Dementia Care Training for Nurses

Dementia Care Training for Nurses Improving Dementia Care Training for Registered General Nurses and Adult Student Nurses: examining the need, efficacy, content and barriers. This Independent Project aims to explore the efficacy of current provision for Dementia care training for Adult branch Student Nurses and Registered General Nurses (RGN’s). A range of audits and research literature on this area of special interest will be examined to obtain a better picture of the situation with an aim to discover a recommendation for whether more training in this area is needed. The content and provision needs of training will also be explored with barriers to effective care and training critically analysed. Introduction Dementia is an umbrella term used to describe a wide range of symptoms caused by certain diseases or conditions associated with decline in a person’s cognitive abilities such as memory, personality changes, impaired reasoning and use of verbal language, which are severe enough to reduce a person’s ability to perform every-day activities (Chater and Hughes 2012). The most common of these diseases is Alzheimer’s reference. Dementia is progressive and incurable, therefore it is vital these people are supported and cared for by nurses who have been trained with the skills and knowledge needed to deliver high quality evidence based care. ADD IN STRONG REFERENCE THAT TRAINING IMPROVES QUALITY EVIDENCE-BASED CARE. There are currently 800,000 people with dementia living in the UK, with these figures expected to rise by 40% over the next 12 years and by 156% over the next 38 years due to an ageing population. Evidence from the Department of Health (2012) shows that 95% of these people are over the age of 65 and are therefore more likely to have complex medical needs. As a result; they spend increased time in acute hospital wards under the care of RGN’s, making training in this area for this group of health professionals a contemporary issue which needs exploration (Department of Health 2012) . The rising number of patients with dementia presents a challenge for all acute hospital trusts and many different health professionals. Such patients experience higher mortality rates and are more likely to have longer lengths of stay than others, they are also more at risk of falls and other incidents whilst in hospital (Cornwell et al 2012). Aside from the cost implications to the NHS when trusts do not get to grips with this challenge, the patients are not getting appropriate care – they are not ‘living well with dementia’ (Department of Health 2009). The National Dementia Strategy set a clear vision that people with dementia and their carers should be helped to live well with dementia, no matter what the stage of their condition or where they are in the health and care system. Through examination of Dementia training efficacy, it is hoped a recommendation will be made to improve the lives of those living with Dementia through changes in Dementia Care training for RGN’s. Following initial exploration of evidence available surrounding Dementia care training, the following issues will be addressed and critically analysed: Why is Dementia Training for RGN’s needed? How can the efficacy of training on Dementia care for RGN’s be improved? What content should be used in Dementia care training? What are the barriers to implementation of Dementia care training? Why is Dementia Training for RGN’s needed? Patients admitted to acute hospital wards with dementia have comparatively poorer outcomes regarding length of stay, mortality and further institutionalism (DH 2009, Alzheimer’s Society 2012). In addition, this group of patients place higher demands for nursing care, are more likely to functionally decline during admission and suffer increased rates of delayed discharge. This can result in permanent decline in health and added costs to NHS trusts (Mukadam and Sampson 2011). Though thought by many to be due to their complex health needs (REFERENCE), The Health Foundation (2011) has suggested a significant reason for these poorer outcomes is lack of professional understanding by RGN’s in providing appropriate care. Improvement in Dementia care is currently a nationwide health initiative reference. National audits over the last 5 years have recommended implementation of dementia services such as dementia lead nurses, standardised assessment and care protocols and compulsory staff training (DH 2009, Harwood et al. 2010, Thompson and Heath 2013, RCP 2013). Yet there are many recent reports of poor and sometimes negligent care suggesting these recommendations have not yet been followed or implemented (Leung and Todd 2010, Francis 2013, RCP 2013). Results from the National Audit of Dementia Care in general hospitals indicated that nurses working on acute wards rated significantly lower adequacy of training than nurses working on care of elderly wards. Other audits such as Counting the Cost report (Alzheimer’s Society 2009) indicated that more than half of nurses had not received any pre or post registered dementia training. Elliot and Adams (2011) further identify the lack of understanding around Dementia, meaning the needs of older people with Dementia are not addressed in many acute hospital settings. As can be seen, the need for specific training in Dementia care for RGN’s is strong. There is evidence to support positive influence on effective care with training. The National Audit of Dementia Care in General Hospitals (NAD 2012) was commissioned by Healthcare Quality Improvement Partnership to address the concerns of care for people with dementia (Tadd et al. 2011). These audits aimed to identify hospital’s provision of assessment, care models and staff training. Following the 1st round of audits in 2011 a report by Thompson and Heath concluded that the main barriers to providing good care were lack of understanding of the condition, not enough time to care and failing to communicate with patients. Improvements are not as forthcoming in dementia assessment on admission to acute wards. Results from the 2nd round audit of NAD acknowledge that there had been improvement in implementation of staff training frameworks in hospitals since the 1st round audit and represented an improvement in care as a result (Royal College of Psychiatrists 2013). The 2nd round report highlighted that approximately 75% of hospitals now provide dementia awareness training to nurses, although almost 50% are still failing to provide dementia awareness training as part of induction programmes. The report suggests that further improvement is required in providing better and more consistent staff training, as despite some progress, there appears to be a gap between actual training and written reports (RCP 2013). As a result, the recommendations outlined and analysed in this Independent project may be of some use in raising positive statistics. How can the efficacy of training on Dementia care for RGN’s be improved? It is the evaluation of this evidence which aims to generate key recommendations for provision of Dementia care training. Elliot and Adams (2011) were able to show improvements in needs met where specific education for RGN’s is provided by a Dementia Nurse Specialist (recommendation number 1). This shows the role of the Dementia Nurse Specialist to be vital in improving the efficacy of Dementia training and infiltrating best possible evidence-based care into clinical practice. However, despite this, the minimal numbers of Dementia Nurse Specialists currently practicing has to be identified as a limiting factor. In many trusts and academic institutions, there is no availability for a Dementia Nurse Specialist to provide training, therefore limiting efficacy even when extensive training is to be provided (Knifton et al. 2014). In terms of training content, it is well documented that evidence used should be reliable and credibly underpin clinical practice as this promotes evidence –based practice and better health outcomes (Jeffs et al. 2013). Evidence based practice is vital in all nurses’ roles (REFERENCE NMC CODE). REFERENCE suggests up to date qualitative and quantitative research is the only knowledge and information base which should be used to allow best care to be provided, hence placing important value of increased use of evidence based research in training sessions. Currently, Moyle et al. (2008) suggests the lack of research used to underpin Dementia training for RGN’s is limiting ability to not only provide best care but also identify those living with Dementia (Chang et al. 2009) RECOMMENDATION 2. However, barriers to evidence based care remain even when high quality evidence is used to support training. Smith-Strom and Nortvedt (2008) have identified that RGN’s ofte n find evidence difficult to interpret and evaluate while Oermann (2009) suggests very little of the content is retained to be implemented into practice. This suggests RGN’s may also need training on evidence based practice and processing research (REFERENCE). Gerrish (2008) suggested the knowledge and skill of the individual nurse prior to receiving specific training heavily influenced their ability to improve their practice following. This suggests multiple training sessions on Dementia may be needed before practice can be changed and improved (REFERENCE). RECOMMENDATION 3. What content should be used in Dementia care training? Tadd et al. (2011) explain that one reason for increased functional decline is that care of patients on acute wards is prioritised from the perspective of the medical condition for which they have been admitted, often overlooking their mental health condition. Most acute wards follow rigid, task driven routines such as drug rounds, meal times and washing, while staff lack the necessary skills required to provide proficient dignified care. This form of nursing can cause increased anxiety and delirium resulting in poorer outcomes for individuals (Tadd et al. 2011, Calnan et al. 2013). Alzheimer’s Society (2009) report that patients admitted to acute hospital wards for longer periods are more likely to suffer from permanent worsened effects of dementia and physical health. They are more likely to receive prescribed antipsychotic drugs and to be discharged to residential care rather than their home (Thompson and Heath 2013). Leung and Todd (2010) acknowledge that specialist services do exist in some trusts and that training in managing behaviour, using life stories and implementing dementia care mapping are all good techniques that can help nurses to improve quality care. Dementia care mapping is an observational method of recording interactions that take place between individuals and nurses over a period of time (Ervin and Koschel 2012). This enables evaluation of what works and doesn’t work for patients, it is a useful way of tailoring person-centred care to help staff understand the experience of dementia from the patient’s perspective while rating quality of care given (National Institute for Health and Clinical Excellence and Social Institute for Care Excellence 2007) (NICE-SCIE). Alzheimer’s Society (2013) suggest that nurses must challenge their task driven ward environment and provide a more flexible approach providing care from the patient’s perspective as this is achievable and beneficial to patients. Leung and Todd (2010) reported that most nurses have received little or no training and are ill equipped to deal with the many challenges that face both patients and nurses. Additionally NICE (2013) state that nurses suggest dementia education programmes should include identifying signs and symptoms, communication and person-centred care methods, treatment to include medicine administration and how to monitor side effects, particular emphasis was placed on requirement to assess pan. Nurses also suggested that learning about the impact of dementia on the individual and managing challenging behaviour would be useful. Dementia training is not a compulsory element of the pre-registered nursing curriculum although this has been recommended to the Nu rsing and Midwifery Council (NMC) by several national organisations. (NICE-SCIE 2007, Alzheimer’s Association 2009, All-party Parliamentary Group on Dementia 2012, Higher Education for Dementia Network 2014 (HEDN)). The NHS Confederation (2010) recognise that providing dementia training to staff could benefit hospital trusts in several ways. These include nurses being equipped to identify those with dementia, therefore being able to implement care pathways appropriate to patients. Effective management of patients with dementia helps avoid disorientation and anxiousness which could reduce the amount of time spent attending to challenging behaviour and allow staff more time to care for all patients on an acute ward. What are the barriers to implementation of Dementia care training? Even when effective dementia training has been provided, barriers to good quality evidence-based care remain and it is important these do not go unnoticed. Identification and knowledge of these barriers alone can minimise their limiting factor (reference). Acute hospital settings pose many challenges to both patients with dementia and the nurses caring for them. Yet Harwood et al. (2011) report that there is little evidence of research aimed at investigating these challenges and the provision of detailed policies on how to deal with them. Patients with dementia are more likely to find an unfamiliar environment unsettling, frightening and confusing due to the nature of impaired cognitive ability (Moyle et al. 2008). This accounts for literature suggesting that an acute ward environment comprised of identical doorways and bed spaces causes added confusion to patients (Reference). This often creates increased disorientation, aggression or withdrawal (Leung and Todd, Thompson and Heath 2 013). This further challenges the nurse’s role in maintaining nutritional, personal hygiene and drug administration tasks as individuals can no longer respond to familiar faces, environment and daily routines (Tadd et al. 2011). Barriers Overcoming the barriers The government accepts improvements are needed and is pinning hopes on the  £3.8 billion Better Care Fund, which will was launched in April 2015. The pot has been earmarked for joint projects between the NHS and local government to encourage more integrated care. STUDENT NURSES 2015 report: Dementia education to bestandardised at degree level some nursing degrees offer only three hours of dementia education throughout the whole three-year course. How this should change following the dementia core skills framework, but it doesn’t state how many hours students will be required to undertake. Student nurse attitudes towards working with the elderly Future plans for RGN’s HEE 2013 Mandate targets. – ensure that tools and training opportunities in dementia are available to all staff by the end of 2018. Current training requierments of RGN’s in relation to Dementia training References Department of Health (2009) Living well with dementia: a national dementia strategy. The Stationery Office, London. National Institute for Health and Clinical Excellence/Social Care Institute for Excellence guideline (2006) Dementia: supporting people with dementia and their carers in health and social care. NICE/SCIE, London.

Recognition and Reversal: Othello Essay

Aristotle classifies both recognitions and reversals as the greatest point of tragedy in a play or story. Recognitions and reversals are consistently used to develop character, advance the plot, and get a reaction of pity and fear from the audience. Recognition is the act of realization or knowledge or feeling that someone or something present has been encountered before. Reversals are a major change in attitude or principle or point of view. For the main character or hero/protagonist to realize everything that has happened throughout, reversals are used by the writer or writers. Recognition is a device which helps readers to realize a reversal. Other ways in which recognitions and reversals can be used is when the audience or reader has pity for the hero. Pity is a result of a combination of reversal and recognition. Another way recognition and reversal can be used is when the reader or audience reacts to fear, a product of reversal and recognition formed into a shocking ending to a plot. The greatest point of tragedy, as Aristotle calls it, happens when not only shock, but reversal, recognition, and pain are presented around the center of the play or story in an unexpected instant to the audience or reader at the end of a play or story. In â€Å"Othello† by William Shakespeare, examples of recognition and reversal can be seen throughout the play as the hero/protagonist Othello, goes through a life changing experience in which he realizes things through a somewhat shaded lens. In the play, as we near the end, the proceedings change and finally Othello is able to see that he has made a mistake. In a perfect world, it would not be too late to change what the aftermath will be. But, in Othello’s case, the recognition in this dramatic play happens way too late for Othello to correct the situation. â€Å"Othello† truly offer readers evident examples of recognition and reversal. Reversal is most evident in the final Act in Scene II where Othello kills Desdemona. Before the murder, Othello’s love for Desdemona is portrayed in Act II, Scene I when Desdemona arrives in Cyprus, â€Å"It gives me wonder great as my content / To see you here before me. O my soul’s joy,†¦As hell’s from heaven! If it were now to die, ‘Twere now to be most happy, †¦Ã¢â‚¬  (Kennedy and Gioia, II. I. 176-177, 182-183). However, as the play moves further along, Iago starts to manipulate the mind of Othello and Othello’s trust in Desdemona starts to diminish. At the start of Act V, Scene I, Othello places a great deal of trust in Iago – â€Å"O brave Iago, honest and just, Thou hast such noble sense† (Kennedy and Gioia, V. I. 32-33). But in Act V, Scene II, the truth about Iago is revealed to Othello by Cassio and Emilia. Othello’s trust in Desdemona is shown throughout the play until his trust starts to wither as Iago twists his mind, â€Å"Yet she must die, else she’ll betray more men . / Put out the light†¦If I quench thee, thou flaming minister, / I can again thy former light restore,†¦Ã¢â‚¬  (Kennedy and Gioia, V. II. 6-9). The greatest recognition in Othello occurs in Act V, Scene II, lines 87-91. Othello kills Desdemona. Then Cassio and Emilia appear and reveal Iago’s evil plot and Desdemona’s innocence. Othello then realizes that he was wrong and that his trusted friend Iago has played him for a fool. Once Othello speaks of the handkerchief he gave to Desdemona as a symbol of their love, Emilia knows that Iago is the person who set up Desdemona and Othello is not the one to blame. Emilia keeps repeating the words, â€Å"My husband?† (Kennedy and Gioia, V. II. 145, 152, 156) as she makes an incomprehensibly swift journey from knowing absolutely that Iago, her dear husband, is honest and totally trustworthy, to realizing that in fact he was the quintessential villain. The most distressing recognition comes near the end of the play, when Emilia, Desdemona’s friend and ally, realizes that her beloved husband Iago is the cause of all the misery and misfortune that is killing th em all. Furthermore, she realizes that she has played an unintentional part in the tragedy by following Iago’s request to steal Desdemona’s handkerchief. It has all been a plot by Iago to destroy Othello, and this is finally revealed to everyone, including Emilia (Kennedy and Gioia, V. II. 179-182, 187-189). To see Emilia come to full awareness is to see first the emotional breakdown caused by this revelation, and then to see it begin to build, as she shows heartbreak, guilt, awareness of betrayal, and recognition of supreme cruelty on the part of someone she has trusted with her life. She finally speaks  with the words, â€Å"Villainy, villainy, villainy!† (Kennedy and Gioia, V. II. 197), knowing she has to persuade everyone of Desdemona’s innocence. Recognition again occurs in Act V Scene II when Emilia hears Othello mention the handkerchief, after he has killed Desdemona: â€Å"With that recognizance and pledge of love / Which I first gave her. I saw it in his hand; / It was a handkerchief, an antique token / My father gave my mother† (Kennedy and Gioia, V. II. 221-224). At the same time, the attending visitors and soldiers, who have been called into action by Emilia’s cries in Act V, Scene II, are also realizing the truth of these terrible events. The reversal occurs as Emilia discloses that it was she who stole Desdemona’s handkerchief, â€Å"She give it Cassio? No, alas, I found it, / And I did give’t my husband† (Kennedy and Gioia, V. II 236-237). Immediately Othello knows that Iago has deceived him, and the recognition occurs as he says, â€Å"Are there no stones in Heaven / But what serves for the thunder? Precious villain!† (Kennedy and Gioia, V. II. 242-243). Emilia cannot contain herself until she has made Othello realize fully that his murder of Desdemona was based on lies told by Iago, who stands with her, threatening her life as she shouts the truth in Act V, Scene II. Her final words come after Iago stabs her for speaking. So, a triple realization happened all at once: Emilia’s living her own devastating heartbreak; she announced the truth for Othello; Othello immediately goes through an explosive episode once the truth is revealed, and then finally sees what deadly mistakes he has made. At the end of the final Act and Scene, after Iago had been exposed by Emilia, Othello feels remorseful about the murder of his wife, â€Å"O cursed, cursed slave! / Whip me, ye devils, / From the possession of this heavenly sight! / Blow me about in winds! Roast me in sulfur! / Wash me in steep-down gulfs of liquid fire! O†¦Dead, Desdemona!† (Kennedy and Gioia, V. II. 285-290). Othello then commits suicide because of the guilt he felt, the plays final reversal. As readers, we are distant from the situation and might think that we would understand what was really happening and alter our actions right away. Unluckily, in the case of Othello, the recognition happens way too late for him to change the sequence of events. Othello does not consider anyone but himself at the point near the end of the play. He does not contemplate to challenge Desdemona, as Iago fills his mind with false truths. Othello does  not question Cassio to find out if the accusations Iago is filling his mind with hold any truth. Othello takes to mind whatever Iago tells him, and does not try to find out if what Iago is saying is actually true. These actions are somewhat out of character for Othello. Usually he is calm and collected. He is a commanding general, which demonstrates that he knows how to direct and read people and how to think things through. Overall, Othello simply makes the error of taking the false truths of what Iago says, rather than investigating it. Ot hello’s deep affection and love for Desdemona make it that much easier for Iago to play with his mind. After killing Desdemona, Othello’s world falls apart in front of him because it is then that Othello realizes the outcome with his recognition of the fact that he was wrong to take the life of the one he so deeply loved based on a false truth. Othello’s world spins around him quicker than he can imagine, before it comes to an end. He has slain the woman he loved most in the world. The man he believed was his best friend twisted his mind and deceived him. All of this is more than he can bear. So, Othello gives one final speech in which he asks the men to remember him as he truly was. Othello requests them not to â€Å"lay it on thick† what a good man he was, nor to defame his character. Othello wanted them to think of him as a man who loved too much, however irrational it might have been. Many exceptional examples of reversal and recognition are shown throughout Othello. Constant use of recognitions and reversals to develop character, advance the plot, and get a reaction of pity and fear from the audience are clearly evident in Othello. Perhaps if Othello would have taken a minute to think about the long term outcome of his actions, he might have seen that there was more than one option of action available to him. However, if Othello had chosen another option, there would have been no recognitions, no reversals, and in turn no drama in the play. Works Cited: Aristotle. GradeSaver. 1999-2011. 11 11 2011. Dictionary.com. 2011. 07 11 2011 . Dictionary.com. 2011. 07 11 2011 . Kennedy, X.J. and Dana Gioia. Literature: an Introduction to Fiction, Poetry, Drama, and Writing. New York: Pearson Longman, 2010.

Nursing Research: Patients View

A national survey of GP and nurse attitudes and beliefs towards depression after myocardial infarction  Joanne Haws, Janet Ramjeet and Richard Gray 2011 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 3215–3223 Aim— to investigate attitudes to depression after myocardial iunfraction Background. Depression after myocardial infarction affects almost half of all patients and has a considerable negative effect on recovery.Despite the increased prevalence of depression in this population, it is often not recognised or treated. Results—Diagnosing depression was perceived as complex by both groups but significantly more so by nurses. We observed that training seems to have a significant effect on reported practice. Practitioners who reported that they had recent training in the management of depression were significantly more accurate in their estimate of how common depressionwas in this population.Depression may be underdiagnosed in this population be cause primary care practitioners, especially nurses, are not aware of how common the disorder is and lack competence in diagnosis. There is merit in developing and testing a brief training intervention to ensure competence in depression screening and treatment in post-myocardial infarction patients. Relevance to clinical practice. Diagnosing depression in post-myocardial infarction patients is perceived by nurses as complex but training in the management of depression is seen as helping practice.SupportLack of supportive recourses can have serious implications for patient care and treatment. †¦Ã¢â‚¬ ¦..stated that nurses did not feel supported by management and the ward environment was not appropriate for psychiatric patients.A similar study by Happell et al (2009) discovered that nurses need the support of management and colleagues. Nurses in this study felt unsafe on the unit because of lack of facilities and institutional resources to address client needs and staff safety fa ctors. A study by Bjongarrd et al (2007) highlights an additional problem in meeting all patients’ needs and  demands by asserting many patients with severe mental illness can also be recourse-draining.Promoting mental health care in a rural paediatric unit  through participatory action research  Brenda Happell,1,2 Lorna Moxham,1,2 Kerry Reid-Searl,1–3 Trudy Dwyer,1,2 Julie Kahl,4 Jodie Morris2 and Narelle Wheatland 3  Aust. J. Rural Health (2009) 17, 155–16A study designed by Happell et al 2009, provides a different view with the aim of promoting mental health care in a rural paediatric unit. The study desgin involved a participatory action research approach proving 24 nurses with the opportunity to become actively involved. This study involved paediatric nurses however results yielded similar to studies on general nurses attitudes in relation to mental illness. This study indirectly implies that mental health is considered a specialist discipline area by many other nursing disciplines and indeed the general public.A lack of understanding of general nurses’ role in the management of young people admitted to the paediatric unit with an acute mental illness, meant participants’confidence in caring for such patients’ was affected: I just never feel like I’m doing the right thing when Ilook after them. [FG1] Participants felt as though they were constantly seeking support and all expressed a strong desire for professional education, training and workshops.Patients viewWorld health organisation 2013People with mental disorders around the world are exposed to a wide range of human rights violations. The stigma they face means they are often ostracized from society and fail to receive the care they require—or in management.People with mental disorders may also face discrimination on a daily basis including in the fields of education, employment and housing.Patients view Johan Ha °kon Bjà ¸rngaard Ã⠀  Torleif Ruud Æ Svein Friis The impact of mental illness on patient satisfaction with the therapeutic relationship.  A multilevel analysis Soc Psychiatry Psychiatr Epidemiol (2007) 42:803–809 Background The relationship between patients and their clinicians is an essential factor in psychiatric treatment. The purpose of this study was to analyze the influence of psychopathology on patient satisfaction with the therapeutic relationship. Method involved collection of data from 969 patients.Patient’s satisfaction with therapeutic relationship was assessed with a six-item scale: sufficient time for contact/dialogue, clinicians’ ability to listen and understand, follow-up of planned interventions, respect for patients’ views/opinions, cooperation among clinicians, and patients’ influence on treatment. Mental illness was assessed using the Health of the Nation Outcome Scales (HoNOS) and Global Assessment of Functioning (GAF) scale. Diagnoses were established using the International Statistical Classification of Diseases and Related Health Problems—10th revision (ICD-10). Treatment outcomes were clinically assessed retrospectively by rating changes from start of treatment on seven items. Multilevel regression analysis was used for a simultaneous analysis of the contribution of patient and team variables. ConclusionsPatients’ perceptions of the therapeutic relationship may be influenced by psychopathology. Teams comprising many patients with severe mental illness may constrain the therapeutic relationship. Hence, resources and organizational measures should be carefully considered in such care units.Because response rates in surveys of patient satisfaction with psychiatric services are usually low, results cannot be unequivocally claimed to be representative of all patients [12, 28]. Although it seems that patients with more severe mental illnessare less likely to participate in patient satisfaction surveys [12] , the possible consequences of low response rates are not fully understood. The following study attempts to overcome the previous limitations of research reported in the literature by analyzing the influence of psychopathology on patient satisfaction with the therapeutic relationship.Data was collected from 8 community mental health centres  which operate operate as local psychiatric hospitals, offering outpatient, day treatment, ambulatory care and limited inpatient services, such as short-term crisis intervention units and longer-term rehabilitation units. All patients receiving treatment during the census period were asked to complete a questionnaire. Clinician-rated information was collected on all patients and could be linked to the patient questionnaire if patients had given their consent to the linkage. Of the 3,040 patients, 1,194 (39%) returned the questionnaire.We were able to link 969 of the 1,194 to the clinical data, as some patients had not given consent to such link age. This study showed that patient satisfaction with the therapeutic relationship was related to clinical assessment of mental illness, both due to each patient’s psychopathology as well as to the composition of mental illness severity in each team.A study by Johan et al (2007) takes a different perspective by analysing the influence of psychopathology on patient satisfaction with the therapeutic relationship. Data was collected from 3,040 patients and only 1,194 (39%) returned the questionnaire. Patient’s satisfaction was assessed using a six-item scale and the patient’s level of mental illness was then assessed using the Health of the Nation Outcome Scales (HoNOS) and Global Assessment of Functioning (GAF) scale.For instance, it is likely that the patients’ mood would be affected by the severity of their illness; hence, to some extent, experiences could be coloured by the mental illness itself. The results of this study indicate that patient’s d egree of mental illness has an effect on their satisfaction of the therapeutic relationship. These results were to be expected as patient’s moods are likely to be affected by the severity of their illness. The results of this study however are limited because of low response rates (only 39% of mental health patients responded) (Johan et al 2007). Low response rates have long been indicated as a common problem in mental health user surveys (Ruggeri 1996).

Essay on Human Nature in Hamlet and a Midsummer Nights Dream

â€Å"It is the nature of people to love, then destroy, then love again that which they value the most.† –Unknown. Countless authors have tried to display love as human nature, but no author does this better than the famous playwright, William Shakespeare. In both Hamlet and A Midsummer Night’s Dream, Shakespeare exhibits how love can control a person. To understand how love controls a person, one must understand that human nature is the sum of qualities and traits shared by all humans. All humans have exhibit love in one way or another, which explains how human nature relates to the controlling aspect of love. In Hamlet and A Midsummer Night’s Dream, conflicts between loyalty to family and friends, lack of trustworthiness towards others,†¦show more content†¦Hermia’s father told his daughter she could marry Demetrius, become a nun, or die. Hermia does not like any of those choices, so rebels against her father and decides to go and mar ry Lysander, her true lover. Love causes Hermia to choose Lysander, which shows how the human nature of love has controlling powers. However, in the end, Hermia’s father accepts the fact that his daughter has love for Lysander and allows them to marry, but not just because they love each other. The marriage of Hermia and Lysander results from Demetrius falling out of love with Hermia. In Hamlet, Hamlet decides to obey and remain loyal to his father, while in A Midsummer Night’s Dream, Hermia decides to go against her father’s requests because of her love for Lysander. While these Shakespearean plays produce two different outcomes between the human nature of love and loyalty, they both show how love controls the loyalty of a person to a loved one. Another point that comes across in Hamlet and A Midsummer Night’s Dream comes as a result of how trustworthiness gets in the way of love. In A Midsummer Night’s Dream, Hermia trusts her best friends, Hel ena to keep the secret that she plans to marry Lysander, without her father’s knowledge. While Hermia thinks she can trust Helena with her secret, Helena does not keep true to her word of not telling anyone the secret. Hermia tells Helena this secret because she not only trusts Helena, she loves her as a friend. Hermia’s love forShow MoreRelatedDefining The Terms Renaissance And Humanism875 Words   |  4 Pagesartistic transformation and advancement between the Middle Ages and the early stages of the Modern age in Europe (2014). In the New World Encyclopedia article â€Å"Humanism†, Humanism’s scope primarily focuses on human beings: human being s place in relations to nature, human potential, human beauty, etc. etc. etc. (2014). 2. Who were the Medici’s? 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The similarities are limited to the device of the confused lovers, and the possible use of magic in order to bring the lovers to their correct partner. The similarities would probably have gone unnoticed were it not for the production notes that came as a supplement on the DVD, wherein Steve Martin bluntly says that he took the idea from A Midsummer Night‘s Dream. But as previously stated, the themeRead MoreWilliam Shakespeare s A Midsummer Night s Dream And Fool1401 Words   |  6 Pagesof the Shakespeare’s fools in his works? And how do particular characteristics about these fools help them achieve this purpose? Through an in-depth analysis of Shakespeare’s arguably two most fa mous fools, Puck (Robin Goodfellow) from A Midsummer Night’s Dream and Fool in King Lear; an argument can be made that the scope of the fool goes far beyond being solely a comedic figure. 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Shakespeare wrote about timeless themes about the human nature surrounded themes of true love, revenge, power-lust, ambition, anger, war, etc, they are not only appealed to the people of Elizabethan England, but also provide a reference for life in his time for us to view the contemporary society. ShakespeareRead MoreWilliam Shakespeare: Greatest Playwright of All1568 Words   |  7 Pagesnew era for England. Shakespeare’s works epitomize arts of the Elizabethan Epoch; through his uses of beautiful and poetic language, iambic pentameter is nearly always used in his style of poetry. Shakespeare wrote about timeless themes about the human nature surrounded themes of true love, revenge, power-lust, ambition, anger, war, etc, they are not only appealed to the people of Elizabethan England, but also provide a reference for life in his time for us to view the contemporary society. ShakespeareRead More Historical References to Faust Essay1693 Words   |  7 Pagesastrologer, physician and prophet.  · When Faust first opens the book by Nostradamus he sees the sign of the macrocosm, which is a diagram of the organization of the cosmos.  · The vision that the sign of the macrocosm inspires echoes Jacob’s dream in Genesis 28, in which he sees a ladder connecting heaven and earth.  · Faust decides to kill himself by drinking poison, but is interrupted by the bells and chorus celebrating Easter.In the Christian tradition, Easter symbolizes rebirth andRead MoreThe Lasting Influences of the Classical World on Other Cultures Across Time in Comedic Texts2727 Words   |  11 PagesThe Lasting Influences of the Classical World on Other Cultures across Time Drama and dramatic performances have consistently been present throughout human society, both as a medium for entertainment as well as a forum for education and critique. Aristophanes, the â€Å"father of modern drama†, was the first to really successfully amalgamate these two ideas together within his dramatic pieces, as can be seen in his works Wasps and Frogs. Shakespeare was the next great dramatist, and arguably the greatRead MoreThe Life and Works of William Shakespeare 2100 Words   |  8 PagesShakespeare write).† Of his thirty-seven plays, thirteen are comedies, ten are historical, ten are tragedies, and four are Romances. Shakespeare also wrote 5 poems and 154 sonnets. Some of Shakespeares more well known works include â€Å"Romeo and Juliet†, â€Å"Hamlet†, â€Å"Othello†, â€Å"Twelfth Night†, â€Å"Julius Caesar†, and â€Å"Macbeth†. These plays are popular around the world and many kids study at least one of Shakespeare’s works during their years in middle school or high school. They are also performed in many drama