A life where I am told to have a certain type of fait h while maintaining an eternal ideology. How this all works in the end, I cannotRead MoreMy Philosophy And Philosophy Of Personal Educational Philosophy1042 Words   |  5 PagesIt is true that many educators do not know what their educational philosophy is. However it is imperative for educators and future educators to know their personal educational philosophies so that they can be accountable, explain how they teach, what they are doing and why. My personal Educational philosophy is made up of four components; metaphysics, epistemology, axiology, and logic. My educational Philosophy Metaphysics (reality) is a combination of realism and idealism, that the mind, spiritRead MoreMy Personal Philosophy : My Educational Philosophy1747 Words   |  7 PagesAbstract My educational philosophy can be summarized in one word â€Å"family†. Every thing can begin and end with the family. This paper examines my personal belief that a student has higher success rate in life when they have a supportive, loving family environment. The primary roles of a mother and father in today’s society are drastically lacking. These particular reasons vary from absentee fathers, overworked single mom, and/or grandparents having to assume the role of parents again. My theory startingRead MoreMy Personal Philosophy : My Philosophy Of Education1046 Words   |  5 Pagesmanipulate the information for their own use in the future. Choosing between the four, I would say my philosophical views line up more as an essentialist. My philosophy of education, is that every teacher and student has an environment where they are challenged, yet still encouraged, in their instructional matter and teaching and learning strategies to prepare them to meet the goals set upon them. A philosophy is a search for wisdom in a particular area; it builds a framework of thinking, and guides instructionalRead MorePersonal Philosophy : My Educational Philosophy1452 Words   |  6 Pages When I first set out to write my educational philosophy, I had absolutely no idea what to write about, to be perfectly honest. So, I thought that I would start with the most essential aspect of an educational philosophy: why do I want to become a teacher? The reason why I want to teach is because I want to be able to impact young people’s lives and help them to learn how to become successful citizens in our world. I feel that it is important that no matter what students do with their lives, they

Novel Object Recognition Test Free Essays

The novel object recognition (NOR) test was used to determine working and spatial memory. In this study 75cm Ãâ€" 50cm Ãâ€" 30cm transparent box was used. Three days prior to the habituation sessions, the rats were exposed to the box to familiarize with the environment. We will write a custom essay sample on Novel Object Recognition Test or any similar topic only for you Order Now On the test day, they were exposed to identical objects to acclimatize with for 5min thereafter, the rats were then returned into their home cage with food and water. Thirty minutes later, the probe test was conducted, each rat was placed inside the box with one of the object replaced by a novel one for 5 min. It is important that (a) the objects have a â€Å"neutral† shape in terms of its significance to the animal, (b) be devoid of any marked characteristics, such as odor and movement, for instance (Li et al., 2011). The total time spent exploring the two objects was recorded. â€Å"Object exploration† is defined as directing the nose and vibrissae to the object at a distance of less than 2 cm, as if â€Å"smelling† it with caution, while bumping, turning around or sitting upon the object were not considered. Discrimination ratio, which is the difference in exploration time, expressed as the ratio of total exploration time with both objects in the choice phase (this ratio allows to adjust for individual or group differences in the total amount of exploration time) was calculated as percentage memory index as shown below: Time spent with new object X 100 Memory index (%) = Total time spent with both old and new object (Ogundele et al., 2014). Morris Water Maze The Morris water maze (MWM) is another apparatus designed to examine the memory impairment in rodents, thus it is highly specific for hippocampal function. This study was carried out as earlier described by Barnhart et al (2015). Each trial began by placing the rat on the platform for 20 s in a bid to allow orientation to extramaze cues found around the apparatus. After orientation, rats were gently lowered into the pool by facing the wall at one of 3 positions (i.e., each at the center of the wall of a different quadrant not housing the platform). After the rat was released into the pool, the observer had to retreat away from the pool to a constant position within the room, such that he served as an additional distal visual cue. Maximum swim time was set at 60 s. Any rat that locates the platform before 60 s was removed from the pool immediately, while the rats that are unable to locate the platform after 60 s of swimming were gently guided to the platform and allowed to re-orient to the distal visual cues for an additional 20 s before being eventually removed from the pool. After removal from the pool, each rat was manually dried with a terrycloth towel and placed in a plastic cage with wood shavings for at least 5 min before returning to the home cage. Each rat was trained twice a day for 2 days with an inter-trial interval of approximately 30 min. Training was conducted at roughly the same time every day in bid to minimize variability in performance due to time of day (Morris, 1984). To examine spatial reference memory, a probe test was administered 24 h after the last training session. During the probe test, the platform was removed from the pool and the rat was allowed to swim freely for 1 min. The rationale of this task was to determine number of time the initial location of the platform was crossed/visited. How to cite Novel Object Recognition Test, Papers

The Law Enforcement Profession Essay Example For Students

The Law Enforcement Profession Essay The Law Enforcement ProfessionAbstractIn order to understand comptemporary law enforcemment, we shouldrecognize the conditions that impact our profession. It is agreed upon by manyscholars that major changes in law enforcement occur every five years. Policingis sometimes characterize like a sandbar in a river, subject to beingchanged continuously by the currents in which it is immersed (Swanson,Territo and Taylor, p. 2). However, in recent years some major changes haveoccurred in a shorter time period. Innovations in law enforcementDuring the past two decades, I have observed major changes in theviewpoint of society towards police officers as the symbol of trust and dignity,the technological advances of communication and information systems in lawenforcement, and the revision of selection and hiring practices for policeofficers. Organizational change occurs both as a result of internal andexternal agents (Swanson, Territo and Taylor, p. 664). These changes havemanifested both positive and negative reverberations in the way we perform ourjob. We will write a custom essay on The Law Enforcement Profession specifically for you for only $16.38 $13.9/page Order now Police officials have contemplated for years over the key to maintaininga positive image for their organization. Unfortunately, several incidents inthe past years have altered societys perception of police in some communities. Police in America are no longer strangers to innovation born of scandal. Lawenforcement agencies nationwide have repeatedly been shaken by controversy andforced to make undesirable concessions. Has law enforcement failed to maintainthe high standards required by the profession? The cost of public trust is high. It increases each time faith must be regain. Historically, law enforcement agencies throughout the nation haveexperienced periods of low confidence in communities preceding episodes deemedto be a breach of trust. Early pioneers in law enforcement history such asAugust Vollmer (1902 1932). Berkeley Police Department and J. Edgar Hoover(1924) the Federal Bureau of Investigation made numerous advancements towardsimproving the professionalism of law enforcement (Anderson and Newman, p. 119 120). Other attempts were made in 1956 by the International Association ofChiefs of Police adopted The Law Enforcement Code Of Ethics (Wilson andMcClaren, p.8)Examples of several historical events locally have attributed tosocietys decline in respect for police. For example, nine members of a LosAngeles County Sheriffs Department special narcotics squad were charged withmisappropriating tens of thousands of dollars confiscated in drug raids (L. A. Times, p. 4, Sept. 9, 1989). Another local incident involved 80 Los Angelespolice officers stormed and wrecked an apartment and allegedly beat severalresidents on Dalton Street. The city was forced to settled in a civil lawsuit by the resident with a settlement of $3 million dollars of taxpayers money(L. A. Times, p. 1-2, August 1, 1988). This incident generated major outcryfrom the minority community to overhaul the use of force policy and procedurewithin the department. Nationally, five New York City police officers were charged with murderin the slaying of a suspect in Queens. All five officers were arraigned onmurder charges in the death of Federico Pereira, 21 years of age, a car theftsuspect who was punched, kicked, and strangled as he was being arrested. Thisis one in a string of accusations of bruality made against New York officers inrecent years (The New York Times, March 21, 1991, p. A 1). In the south,the incident of Officer Donald Jeffries who was honored as Mississippis officerof the year in 1993. He alleged that mental stress was a factor in his robberyof a bank, however, a federal judge in Mobile ruled that he was competent tostand trial for the charge (USA Today, May 13, 1994, p. 8 A). .uaaaa3760c70f4f99bbd9157878216d97 , .uaaaa3760c70f4f99bbd9157878216d97 .postImageUrl , .uaaaa3760c70f4f99bbd9157878216d97 .centered-text-area { min-height: 80px; position: relative; } .uaaaa3760c70f4f99bbd9157878216d97 , .uaaaa3760c70f4f99bbd9157878216d97:hover , .uaaaa3760c70f4f99bbd9157878216d97:visited , .uaaaa3760c70f4f99bbd9157878216d97:active { border:0!important; } .uaaaa3760c70f4f99bbd9157878216d97 .clearfix:after { content: ""; display: table; clear: both; } .uaaaa3760c70f4f99bbd9157878216d97 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .uaaaa3760c70f4f99bbd9157878216d97:active , .uaaaa3760c70f4f99bbd9157878216d97:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .uaaaa3760c70f4f99bbd9157878216d97 .centered-text-area { width: 100%; position: relative ; } .uaaaa3760c70f4f99bbd9157878216d97 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .uaaaa3760c70f4f99bbd9157878216d97 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .uaaaa3760c70f4f99bbd9157878216d97 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .uaaaa3760c70f4f99bbd9157878216d97:hover .ctaButton { background-color: #34495E!important; } .uaaaa3760c70f4f99bbd9157878216d97 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .uaaaa3760c70f4f99bbd9157878216d97 .uaaaa3760c70f4f99bbd9157878216d97-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .uaaaa3760c70f4f99bbd9157878216d97:after { content: ""; display: block; clear: both; } READ: Jimmy Carter EssayThe case of Arthur McDuffie (Dec. 17, 1979) in Miami, a black maledied after a high speed police chase. The police reports indicated thatMcDuffie died from being thrown from his motorcycle during the chase. Theresults of an investigation disclosed that the McDuffies death may have beencaused by police instead of an accident. After being indicted and found notguilty by an all white jury, riots broke out in black neighborhoods,especially Liberty City resulting in arson and looting that left 18 persons deadand more than 300 injured. This catastrophe forced the Miami PoliceDepartment to reexamine and revise their use of force policies and procedures(CQ Resear cher, p. 645). The Jeffrey L. Dahmer Case characterize a situation when the police failto properly handle a call of a suspicous nature. Dahmer was charged withmurdering at least 15 young males. On May 27, 1993, two Milwaukee citizensreported a naked young male in the middle of the street bleeding and unable tostand. The boy name was Konerak Sinthasomphone, a 14 year of laotain boy. Dahmer was able to persuade the officer that the boy was a live in lover. Theboy was later slain by Dahmer in his apartment after the officers left the scene. A storm of portest came from the minority and homosexual communities accusedthe officers of displaying racial prejudice. The officers were also criticizedfor dismissing the incident as a boyfriend-boyfriend thing (CQ Researcher, p. 637). One of the most celebrated cases in recent times was the beating of ablack motorist by several white police officers in Los Angeles. It stirrednationwide concern about police brutality. On March 3, 1991, Rodney Glen King,25 years of age, was severely beaten by Los Angeles police officers after beingstopped at the termination of a vehicle pursuit, which was originally started bythe California Highway Patrol. A videotape of the incident is shown repeatedlyon television over the next few days. The aftermath of the trial that acquittedthe officers involved in the Rodney King beating speaks highly of the sentimentfelt in the minority community (ICLAPD, p. 14-15). Another discouraging sign that little has changed is the continuingpattern of police abuse. Most recently on July 29, 1994 Compton Police OfficerMichael Jackson was captured on videotape striking a 17 year old male in thehead with his baton. This scene did not win sentiment from the public norrevitalize the compassion felt by many after the Rodney King incident. Whilethis incident appears unjustified and even later deemed to be justified, itwill not help the image of law enforcement. Some citizens truly believe the police represent the wealthy and not thepoor. Two researchers Geoffery P. Alpert and Roger G. Durham (1988) examineddifferent ethics diversed communities in Miami. There, they discovered muchmore negative and suspicious attitudes toward the police and regard them asrepresentatives of the majority class, not agents of social control (CQResearcher, p. 650). The media have also contributed to the fracturing byplaying up dfferences and tensions. As citizens spend more time working with the police, they learn moreabout the police function. Experience has shown that as citizens knowledge ofthe police increases, their respect for the police increases as well. Thisincreased respect, in turn, leads to greater support for the police. Theimage of the police might benefit from the implementation of Community-InvolvedPrograms in todays organizations. The Los Angeles Police Department and manyother agencies are exploring Community-Based Policing to help heal the woundsleft by conduct perceived by the public as police brutality (Los Angeles Times,April 17, 1994). Police administrators must be aware of public opinionbecause Public confidence in a police department is directly related to theimage that citizens have of their police, and these images are formed from theimpressions people gain about law enforcement (Earle, p. 20). .ufca44c6a5eef1e3407cad2e4471c66d9 , .ufca44c6a5eef1e3407cad2e4471c66d9 .postImageUrl , .ufca44c6a5eef1e3407cad2e4471c66d9 .centered-text-area { min-height: 80px; position: relative; } .ufca44c6a5eef1e3407cad2e4471c66d9 , .ufca44c6a5eef1e3407cad2e4471c66d9:hover , .ufca44c6a5eef1e3407cad2e4471c66d9:visited , .ufca44c6a5eef1e3407cad2e4471c66d9:active { border:0!important; } .ufca44c6a5eef1e3407cad2e4471c66d9 .clearfix:after { content: ""; display: table; clear: both; } .ufca44c6a5eef1e3407cad2e4471c66d9 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ufca44c6a5eef1e3407cad2e4471c66d9:active , .ufca44c6a5eef1e3407cad2e4471c66d9:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ufca44c6a5eef1e3407cad2e4471c66d9 .centered-text-area { width: 100%; position: relative ; } .ufca44c6a5eef1e3407cad2e4471c66d9 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ufca44c6a5eef1e3407cad2e4471c66d9 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ufca44c6a5eef1e3407cad2e4471c66d9 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ufca44c6a5eef1e3407cad2e4471c66d9:hover .ctaButton { background-color: #34495E!important; } .ufca44c6a5eef1e3407cad2e4471c66d9 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ufca44c6a5eef1e3407cad2e4471c66d9 .ufca44c6a5eef1e3407cad2e4471c66d9-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ufca44c6a5eef1e3407cad2e4471c66d9:after { content: ""; display: block; clear: both; } READ: Fifth Business: Search For Self Identity EssayAs society changes, technology changes to address the enormous demandsof the world. Police managers across the country are faced with the dilemma ofdecreased fiscal resources and the same responsibility to maintain high servicelevels. In order to be effective, law enforcement agencies must aggressivelyexploit the new technological advances in radio and telephone systems. For thelast two decades several technological advances have aided law enforcement inbecoming more efficent and effective in serving their communities. For example, in November 1992, the Morgan Hill Police Departmentsimplementation of mail-out reports were handled by the computer system. Thedepartment made minor modifications to their PC network-based Computer aideddispatching (CAD) system. The process begins when the police dispatcherreceives a call from a victim and types the basic report information into thecomputer. The computer automatically generate a partially completed, pre-addressed incident report form, which is then mailed to the victim. After thevictim completes the form, he or she returns it to the police department. Thedepartment received a favorable response from the community on its CitizenAssisted Reporting System (CARS) (California Peace Officer, p. 15). The new technology and equipment available to law enforcement is onlylimited by the imagination. Several years ago California was the poineer in theuse of mobile data terminals (MDTs) in its patrol cars. These low-band radio-driven systems allow officers to access all of the available law enforcementdatabase systems to receive and send messages. Officers could type messagesmeant just for the dispatcher, and they could send typed messages back andforth to other mobile units (California Peace Officer, p. 13). With the introduction of radio and satellite driven system on the market,law enforcement agencies will be able to link each patrol unit through a laptopcomputer to a broad array of databases and systems which include NCIC, DMV,CLETS, CJIS, PIN, county records, departmental databases and more. Somesystems are capable of displaying a geopgraphical map depicting all previouscrimes in an area by type and where they occurred. The reports of all crimes inthe last 48 hours can be called to see what was written about the occurrence. These Personal Data Terminal (PDTs) or Mobile Data Computer (MDCs) can also beused to input, transmit or download reports at the station (California PeaceOfficer, p. 13). The more advanced mobile computer terminals feature built-in peripheraldevices such as mobile printers, automatic vehicle locator (AVL), fingerprintscanner, mobile camera, magnetic stripe card reader, and bar code scannerwith a color display screen. In summary, the profession of law enforcement is continually changingbecause of the demands placed on it by societyLaw

The case study of a client the author met during her placement period in one of the NHS trust. The WritePass Journal

The case study of a client the author met during her placement period in one of the NHS trust. Introduction The case study of a client the author met during her placement period in one of the NHS trust. IntroductionREFERENCESAPPENDICES     APPENDIX 1  PERSONAL HYGIENEINTEVENTION/ACTIONEXPECTED OUTCOMEAPPENDIX 2  SLEEP PATTERNINTERVENTION/ACTIONEXPECTED OUTCOMESAPPENDIX 3  MEDICATIONINTERVENTION/ACTIONEXPECTED OUTCOMEAPPENDIX 4MOODINTERVENTION/ACTIONExpected outcomeAPPENDIX 5SUICIDEINTERVENTION/ACTIONExpected outcomeTo prevent further relapseAPPENDIX 6SECTION 3 MENTAL HEALTH ACT (1983)INTRVENTION/ACTIONExpected OutcomeAPPENDIX 7  OBSERVATIONSINTERVENTION/ACTIONEXPECTED OUTCOMEAPPENDIX 8LESSON PLANOBJECTIVES Related Introduction This essay is based on the case study of a client the author met during her placement period in one of the NHS trust. Confidentiality will be maintained to protect the clients sensitive data as stated under Data protection Act (1998). Therefore, a pseudo name will be used and hospital name withheld throughout the essay. This is in collaboration with NMC (2008) Code of Professional Conduct. The author will discuss about assessment strategies used by the team to assess the client. The essay will develop by identifying factors contributing to client mental health concerns and in addition the author will look at agreed care plans. Discussion on own contribution and those of others in implementing and evaluating agreed care plan actions will be revisited as well. The author will also reflect on mental health education and practice carried out with the client and his family. In conclusion the author will summarise the case study by reflecting on how she experienced the procedures of her tr eatment from assessment throughout to recovery plan. Richard (pseudo name), is a 20 year old white male who was admitted in one of the NHS acute wards in England under Section 3 of Mental Health Act (MHA, 1983). He is known to the service since the age of 13 and has been diagnosed with schizophrenia. This was his sixth admission and he has been to a mental rehabilitation and recovery unit twice during his previous admissions and presently he is under care of Community Psychiatric Nurse (CPN). He is known to be escorted by police on all his hospital admissions. Richard grew up under the care of his mother who was single with different men coming in her house. She was unemployed and lived on benefits in a two bedroom council flat since Richard was two years. The area was crowded, multicultural with a high rate of drug, theft and violence crimes (UpMyStreet, 2011).   As he grew up, he played with friends raised from the same financial/economic and social background as his, in the Council Estate in which he resides. Drinking alcohol excessively and smoking any sort of cigarettes is common in his home and his neighbourhood. As a result Richard was easily influenced into excessive drinking and smoking. He began using the little money he was given by his mum to feed his habit. His friends smoked cannabis and all sorts of drugs and it did not take long for him also to join them in smoking it. According to Rausch and Young (1991, Pg 4) cannabis is â€Å"a depressant drug with hallucinogenic properties†.   This reality catches up with him as he increasingly gets accustomed to cannabis. Around the age of 14, he started using illicit drugs like Heroin and crack cocaine. According to Edlin and Golanty (2009, Pg 377) these drugs stimulates the nervous system. What this means is that when a person is under the influence of these drugs, even though it is a crime on its own, can easily go to the extreme of anything he/she is performing or have wrong judgements that may easily result into another crime. Richard had family history of Mental Health; both his grandparents died of Alzheimer’s Dementia. According to epidemiology studies people with family history of mental health have high risk of having mental health in future. Richard was admitted after the CPN and his mother were concerned about his behaviour, for example, walking naked around the house; not attending to his personal care; very withdrawal; laughing inappropriately; low moods; responding to voices and not taking his prescribed medication. They tried to bring him into Hospital informally but he refused as he had no insight into his condition, therefore, CPN informed the Approved Mental Health Professional (AMHP) who then arranged for mental health assessment and brought him formally under section 3 of Mental Health Act 1983 (MHA 1983). On admission, he was under influence of drugs and was not able to stand properly; therefore, he sat on a wheelchair to avoid risk of falling. He looked untidy with long uncombed hair, wearing dirty clothes and appeared to be in need of using the toilet. The author and other nurse took him to the toilet/bathroom and were able to get the urine sample which was sent for test and confirmed that illicit drugs were present. Whilst in the bathroom, he was assisted to have a bath and get changed into clean clothes. This also gave the author and other nurse opportunity to do Body map. He was responding to both visual and auditory voices. He could not maintain eye contact. Every time staff looked at him he puts his head down. During body map, it was found that his fingers and toes appeared purple with wounds. This was documented on Body Map Form (See Appendix 10a). The nurse said that the type of wounds is common to people who inject themselves with drugs. However, he sat on a scale to weigh him and his height taken as per assessment procedure. His weight was 48kg and height 1.78m (See Appendix 10b). According to Body Mass Index (BMI) Richard was 15.1 under weight. Understanding this from his lifestyle, it appears that he was living on a poor diet because most of his money went towards drugs instead of food, clothing and toiletries. Vital signs such as Blood Pressure, Temperature, and Pulse were taken and recorded (See Appendix 10c).   Night Staff reported that Richard becomes restless during the night asking to leave hospital. On doing this he turns to be aggressive presenting with threatening manners. Richard was reminded that he was under section 3 (MHA 1983) and nurses read his rights for him to rem ind him that he was not able to leave the ward without section 17 which requires Consultant’s approval (See Appendix 10d for patient’s rights). All these behaviour according to Patrice (1994) are drugs unforeseen effects. Through involvement with the Multi-Disciplinary Team (MDT), the author got an opportunity to participate in the assessment, for Richard’s needs, planning of his care, implementation and evaluation of the planned interventions. According to Ward (1992) assessment is a form that the nursing team use to measure what clients can do independently and their coping strategies. Walsh and Kent (2001 Pg 140) argued that assessment is about looking at a â€Å"patient as a whole† that is â€Å"physically, socially, biologically and psychologically†. During the assessment different assessment tools, approaches, observation techniques were used by different members of the team depending with their conceptual frameworks or models of practice. The team was comprised of the Author, Psychiatric Doctor, Physiotherapist, Occupational Therapist, Registered Nurse, Psychologist etc. However, all these were to fulfil holistic nursing care. Schultz and Vibeck (2002) views assessment as the initial step carried out during first stage of admission. Care Program Approach (CPA 1991) was used to assess Richard. According to The Sainsbury Centre for Mental Health (2000), CPA has a goal-achieving feature. It gives an efficient framework for a coordinated care provision and resource allocation. In this, a patient is allocated a key worker; a detailed assessment to each client’s needs is clearly stated and the client is involved in the recovery plan. However, interview was done, which involved Richard and his mother. They were assessed on their needs, for example housing, finance, physical and mental health status, past and current medication, education, sleep pattern and coping strategies. During the interview the author and other team members maximised their knowledge and skills, especially communication skill. According to Porritt (1984, Pg 3) communication is the main way by which human beings interact and can be view ed as a social process. It was witnessed that Richard was hallucinating; had paranoid ideas; restless; confused at times; presenting flat moods. He was denying to what was taking place at the same time avoiding eye contact and crying. All these were influenced by drugs he took.   Ross (2001) describes this as common to people who are depressed. The team was highly experienced and understood how to deal with these factors that might impinge assessment. Active listening skills were brought into use, for example: reflecting everything Richard had said and clarifying   with him; at other times paraphrasing and also asking him to summaries; speaking simple, clear and straight forward without use of jargon (Porritt, 1984). Good distance from him and sitting posture was maintained professionally for him to feel relaxed and engaged into the discussion (Egan, 2002).   When talking, they squarely faced him, with open gestures and smiling. Suitable questioning strategies were utilized, for example, open and close ended questions. One example of this type of questions he was asked was as follows: â€Å"What is your daily routine?† However, the author/student had limitations and boundaries to work on, therefore, during interview the doctor was asking questions and the author was documenting the answers on assessment form inst ead of asking questions as well. She had to maintain that and maximise understanding, acquiring skills and knowledge. According to McGuire and Priestly (1985, Pg7) â€Å"a knowledge of your own limit immense great benefit in itself and may be indispensable for solving some kinds of problems†. Literacy and numeracy skills were involved in the process when calculating points scored and lay down in a form of a scale. These were documented on assessment forms and the author’s mentor double checked to assess if they were well completed to the standard. These were to meet the NMC Code of Professional Conduct on documentation and record keeping (2008). It was concluded that the trigger for all His problems was substance misuse; therefore, he was referred to Drug Clinic for detoxification and was to be prescribed methadone depending on the level of drugs in the blood. Stopping drugs completely could result in death by acute causes ((Prof ) Jones,   2004).   Mirtazepine 15mg once daily, Zopiclone 7,5mg once at night and paracetamol 500mg three times daily was prescribed. Risk assessment was carried out using Threshold Assessment Grid Tool (TAG see Appendix 10e). According to DOH (2002), this tool assesses client potential risk to him or others, that is, looking at clients past history of violence; self harm or others; patient social network and neglect. TAG simply assesses the severity of service user’s mental health problems (Slade, 2000). It was noticed that Richard was at risk of blood transported diseases, for example, HIV and Hepatitis. Blood test was done and Richard was informed that the results were negative.   Advice was given that the blood test will be repeated again after six months as HIV studies refer this period of months as window period. Level three observations commenced, where the staff had to monitor him on one to one. Close monitoring was important on Richard because he was depressed and was on antidepressant medication, therefore, suicidal thoughts were most likely to affect him (Carolyn et al, 2008). Care planning is one of the requirements of CPA. According to Hogston and Simpsons (2002), care planning is a process that provides a â€Å"road map† to guide everyone involved with patients’ care. Richard and his mother participated in planning.   According toSeaback (2006) patient involvement make them feel empowered, valued and committed to goals sat out. However, Maslow Hierarchy of needs triangle indicates that basic, low level needs should be satisfied first. Following this triangle, needs to be met were housing, weight building, job, personal hygiene, sleeping pattern, compliance with medication and dealing with suicidal thoughts. Due to word limit of this assignment, three of these will be discussed and others written in appendix (1 to 9). Since the problem was triggered by substance misuse, this can be viewed as the umbrella of all other needs, thereby makes health promotion the top priority. A health promotion care plan was devised involving Richard and his mother. This was done according to DOH (2004) that, the care plan is to be individualised and tailored to meet each client’s needs . It involved educating Richard about his illness and researches about substance misuse. Richard and his mother agreed that he was going to attend Drug- Misuse-Team clinic to get more help on detoxification and how to quit drugs. Therefore, a referral was sent to Drug-Misuse -Team, who came to assess and take him on board. The author sort consent from the mentor (Richard’s key worker) to work collaboratively with them in order to achieve this assignment and get insight into planning and delivering a teaching session on substance misuse. According to Body Mass Index, Richard was under weight therefore, food and fluid chart were put out to record the intake (See Appendix 10f). Whitney and Rolfes (2008, Pg 579) suggest that, the prolonged use of drugs causes dehydration, loss of appetite which result in loss of weight which can lead to malnutrition and swallowing problems. Staff members were informed and communication book completed to make sure Richard has adequate diet and fluid. Weight chart was put in place for him to be weighed weekly (See Appendix 10g). Dietician was contacted to come and give advice on which foods to offer Richard. She came and carried out assessment with Richard and advised staff to offer him soft diet as he was likely to have problems with swallowing (Whitney and Rolfes, 2008). This was to be reviewed weekly during Multi-disciplinary Meetings. Food supplements in the form of fort sip, fort cream and Calogen were prescribed; this was in line with Stanfield and Hui (2009) who notes that these fo od supplements help building the body but they must be taken alongside with meal not as a substitute. To meet his social needs Richard agreed to work collaboratively with the Social Worker who planned to find accommodation in a different area from his friends. His care co-ordinator was to monitor him effectively whilst at home to prevent further relapse and discouraging him to associate with friends who abuse drugs. Welfare state benefits began to be processed whilst he was still in hospital. In the care plan Richard agreed to go back to college in order to achieve his goals because he wanted to find a job. According to Radomski and Latham (2007), education is the primary goal to dysfunctional people as it increase their self esteem, work experience, outdoor activities and prevent risk of exclusion. He also agreed to take some voluntary work whilst he was still in hospital and Occupational Therapist (OT) was to come and collect him twice weekly as soon as he was ready to start. During his community activities the consultant completed Section 17 Mental Health Act (1983) which was ther e to allow Richard to go outside the ward for four hours a day. These care plans were to be monitored daily and evaluated every now and then as Richard progressed. Within six weeks after admission, changes began to be noticed on his behaviour and appearance. Reflecting to progress, he began to put weight which proved that the supplements were working, therefore, weight care plan was changed from weekly weight to fortnightly. However, food and diet chart continued as it was still important to find out how much he eats and drink. The food supplements were discontinued after the Dietician’s assessment in which it was reported that he was progressing well and proper diet was encouraged. In the process, he was maximising the use of gym to build up his muscles. Evidence in progress was witnessed when he began to use his own initiative to attend to his personal needs independently; therefore, his care plan pertaining to personal hygiene was reviewed and reduced to supervision. The Social Worker got him an apartment that was close to his mother and his benefits were processed. He began receiving weekly payments which he collected accompanied by staff. He was able to buy his toiletries, clothes and other foods preferred. When Richard started activities with OTs improvement on his capability and potential to do things better was witnessed. Initially, he required a wheelchair when going out because he was assessed as weak and at risk of falls, however, this was discontinued and a wheelchair was no longer needed to mobilise him. Richard was advised to increase his activities as he enjoyed participating. He got a place at the local college to study carpentry. His medication was reviewed and changed; Zopliclone and Paracetamol were to be given as per his request (PRN) because he was sleeping well at night and no more headaches as before. The author also reported progress on teaching session conducted with Richard as presented in the later part of this assignment. Analysing the introduction of receiving benefits weekly while in hospital, Staff members witnessed some incidences (although few) were service users smuggle drugs into hospital. Giving Richard money appeared to be a risk because he might use it for buying drugs. However, this was an issue dealt with in advance, in the Criminal Law Review (1992) Police have right to stop and search anyone in possession of controlled drugs under Misuse of Drugs Act 1971 which also gives hospital staff same powers to do stop and search to detained patients. Therefore, the stop and search use to be conducted by staff and police once every now and then and all drugs, alcohol, dangerous weapons found were to be confiscated. However, the reason for stop and search was always explained to patients to avoid breaking the therapeutic relationship between client and nurses which is build upon trust, respect, genuineness and empathy. On substance misuse care plan, all staff had a responsibility to educate Richard on health promotion. The author working collaboratively with the mentor planned the teaching sessions which focused on developing an understanding for Richard and family that drugs are detrimental to their health. The author put together session plan (see appendix 8). At this point the greatest dilemma was that, the author had no experience in teaching sessions of this nature. However, support was available from the mentor when needed Blais (2002) views teaching as a system of activities whereby learning occurs. Hinchcliffe (2005, Pg 63) added that, â€Å"learning is any event that brings about relatively permanent change in behaviour resulting from either experience or practice†. To achieve a meaningful session the author usually began by defining the purpose of the lesson to the group. Each and every individual were given chance to participate, contribute and criticise the session. Information   for teaching was gathered through current research, evidence based practice ideas,   clients experience and   other professionals as recommended by NMC Code of Professional Conduct (2008) that, one â€Å"has to keep his/her knowledge and skills up to date and deliver care based on current evidence†. According to Jarvis and Gibson (2001) rehearsing helps develop confidence and reduce nervousness, therefore, rehearsals were done with the mentor before the final session. This helped to boost confidence a nd to correct and polish work before presenting it to Richard and group. In implementing the teaching session, the author used the activist strategy, according to Nicklin and Kenworth (2000) this is a teaching theory that allows clients perform more activities to motivate themselves and enjoy the learning experience. These activities were group work that includes discussion, listing substances and identifying relapse signatures. To make this teaching theory effective some resources were used, for example, flip charts, simplified diagrams and video clips. All these helped to draw attention as some realised that the symptoms they were experiencing were similar to what they saw on the teaching resources. They responded by answering each other’s questions. This proved that they were listening to teaching session. At some point they debate which made the session more enjoyable.   Use of leaflets was avoided in the session because most of them including Richard got a lot of leaflet information teachings from drug misuse clinic. During the session, the author had to use skills such as maintaining the tone of average voice because lowering it was going to give wrong signal to clients that information given was questionable. Raising the voice could be associated with threatening manner or shouting (Porritt, 1984). Listening was a skill used a lot to attract clients into discussion. In doing this, the author avoided repetition of phrases; hesitation; was facing them and maintained eye contact in order to communicate effectively without reading from the script (Egan, 2002). At the beginning of the lesson, the author advised clients to maintain confidentiality in case some clients disclosed important information and at the same time encouraged them to maintain respect and dignity in line with NMC code of Professional Conduct (2008). An evaluation tool (see appendix 9) was designed by the author to get feedback from Richard and group. Some expressed that too much material was used, for example, flip chart and handouts. Some pointed out that they could not keep in memory words used especially in flipcharts. Few of them believed that drugs have no effect on mental health despite all education they got; they still believed mental health comes like any other disease, for example, diabetes. Generally, most were good comments such as â€Å"It was informative, well taught, the session was well timed and of good length, the teaching was helpful in personal life, the session reflected real experience in life, etc†. According to authors’ work experience and opinion, giving up drugs is up to individuals not what clients are told. With the view of hospitals, there is a number of health care professionals who smoke cigarettes but they are quite aware of the effects. Mcdowell and Spitz (1999) argued that people give up on their own will as the substance misuse cycle is like any other recovery cycle and that varies depending on individuals. Reflecting to the whole case study, the author was impressed to see what she knew in theory put in practice, for example, individualised care. Hinchcliff (2005) argued that reflection is the way in which everyone revisits the events that happened and how these could have been done differently.   Therefore, the author hereby suggests that Richard would not have relapsed if the government’s welfare state system was fit for purpose. Evidence in the text shows that Richard grew up and lived in a community associated with poverty and social exclusion. It was also mentioned that the Social worker got an apartment for him in a better area. This means that the state is failing other places by inadequately supporting them. After detoxification the social input offered to Richard were sufficient enough to avoid his admission into hospital. That kind of social input and support was suppose to be given to Richard from birth to present. In short prevention is better than cure. Furthermor e, it is encouraging that Richard and family were involved in all aspects of care. Richard was able to take a lead which was useful because it encouraged him to work toward his goal. The only skill to endeavour apart from what the team used so far is Focus Solution Therapy (Simon and Nelson, 2007) as it also encourages clients to focus on their goals instead of the problem. Richard remained in hospital. REFERENCES Blais K (2002) Professional Nursing Practice: concepts and perspectives; Prentice Care Program Approach (1991) Department of Health 1090; Relapsing or Recovery: England Carol C.G, Baldwin R, Burns A (2008) Integrated Management of Depression in Elderly: Cambridge University Press Data Protection Act (1998) Department of Health: Record Management, The stationary office Department of Health (2002) Department of Health, Best practice in Risk Assessment: The stationary Office Department of Health (2004) The NHS Improvement Plan: putting people at the heart of public service: The stationary office. Edlin G, Golanty E (2009) Health and Wellness: Jones and Burtlett Learning Egan, G. (2002) The Skilled Helper a problem management approach to helping’. Brooks Cole Hinchcliffe, S. (2005) the Practitioner as a Teacher. 3rd Edition. The fractioned as a teacher. London, Churchill Livingstone. Hogston R and Simpson (2002) Foundation in Mental Health Practice. New York: Macmillan Jarvis, P. and Gibson, S. (2001) the Teacher Practitioner and Mentor: in Nursing, Midwifery, Health Visiting and Social Services, 2nd Edition. Cheltenham: Nelson Thorns Ltd. Jones R (Prof)(2004) Oxford Textbook of Primary Medical Care; Volume 2: Oxford University Press. Mcdowell. D. M, and Spitz, H. I, (1999) Substance Abuse from Principles to Practice, London, Brunner / Mazel. Mental Health Act (1983) Department of Health: Acts and Bills, England McGuire J, Priestly P (1985) Offending behaviour: Skill and stratagems for going straight; Batsford Academic and Education Nicklin, P.J. and Kenworth, N. (2000) Teaching and Assessing in Nursing Practice: An Experimental approach 3rd Edition. London: Brailliere Tindall. Nursing and Midwifery Council (2008). Code of Professional Conduct: Standard for Conduct, Performance and Ethics, London: NMC Patrice G (1994) An Introduction to pychology: Routledge Porritt L (1984) Communication: choices for nurses; Churchill Livingstone Seaback W. (2006) Nursing Process Concepts and Application 2nd ed London: Delmer, T. Learning. Schultz, M and Videbeck H (2002) Manual of psychiatric Care Plans Philadelphia: Lippincott Simon, J. K and Nelson, T. S. (2007). Solution-focused brief practice with long-term clients in mental health services: Im more than my label. New York: Taylor Francis Slade, M. (2000) What outcomes to measure in routine mental health services, and how to assess them – a systematic review. Australian and New Zealand Journal of Psychiatry, 36, 743 -753 Stanfield P, Hui Y. H (2009) Nutrition and Diet Therapy: Self-Instructional Approaches: Jones and Bartlet Learning Radomski M. V, Latham C. A. T (2007) Occupational Therapy for Physical dysfunction: Lippincott William and wilskins Rausch S, Young M (1991) Be a Winner: an educational programme to prevent drug abuse: University of Arkansas Press Ross A.J (2001) Coping when a parent is Mental ill: The Rosen Publishing Group The Criminal Law Review (1992) Law: Sweet and Maxwell The Sainsbury Centre for Mental Health (2000) Care Program Approach (Available at); http://sainsburycentre.org.uk(Accessed on 25April 2011) UpMyStreet (2011)B70 house prices, property crime rate, local neighbourhood and schools (Available at); upmystreet.com/b70.html (Accessed on 25 April 2011) Ward M. F (1992) The Nursing Process in Psychiatry: Churchill Livingstone Whitney E.N, Rofles S.R (2008 Pg 579) Understanding Nutrition: Cengage Learning; Hampshire APPENDICES      Appendices provided here are:  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Appendix 1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Personal Hygiene- care plan Appendix 2  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Sleep- care plan Appendix 3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Medication-care plan Appendix 4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Mood- care plan Appendix 5  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Suicide-care plan Appendix 6  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Section 3 Mental Health Act- care plan Appendix 7  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Observation –care plan Appendix 8  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Lesson plan Appendix 9  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Evaluation Tool Appendix 10a  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Body Map- Assessment Tool Appendix 10b  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Body Index- Assessment Tool Appendix 10c  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Vital Signs- Assessment Tool Appendix 10d  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Section 3 Mental Health Act (1983) Patient’s Rights Appendix 10e  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Threshold Assessment Grid- Assessment Tool Appendix 10f  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Food and fluid Charts- Assessment Tool Appendix 10g  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Weight Chart- Assessment Tool Where information is deleted or omitted is done deliberately to protect confidentiality of the source APPENDIX 1   PERSONAL HYGIENE INTEVENTION/ACTION 1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Richard to be assisted by one staff with his personal hygiene needs daily. 2  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Staff to encourage him to use preferable deodorant. 3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Staff to encourage him to wear clean clothes daily. 4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Staff to encourage him to shave every now and then. 5  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Staff to encourage him to brush his teeth and comb his hair daily when attending to his personal hygiene needs. EXPECTED OUTCOME 1 For Richard to be able to attend to his personal hygiene needs independently. 2 For Richard to look presentable all times. 3 For Richard to continue practising this skill when discharged. APPENDIX 2   SLEEP PATTERN INTERVENTION/ACTION 1   Richard to be commenced on sleep chart to monitor his sleep pattern. 2 Staff to offer him warm milk drinks before bedtime to help him sleep, but avoid caffeinated drinks 3 Staff to offer him warm bath priory to bed. 4 Staff to keep him occupied with activities during the day and discourages him to sleep until evening. 5 Staff to monitor any side effect of his current medication to his sleep pattern. EXPECTED OUTCOMES 1 For Richard to have long sleep hours. APPENDIX 3   MEDICATION INTERVENTION/ACTION 2 Richard to take all his prescribed medication. 3 Staff to educate him on importance of taking medication. 4 Staff to educate him on his prescribed medication. 5 Richard to discuss with the Doctors on other routes if he does not want oral medication. 6   Staff to monitor concordance with medication and observe for side effects and therapeutic effects. EXPECTED OUTCOME 1 For Richard to have knowledge on his prescribed medication. 2 To maintain recovery. 3   To prevent further relapse APPENDIX 4 MOOD INTERVENTION/ACTION 1   Staff to have one to one session with Richard once daily. 2   Staff to monitor his mood and document daily. 3 Staff to encourage him to participate in ward activities. 4 Staff to encourage him to interact with fellow peers. 5   Staff to use de-escalation skills when Richard becomes aggressive, restless or when he ask to leave. 6   Staff to use lock door policy when Richard threatens to leave the ward, document the incident and then inform the doctors. Expected outcome 1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   For Richard to be able to ventilate his feelings and thought to staff. 2  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   For Richard to be able to interact with fellow peers and staff. 3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   To maintain his safety and others APPENDIX 5 SUICIDE INTERVENTION/ACTION Staff to monitor Richard on one to one observations Staff to monitor side effects of depressant medication Staff to educate him on depressant medication Team to review his medication regularly Richard to have psychologist input To be referred to Therapy and Recovery Unit for CBT and Relaxation Expected outcomeTo prevent further relapse To prevent suicide or harm risk To help Richard achieve optimal function Richard to recover and maintain   treatment APPENDIX 6 SECTION 3 MENTAL HEALTH ACT (1983) INTRVENTION/ACTION Staff to read Richard’s right to him Staff to give him medication as prescribed Staff to inform him on lock door policy and observation levels Richard to have a signed Section 17 when he wants to go outside the ward. For the care plan to be reviewed weekly by the team. Mental Health Coordinator to be informed of Richard section status as well as family Expected Outcome For Richard to be able to understand his rights For Richard to follow the section guideline at all times For Richard to be in a position to get support and guidance in appealing if they is a need. APPENDIX 7   OBSERVATIONS INTERVENTION/ACTION Staff to maintain Richard’s observation level Staff to increase observation level if appropriate Staff to record appropriate observation Staff to inform MDM of any change as appropriate No one should observe for longer than two hours at any one time EXPECTED OUTCOME Staff to provide information for ongoing behavioural and risk assessment including specific behaviours and triggers Staff to monitor all changes in behaviour Staff to enhance the safety of Richard’s behaviour at risk including: suicide attempts;   harm to others; self injury; risk of absconding and   potential risk of neglect APPENDIX 8 LESSON PLAN TOPIC: Substance Misuse and Mental Health Target audience: Patients, Staff, Family Date: 20 / 05 / 2010  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Time: 14.00 hrs Venue: Meeting Room  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Expected Duration: 1Hour OBJECTIVES To enable clients to: a) Understand what the meaning of the terms â€Å"substance misuse†. b) Understand the difference between the benefits of prescribed medication and the intoxication of illicit drugs c) List the different types of substances likely to be abused d) Discuss the effects of substance misuse on mental health e)   Identify their own relapse signatures f) Identify ways of getting help. TEACHING RESOURCES  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  ACTIVITIES Handouts  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Discussion Flip Charts  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Group Work Overhead projector  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   watching a Video Television and video player  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Lesson Evaluation Video tape APPENDIX 9    EVALUATION TOOL Circle the appropriate answer 1) Objectives clear.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Yes / No 2) The teaching material was useful.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Yes/ No 3) The teaching material was easy to understand.     Ã‚  Yes / No 4) Discussions and group activities were useful.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Yes / No 5) The language used was easy to understand.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Yes / No 6) The presenter was speaking clearly.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Yes / No 7) The subject well researched.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Yes / No 8) The subject brought new things I did not know.  Ã‚  Ã‚   Yes / No