A Reflective Account Of The Impact Of Psychosocial And Cultural Issues Nursing Essay
For the purpose of this assignment, I have used Gibbs’ reflective cycle to reflect on the impact of psychosocial and cultural issues affecting decision making in dietetic practice. For many decades, psychosocial and cultural factors have been researched and recognised as important determinants, which can have serious impact on health and eating behaviour . In this reflective piece, I have focused on how these factors have the potential to contribute to malnutrition in the elderly. As a consequence, it is imperative that dietitians are able to recognise these issues and consider how they may impact on the negotiated advice (REF). My subject was a 79 year old lady who had been referred to the dietetic clinic for advice on nutritional support. She had experienced an unintentional weight loss of ten kilograms (‘kg’) over the course of two years, since her husband had passed away. Her drastic weight loss had become a serious concern for her, which led to her referral by her general practitioner (‘GP’). Description (What happened) During the consultation, the patient explained that she had lost three kg in one month, which is when she started worrying as she noticed how loose her clothes had become. I examined her food diary and asked a series of questions to find out what she may have been doing differently to account for the weight loss. She reported her food portions had not changed and that she was eating more in order to gain weight. She seemed to be having a varied diet, although at her last visit to her GP at the beginning of the year, she was informed that she had impaired fasting glucose (‘IFG’). She had therefore decreased her intake of sugary foods as she was afraid of becoming diabetic. Another major event that had occurred more recently was that she had moved to a smaller place which was more suitable for her since she was now on her own. Feelings (What were you thinking/feeling) When she mentioned she was now a widow, I sympathised with her and immediately thought this was the reason for her weight loss. Further questioning revealed that she had battled with loneliness following the loss of her husband of 55 years. . Several psychosocial factors emerged from this initial part of the consultation, which can be regarded as pressures felt by the patient . The first two included bereavement, which is classified as one of life’s stresses, and the state of depression, which she may have endured following this traumatic event .. A significant attribute of bereavement and depression is appetite loss, which is also accountable for high mortality rates in the first six months of the loss of a loved one. In this case, she no longer had anyone to appreciate her cooking efforts and the deprivation of companionship at mealtimes becomes a reminder of her loss. A time intended for communication, joy and bonding had become a painful experience, leading to lack of interest in any activity related to food or eating. The reduced enjoyment of the social aspect of mealtimes had made eating more of a chore . It is important to remember eating as a social variable and recognise that it is part of our self and social identity, which also makes it a cultural variable. It is a structured part of one’s everyday life and a valued social activity for most married people. Food habits developed throughout life are an important component of culture and strongly influences food decisions. Therefore, the stress of bereavement has the power to alter the social, psychological and cultural significance of food during this difficult time . These issues were sensitively addressed in the consultation. The patient reported that the support of her son had helped her through the grieving process and that she had accepted the loss and was moving on. Other social determinants which impact eating behaviour include access to food, and ability to cook food and share meals with others . The patient reported she was doing her own weekly shopping and that she had started consuming more ready-meals as she still struggled cooking just for herself. Therefore, she only cooked when her son and family came to visit at the weekend . I suggested joining a social club in the area where they regularly meet for lunch and other social gatherings, which could help improve her moral , but she was reluctant to do so. She explained that she suffered from urinary incontinence and found it embarrassing having to urinate so frequently when around people. I thought it would be ideal if she could have that kind of social interaction as it can have a great impact on appetite and meal size. Meal ambiance which incorporates factors such as acquaintance, conversation and pleasantness, have been shown to improve levels of ingestion and is an important stimulus modulated to help stimulate appetite in places such as nursing homes . The mechanisms by which a person is affected by social support varies depending on the individual, however, the potential support that can be provided from social structures has been shown to aid in maintaining nutrition in certain elderly people . Relocation and change of environment can also yield negative outcomes in terms of psychosocial disturbances such as, confusion, anxiety, depression and loneliness associated with transferring from one place to another and leaving behind treasured memories or souvenirs of a loved . Two months prior, she moved to a smaller house, which had been a very stressful time for her. She had settled into the place but she reported having had a hard time adjusting. This is an area I should have explored. For example, had she made any friends in the surroundings or whether she was still able to meet her old friends, was she getting familiar with the new neighbourhood she was in, were there any safety issues that needed addressing which we could help support her with, and so forth. These issues would have a heavy impact on her intake and weight if they were causing her anxiety or depression . Financial constraint is another psychosocial factor to consider when giving dietary advice, as unaffordability affects intake . The patient reported she drove to do her weekly shopping from a reputable supplier in town. According to her food diary, she did not appear to be restricting herself. However, as research suggests, misreporting of food diaries is common where patients try to present themselves more favourably . Decline in cognitive function is Another psychosocial issue I had to consider was the food anxiety which had been created following the IFG test. Her GP had told her she was in the pre-diabetic stage and so she had eliminated most fruit and all high sugar foods from her diet as she was worried about becoming diabetic. The burden of disease caused her to change the way she felt about certain foods . She was now anxious about eating any foods with sugar. I explained that she did not have to exclude sugar from her diet completely. This in turn created confusion as my advice was conflicting that of her GP’s. I explained about glucose absorption and that she could add sugar to her puddings, cereal and so forth, which would slow down absorption of the sugar and help with better blood glucose control but to still avoid pure forms of sugar e.g. sweets. She was relieved to discover that and it seemed to make her happier that she could relax her diet. From there is an exploration of psychobehavioral models of appetite, and address issues of depression, bereavement, and social interaction before examination of personality and anxiety disorders. These issues are then considered as related to cognition and memory. Cultural factors: access to appropriate foods Communication Attitude, values, beliefs, behaviours – shared by society/population Psychosocial factors: Attitude Peer pressure Cultural, religious and regional factors: cultural origins, religious background, beliefs and traditions of culture and race, geographical region. DeCultural factors Food habits are a component of culture that make an important contribution to the food decisions consumers make “Food habits are seen as the culturally standardized set of behaviors in regard to food manifested by individuals who have been reared within a given cultural tradition. Although some view culture and food habits as static and unchanging, it is now recognized that they are continually changing as they adapt to travel, immigration, and the socioeconomic environment (Jerome, 1982; Lowenberg et al., 1974; Senauer et al., 1991; Kittler and Sucher, 1995). When modifying food intakes to meet dietary recommendations there are certain aspects of food habits that are difficult to change, such as the concept of meals, meal patterns, the number of meals eaten in a day, when to eat what during the day, how food is acquired and prepared, the etiquette of eating and what is considered edible as food. (Lowenberg et al., 1974; Kittler and Sucher, 1995). Food is always used to satisfy hunger and to meet nutritional needs. Food is used to promote family unity when members eat together. It can denote ethnic, regional and national identity. It is used socially to develop friendships, provide hospitality, as a gift, and as an important part of holidays, celebrations and special family occasions. In religious rituals and beliefs certain foods have specific symbolic meanings, or there may be prohibited foods or food taboos. Food can be used to show status or prestige, make one feel secure, express feelings and emotions, and to relieve tension, stress or boredom. Food controls the behavior of others when used as reward, punishment or as a political tool in protests and hunger strikes. Evaluation (What was good and bad about the experience) Why decided to go down that route? Behavioural change model Analysis (What sense can you make of the situation) Conclusion (What else could you have done) Action plan (If it arose again what would you do) What have I learnt from this experience What was the outcome of this experience
Focusing Oriented Counsellor: Career Development Reflection
professional essay writers Dvonne Loring The following essay is a reflective piece on my growth as a Focusing oriented counsellor over the course of the semester. It will document my introduction to focusing as a subject, my experience as a Focuser and as a companion and the evolution of each throughout the semester. In addition, my understanding of the process and the development of my own existing skills and the acquisition of new skills will be stated. A final reflection on my relationship with Focusing as the subject draws to a close will also be included. Over the course of the semester, I have consolidated my understanding of Experiential Focusing, the concept of the felt sense and how they contribute to therapeutic healing. I began this subject with no knowledge of Focusing whatsoever. The idea of bringing my awareness and entering the body was daunting for me as I operate on a very cognitive level. Learning that experiential Focusing is a gentle process oriented approach to therapy that invites the utilization of the body’s rich wisdom to facilitate therapeutic change (Cornell, 1996) helped ease some of my subject related anxiety. I learnt that to access this inner knowledge, a person’s awareness is shifted inside and navigation is done with the enigmatic felt sense as a guide, rather than intellectualizing (Purton, 2007). The felt sense is the quintessential concept of Focusing and one of many key aspects and principles developed by Eugene Gendlin. It is important to note however, Gendlin did not invent Focusing, it is a natural skill that he discovered (Cornell, 1996). It took me some time to really grasp what the felt sense was as it is not an emotion nor a body sensation or an altered state. A felt sense is a subtle, whole body sense of a complex situation (Gendlin, 1996). The more I attuned to and became aware of my own felt senses through experiential practice, where I learnt how to describe it rather than interpret it, the deeper my understanding became of the subject as whole throughout the semester. I had to learn that it was about feeling, not analyzing (Purton, 2007). What Focusing does is it accesses the felt sense which draws from a place of emergent unconscious process that is ready to be put under the light of consciousness. It draws from the vast realm of knowledge from the edge of awareness and channels it into transformational potential through in the moment experiencing. Focusing allows us to dip below the surface of the explicit into the implicit (Silverton, 2014). Thus with the use of the Focusing process and the felt sense, I began to realize I was learning how to help clients engage with their feelings and facilitate here and now experiencing, which is the key to successful therapy (Purton C, 2007). The Focusing process helped me release the angst I was experiencing about being a Focuser, and it also helped me with the struggle I was experiencing towards the subject itself. The idea of being a Focuser initially triggered some dim anxiety in me. I was concerned about what I might come across inside. Learning how gentle Focusing is however, and welcoming whatever arises (Gendlin, 1996) as well as understanding that the Focusing ‘procedure involves the maintenance of a comfortable distance’ (Purton, 2007, Pg. 46) was reassuring for me. I began using the experiential practice sessions where I was the Focuser as an opportunity to explore my existing and very present resistance to the actual subject and its content. There was always something in me that was stopping me from fully embracing the subject matter. With use of the Focusing process, I was able to enter my body with that as my issue and get a full body sense of it. Simply being with my felt sense caused a felt shift – a moment of movement (Purton, 2007). Having this experience on several different occasions was uplifting for my relationship with the subject and also empowered me as a Focuser. It helped me understand that encouraging clients to know they are the experts will motivate them to ask, interrupt, ignore or even to simply have a voice when something does not feel right for them in a session. They have choice and are allowed to communicate their preferences about what they need from their therapist as a Focuser and from the process, as it is their process (Leijssen, 1998). In doing this, they have an opportunity to achieve a real sense of self-autonomy as I did, which is what this non-directive process empowers clients to accomplish (Purton, 2007). My understanding of the importance of presence strengthened my ability to be a companion. Being in the role of the therapist, I wanted to execute my learning soundly and accurately. I wanted to have the Focusing attitude which embodies presence, gentleness and the ability to be vulnerable (Leijssen, 1998) and to also employ facilitative language with the use of appropriate reflections and invitations rather than questions. I learnt that the philosophy behind this approach highlights that the focusing process is not a technique but a way of being; it is an attitude to embody (Purton, 2007). I had to learn how to facilitate the process while personifying the Focusing attitude; it was a matter of finding the delicate balance between the two so that the Focuser perceives the empathy and acceptance that is being offered to them (Purton C. , 2004). Whenever I was in the process and my mind became cluttered with the theory and how to execute the skills I was learning whilst trying to hold space for the Focuser, I would remind myself to just be; my being was much more therapeutic than my doing. Bringing my awareness to my Focuser became an anchor for me. Ironically, in my attempts to perfect my ability to be a Focusing-oriented counsellor, I was in fact pushing myself further away from the most important thing which was my presence (Purton, 2007). What I learnt to remember is that all of this takes place in the present moment (Silverton, 2014). By being with my client and putting my trust in being guided by their process reminded me that I was not the expert which in effect liberated me as a companion. I was able to consolidate my understanding of the Focusing process which was helpful for some of the difficulties I came across in my practice. Gendlin’s six step process helped me grasp each stage. The process incorporates – (1) Clearing the space, (2) Felt sense, (3) Handle, (4) Resonating, (5) Asking and (6) Receiving (Purton, 2004). I found clearing the space a valuable method that can be used on its own or within the Focusing process, as a tool for stress reduction (Purton, 2004) through creating appropriate metaphoric distance. This practice can become a wonderful friend, offering a path to self-knowledge (Silverton, 2014). My experience with the process illustrated to me I was confident leading my Focuser in and coming out. Inviting a felt sense to emerge and getting a handle were the most difficult steps as it was hard initially for me to differentiate when my Focuser was describing ‘something’ or a ‘part of them’ as a pose to when they had discovered a felt sense. Sometimes an entire session would be checking in with the Focuser to see if a felt sense was going to emerge. With further practice, Gendlin’s steps became more of a guide for me. The process follows the material of the Focuser therefore the process cannot be rigid. The Focusing process is actually quite simple, but I found the complexities as a companion lie in the multitude of complex processes that include the language, terminology, how to reflect, how to invite and how to create the right amount of distance in order to follow the unfolding process with the Focusing attitude. Being aware of the subtle nuances of the Focuser in their tone, mannerisms and gestures was also important as in these are avenues to intricate possibilities for moving forward (Fleisch, 2009). The more I grappled with the process, the more I was able to identify areas for further improvement in my practice. In doing so I was learning how to deepen the client’s awareness to their own embodied knowledge (Fleisch, 2009). This subject gave me an opportunity to consolidate existing skills and develop a set of new skills. Core person-centred conditions such as presence, unconditional positive regard and empathy are all essential in the Focusing process. I gained further experiential practice as a companion at grounding myself with presence, holding space and meeting my client’s with unconditional positive regard. Despite majority of my Focuser’s having their eyes closed during their process, I would still mirror their non-verbal communication, as this helped me to remain present and was helpful in my attuning process. Once I had a reasonable theoretical understanding of the Focusing process I had to master the acquisition of new skills such as facilitative language used to support presence and to stay with the emerging process at hand. Reflecting is important as it helps the client know they are being understood. Reflections should follow the Focuser and their felt sense as this is the therapist’s attempt to grasp what the client is experiencing by repeating back exactly what they are trying to say (Gendlin, 1996). It is done with a soft and gentle tone of voice which came quite naturally for me, and always precedes an invitation. I definitely found invitations were much more effective in accessing felt senses than asking questions. Questions run the risk of deviating from presence, and shift the client back to a cognitive level of thinking. Invitations encourage a friendly attitude towards the felt sense (Gendlin, 1996). Focusing is a constant intervention with its consistent checking in and checking back. By strengthening these existing and new skills, my facilitation to help clients to attend wholly personal issue improved. Thus they can open up fresh perspectives and new insights which is what Focusing offers (Silverton, 2014). My relationship with Experiential Focusing has grown over the semester as it coincides with my beliefs about what therapy encompasses. I respect the Experiential Focusing approach in that it is non-directive and follows the guided process of the Focuser. It really reinforces my true belief in every human being’s ability to self-actualise and my role as a Focusing-Oriented counsellor within the holistic framework aids in facilitating this. I deeply resonate with its gentle approach and how through presence, a client can feel heard, met and have their existence validated but to also have the opportunity to listen to and potentially build a relationship with their felt sense (Silverton, 2014) to access their own empowering knowledge. Focusing sees an individual in process, not as a problem or pathology. Rather diagnosing and curing, Focusing gives a person the opening to be and to allow. This was affirming for my learning and development as an aspiring person-centred, holistic counsellor. The bulk of my learning in this subject came experientially. Cognitively it was a struggle to understand, but I found my inner understanding of fundamental Experiential Focusing concepts grew tremendously through actually participating in or observing the process. The more I understood what the felt sense was and became aware of my own, the more the comprehensive the theory became for me. Thus, Focusing taught me how to deal with ambiguity and vague ideas, and gave me the ability to simply sit with them. It comes as no surprise that the hard to recognise notion of the felt sense is hard to grasp in contrast to our social context where there is huge pressure in our technological culture to know (Silverton, 2014). We have lost trust in our bodies and our feeling (Cornell, 1996), forgetting that the body has sophisticated understanding and Focusing gives a means of accessing that. With Focusing being process-oriented means it is fluid. It can adapt to people varying a great deal in being able to sense what is going on in their bodies (Purton, 2004), ‘letting that which arises from the Focusing depths within a person define the therapist’s activity’ (Leijssen, 1998). This is at the core of person-centred methodology and my personal beliefs. Through theoretical learning and experiential practice, I have gained insight and deepened my self-awareness through participating in the Focusing process as a Focuser, observer and a companion. These have all contributed to my growth as a Focusing-Oriented counsellor over the semester, all of which have been essential for my learning as a holistic counsellor. I have embarked on a learning journey to have a comfortable relationship with strong feelings, to acknowledge them and listen to them using the Focusing method, and I now have the ability to invite a client for an opportunity to do the same. Focusing offers a safe and contained environment to access and explore the felt sense which has its own depths of meaning (Gendlin, 1996). By encouraging felt experience as a whole, one gains admission to an abundance of emotional self-healing. Bibliography Cornell, A. W. (1996). The Power of Focusing. Oakland: Raincoast Books. Fleisch, G. (2009). Right in Their Hands: How Gestures Imply the Body’s Next Steps in Focusing-Oriented Therapy. Person-Centred and Experiential Therapies, 173-188. Gendlin, E. (1996). Focusing-Oriented Psychotherapy. A Manual of the Experiential Method. New York: The Guilford Press. Leijssen, M. (1998). Focusing Microprocesses. In L. W. Greenberg, Handbook of Experiential Psychotherapy (pp. 121-154). New York: The Guilford Press. Purton, C. (2004). Person-Centred Therapy: Focusing-Oriented Approach. London: Palgrave Macmillian. Purton, C. (2007). The Focusing-Oriented Counselling Primer. Ross-on-Wey: PCCS Books. Silverton, S. (2014, October). How to Think Like a Poet and Make Better Decisions. Retrieved from British Focusing Association: http://www.focusing.org.uk
Research Report Powerpoint Presentation
Research Report Powerpoint Presentation.
In 10-12 slides, including the title and reference slides, outline your research proposal to present to your classmates. Speaker notes are required to provide additional information for your bullet points. Please see the attached document, “PowerPoint Instructions,” for further tips. The PowerPoint will need to include:Introductory section: including your problem statement and your hypothesis.Method section: including your description of the participants, apparatus/materials/instruments, procedure, and design you anticipate using.Results: discuss how results would be gathered for which statistic was used, the alpha level (.05), critical value, and degrees of freedom. (Do not create fake results.)Discussion: requires 4 paragraphs that include:Describe what it would mean if you obtained significant results. Then describe what it would mean to obtain nonsignificant results.Discuss how your study followed APA ethical guidelines, by discussing the use of an informed consent form, debriefing statement, deception, and obtaining IRB permission.Discuss any limitations in your study (e.g., possible confounding, lack of random assignment or random sampling, etc.)Conclude with a discussion of future studies that could arise from your study.Appendices: two figures, OR two tables, OR a table and a figure. For example, set up a table focusing on participants, include your individually created survey, use/cite tables from a previous study, refer to Chapter 14 summary table, include Informed Consent figure and/or Debriefing Form figure. If unsure, contact your instructor for confirmation of appendices.Reference Slide: APA-formatted reference slide.
Research Report Powerpoint Presentation
Please answer the following in an IRAC style essay quoting proper case law
Please answer the following in an IRAC style essay quoting proper case law.
Mon E. Bags, Chief Executive Officer of Earns A Lot Enterprises, received total compensation of $2,500,000.00 in 2017. The compensation included a base salary of $750,000, commission income of $1,250,000 and a performance bonus of $500,000. Mr. Bags’ compensation placed him in the top 25% of all chief executive’s in the industry.Earns A Lot is located in State X. While the national economy has experienced an economic slowdown, State X has a strong and vibrant economy. Mr. Bags has been the chief executive officer for five years.Earns A Lot, which has long had a reputation for paying very competitive salaries, recruited Mr. Bags from its chief rival, Wanna Be Industries. When Mr. Bags became the chief executive of Wanna Be, the company was on the verge of liquidation. Within five years, Mr. Bags took Wanna Be from the steps of oblivion to the top of the industry.While Earns A Lot has a solid reputation of consistent top tier performance, it has long believed there was room for substantial growth and so hired Mr. Bags. Indeed, under Mr. Bags’ leadership, Earns A Lot has seen gross revenues grow by over 20% per year. Nonetheless, Earns A Lot is concerned whether the company will be able to deduct Mr. Bags’ 2017 compensation.Will Earns A Lot be able to deduct Mr. Bags’ 2017 compensation? Please write a memo answering this question, citing the appropriate authority. An IRAC-style essay is appropriate for this assignment.
Please answer the following in an IRAC style essay quoting proper case law