Values Practice Issues Within Mental Health Nursing Practice

Values Practice Issues Within Mental Health Nursing Practice Using the values identified in the attached book (empathy and importance of self expression) review prepare a 2000 word discussion and analysis of values practice issues within mental health nursing practice. Introduction This essay aims to explore some issues around values and practice in mental health nursing. The essay builds upon a previous piece of work undertaken as a formative assignment, a review of a book read by the author, which raised some key points which may be important in mental health nursing practice. The process of uncovering these issues, in response to reviewing and reading a work of fiction, was one which led to a connection of ideas, from what the book presented, and from the author’s personal experience, life experience, and clinical experience and learning to date. The identified issues are to do with compassion, empathy and the importance of self-expression. These are all issues which the author believes are very much taken for granted in everyday life, but which become very significant for users of mental health services, and for mental health service providers, because they affect many areas of the person, their experience, and the therapeutic relationship. This essay will explore these issues in the light of some of the published theory and debate on these topics, and the author’s own point of view and experiences. Discussion It would seem that within mental health nursing, the relationship between the mental health nurse and the client is very important, but this relationship is based on certain values which must underpin nursing care (Eagger et al, 2005), and certain needs or requirements that the client might feel in relation to the nurse. Nurses working within a framework of values is no new thing, and values (and ethics) have always underpinned medicine and healthcare (Eagger et al, 2005). According to Svedberg et al (2003), â€Å"Mental health is created by the interwoven process of one’s relationship to oneself and to others†, which would suggest that the relationships the client forms with anyone involved in supporting mental health are doubly important. The client may find self-expression important for themselves, but also they will require compassion from the mental health nurse. The nurse, in turn, may be challenged by the client’s self-expression, and may find it hard to feel compassion or to empathise with the client at times. One of the challenges of providing compassionate care and even for the mental health nurse to experience compassion is the supposed relationship which some authors have found between perceived suffering and caregiver compassion. Schulz et al (2007) suggest that there are links between perceived suffering and the level of caregiver compassion. If this is the case, then it could be argued that some mental health nurses who do not feel or display compassion are doing so because on some level they do not perceive or believe the client to be truly suffering, or to be worthy of compassion. This would raise an ethical issue, because all the patient’s needs should be met, no matter what the ‘personal’ response to the client. However, this could be a lack of perception on the part of the mental health nurse. Akerjordet and Severinsson (2004) discuss the issue of emotional intelligence in nursing, a concept which affects the nurse-patient relationship, particularly within mental health nursing. Salovey and Mayer (1990) define emotional intelligence as â€Å"the ability to monitor ones own and others feelings and emotions, to discriminate among them and to use this information to guide ones thinking and actions† (p 185). In their qualitative study, Akerjordet and Severinsson (2004) found four dominant themes about emotional intelligence in mental health nursing â€Å"relationship with the patient; the substance of supervision; motivation; and responsibility.† This would suggest that emotional intelligence on the part of the nurse is important within mental health nursing. Akerjordet and Severinsson (2004) suggest that emotional intelligence â€Å"stimulates the search for a deeper understanding of a professional mental health nursing identity† and that â€Å"emotional learning and maturation processes are central to professional competence, that is, personal growth and development.† (p 164). Therefore, the mental health nurse would need to develop the emotional intelligence to understand why they are finding it hard to feel compassion for the client, and to take action to remedy this, and to act in a sensitive and supportive way towards the client, even if they do not truly feel compassionate towards them. Shattell et al (2007) carried out research on the therapeutic relationship within mental health services, and found that clients expressed experiences of the therapeutic relationship under the following themes: relate to me, know me as a person, and get to the solution. â€Å"A therapeutic relationship for persons with mental illness requires in-depth personal knowledge, which is acquired only with time, understanding, and skill. Knowing the whole person, rather than knowing the person only as a service recipient.† (Shattell et al, 2007 p 274). This would suggest that the mental health nurse should be motivated to develop an empathy with the client through this knowledge, and should actively engage in seeking out ways to know and to understand the client. This may relate back to the issue of emotional intelligence, because the mental health nurse needs to know themselves very well, and to understand themselves and their professional persona (Akerjordet and Severinsson, 2004) b efore they can then go on to get to know and understand, and empathise with, the client. Hamilton and Roper (2007) discuss the concept of insight, looking at its theoretical underpinnings, and the fact that it is problematic in mental health nursing because it can be difficult to have insight into patient’s experiences of mental illness. Insight is seen as part of the process of getting to know and understand the client, and from this, developing a knowledge of their mental illness, including diagnosing their particular mental illness (Hamilton and Roper, 2007). However, developing this insight is made difficult by problems such as the perceived difference in power between caregiver and client, and the expectations of ‘patient behaviours’ (Hamilton and Roper, 2007). This would suggest that the mental health nurse needs to see each patient as an individual, as unique, and to take the time to truly get to know the person and their experience of mental illness. Definitions of mental illness, and labels, can make this harder, for the nurse, and for the cl ient as well, who fears being reduced to his or her disease rather than being seen as a person who is ill (Hamilton and Roper, 2007; Shattell et al, 2007). Research by Shatell et al (2006) emphasises this point. In their study, clients raised a number of issues around being understood by mental health caregivers, and it was this concept of being understood which seemed most important in developing an effective therapeutic relationship. Some of these concepts include: feeling important; establishing connections, and being on the same level (Shatell et al, 2006). Research by Svedberg et al (2003) found similar results, and in their study â€Å"the patients described how the feeling of mutuality in the relationship with the nurse was important for the promotion of health processes. Mutuality was achieved by doing things together and by having a dialogue with each other.† (p 451). This author feels that these ideals can be properly achieved by mental health nurses who take time to get to know the client and who develop empathy with the client through focusing attention on them. The patients wanted to feel understood in Shatell et alà ¢â‚¬â„¢s (2006) study. â€Å" Feeling important was a major consequence of being understood. Being understood made patients feel like human beings rather than being treated like a number or being treated like in a factory. Participants wanted to be treated like human beings, not as sick, mentally ill persons; like persons, not a set of diagnoses â€Å" (Shatell et al, 2006 p 237). This could be viewed as a consequence of the compassion and self-awareness of the nurse as a professional, and of their ability to see the client as an individual, to not be prejudiced by anything about them, especially not their illness. This is very important. This author believes that compassion and empathy develop through getting to know the client properly, and that these all enhance the therapeutic relationship. Shatell et al (2006) also suggest that clients feel important when they know the nurse has been thinking of them at times other than face to face contact, and this is something to think of for practice, particularly in relation to the conversations that nurses have with patients. It is also important that mental health nurses develop proper listening skills, which would also allow them to develop compassionate understanding, and support the client in expressing themselves (Freshwater, 2006). Encouraging self-expression is an important part of nurses getting to know their patients, it would seem, but self-expression is not easy for many people. People with mental illness are often negotiating a range of different sense of what constitutes their ‘self’ (Meehan and Machlachlan, 2008). â€Å" For example, a professional woman becomes a mother and wife or ‘homemaker’ when she leaves the office for home. In changing from one self to another type, her multiple self voices renegotiate their hierarchy and positions and create a coherent self story consistent with the role of mother and wife.† (Meehan and Machlachlan, 2008). These negotiations can be problematic for the person with mental illness, and this just provides one example of how complex understanding the self can be, which makes self-expression similarly challenging. Yet it would be worthwhile to develop activities and actions which would sup port this. It may be that there are ways that mental health nurses can encourage or support self-expression and the development of caregiver understanding of the client. For example, Raingruber (2004) discusses the use of poetry in child and adolescent mental health, as a means of self-expression, arguing that poetry has the power to allow clients to develop self awareness and to express their feelings. Raingruber (2004) suggests that â€Å"The complexity, power, and beauty of language within poetry allow the expression of intense human experiences† (p 14). While there are drawbacks and limitations to the therapeutic use of poetry, it might be that this offers one kind of opportunity for self-expression, on the part of the client, and empathy, on the part of the mental health nurse. â€Å" When an appropriate moment arises, poetry should be used to help clinicians, nursing students, and clients become more aware of and open to possibilities.† (Raingruber, 2004 p 16). However, this author believes that the mental health nurse would need some skills in this area, or to be someone who is perhaps comfortable with using or writing poetry themselves, if they were to use it to any great extent with clients. Feen-Calligan et al (2008) make similar assertions about using visual art in supporting mental health users who are substance misusers. Feen Calligan et al (2008) found that â€Å"As the women learned to verbalize their feelings and reflect on their situations through interpretative interactions with visual art, they gained insight into their feelings and issues they faced in their recovery from chemical dependency.† (p 287). This research seems to show that using visual art and image processing allowed the women to fully express their feelings in ways they had not been able to before (Feen-Calligan et al, 2008). Again, some kind of knowledge or skill on the part of the nurse would be necessary. Both of these examples are of arts-related activities, and relate strongly back to the formative assessment and book review. It might be that there is great scope within mental health nursing to encourage self-knowledge, self-expression and mutuality through the use of creative arts an d fiction. Certainly this would provide a way for nurses to relate to clients more readily, to be on their level, and to talk in terms and metaphors that they are familiar with. Conclusion It would seem that underpinning mental health nursing are a number of core values which need to be more explicit in the discourses around the profession and in the practices of those within it. Svedberg et al (2003) state: â€Å"The most important goal of nursing care is to promote the subjective experience of health. The health promoting efforts of mental health care nurses must be aimed at creating encounters where the patient will be confirmed both existentially and as an individual worthy of dignity.† (p 448). The core values of mental health nursing should orientate towards this kind of confirmation of worth on the part of the healthcare provider for the client. Eagger et al (2005) state: â€Å"Organisations, too, would benefit from a clear, values-based statement that staff at all levels can identify with. Institutions encouraging a culture of care can contribute significantly towards creating a healing environment for staff as well as patients.† ( p 28). This would be particularly relevant for mental health nursing and mental health services, and might signify and important area for future practice development. Undertaking this exploration has shown to the author the need for self-awareness and emotional intelligence on the part of mental health nurses, as a prerequisite for developing true compassion and empathy. Fostering self-expression amongst mental health services users, providing opportunities for this, and supporting them by paying attention and understanding them, is also important. While some experiences so far might suggest that in certain contexts and situations, this might be difficult to achieve, it should be the goal that we all strive for, and these are core values which should underpin all of our practice. References 214727 Akerjordet, K. and Severinsson, E. (2004) Emotional intelligence in mental health nurses talking about practice International Journal of Mental Health Nursing 13 (3) 164-170 Benner, P. 2000. The wisdom of our practice: thoughts on the art and intangibility of caring practice. American Journal of Nursing. 100(10):99-105 Busfield, J. 2000 Rethinking the Sociology of Mental Health, Blackwell, London Castledine, G. 2005. Recognizing care and compassion in nursing. British Journal of Nursing. 14(18):1001 Eagger, S., Desser, A. and Brown, C. (2005) Learning values in healthcare? Journal of Holistic Healthcare 2 (3) Feen-Calligan, H., Washington, O. and Moxley, D.P. (2008) Use of artwork as a visual processing modality in group treatment of chemically dependent minority women. The Arts in Psychotherapy 25 287-295. Freshwater, D. (2006) The art of listening in the therapeutic relationship. Mental Health Practice 9 (5). Hamilton, B. and Roper, C. (2006) Troubling ‘insight’: power and possibilities in mental health care. Journal of Psychiatric and Mental Health Nursing 13 416-422. Meehan, T. and MacLachlan, M. (2008) Self construction in schizophrenia: a discourse analysis. Psychology and Psychotherapy: Theory Research and Practice 81 131-142. Pilgrim, A. Rogers, D. 2005 Sociology of mental health and illness 3rd edition. OUP, Buckingham Salovey, P. Mayer, J.D. (1990) Emotional intelligence Imagination, Cognition, and Personality, 9, 185-211 Schulz, R., Hebert, R.S. and Dew, M.A. (2007) Patient Suffering and Caregiver Compassion: New Opportunities for Research, Practice, and Policy. Gerontologist, v47 n1 p4-13 2007 Raingruber, B. (2004) Using poetry to discover and share significant meanings in child and adolescent mental health nursing. Journal of Child and Adolescent Psychiatric Nursing 17 (1) 13-20. Shattell, M., Starr, S. and Thomas, S.P. (2007) Take my hand, help me out: Mental health service recipients experience of the therapeutic relationship. International Journal of Mental Health Nursing. 16(4):274-284. Shattell, M., McAllister,S., Hogan, B. and Thomas, S.P. (2006) â€Å"She took the time to make sure she understood.† Mental Health Patients’ Experiences of Being Understood. Archives of Psychiatric Nursing 20 (5) 234-241. Svedberg, P., Jormfeldt, H. and Arvidsson, B. (2003) Patient’s conceptions of how health processes are promoted in mental health nursing. A qualitative study. Journal of Psychiatric and Mental Health Nursing 10 448-456.

In school suspensions, out of school suspensions and expulsions Essay

Expulsions and suspensions refer to the disciplinary sanctions and dispensations that are imposed and rendered to students who have committed behavioral misconduct while at school. Expulsion refers to the permanent removal of a student from the schooling system. Expulsion comes following the commission of certain offenses that are deemed extraordinarily serious. In the case of such an expulsion, the law provides that such a student may not be absorbed within any other schooling system (Skiba, Eaton, Sotoo, 2004). According to the federal education law on District schools, an expelled student is never allowed to be ploughed back to any school. Schools are therefore supposed to adhere to strict guidelines and regulations for students that are under expulsion. Suspension on the other hand while in or even out of school refers to a partial and short lived detachment of a student from the normal schedule of the school. This may either be for some three days, some ten days or a period that could be longer than this. An indefinite suspension by a school principle demands that a student is rendered with all the laid down protections as he/she was under expulsion. The federal law provides that disabled students be given a different treatment which provides them a greater capacity of protection towards their discipline while at school. Consequently, the district is supposed to evaluate whether students under expulsion could be subject to special needs in order to provide them with the most optimal state of justice while under this regulatory penalty (http://idea. gseis. cla. edu/publications/suspension/images/suspension. pdf). According to the federal law, principals are given the mandate to expel students that may posses dangerous weapon(s), controlled medication, alcohol or illegal drugs and making any assault to the school employee(s). Also, students may be expelled or suspended when under the conviction or charge of felony. Expulsion or suspension consequently calls for a hearing which in this case may be either formal or informal. The informal hearing is that which comes immediately after the occurrence of the offense. Informal hearing may only remedy a suspension. However, a formal hearing is that which occurs before the expulsion of a student. A formal hearing requires a full notification of the student as well as his/her guardian or a parent on matters such as the place of the hearing, reasons, time and location. Temporary suspension may also come along in the event the principal has the believe that a certain student is of threat to the school employees, property or even to his/her fellow students (http://www. yh. com/HealthTopics/HealthTopicDetails. aspx? p=114&np=99&id=2239). The law also provides that the student be dispensed with certain legal rights on matters of expulsions and hearings. This may include notice of the charges that should be written. In this context, the student is under the legal obligation of been provided with an explanation that is written explaining the exact parameters of the trouble confining him/her to expulsion or suspension. The principal should also provide a hearing notice that should be written. This should include date of this hearing, place and time. The student is also under the right of bringing a representative such as an advocate or a lawyer. He/she is also under the legal right of bringing evidence or witnesses as a supplementary to the case (http://www. clcm. org/student_suspension. htm). Both expulsion and suspension are deemed good models to reinstate a child’s behavior and bring control in the normal running of the school.

Comparative Academic Review

Introduction The aspects of psychiatric treatment of patients have been widely discussed in the academic literature on the subject in the last several decades. In two separate studies, Christina Katsakou et el. (2010) and Jelena Jankovic et. al (2011) trace the practical implications of treatment satisfaction and caregivers’ experiences respectively. Both studies cover specific aspects of psychiatric treatment in the UK. The first study focuses on the coercion and treatment satisfaction among patients, who have been admitted for psychiatric treatment involuntarily. The research, conducted in 2010, reveals the impact of coercion on the satisfaction of treatment among patients, as well as the psychological aspects of coercion. The study has been conducted as an observation in 22 hospitals in England, where a total of 778 patients were recruited (Katsakou et. al, 2010). Their satisfaction with the treatment they received has been measured at different stages: one week, one month, three months and one year after the admission. In order to measure the levels of satisfaction, the authors have used factors such as clinical improvement and clinical characteristics. The results from this study were obtained using standard statistical analysis, and indicated an increase in the satisfaction among involuntarily admitted patients between their first admission and the different follow ups. The second study, conduc ted in 2011, focuses on the experiences of family caregivers during involuntary hospital admissions of their relatives. It is a qualitative study, which used as a research method semi-structured interviews, conducted with 29 caregivers whose relatives have been admitted involuntary in 12 hospitals across England (Jankovic et.al., 2011). Throughout the study, major themes have been identified, such as relief and conflicting emotions, frustration with the delay of getting help, etc. The results of the second survey have concluded that the role of the family caregivers can be enhanced if their duties are valued enough, without turning into a burden. The purpose of this brief academic review is to critically compare both studies, highlighting their strengths, weaknesses and possible contributions to the literature on the subject. Both studies provide valuable insight on the subject of treatment of patients with mental illnesses, and reveal the interactive nature of the clinical process as a dynamic interaction between different elements – institutions, caregivers, and patients. Both studies manage to reveal the intricacy of the connection, which exists between coercion and satisfaction in the first case, and family caregivers as active elements in the process of involuntary admission in the second case. The first study uses a quantitative research method and statistical analysis, based on an observational study. The study has been conducted in 22 hospitals in England. The advantage of the choice of this method for the purposes of study is its accuracy and straightforwardness. Results obtained through observation are easier to analyse, and presented in a comprehensible and consistent manner. In terms of the design of the research, the use of timeline base is a feasible option, which meets the research aims of the study and unfolds different aspects of satisfaction among patients. The fact that the patients have been examined at three different periods following their first admission provides the researchers with the possibility to explore how satisfaction (or dissatisfaction) develops gradually. This is an important feature of the research design deployed, because here satisfaction is discussed in relation to memory and emotions, which change over time. This changeability has been ca ptured with the choice of the design. Also, it is a good way to operationalize and thus measure the main variable – patients’ satisfaction. Despite the fact that the operationalization of satisfaction was enhanced through the use of specific research design, the study could have also benefited from a bigger emphasis on open interviews, conducted with a certain (perhaps smaller) portion of the patients. This is because interviews allow for more abstract and personal issues to be uncovered in the research and these are issues which are usually unquantifiable and difficult to detect in observational studies and semi-structured interviews. As far as data collection is concerned, the authors of the first study have used two different models, designed to measure satisfaction – one concentrating on potential base lines predictions combining satisfaction scores from all time points (baselines, one month and three months) and another one concentrating on the results from the follow ups only. The data was analysed using a three step model, and applying standard linear statistical analysis (Katskakou et.al, 2010:287-288). This comprehensive choice of methods and models for data collection has enhanced linear results, which allow readers to obtain an extensive view of satisfaction not only as an isolated variable, but also as a process, which is happening over time. However, one of the weaknesses of this study in the methodological part is the sampling. The researchers have attempted to obtain a representative sample, covering hospitals from different geographic areas and patients of different ethnic and social backgro unds. Little, if anything is mentioned however on how the eligibility of the patients has been identified (eligibility criteria). Another weakness in the methodology part is related to the decreasing number of patients interviewed at the baseline, the first month and the third month and one year. For the baseline, the patients are 778, and for the one year follow up their number has decreased almost in double – 396 (Katskakou et.al., 2010: 289). This might pose some problems related with the generalizability of the results obtained and the consistency of observations. Although it would be a formidable task to keep the number of patients at each point exactly the same, at least proximity in the numbers of interviewees could have been targeted. Another possible weakness of the study is related with the lack of causality between coercion and satisfaction. In other words, the study does not necessarily reveal a cause-effect relationship between the two, because coercion in this observation has been explored as an individual projection. However, this can also be looked at as an advantage, because a cause-effect relationship between two abstract concepts can oversimplify their existence in a particular setting. To compare, the second study uses a very different methodology. It is a qualitative study, and the variables measured here are even more abstract compared to the first study. The psychological aspects of personal experiences relating to care are difficult to capture and quantify, and this is important to mention in the methodological review of the second study. In terms of choice of methods, the authors have used semi-structured interviews, conducted among family caregivers of 29 patients admitted involuntary against 12 hospitals in England (Jankovic et.al., 2011: 1). Compared to the first study, here the sample is much smaller. It is arguable whether such a small sample can provide results, which are generalizable. Perhaps the authors have decided to choose smaller number of participants in order to observe the matter more closely. Here it is important to note that the issue of carers’ experiences is sensitive and often a stressful one. Therefore a smaller sample would give t he chance to conduct more detailed interviews, and thus capturing nuances of the matter, which remain unexamined in studies involving larger samples, due to time constraints. Another problem with the sample, just like in the first study, is its ability to represent the population. A closer look at the participant’s characteristics in the second study reveals that in more than 50 percent of the cases, the relationship of the carer to the patient is â€Å"parent† (Jankovic et.al., 2011: 3). This fact could have influenced the results, since parents tend to be much more concerned for their children. They are concerned first as patients, and then as carers – therefore a more representative selection of the carers could have taken place (for example equal number of carers who are patients, partners, siblings or children). Yet, the study manages to make good use of thematic analysis, clustering answers of the patients and identifying four important themes – rel ief and conflicting emotions in response to the admission, frustration with the delay in getting help, being given the burden of care by services and difficulties with confidentiality (Jankovic et.al, 2011:3-4). Just like the first study, the methodology is well-implemented in terms of coding. In the second study, two independent researchers have been selected to code the interviews, and the results have been finalized through a joint discussion (Jankovic et.al, 2011:3). In both studies, the methods chosen have met the research criteria, and have been meticulously implemented to produce comprehensive and well-themed results. Also, the proposed hypotheses have been well tested. Here it is important to note that both studies tackle issues, which are not easily quantifiable or measurable. The first study concentrates on satisfaction among patients which have been involuntary admitted for treatment, while the other one focuses on an even more sensitive and abstract issue, related with personal experiences among family caregivers in the cases when patients have been admitted for treatment. Therefore the authors of both studies have made significant effort in the planning of the research, its design and implementation in order to make the themes of their research measurable. As a result both studies have managed to create consistent results. The first makes coercion and satisfaction measurable, with the implementation of a 0 to 5 scale of coercion and inco rporating the results in a separate model. Critics would suggest that the method implemented in the first study is too rigid for the investigation of issues, which are deeply psychological and reflect the personal perceptions of patients on the way they have been treated. Although the study could have benefited from a combination of qualitative and quantitative methods, its reliance on quantitative techniques only does not affect the overall validity of the results. Perhaps one of the biggest strengths of this study is that through the interpretation of the results, the authors manage to reveal the connection between patients’ satisfaction and coercion as an individual perception. As already mentioned, the second study relies solely on a qualitative technique. They authors capture the nuances in the experiences of the caregivers, and interpret the results closely adhering to the themes, identified by them during the data analysis stage. Both studies deal with aspects of psychiatric treatment, which are challenging due to their specificity. Therefore they both make significant contribution to the literature and theory on the subject. The first study sheds light upon the complexity of coercion as an individual perception, and its results resonate with those obtained in earlier studies (Lidz et.al, 1998; Sorgard, 2004). Observing coercion as an individual perception, projected by patients as a result of hospital surroundings and treatment, shows a major transition in clinical psychology, and a shift towards a more constructive approach for understanding patients’ reactions. In this sense, this study can be classified as a constructivist study, because it measures how perceptions are formed and exemplified by particular patients in particular environments. It deviates from earlier studies on the subject, like the ones conducted by Svensson et al. (1994) and Spenseley (1980), which observe patients’ satisfa ction with treatment in their entirely empirical dimensions, ignoring individual projections. Similarly, the findings and conclusions from the second study (Jankovic et.al, 2011) resonate with conclusions from previous research on the subject (Simson et. al, 2002; Jones et.al, 2009). Therefore this study belongs to a particular body of literature in clinical psychology, which explores the psychological and social impact on families of care for people with mental disorders. Both studies contribute to their relative subjects, and might have important implications in terms of policy reform in health care services for people with mental illnesses in the UK. Recommendations for policy-makers in this sector, stemming from Jankovic’s study include an improved service, which would ensure that carers obtain proper assistance and cooperation from hospitals prior to the admission of mentally unwell relatives. This would have positive implications to the quality of treatment of mentally unwell patients, by enhancing cooperation between carers and institutions, which would inevitably lead to a better distribution of responsibilities. Katsakou’s study might have policy implications as well, because it reveals the necessity for interventions, which would reduce patients’ perceived coercion. In conclusion, both studies discussed in this review present specific aspects of treatment of mentally unwell patients. Despite some weaknesses in sampling, and some minor limitations, both studies make significant contributions in their relative fields, and offer new, and well-supported angles of interpretation on the themes they cover. Both studies make good use of research methods, despite the differences in the number of participants for the first and the second study. Some issues related to generalizability of the results have arisen, such as the decreasing number of observed patients in the first study and the small sample in the second study. Still, the data analysis and the interpretation of the results obtained have been meticulously carried out and well situated in the context of existing literature. In addition, both studies might serve as a basis for policy-reform in the UK healthcare system, ultimately leading to improvement of the latter. In sum, the studies present coh esive and well-researched conclusions and can be a useful reading for students and professionals, occupied in the field of Clinical Psychiatry, Health Services and Public Policy. Reference list: Jankovic J, Yeeles K, Katsakou C, Amos T, Morriss R, Rose D, Nichol P, McCabe R, Priebe S (2011) ‘Family caregivers’ experiences of involuntary psychiatric hospital admissions of their relatives – a qualitative study’, PLoS ONE 6(10): e25425. Jones IR, Nilufar A, Catty J, McLaren S, Rose D, Wykes T, et al. (2009) Illness careers and continuity of care in mental health services: A qualitative study of service users and carers. Soc Sci Med 69: 632–639. Katsakou C, Bowers L, Amos T, Morriss R, Rose D, Wykes T, Priebe S (2010) ‘Coercion and Treatment Satisfaction Among Involuntary Patients’, Psychiatric Services 61: 286-292 Lidz C, Mulvey EP, Hoge SK (1998) et al: Factual sources of psychiatric patients’ perceptions of coercion in the hospital admission process. American Journal of Psychiatry 155:1254–1260 Simpson EL, House AO (2002) Involving users in the delivery and evaluation of mental health services: systematic review. BMJ 325: 1265–1268 Sorgaard K (2004): Patients’ perception of coercion in acute psychiatric wards: an intervention study. Nordic Journal of Psychiatry 58:299–304 Spensley J, Edwards DW, White E (1980): Patient satisfaction and involuntary treatment. American Journal of Orthopsychiatry 50:725–729 Svensson B, Hansson L (1994) : Patient satisfaction with inpatient psychiatric care. Acta Psychiatrica Scandinavica 90:379–384

Skeletal Muscle Physiology Physioex Exercise 2 - 1761 Words

I have only listed the questions that required answers that are a part of this exercise. A C T I V I T Y 1 Identifying the Latent Period How long is the latent period? _____2.78____ msec Note: If you wish to print your graph, click Tools on the menu bar and then click Print Graph. 5. Increase or decrease the stimulus voltage and repeat the experiment. (Remember that you can clear the tracings on the screen at any time by clicking Clear Tracings.) Record your data here: Stimulus Latent voltage: ____4.0____ V period: ____2.78____ msec Stimulus Latent voltage: ____3.0____ V period: ___2.78_____ msec Stimulus Latent voltage: ___10.0_____ V period: ____2.78____ msec Does the latent period change with different stimulus voltages?†¦show more content†¦A C T I V I T Y 6 Tetanus 4. Click Multiple Stimulus and watch the trace as it moves across the screen. You will notice that the Multiple Stimulus button changes to a Stop Stimulus button as soon as it is clicked. After the trace has moved across the full screen and begins moving across the screen a second time, click the Stop Stimulus button. What begins to happen at around 80 msec? Hits a plateau. What is this condition called? Tetanus. 5. Leave the trace on the screen. Increase the Stimuli/sec setting to 130 by clicking the (_) button. Then click Multiple Stimulus and observe the trace. After the trace has moved across the full screen and begins moving across the screen a second time, click Stop Stimulus. How does the trace at 130 stimuli/sec compare with the trace at 50 stimuli/sec? The twitches have fused. What is this condition called? Complete (fused) tetanus. 9. Examine your data. At what stimulus frequency is there no further increase in force? 146 stimuli/second What is this stimulus frequency called? Maximal titanic tension. 11. Click Clear Tracings to clear the oscilloscope screen. If you wish to print your data, click Tools and then Print Data. A C T I V I T Y 7 Fatigue 1. Design an experiment that demonstrates fatigue on the oscilloscope screen. Hint: Set Stimuli/sec to above 100. In fatigue, what happens to force production over time? The muscle is unable toShow MoreRelatedExercise 2 Skeletal Muscle1366 Words   |  6 PagesAnatomy and Organization of Skeletal Muscle and Muscle Physiology Lab 9 Skeleton Muscle Physiology: Computer Simulation Exercise 16B - Page PEx-23 Activity Sheet Objectives: †¢ Use a simulation of skeletal muscle experiments to investigate threshold stimulus, maximal stimulus, multiple motor unit summation, wave summation and tetanus and the graded contraction. †¢ Develop and test hypotheses related to muscle contraction. †¢Read MoreSkeletal Muscle Physiology5316 Words   |  22 Pages S E 2 Skeletal Muscle Physiology O B J E C T I V E S 1. To define these terms used in describing muscle physiology: multiple motor unit summation, maximal stimulus, treppe, wave summation, and tetanus. 2. To identify two ways that the mode of stimulation can affect muscle force production. 3. To plot a graph relating stimulus strength and twitch force to illustrate graded muscle response. 4. To explain how slow, smooth, sustained contraction is possible in a skeletal muscle. 5. To graphically