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Lab Report
Students are required to write a laboratory report, not exceeding 1,500 words in accordance with APA (American Psychological Association, 6th edition) formatting requirements.
The report is based on the experiment conducted in laboratory classes during Week 3 of the semester. The report should include:
A literature review and critique of the relevant literature.
What is Mindfulness?- a paper trying to operationalise Mindfulness
Selective Attention IMPROVES under stress- this paper argues that being stressed can improve attention performance
Selective Attention is IMPAIRED by stress- this paper argues that stress impairs selective attention (although using a different task to us to measure attention BUT a similar method of inducing stress)
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Stress Management Training and Home Visit Scheduling System
Introduction
Burnout has been identified as one of the main factors impacting the performance of home healthcare nurses. This mostly results from long working hours and many patients to attend to, such that they end up being too exhausted and stressed out. The nature of work that nurses do is also exhausting, given that it involves standing and running around all day, with insignificant breaks between one assignment and the other.
While the straightforward solution would be to increase the number of nurses so that the work is manageable, this may not feasible due to economic pressures, hence the need to come up with strategies to help the nurses manage their current situation better. This paper is a discussion of the impact of conducting stress management training and implementing a home care visit scheduling system to reduce burnout among nurses.
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Discussion
Stress management training
A stressed nurse is likely to have low productivity and energy levels and thereby more prone to burnout. Stress management training would be highly effective in helping nurses cope with everyday challenges and ensuring that they live a balanced life. Abel, Abel and Smith (2012), note that a majority of people are overwhelmed by stress because they are incapable of making proper decisions and plans to address their daily stressors.
Training would help the nurses in identifying their sources of stress and how these can be managed to make life easier. Training for example could help them learn how to prioritize issues and thus make proper personal plans based on the time available to them.
When people experience symptoms of stress including constant headaches, poor concentration, forgetfulness and insomnia among other signs, there is a significant likelihood that they are not aware that they are suffering from stress. Stress management training would provide nurses with an opportunity to understand stress, its causes and effects (Dhobale, 2009). This way, it is possible for the nurses to evaluate themselves and establish the stressors in their lives so as to deal with them.
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Knowledge of daily stressors ensures that they can be effectively addressed using various strategies in order to relieve the affected person (Dhobale, 2009). Once the causes of stress have been identified, it is easier to anticipate them and make necessary plans to ensure that they do not overwhelm the nurse again.
This in itself addresses the issue of burnout because absence of stress means that the individual has more energy to execute their duties. Dhobale (2009) notes that after training, self-management of stress through psychological techniques, physical exercise, breathing exercise, massage and indulgence in hobbies among other things is likely to be witnessed.
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Poor time management is a leading factor in triggering stressors as noted by Abel, Abel and Smith (2012). This is a common problem among home healthcare nurses and can be a major cause of stress. It is difficult for nurses to determine how much time they will spend with a patient because of lack of a properly laid out time plan. Stress management training places major focus on time management as a strategy to reduce stress.
Through this training, nurses would be taught how to schedule their home visits and how to plan their time to ensure that they only take the necessary amount of time to attend to a client. This will ensure that the nurses attend to more patients with lesser time, thus reducing burnout to a great extent. The fact that the nurse is likely to have adequate time for non-work activities in order to create a proper work-life balance leads to a reduction in the occurrence of burnout.
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Stress management training for nurses is not only useful to them but it can also help close acquaintances and colleagues. Milliken (2007) notes that the knowledge gained from the training may be passed on to other people, who would also benefit from better stress management. Assuming that the beneficiaries are mostly other nurses, the result would be a less burnt out workforce.
Home visit scheduling program
Designing a system that effectively schedules home visits would play a great role in reducing burnout among nurses. In the absence of a well designed system, nurses design their own schedules and often maintain unpredictable hours (Hall, 2011). In most cases, home visits are not well planned and nurses mostly end up spending so much time in one home and hence rescheduling consequent visits. They also have to travel frequently to keep up with the visits, hence increasing exhaustion.
Furthermore, a majority of nurses do not have a structured home visit plan to guide the visit and this often results in poor time planning (Mankowska, Meisel and Bierwirth, 2014). A system to schedule home visits would clearly indicate the number of homes to be visited each day, the number of hours to be spent in each house based on client needs and the issues to be addressed by the nurse during the visit. This would save time and thus reduce burnout.
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A scheduling system for home visits would ensure better coordination between healthcare workers and thus reduce conflicting schedules and information gap. Where there are different healthcare workers attending to the same patient, there may be conflict of schedules and thus difficulty in coordinating services (Pinelle and Gutwin, 2003). In the event that a nurse finds a patient being attended by another healthcare worker, they are forced to wait for them to finish with the patient or postpone the session and thus end up wasting a lot of time (Mankowska, Meisel and Bierwirth, 2014).
Due to the fact that each healthcare worker makes their own notes which are rarely shared because they are made on paper, it is difficult to track reports of other healthcare workers attending to the patient, which may bring confusion. It also becomes difficult for synchronous communication to be initiated because health workers cannot trace other healthcare workers’ schedules to know when they are available (Pinelle and Gutwin, 2003).
Such kind of communication breakdown can be addressed through the use of a scheduling system, which ensures that each healthcare worker logs in information concerning their sessions with the patient. Through the system, it is easy to follow schedules made by other healthcare workers, such that nurses can plan the most appropriate time to see clients to avoid time wastage, as well as identify the best time for synchronous communication (Pinelle and Gutwin, 2003). Improved efficiency is not only expected to increase productivity but it also reduces the probability of burnout among nurses.
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The home visits scheduling system is bound to improve efficiency in terms of number of homes visited per day and also save nurses long exhausting hours of travel (Mankowska, Meisel and Bierwirth, 2014). The system would cluster homes according to location in order to plan for effective travel. Visits would be scheduled in such a way that homes in the same area are clustered for same day visits as opposed to visiting different areas the same day. This would reduce the travelling time and also reduce exhaustion, consequently reducing burnout.
Considering the fact that the system has all the information about clients in one place, the nurse can easily retrieve information and make well-versed decisions based on the information. This works better than using client files because not only is the information easily retrievable, the nurse can make updates and easily compare notes for different clients. Such information can guide the nurse on areas of care to concentrate on, based on client history. Availability of information at the click of a button would go a long way in reducing burnout among nurses and thus enhance productivity.
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Conclusion
It is undeniable based on the discussion that stress management training and introduction of a home visit scheduling system would be effective in reducing burnout among home healthcare nurses. Notably, training nurses on stress management will ensure that they are more aware of their daily stressors, why they occur and how to deal with them. Time management taught during this training is also highly important in promoting efficiency and reducing burnout.
The home visit scheduling system would make it easier for nurses to plan visits, avoid conflict visits and promote communication synchronization. Through this system, visits would be well planned and there would be reduced rescheduling of visits. This essentially translates into less burnout by the nurses. The stress management training and home visit scheduling would therefore impact home healthcare nurse burnout in a significant manner.
Hall, R. (2011). Handbook of Healthcare System Scheduling. New York, Springer Science & Business Media.
Mankowska, D., Meisel, F., & Bierwirth, C. (2014). The home health care routing and scheduling problem with interdependent services. Health Care Management Science, 17(1), 15-30. doi:10.1007/s10729-013-9243-1. Retrieved from eds.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=12&sid=a576b81a-91da-4e90-bca3-a6f0a26ae995%40sessionmgr114&hid=111
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Self Harm: Safe Guarding in Health and Social Care
Self harm is a complex issue not only in its definition but also in relation to the insufficiency of data available with regards to the patterns and frequency of this subject across the globe. It is important to not that there is no “universal definition” of self harm. Moreover, diverse views have been raised concerning the causes and risk factors among individuals that harm themselves or others. Generally, self harm which is also referred to as self injury is best understood to entail an individual causing intentional physical pain as a way of solving difficult or painful emotions.
According to the study conducted by Hawton et al,it was determined that some people may harm themselves or others as a means of communicating their distress to the general public (Hawton et al, 2012). This disorder can also be an act of rebellion and the attempt to individualize oneself, a manner of relieving intense anxiety temporarily, a way to regulate pain, an effort to manage emotional numbness, or more still an effort to manipulate other people.
Individuals who harm themselves or/and others may develop an immediate sense of relief by partaking in it. However, it is worth noting that this feeling is a temporary solution the feelings that were distressing them initially will end up recurring once more. Additionally, chronic self harm can result in the development of irreversible damage to the body and/or permanent scarring. This paper seeks to find out why some individuals are more vulnerable to abuse and harm self and others as well as the associated risk factors to this type of behavior.
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Causes of vulnerability to abuse and harm
Just like all other mental disorders, there is no single factor that predisposes a person to engage in self harm. In general, self harm results due to inability of a person to properly manage psychological pain in a manner that is healthy. Often, individuals who engage in this form of unhealthy conduct find it difficult to regulate, express, or understand their emotions. The factors that make individuals to be prone to abuse and harm self or others can be classified as follows;
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Social factors
These are ranked asthe commonest cause of abuse and harm due to the emotional distress that they arouse in people. Social factors that have been pointed predispose individuals to harm include;
Having difficult relationships especially with friends and partners
Having difficulties at school. This is seen commonly among the youth who work hard to obtain good grades but then they end up not getting the results they expected.
Difficulties at work such as demotions, unfair treatment by senior workers and layoffs can also make people to be prone to harm and abuse.
Bullying: This can be at home by older siblings, relatives, or neighbors. It can also be exercised in school or at work. An example of harm to others that was due to bullying is the recent case that was all over the news whereby an American student went to school with a gun and started shooting fellow students randomly (Fisher et al, 2012).
Poverty, whereby a person has several responsibilities such as paying house rent, paying for children school fees, and providing the basic needs for his/her family. This is common among adults who end up being depressed and may subject their depression on their children by beating them up over petty reasons or even without any reason at all.
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Drug and substance abuse: Individuals prone to alcohol and substance abuse disorders tend to be aggressive and are more likely to make claims of having suicidal thoughts or even previous suicidal attempts. In a recent study by Daine et al (2013) of about 6500 adults who enrolled in addiction treatments it was proven that individuals who had engaged in serious acts of violence such as murder, rape, and assault leading to serious injury were more than twice likely to report several suicidal attempts.
Sexuality- Persons who come to terms with their sexual orientation such as being bisexual or gay may be a danger to themselves.
Cultural expectations can promote vulnerability of harm to self. A good example is that of arranged marriages whereby ladies are often forced into marriages against their will or worse even at a tender age.
Trauma can also enhance vulnerability of this disorder. Some causes of trauma include; physical or emotional, sexual abuse such as rape or domestic abuse. The death of a close family member or a close friend and having a miscarriage are also common predisposing factors.
Emotional Distress
Emotions have also been linked abuse and harm vulnerability. An unhappy situation or the distress from a traumatic experience can result in feelings of self hatred or low self esteem. These emotions gradually build up and it becomes difficult for people to seek help. Therefore, self harm or harming others may be a means of releasing these pent-up feelings.
They also indulge in this behavior as a way of coping with their problems. Usually, this is not a sign of seeking attention, but an indicator of emotional distress. Some of these emotions include; guilt, anger, anxiety, grief, numbness or emptiness, loneliness, silenced as a result of abuse, and a feeling of being disconnected from the world.
People that are more prone to harm themselves and others may be having difficulties in regulating or managing their emotions (Figley et al, 2013). Therefore, they use self harm as a means of managing the anger and tension. Further research also reported that such individuals are poorer in solving problems.
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Psychological Causes
These also increase the tendency of people to take part in abuse and harm. For example;
People may be having repeated thoughts about harming themselves and they feel like doing it,
Self harm can also be linked to borderline personality disorder- a disorder that causes instability in a manner that one thinks, behaves, or feels,
Dissociation or loss of touch with oneself- self harm occurs without realizing it,
Organic reasons have also been associated with aggressive outbursts. Take an example whereby a person has damage to his/her frontal lobe or certain forms of epilepsy. In such circumstances, it is difficult to pin-point comprehensible argument for the expression of aggressive episodes.
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Risk Factors for Harming Self and Others
The risk factors of self harm and others are not static. Their value of prediction keeps changing depending on period they occur in a person’s development, social contexts, and the circumstances that one faces. They can be found in an individual, the surroundings, or the individual’s ability to react to the requirements or demands of the environment.
Some factors start manifesting as early as childhood while others do not appear at all until adolescence period or adulthood. Some risk factors entail the family, the school, the neighborhood, or the peer group. Risk factors will be classified as follows for clarity.
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Depression and mental illness
This is one of the most obvious risk factors for indulging in harm to self and others. According to the research conducted by Andover et al, it was proven that mental and addictive disorders result in almost 90% of the suicidal cases reported (Andover et al, 2012). At least one in every twenty youths suffers from mental disorders that are severe enough to impair judgment. However, the sad news is that less than 20% of these individuals receive treatment. Most of those who harm themselves suffer from depression.
School risk Factors
Individuals who view their instructors as not understanding or caring or do not coexist peacefully with their peers have vulnerability of harming others or themselves. They may be associated with the following features;
Past suspension or expulsion for violent behavior
Social isolation, aggressiveness in grade K-3 or hyperactivity
Misbehaving in class, truancy, or being involved frequently in fights
Severe disciplinary issues
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Anger or frustration when handling school artwork or essays
A student that has previously brought a weapon at school
Academic failure when joining school
Academic pressure from parents and guardians.
Community risk factors
Persons that are highly exposed to community violence are at severe risk of engaging in self-destructive behavior. This usually arises when one shapes his/her conduct after what they have learned and experienced in the community. Moreover, some youth who grow up without having meaningful connections with responsible adults lack the necessary guidance that they should acquire so that they may cope with their daily lives (Moran, et al, 2012). Other community risk factors include;
Severe economic deprivation
Easy accessibility to guns, weapons, and other dangerous equipments
Poor community organization and low attachment in the neighborhood
Few recreational activities for people in the community especially the youth
Individuals who have engaged previously in vandalism and destruction of property
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Personal Risk Factors
Persons who have been involved in violent behavior previously
History of being bullied by friends, classmates, or relatives
History of uncontrolled angry outbursts and tantrums
Individuals who have previously bullied their peers and younger youths
Aggression to animals
Alcohol and substance abuse
Previous attempts of suicide
Fire- setting
Persons that result in calling of names and cursing when they are mad
Recent experience of loss, humiliation, or rejection
Cult or gangs involvement
Unstructured time
Preoccupation with explosives and other weapons
Does not own up and blames others for problems they are responsible for
Often having mood swings and significant depression
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Family Risk Factors
History of possession of a weapon and use by a family member
History of being punished frequently
Previous family violence
Inconsistent or severe punishment
Lack of support or proper supervision from parents and guardians
Youth has a past history of abuse by a family member
Individuals who grew up without clear expectations or standards of behavior being imposed on them by their care givers.
Cultural Risk Factors
Conformity issues and assimilation, variations in expectations and gender roles feelings of victimization and isolation can all increase the levels of stress and vulnerability of people. In addition, some cultures especially the Pacific and Asian cultures view self harm particularly suicide as a rational reaction to shame.
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Situational Crises
Daine et al argues that about 30% of individuals’ cases of abuse and harm to self and others are linked to an identifiable precipitating occurrence such as loss of a valued relationship, divorce of parents, the passing away of loved one, or sexual abuse. Normally, all these events coincide with other risk factors (Daine et al, 2013).
Conclusion
Some individuals view self injury engagement as a means of coping with their emotions. However, the troubles they are running away from will still be present even after their self-mutilation. Moreover, the relief that these individuals feel after involving themselves in self harm or abuse of others is usually short term.
Therefore, it can result in greater amounts of self-injurious conducts to acquire relief. Some people have even gone further and described self harm as an addiction. It is difficult to manage such behave just like any other compulsive behavior or addiction. However, proper management plan should be put in place to help these people fight the condition.
Some of the interventions that can be used include interpersonal treatments, therapies of problem-solving, and use of “emergency card” mode of interventions (Rossouw and Fonagy, 2012). Other treatment forms that have proved to be essential include dialectical conduct therapy which is administered often among individuals who self-harm themselves and/or others from time to time.
The burden associated with injury to self and others is often a heavy one, especially because people who engage in this behavior do it in private where they hide their secret from their loved ones and friends. They create a burden that is extremely hard to carry. This may result in more severe self injury to escape the feelings. Therefore, proper platforms should be established whereby such people can be access easily for counseling and support.
Daine, K., Hawton, K., Singaravelu, V., Stewart, A., Simkin, S., & Montgomery, P. (2013). The power of the web: a systematic review of studies of the influence of the internet on self-harm and suicide in young people. PloS one, 8(10), e77555.
Fisher, H. L., Moffitt, T. E., Houts, R. M., Belsky, D. W., Arseneault, L., & Caspi, A. (2012). Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study. bmj, 344, e2683.
Hawton, K., Saunders, K. E., & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. The Lancet, 379(9834), 2373-2382.
Rossouw, T. I., & Fonagy, P. (2012). Mentalization-based treatment for self-harm in adolescents: a randomized controlledtrial. Journal of the American Academy of Child & Adolescent Psychiatry, 51(12), 1304-1313.
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