The Genogram As An Assessment Tool Nursing Essay

The Genogram As An Assessment Tool Nursing Essay A Genogram is a resourceful clinical tool that is being used by family therapists and medical professions as an assessment tool to assist in identifying a patients important family information (Shellenberger, et al, 2007, 368). Adding a cultural layer to the genogram has assisted many medical physicians in understanding the reasons why some patients dont understand the medical diganosis and refuse medical treatment (372). The genogram that includes biological history and cultural history has been found to be a resourceful instrument that is becoming part of the clients medical records (368). The genogram can also be used to focus attention on the biopsychosocial context of the patients health and wellness concerns (368). To start a genogram, one begins with basic answers to questions taken in during the intake session at the patients first visit to the family physician or family therapist.   The therapist or practitioner would include important events, such as deaths, marriages, and divorces all deserve careful study (Nichols, 2010, 125). It would also include answers relating to the patients nuclear family such as who lives in the household (name, age, gender, occupation, and education), where the other members live, and what health related changes or problems have the family faced most recently (Shellenberger, et al, p. 369). Other significant information included in the genogram would be concerns regarding pregnancies, illnesses, hospitalizations, deaths, and even psychiatric problems such as depression, anxieties, and phobias (Nichols, 2010, 125). In addition, dates and relationships provide the framework to explore emotional boundaries, triangles, fusion and cutoffs between family members, and critical conflicts that occur among family members (125). The answers to these questions and questions relating to biological heredity will indicate whether there are common themes that show up through generations which would indicate possible cause to current medical or psychological concerns (125). Common themes like cardiovascular disease, diabetes, and hypertension are just a few that tends to be hereditary. Genograms can find a link in a family history that indicate psychosocial problems (i.e. domestic violence, substance abuse, relationship difficulties) as well as cultural beliefs, values, attitudes and he alth practices (Shellenberger, et al, 369-370). After the patient assessment is complete the information can be transformed into an organizational family tree type drawing with symbols used to identify gender. For example, men are notated by squares and women by circles, with ages inputted inside the frame (Nichols, 2010, p. 124).   Horizontal lines indicate marriages, with the date of marriage written on the line and vertical lines connect parents and children (124). These are just a few basic symbols to get the genogram started.   (See attached diagram for further details of symbols used to expand the genogram.)   Theres no attachment. There are many uses of genograms in family therapy that have been found to be extremely successful. Therapists have reported that using the genogram as a tool for family members to express emotions by telling facts and not opinions can prevent unnecessary negative comments and frustration. The genogram can also be used to initiate a cooling down period after a heated family battle and can be a way that a therapist can connect with their client in order to lay the foundation for positive relationship (Schilson, Braun, and Hudson, 1993, 201). It has found to be a means through which a therapist can learn key words and ideas for later use when developing goals and direction with their clients. When a therapist looks into each family members personal concerns, values, wishes and fears they are better able to connect to the core issues causing conflict. The genogram can capture information about the family structure, major life events, repetitive illnesses and eventually the process can be therapeutic (201). These benefits all aim to assess, while it boosts patient morale by highlighting individual and family coping strengths.   The positive relationship that is established during the intake session supports the relationship between client and therapist by gaining the patients trust and connection with the health care staff (201-202).   Ã‚  Ã‚   When genograms were used as a training tool in preparing therapists and physicians for working in their field they became more effective in developing the client-practitioner relationship. (Aten, Madson and Kruse, 2008, 111-112).  Research on the effectiveness of genograms as a tool can teach family therapist and supervisors in training ways to assess their clients family relationships and history but it also helps gain self awareness and self reflection during their internship (111-112).       It has been shown that cultural issues can affect patients, families, and health providers perspective on the specific illness. It also discovered that cultural genograms were used to further develop training for postgraduate student and to develop their skill set in understanding cultural sensitivity which helped gain insight, sensitivity and awareness to cultural issues. This ongoing training influence the quality and outcome of the patient and family encounter (112).    Trainees are able to explore their own ethnic and cultural heritages and draw personal genogram depicting these origins (115).    Shellenberger, et al (2007), proved that when residents learn how to create their own individual cultural genogram enables them to understand their beliefs, values, attitudes and how general health practices differ from their own found the cultural genogram to be a continuous working document used throughout the sessions, collecting as much information on the intake interview and add to it on subsequent visits (380).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Similar to the traditional genogram, the cultural genogram provides information about where the family members are from, their health beliefs and behaviors, the gender roles within the household as well as culture and health resources (368).   They showed that the use of cultural genograms as teaching tools in medical practice proved to be beneficial when used in cultural sensitivity training.   It proved to be a creative, practical tool to assist clinicians in understanding the history of the client (380). Aten, Madson and Kruse (2008) found that an introduction to family functioning and cultural competence resulted in a deeper positive response from students to learn a structure approach to identify cultural information for use in a clinical setting (114).    Also indicated that when patient and provider do not share a common culture, communication can be challenging among the extend family.    Without this type of understanding and knowledge of the patients past can lead to misunderstanding of a patients culture and family. It can lead to the patients feeling disrespected or uncomfortable or receiving care that is inconsistent with important cultural practices (Shellenberger, et al, 2007 p.371).    Today the cultural diversity of the U.S. population, combined with the increasing cultural diversity of medicinal students and primary care residents, has created a critical need for approaches to cultural sensitivity training that are not tied to any single culture (380).    By building on this understanding, providers can then develop management plans that are more consistent with the patients worldview and more likely to be followed.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Although Schilson, Braun, and Hudson (1993) have discussed many benefits of using the genogram as an effective tool in the medical field, it has not been implemented in most practices due to the extensive time it takes to gather the information.   The extensive family histories are found to be a time consuming task that some find impractical in a busy office practice (203). The family physicians who have successfully intergraded genograms into their practices acknowledge that the genogram does take more time to process and will increases the length of time during each visit; however they also claim that the extra time required is often spent building patient rapport (Shellenberger, et al, p.372). The rapport building provided useful family information that can be used to address a patients concerns during a particular office visits or at some future visit.   As a result therapists were able to use reflective listening to contribute to the healing process of the patient (372). The more intense understanding of the past and present experiences and responses contributed to a more supporting and effective treatment strategies (372). In conclusion, this research indicates that the family therapy and medical practitioner have found many useful ways of assessing families in which the families themselves can participate. The purpose of this research was to examine the implications of the benefits of the genogram. The assessment process and procedures described here depend upon mutual engagement and participation of both the therapist and client. The family therapy has been incorporated into several family-medicine training programs and proven to be successful. The other alternatives for physicians who prefer not to use the genogram often refer to the family therapist to continue to aid the physician by acting as a referral source for patients. It is likely that further qualitative and quantitative research will clarify how the two professionals can work together most efficiently to benefit the client.   Per Shellenberger, et al, (2007), clearly, as health care evolves into total life care, the family physician/family therapist association prom-ises to be a vital union, beneficial to care providers and the patients and clients they serve (380).

The Ethics of Capital Punishment Essays -- Papers

The Ethics of Capital Punishment Ethics is "the study of standards of right and wrong; that part of philosophy dealing with moral conduct, duty and judgement.'[1] Capital Punishment is 'the death penalty for a crime.'[2] The word "capital" in "capital punishment" refers to a person's head as in the past; people were often executed by severing their head from their body. Since the early 1800's, most executions have resulted from convictions for murder. The death penalty has also been imposed for such crimes as armed robbery, kidnapping, rape and treason. Some people believe that capital punishment is necessary for punishing people that have committed any type of crime, much of the time because these people want justice; others think that capital punishment is only necessary in extreme cases, such as murder, while others believe that it is wrong and shouldn't be aloud to take place. Amnesty International's thoughts on the death penalty is that it is 'cruel, inhumane and degrading punishment and a violation of the right to life'[3]. In extreme cases, I believe that people should be punished. People who commit crimes such as murder (mass or only an individual killing), rape and kidnapping should all be punished for what they have done. For example, the current issue with the Balibombings "mastermind". Amrozi Bin Nurhasyim is up for trial and if proven guilty, the death penalty will be imposed. Although he himself believes that he is a hero, I believe that as he killed so many and injured many more, the death punishment is the only fitting and adequate punishment. Many people oppose the death penalty because they consider it cruel.... ... that Capital Punishment is the best way to go to punish people who murder and commit other drastic crimes. I believe that murders should have the Death Penalty imposed to punish them for taking someone else's life, although everyone has their own opinion and that is fine to have a different opinion. Whether Capital Punishment is ethical is also up to your own beliefs, and I hope this essay has given you an insight into Capital Punishment and helped you determine you own opinion. --------------------------------------------------------------------- [1] World Book Online Dictionary - http://dictionary.worldbookonline.com/wbol/wbDict?lu=ethics [2] World Book Online Dictionary - http://dictionary.worldbookonline.com/wbol/wbDict?lu=capital%20punishment [3] Amnesty International Report "The Death Penalty"

A Famous Personality Who Has a Great Influence on Me

In the world, most of people need to change themselves. It might be they meet somebody who inspires them to do something that never done before and I am one of those people. I love volleyball so much since I watched SAORI KIMUEA on a TV. She is a Japanese volleyball player and very famous because of her beauty, talent, and skills of competition which are reasons for me want to be like her. The previously, I met her. I disliked exercising very much I had never thought that sports were very exciting. I wasn't interested in any sports.I was very an inert person and didn't prepare to study, do activities with friends, or the challenging things until I had seen the fierce volleyball game that SAORI KIMURA played, I felt enjoyable and wanted to play, the same time I really admired her smile, beauty, and sweet moving which are the important things for me or can say another way that I want to change myself form an inert person into an enthusiastic person. Initially, I just only watched I did n't know the rules of volleyball and how to play it.I didn't have courage I was afraid of the mistakes, but I want to be the best volleyball player, so I decided to play for my dream. I tried to play, but my first time wasn't easy I began to use my arms to hit the ball, suddenly the ball was backward. In fact, it should be forward, at that time my friends laughed very loud. It was so embarrassing, but I had never surrendered, I tried again I practiced harder and harder. Finally, I can play volleyball better than before, and last year, I became to be a volleyball player of my school team I was very glad.The volleyball taught me many things such as what is the teamwork? Don't be afraid and technical of doing new things because everything has to practice the same as playing volleyball. For those reasons, I don't have to worry about mistakes when I do the challenging things. I have to thank Miss SAORI KIMURA who is my inspiration she makes me know the endeavor and have more daring espec ially, I can play the volleyball like her even thought I haven't been good enough yet, but I promise that one day I will be the famous volleyball player like SAORI KIMURA.

How does Grace Nichols convey the life of the slave women in her poetry? Essay

One way Grace Nichols shows us how the slave women had to live is by saying what they had to do for their captors. In her poem ‘We the women’ Grace says ‘we the women who cutclearfetchdigsing’. The idea of not putting spaces between each work shows how hard they had to work without a break. Grace also says ‘we the women who toil’ which also shows how hard they had to work. The simile ‘whose deaths they sweep aside as easy as dead leaves’ shows how much they were hated and seen as pieces of rubbish. The use of the word ‘we’ in the poem shows just how many women had been captured and a gives a sense of empathy with the slave women. The sun in this poem is shown as a bad figure even though it gives life. To the slaves it is bad because it makes the labour they have to do even harder than it should be. The slaves tried to cheer themselves up by singing. The verb ‘sing’ in the poem has a religious connotation which shows their belief in God. However, this belief is doubted by the suffering they have to endure day after day and also because their prayers go unsung, as Grace says. We see with the used adjective ‘unadorned’ that the slaves were treated badly, misused and badly dressed because appearance did not matter to the captors only work. Grace Nichols uses repetition to convey the harshness of their lives as well. The words ‘old dry-headed women leaning on her hoe’ are repeated in the poem ‘Up my spine’ to show how bad their condition was and how mistreated they were. It also shows the amount of heat exhaustion they get and the lack of rest they have. Their heads are burnt by the sun and the skin is dry. Grace also says in that poem that they have to work even if they are injured and hurt. This shows how much they disliked slaves but had to use them for work to make money. The phrase ‘Way back time when she had a fall’ is used to show that there is no medical help for the workers so they work till they die. Grace uses the senses to convey how awful the slaves’ lives were in this poem as well. Two examples of this are ‘I see the pit of her eye’ and ‘I hear her rattle bone laugh’. This also conveys the physical state that the slaves were in and how they looked. However their captors did nothing to help as it did not matter to them what they were like as long as they worked. The second example gives a feeling of hatred to the poem as she thinks that the slaves would want revenge on the overseers for what they did to them. After all no-one would want to work all day for nothing. The simile ‘twist up and shaky like a crippled insect’ which also conveys their lives. In the poem ‘Water pot’ the workers are slaving away in a plantation centre. Grace says in it, ‘there’s a water pot growing from her head’. This is because the slave woman is carrying it on her head whenever they needed water which, in the heat, is often. It also shows how much work they had to do and for how long every day. Grace says in this poem as well that they are like cattle ‘always hurried’. This conveys how badly they were treated and actually what the captors saw them as. The words ‘tried to walk like a woman’ is used to show how injured they were because of work and the fact they could not walk properly. Grace implies that the slaves had to pull themselves erect to keep some self-esteem, to keep going and not give up, and to show the overseers they will survive whatever they throw at them. However a vast number of slaves died during the 18th century alone. ‘Ala’ is a poem about a woman killing her own child and then being punished for it. In the poem, the slave has given birth to a child which she does not wish to keep because of who the father is. In this instance the father is one of the overseers/captors who raped her. This poem also symbolizes the horror the slave women had to go through and the fact that the title is a religious word meaning ‘god’ their cry for help to their God. The woman who is being tortured is lying on a board with her arms and legs spread-eagled and staked to the ground. This is an implication of Jesus as he was crucified on a cross. The overseers see this woman as a ‘rebel’ and are making an example to the others by killing her publicly. She is the scapegoat. Grace uses repetition here to show to us what was in line for the other women if they did the same. She also says the slave has sent the new-born soul winging its way back to Africa. This implies that the baby is an angel as it has not been forced to work or put through any physical labour. Grace says the soul has gone to Africa because it is where most of the slaves originated from and it is then free. This woman is being eaten alive by red ants as a form of capital punishment for her actions. The personification in the line ‘and the sun blind her with his fury’ adds to the cruelty. The sun is a male figure and so takes the side of the men. The other slaves then pray to God for the deceased woman to be accepted in the pocket of his womb. This is a link up with the baby who was also killed. They are asking for the both of them to be free. Another poem Grace uses to convey the lives of the slave women is ‘In My Name’. This poem goes on about the horror the slave women had to go through. In this instance the baby is not killed therefore it is the opposite of ‘Ala’. The slave is in labour, giving birth to her ‘curled bean’ as Grace describes it. The woman’s belly is an arc of black moon. This shows how unwanted the babies are and that the fathers are the overseers. The colour ‘black’ is evil and we get the impression of what birth is like the way she squats over the dry plantain leaves and commands the earth to receive you. The baby is being dropped here onto the ground because there are no medical facilities available. Grace says the baby is ‘my tainted, perfect child’. This is an oxymoron because she is saying two virtual opposites together. The hatred towards the overseers raping them is shown in the words, ‘my bastard fruit’ and ‘my strange mulatto’. The second example shows that the baby’s father’s parents are mixed race and the mother does not like this. It will always remind her of the slave drivers or her captors if she ever escapes from their grasp. Where as the first shows how appreciative the overseers are of the baby but not the mother. She wishes it wasn’t born so it did not have to become a slave. Grace uses the words ‘my sea grape’ to show how far they have had to travel before arriving at their work place or deathbeds in many instances. At the end she says ‘now my sweet one it is for you to swim’ showing that the baby should make its own decisions on its life and to begin its journey. Overall Grace Nichols poems show her hatred towards what happened to her ancestor’s long time ago and what is still happening today in some places. She believes ruling on it should be stricter and so there will be no slaves left.

Play script Essays - Culture, Human Behavior, Entertainment

Play script Essays - Culture, Human Behavior, Entertainment Group Play Script Man living in his house Narrator: old man Jones living there. he's been there for a long time. All his memories are here. Landlord comes and (air knock on door) "Hello Mr. Jones how are you" "I'm here to notify you that as of next month the rent prices will be increasing" (charges more on living space) "I'm sorry sir, but the developer told me i had to raise the prices, the competition of the housing complexes is getting fierce" "Besides there's other people willing to pay more for this house" "I have to keep up with the market you know" Narrator: this is an example of capitalism. With the mindset to maximise profit the landlord has kicked the elderly man out Man is obviously upset, talks about family and living here forever Man is homeless now Narrator: Fast forward this man is now homeless and the home that held all his memories is now for sale "White man" Connor comes talks to the landlord and inquires about the property and talks about how cheap the living area is. Narrator: The price of living went from 800 to 1,600 which was a steal for Connor Narrator: in a fit of rage Jones fights Connor and gets arrested *i'm arresting him* Jones realizes Connor has taken his home As narrator returns to spot Landlord: "I'm sorry for what just happened our neighborhood has changed drastically and some people just aren't happy with it" "the crime rate has actually decreased in this neighborhood" Narrator: This is a prime example of Pyrrhic defeat which is a theory by J. Reiman. Pyrrhic defeat theory explains how the criminal justice system serves the rich by its failure to defeat crime. The criminal just creates the image that crime is exclusively the work of the poor which in turn serves the interest of the powerful. The crimes done by poor people has been reported as going down but by the pyrrhic defeat theory it is just being masked to hide the true crime which in this case is gentrification that is being done by the developers. Starts presentation Gentrification is: the process in which affluent people move into poor homes and neighborhoods and attract new and more expensive businesses

Joint Functions Commander's Planning Guidance Coursework

Joint Functions Commander's Planning Guidance - Coursework Example CFLCC units will be prepared for transition to Phase II (Seize the Initiative) operations should sequential FDOs fail to prevent an attack by Ahurastan (AH) into Azerbaijan (AZ). The CFLCC command staff’s problem frame has identified two areas of concern. The first is that the commander has identified the mobility corridor vicinity of GANJA (KIROVABAD) as decisive terrain in CFLCC’s movement from TBILISI to the KURA River basin. This mobility corridor is canalized by urban terrain in the north and mountainous terrain in the south. The CFLCC command believes that failure to control this mobility corridor will significantly impede the success of IAW EUCOM CONPLAN 4567-15. e. The second area of concern is that AH may attack before JTF-CASPIAN has fully deployed. The CFLCC command has analyzed this ECOA, and their worst case assessment is that the ADF brigades deployed along the AZ border may only be able to delay AH ground forces 24-48 hours. Because of the accelerated tim eline, there will be limited JTF-CASPIAN forces available to support this contingency mission. OPERATION’S PURPOSE: Prevent Ahurastan forces from controlling the mobility corridor from the vicinity of GANJA (KIROVABAD) to BAKU utilizing a THREE PHASE OPLAN,. AH Capstone mission is the isolation of BAKU IOT leading to a political settlement that will recognize AH’s oil claims in the region. Phase I –DETER- Pre-conflict preparation and transition to war: M-day to D-day. Provide aggressive reconnaissance and presence within the GANJA (KIROVABAD) to BAKU Area of Operations (AO). Coalesce and integrate combined battle plan and order of engagement with all allied forces AZ. Commence pre-emptive Phase II (Seize) deployment of forces into staging areas. Phase II-SEIZE- Initial transition to war. D-day to OPLAN Day 4. Commence interdiction attacks with long-range fires and attack aviation forward of PL BLACK to disrupt lead tactical

Decision support Systems (DSS) United Arab Emirates context Essay

Decision support Systems (DSS) United Arab Emirates context - Essay Example At the present, we can see lots of innovations in how business organizations make use of automated information systems in making decisions. In fact, as a number of business organizations and managers have become more knowledgeable, decision support systems (DSS) have started evolving from its opening as a private support tool and now it has emerged as the common resource in a business organization (Xiaoli & Gaojin, 2010). Especially, the United Arab Emirates (UAE) where the majority of organizations heavily rely on data and decision making to run their businesses. This basic purpose of this research is to discuss the use of decision support system in the context of the United Arab Emirates (UAE). This paper shows how the use decision support systems and techniques can be useful especially in the UAE. A â€Å"decision support system (DSS) is an application of an information system that provides users with the appropriate decision-oriented information when a decision-making situation takes place.† Additionally, a decision-support system allows the business management to take effective decisions by collecting and combining information, appropriate logical models and applications, and user-friendly interface into a single strong system that facilitates unstructured or semi structured decision making. In this scenario, a DSS also offers to its users a proper set of tools, techniques and support and services for making effective use of key blocks of data (Laudon & Laudon, 1999, p. 468; Whitten, Bentley, & Dittman, 2000, p. 47). The basic objective of a decision support system is to help top management in decision making. In this scenario, decision support systems are not developed to be used by technically skilled people however these systems are particularly designed by keeping in mind the specific needs and requirements of managers or CEOs. Additionally, they are provided with an easy to use interface through which they can interact