Essay about Confederation and Constitution - 1652 Words

Confederation and Constitution After the American Revolution, a new government had to be established. The Constitution that was written took power away from the people. It led to rebellions from poor people and farmers. Daniel Shays, a former Revolutionary Army captain, led a rebellion with farmers, against laws which were not fair to the poor. They protested against excessive taxes on property, polling taxes which obtained the poor from voting, unfair actions by the court of common requests, the high cost of lawsuits, and the lack of a stable currency. They wanted the government to issue paper money, since it is cheaper then gold and silver coins. Once retired George Washington heard of this, he immediately went to†¦show more content†¦Later, he said â€Å"God forbid we should ever be twenty years without such a rebellion. The people cannot be all, and always well informed.† (Jefferson is Unenthusiastic 1787) Here he is saying that America just has to have a rebellion and can’t live in peace. He is right that all the people cannot be always well informed, but attempting to keep them well informed is the key to success, which I believe the government did not, and still does not do. In a letter to James Madison, Jefferson said â€Å"†¦what I do not like. First the omission of a bill of rights providing clearly and without the aid of sophism for freedom of religion, freedom of the press, protection against standing armies, restriction against monopolies, the eternal and unremitting force of the habeas corpus laws, and trials by jury in all metters of fact triable by the laws of the land and not by the law of Nations.† (Thomas Jefferson, Letter to James Madison on the Constitution Dec. 20, 1787) â€Å"†¦greatly dislike, is the abandonment in every instance of the necessity of rotation in office and particulary in the case of the President.† Again, he is for rebellion and freedom for men. George Mason, was anShow MoreRelatedConfederation and Constitution1594 Words   |  7 PagesConfederation and Constitution United States History Professor: 9/30/12 The Articles of Confederation were a great start to shaping and unifying our country, but it was just that, a â€Å"start†. It needed to take the country as a whole into consideration in order for it to hold this unity in place. The Articles of Confederation led to the Constitution of the United States. Although similar in some aspects, very different in others. The articles had many weaknesses that wereRead MoreConfederation and Constitution1483 Words   |  6 Pages| Historical Essay: | Confederation and Constitution | | Jason Sherman | | | The Articles of Confederation, the first constitution of the United States, was adopted by the Continental Congress on November 15, 1777. However, sanction of the Articles of Confederation by all thirteen states did not occur until March 1, 1781. The Articles created a loose confederation of sovereign states and a weak central government, which resulted in most of the power residing with the state governmentsRead MoreConfederation and Constitution1416 Words   |  6 PagesArticles of Confederation vs. Constitution   http://www.123helpme.com/search.asp?text=American+History http://www.archives.gov/exhibits/charters/constitution_history.html â€Æ'   There were many differences between the Articles of Confederation and the Constitution. At the end of the American Revolution the free states needed some sort of control that would generate to a unified country. Issues arose such as: How should power be divided between local and national governments? How should laws be madeRead MoreConfederation and Constitution1793 Words   |  8 PagesCONFEDERATION AND CONSTITUTION    By: Instructor: Comparison between the Articles of Confederation and Constitution The Articles of Confederation, formally known as the Articles of Confederation and Perpetual Union, refers to an agreement between the thirteen founding states that first formed the United States of America as a confederation of sovereign states. The Articles of Confederation had served as the first U.S. constitution (MerrillRead MoreConfederation And Constitution Vs. Constitution Essay1230 Words   |  5 PagesConfederation and Constitution The English Parliament in the 1760s decided to increase taxes to the American colonies, which was established by the colonies as unjust due to taxation without proper representation in the parliament. As a result, the 13th colonies decided to create their own government and in 1777, Congress drafted the Articles of Confederation. This was America’s first written constitution. After the Revolutionary War, the Federal government under the Articles did not have enoughRead MoreConfederation and Constitution Essay1539 Words   |  7 PagesThe Constitution of 1787of the United States of America is signed by 38 of 41 delegates present at the conclusion of the Constitutional Convention in Philadelphia. Supporters of the document paid a hard won battle to win ratification by the necessary nine out of thirteen U.S. states. The Articles of Confederation, ratified just before the British surrender at Yorktown in 1781. Congress the central authority had the control to govern foreign conc erns, conduct war, and control currency. These powersRead MoreThe Articles of Confederation and The Constitution1238 Words   |  5 Pagesgovernment has been defined by two very important documents. Reflecting on all governments of the past, they laid forth an impressive jumble of ideas that would lead the way to where we are today. These two documents are the Article of Confederation and the U.S Constitution. These two documents of precedent are both similar and unique, each with its own pros and cons, and neither being perfect. Both these documents addressed the prominent vital in national vs. state sovereignty, legislative selectionRead MoreThe Constitution And The Articles Of Confederation1373 Words   |  6 Pageswould enforce them? I will address some of the differences between the Constitution and The Articles of Confederation. The Articles of Confederation were designed and formed from the thirteen states that created a Confederation known as the â€Å"league of friendship†; their goal was to find solutions for problems; and one of the first attempts to create a system. The Articles of Confederation was our nation’s first constitution; during the last years of the Revolutionary war, the government had beenRead MoreThe Articles Of Confederation And The Constitution921 Words   |  4 PagesConstitution and Articles Analysis The Articles of Confederation and The Constitution were both written I believe to ensue peace in a new nation where great freedoms had just been betrothed upon. Both written within ten years of each other, the main point it was trying to get across was the idea of one nation. They were written by the same people who all in all had similar ideas. There are many differences as well. From the main one being sovereign states, to how many states must approve an amendmentRead MoreThe Articles Of Confederation And The Constitution891 Words   |  4 Pages Throughout American history, many Americans assume that too much power is given to one party or the other. The Article of confederation was important in the United States because it affected the way over government functions today. Specifically, under the Article of confederation, the United States was intended to be formed on a basis of Federalism. Within this structure of Federalism, states have their own rights and majority of power with its people. The federal government on the other hand,

Police Brutality Law And Legal Definition Essay - 1944 Words

A father purchased a toy gun as a birthday gift for his young son. His son went outside to play and and encountered a police officer who shot him seven times. This incident occurred in Sonoma County in October 2013. A similar incident occurred in November 2014 when Cleveland police killed a 12-year-old boy carrying a toy gun. Use of excessive force by police is common in impoverished black or brown communities. The website, uslegal.com, defines police brutality as: Police brutality is a civil rights violation that occurs when a police officer acts with excessive force by using an amount of force with regards to a civilian that is more than necessary. Excessive force by law enforcement officers is a violation of a person s rights. Excessive force is not subject to a precise definition, but it is generally beyond the force a reasonable and prudent law enforcement officer would use under the circumstances (â€Å"Police Brutality Law Legal Definition†,2013). Cases of brutality from people, who are supposed to protect against it, have existed even when the United States was a fairly new country. The oppression by people in power, even the U.S. Constitution excludes â€Å"Illegal persons† as three fifths of a person, which includes slaves, immigrants, and Native Americans. Another example of oppression by individuals in power would be during the Indian Removal Act of 1830, millions of native peoples were removed from lands that they had been living on and cultivating forShow MoreRelatedPolice Brutality and Profiling1196 Words   |  5 Pagessigning up for so they should not be pitied. Police officers face dangers everyday but profiling and racially motivated brutality is not justifiable and officers should be severely punished for committing these crimes. To begin with police officers faces more dangers than the average American citizen, â€Å"generally police are about three times as likely to be killed on the job as the average American† (Blako). â€Å"Some of the most important hazards police face are assaults, vehicle crashes, being struckRead MorePolice Brutality And The United States1479 Words   |  6 Pages Police Brutality in the United States University of Nebraska Kearney Colton Blankenship Abstract This research paper is an overview of police brutality in the United States. The paper covers what police brutality is and the definition. The information about police brutality is expanded about what is reasonable and excessive use of force an officer can use. Information is included about the thoughts of what the citizens feel about police brutality. Among the white andRead MoreCj415 Final Exam1716 Words   |  7 Pagescom/shop/cj415-final-exam/ The ________ hypothesis regarding crime argues that as a country undergoes economic development, its crime rate increases. slippery slope globalization modernization transnational crime 2 points Question 2 Generally, the police forces of any given country are much more likely to be dealing with ___________ crime and much less likely, if ever, to be dealing with _________ crime. transnational, international international, transnational national, global organizedRead MoreThe Violence Of Police Officers Essay1431 Words   |  6 Pagesmotivated police brutality and societal discrimination. Though his efforts were not in vain, today’s media representation of law enforcement impacts the societal cultivation of police officers in a negative way. Media outlets, in the forms of television, radio, or social websites, create a cynical view of police officers, which influences societal beliefs and creates negative connotations. These days, police are often stereotyped as aggressive, corrupt beings. The growing hatred for police officersRead MorePolice Brutality And The Police Essay940 Words   |  4 Pages Police brutality refers to the use of excessive force against a civilian. The controversies that surround the topic of police brutality relate to different definitions and expectations over what is meant by excessive force. Indeed, police officers are expressly authorized to use necessary, reasonable force to perform their duties. As Jerome Skolnick, an influential police scholar in the United States, underscores: â€Å"as long as members of society do not comply with the law and resist the police, forceRead MorePolice Brutality And The Police1439 Words   |  6 PagesIn today’s society the police are harassed for supposedly abusing their power against people who commit crimes and innocent bystanders however the general public usually mix those two categories of people with each other. Officers are blamed for whatever course of action they decide to take in order to prevent a serious threat from arising. Consequently, the public is having a growing fear of the police, their own definitions of excessive force are biased, the police abuse their powers, etc. TheRead MorePolice Brutality1192 Words   |  5 PagesPolice brutality is one of the most severe human rights violations in the United States, and it occurs in many communities. Police officers have one of the hardest jobs out there. They have to maintain public order, prevent, and identify crime. Throughout history, the police community has been exposed by brutality in one way or another. Violence by law enforcement officers in the United States is one of the most serious human rights violations in the country. Police officers have engaged in unjustifiedRead MoreThe Problem Of Police Brutality1646 Words   |  7 Pages One of the biggest problems that plague America is police brutality. The job of the police is to protect the community they’re assigned to work in, from any illegal activity that occurs. However, there are officers who believe they are above the law. Police brutality has been a political oppression that has been occurring more many years. There’s been many cases of excessive force towards innocent civilians by an officer that has sparked a national outrage. Stephan Lendman of Media with ConscienceRead MorePolice Brutality And The Police851 Words   |  4 Pagesthe police, your opinion may vary. Let me ask you a question about our police force. But keep this in mind, in October 2015 alone, there was 81 deaths by the police. With that being said, who’s to protect us from whose protecting the block? I don t care who you are, you have to be able to realize nowadays that the police brutality is getting out of hand, that the power surge is growing and growing. Look around, there s an increase of civilians death via cops, an increase of reports of police wrongdoingRead MorePersuasive Essay On Police Brutality1471 Words   |  6 Pagescases of police brutality. Officers are faced with many threatening situations everyday forcing them to make split-second decisions expecting the worse, but hoping for the best. Therefore, police brutality severely violates human rights in the United States. Police officers have one of the hardest jobs America has to offer. They have to maintain public order, prevent, and identify crime. Throughout history, the police community has been exposed by violence in some way or another. Police officers

Developing practitioner Free Essays

string(144) " open and honest accounts in case of bad marks, leading to them writing what they think others want to hear and not the truth \(Teekman 2000\)\." Introduction Reflection has increasingly become an essential element of nursing professionalism. However, the term ‘reflection’ is not clearly defined in the literature and most definitions could be described as complex or vague (Atkins and Murphy 1993). Williams and Lowes (2001) define reflection as; ‘†¦. We will write a custom essay sample on Developing practitioner or any similar topic only for you Order Now a way of exploring and evaluating previous experiences and appreciating their value on personal practice and self.’ (pg. 1) Reflection is important to student nurses as it enables us to look at ourselves and our practice objectively. However, Mackintosh (1998), as well as other authors, are dubious that reflection can do all that it claims to do. What is agreed by nursing writers is that we can grow and mature as both a professional and a person by integrating our theory and knowledge into practice. The process of reflection can help move us from a student, to a nurse, and later to a competent and expert practitioner (Benner 1984). As nurses we should have the competencies to identify and respond to issues and make decisions that are informed and based on knowledge. All healthcare professionals make daily decisions that have ethical implications. Ethics for student nurses can be challenging as many of these decisions are emotive and students find these feelings hard to dismiss and difficult to rationalise (Clarke 2003). In their study, Ellis and Hartley (2001) found that student nurses expressed concerns over ethical problems and their ability to deal effectively with them. With the focus on a legal and ethical issue which I encountered whilst on clinical placement, I will reflect upon and critically analyse the issues raised in the incident using a recognised model of reflection. The model which I have chosen for this purpose is Borton’s Reflective Framework (1970, in Jasper 2003) which is increasingly being used by healthcare professionals as an approach for reflection. Jasper (2003) describes Borton’s model as simple and pragmatic, which meets the needs of practitioners to describe, make sense of and respond to situations. Howev er, the model has been criticised and Rolfe et al (2001) suggest it does not include the finer details of reflection and offers no prompts as to how reflection is to be conducted within each stage of the process. Even so, Rolfe et al (2001) do state that in comparison to Gibbs’s (1988, in Jasper 2003) and Johns (1998, in Johns 2005) models of reflection, it can be seen that the activity of reflection leads to action being taken in Borton’s framework, rather than just proposed, therefore moving from the realms of ‘maybe’ back into the reality of practice. The simplicity of the model and the proposal of action being taken in future situations prompted me to consider this model for this assignment purpose. Also, when reviewing the literature around reflective models, I found evidence by Burrows (1995) to suggest that nursing students under the age of 25 do not have the cognitive abilities and experience to reflect and alter their practice. Bulman and Schutz ( 2004) reiterate this perspective by implying that less mature students are more inclined to use more descriptive models such as Gibbs rather than more advanced, as these may not be of any use to them. As I would consider myself a mature student and want to develop my knowledge beyond that of a novice practitioner, taking into account the simple structure of the model as discussed, I feel that Borton’s Reflective Framework (1970) is an appropriate choice to use as a guide to my reflective account. The incident I have identified to reflect upon involves the refusal of further treatment by a patient who is terminally ill. With a view to gaining new knowledge, insights and to further develop as a nurse practitioner, I will reflect upon the ethical and legal issues that arose from this encounter. These include autonomy, beneficence, capacity and informed consent, as well as my own feelings and preconceptions. I will maintain confidentiality throughout this assignment by changing the names of those persons involved incompliance with the Nursing Midwifery Council (NMC) ‘Code’ (2008). Reflection in nursing Reflection is not just about adding to our knowledge; it is about challenging the concepts and theories as we try to make sense of that knowledge (Burton 2000). Kim (1999) argues that constructing knowledge from clinical practice is not enough and that nurses must also reflect on how that knowledge can lead to intentions to act. Several authors distinguish a gap between theory and practice in nursing (Conway 1994; Lauder 1994) and suggest that reflective practice may be the process with which to alleviate this. However, these authors do not support their claims with any evidence and are only offering opinion. The question still remains as to whether reflective practice produces better patient care as intended as there is very little research evidence on the benefits of reflective practice in nursing (Hargreaves 1997). Burton (2000) further reiterates this point by recognising that reflection relies entirely on information from patients and claims to be to their benefit, but is resear ched solely in the terms of the effects on practitioners. Reflective practice is also a fundamental concept of nurse education, with students encouraged to challenge their clinical practice and widen their knowledge base. However, Mackintosh (1998) stated that; ‘The implementation of reflection for students is as uncertain as its definition, with no guidelines or uniform method of application available.’(pg. 7) This criticism is evident in more recent literature, with Ireland (2008) and Hong and Chew (2008) both recognising that there are no definite guidelines on how to structure reflective practice in education. Writing reflective journals is one way reflective practice is encouraged in education as it allows students privacy and also to look back at previous entries to see how they have developed as nurse practitioners. However, Hargreaves (1997) suggests that reflective journals can be repetitive and time consuming, leading to boredom for the student. Hargreaves (1997) also proposes that when students are required to reflect in groups, this can lead to low self esteem as there is a lack of privacy. Also, when reflecting-on-action for assessment purposes, students may feel anxious about writing open and honest accounts in case of bad marks, leading to them writing what they think others want to hear and not the truth (Teekman 2000). You read "Developing practitioner" in category "Essay e xamples" When reflecting-on-action for this assignment purpose, I have been aware of these issues and this has encouraged me to reflect a true account of the incident, regardless of how difficult I may have found it to expose myself in such a way. Ethical issues relating to confidentiality also arise when reflecting, both for the person writing them and for the patient, as writing ‘stories’ about them without their consent can been seen as bad practice. However, Hargreaves (1997) argues that nurses have always ‘used’ patients and it is these experiences with patients that shape practice and it can be proposed that if a patient’s case is discussed but she has no knowledge then it can cause no harm and may actually benefit the patient directly or indirectly (Hargreaves 1997). Despite these criticisms, as opposed to giving care uncritically, reflection allows nurses to examine, question and learn from their experience and Andrews et al. (1998) recognise a danger of nursing care becoming ritualistic if it is not challenged. Using the three basic starting points in Borton’s Reflective Framework (1970) as a guide to the structure of my account, I am now going to reflect on the ethical and legal issue which I encountered recently whilst on clinical placement. What? It is important to recognise before recounting the incident, that as well as students being inclined to alter the scenario when reflecting-on-action as acknowledged, hindsight bias (Jones 1995) is also a concept by which a person’s recollection of events is influenced once they know the final outcome of the situation. Factors involved in hindsight bias are the desire to appear correct, maintain self esteem and to enhance feelings of competence (Jones 1995). Also stressful situations can affect attention and Saylor (1990) concluded in his study on recall, that for novice nurses and students in difficult interpersonal situations, such as topics on death, these are likely to cause stress resulting in less important issues being remembered. I had been involved in Mrs Jones’s care for a number of weeks and I was aware that she had returned from theatre the day before where she was to have had a secondary tumour removed. I was also aware, as was she, that she was terminally ill. I was in the room with Mrs Jones and her husband and we were chatting as I did her clinical observations. She was telling me that she was not afraid of dying and that she had been very lucky and had had a wonderful life. I felt very saddened by this and can clearly remember thinking to myself that I must remember what they told us in University about communicating with the dying patient, as I didn’t know what I was going to say once she finished speaking. In the end I decided that it was best if I say nothing rather than saying something inappropriate. This made me feel guilty at my own incompetence. The consultant then entered the room with my mentor and I asked my mentor if I should leave, but Mrs Jones insisted that I stay. The consultant then told Mrs Jones that they had been unable to remove the tumour. Mrs Jones nodded at this and said that she thought that would be the case. I suddenly felt out of my depth and wished I could just leave the room. The consultant continued by saying that he could offer Mrs Jones radiotherapy to try and shrink the tumour and prolong her life. He told her the side effects of the treatment, the frequency and also that it would not cure her, only ‘give her more time’. Mrs Jones stated that she did not want any more radiotherapy and just wanted to be pain free. I felt quite upset at this point and was trying not to make eye contact with anyone else in the room as I knew I would probably cry. The consultant continued by saying that although radiotherapy had side effects, it could add months to her life, and that there were options avai lable to help counter the side effects and that it might be worth considering. I remember thinking that Mrs Jones will probably decide on the radiotherapy if the doctor says it is the best thing to do, I couldn’t make sense of why she wouldn’t. Mrs Jones stated again that she did not want any further treatment, that she had discussed it with her family and that all she wanted was for her kids to see that she was happy, pain free and peaceful. Mrs Jones’ husband was crying at this point but told the consultant that they had talked about it and that he respected his wife’s decision and they would now like some time alone. At that the consultant, myself and my mentor left the room. The incident played on my mind immediately afterwards and although I wanted to talk with someone about it, I knew if I opened my mouth to speak I would cry so I busied myself with other things. So What? I had nursed Mrs Jones for a number of weeks and felt personally affected by her prognosis and her refusal of treatment to prolong her life. Mrs Jones was the same age as my own mother and had similar family dynamics to myself. I felt guilty that I could not offer some sort of comforting response when talking with her and during her interaction with the consultant. The feeling of guilt elevated as I felt inadequate to respond in what I felt was an appropriate manner. A study carried out by Kelly (1991) found that feelings of guilt are evident in students and appear more frequently as students gain experience. These findings are similar to those of Smith (1998) who concludes that guilt feelings in students are associated with a perceived inadequacy of personal responses and ethical dilemmas. The more experience gained, the more students felt fearful and guilty as they worry about what will be expected of them. I can relate to this evidence having worked in the health care setting for a number of years prior to starting my nurse training and now being in my second year, I have high expectations of myself and my practice. I feel that if I don’t match up to these expectations, and what I believe other people expect from me, I am letting myself and others down. Smith (1998) recognises that students develop coping mechanisms such as detachment and adopt these when they are in situations that are difficult for them. I tried to detach myself from the situation by not making eye contact or speaking as I felt out of my depth within the situation. Although detachment can be seen as a threat to the nurse-patient relationship, Smith (1998) concluded that some degree of detachment is necessary for students to maintain the ability to function and prevent breakdown. I adopted this coping mechanism to prevent myself from crying and upsetting the situation further, which appears to support the findings proposed by Smith. However in a study carried out by Kralik et al (1997) on patient’s experiences in hospital, the participants stated that, when cared for by nurses who appeared detached, it was a negative experience and they felt vulnerable and insecure. I am aware that if I allow detachment to become embedded within my future practice it may aff ect my ability to offer compassionate care to patients. Although I was aware of the knowledge around communication with the terminally ill, I was unable to reflect-in-action and apply this knowledge to practice. Schon (1983) describes reflection-in-action as the way that nurses think and theorise about practice whilst they are doing it. This is seen as an automatic activity that occurs subconsciously in practice. According to Street (1992), students experience difficulty connecting theory with the realities of practice. However, Street does suggest that there are indications that students are able to integrate theory gained in the classroom with practice, but at first it is deliberate and conscious. This evidence suggests that reflection-in-action is developed through experience. I felt upset that Mrs Jones did not want any further treatment and I kept thinking that if it was my own mother I would want her to stay alive as long as possible. I may have felt like this as I did not want to experience the grief that comes with death, which appears now to be a selfish act. The refusal of treatment with a view to end of life can sometimes be associated with voluntary euthanasia. This term involves the deliberate intervention or omission with the intent of ending an individual’s life at their request (Saunders and Chaloner 2007). Despite a Bill passing before parliament on assisted dying or assisted suicide, existing laws remain unchanged and euthanasia of any sort is illegal in the UK. However a person’s right to refuse treatment is legal in the UK and is supported in the NMC ‘Code’ (2008) which states; ‘You must respect and support people’s rights to accept or decline treatment and care’. Although the consultant was persistent in his offer of further treatment, he did not at any time disregard Mrs Jones’s decision to refuse treatment. UK law goes to great lengths to protect a person of full age and capacity from interference with personal liberty. In the case of Sidaway v Bethlem Royal Hospital (198 5) it was stated that; ‘a capable adult has an absolute right to refuse to consent to medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision may lead to their own death.’ (Lord Scarman 1985 pg. 3) This absolute right has been upheld in more recent cases such as Re T (adult: refusal of medical treatment) (1997) and Re B (adult: refusal of medical treatment) (2002). The courts also recognise that in law there is a distinction between letting die (refusal of treatment) and killing a person (euthanasia), even though this is not accepted by some philosophers (Dimond 2005). Saunders and Chaloner (2007) question whether there is a moral distinction between withholding life sustaining treatment at the patients request and actively taking steps to end the patient’s life at their request. However, a concept that is shared amongst UK law, literature and philosophers is the respect for a person’s autonomy. This makes me consider whether the consultant, despite his persistence, did not disregard Mrs Jones’s decision as he was respecting her right to be autonomous. Buka (2008) proposes that to be autonomous means to be able to choose for oneself and involves individuals being able to formulate and determine the course of their own life. Autonomy consists of values and beliefs that are unique to the individual and that change with circumstances, so what Mrs Jones considered to be of value to her prior to her illness could well have changed at the time of the incident. Also what Mrs Jones believed to be of value to her could very well be different to what I would consider to be of importance. Begley (2008) acknowledges that dying well involves living well until the end of life and living well throughout the dying process depends on the responses of each unique person to the conditions in which they find themselves. Mrs Jones spoke about wanting her kids to see she was happy, pain free and peaceful, which appeared to me to be her main priority. Mrs Jones also spoke about how she was not afraid to die and that she had had a wonderful life. In their study of patients with incurable cancer, Voogt et al. (2005) found that while approximately a third of the participants strove for length of life, a third wanted quality of life. Mrs Jones’s values and beliefs may have been intertwined with an autonomous decision to die with dignity. Radley and Payne (2009) suggest that when people refuse treatment later on they want to spend quality time with their family without the side effects of treatment. Tingle and Cribb (2007) also recognise that although medicine can now provide the means of staving off death, the cost to the individual may be too high. Some may not want to spend their last days or weeks attached to tubes and drips. Tingle and Cribb further reiterate their point by proposing that it needs to be recognised that even if the pain of those who are terminally ill can be controlled, what they may fear the most is the technology that potentially leads to a loss of self-respect and self esteem. The concept of dying with dig nity is supported in UK law, and Article 3 of the Human Rights Act (1998) states that ‘no-one shall be subjected to torture or inhuman or degrading treatment or punishment’, an article which can be used to support cases of withdrawal of treatment. An autonomous person is also defined by Beauchamp and Childress (2001) as an individual who has the capacity to make decisions for themselves, as well as being competent to evaluate and deliberate information in order to reflect their own life plan. Capacity in the law is defined as the ability to understand information and make a balanced decision (Griffith 2007). Capacity is a fundamental component of autonomy and the Mental Capacity Act’s (2005) starting point is the presumption that a person has the capacity to make decisions for themselves unless it can be shown that they are incapable. Mrs Jones had been involved in decisions to do with her care throughout her treatment and the consultant knew her well. However, Tingle and Cribb (2007) suggest that patients are not very good at saying when they don’t understand and Pellegrino (2004, in Harrison et al. 2008) found in his study that patients suffering from cancer are on a negative spiral of events which may diminish their clinical competence and result in feelings of ‘powerlessness’. This evidence could suggest that Mrs Jones may have felt that she did not have the power to not only make a competent decision, but to tell the consultant that she did not understand what he was saying. The decision of whether a person has capacity is to be made at the time of the decision making (MCA 2005) and Larcher (2005) acknowledges that clinical competence may fluctuate, depending on the circumstances and compounding factors such as pain. Mrs Jones had regular analgesia to control her pain and did not before, during or after the encounter make any complaints of discomfort. She had support from her husband and was familiar with her surroundings as well as the staff present in the room. All these factors indicate to me now that Mrs Jones had the capacity to evaluate and deliberate the information given to her and make a decision that reflected her own life plan. The main principle of the Mental Capacity Act (2005) stresses that a person’s right to autonomy must be respected and can be further supported by requiring steps to be taken to maximise decision making capacity. One of these steps is informed consent. The Mental Capacity Act (2005) states that information given must include the nature of the decision, the purpose for which it is needed and the likely effects of any decision made. The need to weigh the information as part of the process of making the decision has been described by the courts as; ‘The ability to weigh all relevant information in the balance as part of the process of making a decision and then use that information to arrive at a decision.’ (Re MB Caesarean section 1997, in Griffith 2007). The consultant gave Mrs Jones information about her prognosis and treatment in compliance with the Mental Capacity Act (2005) as well as other health care policies (DOH 2007; 2008). He disclosed the factual details such as the advantages and disadvantages of the treatment and the potential side effects of undertaking further radiotherapy. However questions still arise as to how much information needs to be disclosed to the patient before consent can truly be said to be informed. As a moral matter it has been suggested that you should disclose whatever information a reasonable person would want to know plus whatever further information the actual individual wants to know (Radley and Payne 2009). However, research carried out by Clarke (2003) does suggest that patients demonstrate poor levels of knowledge and comprehension, particularly where bad news has been given. When the consultant told Mrs Jones that they hadn’t been able to remove the tumour she had replied that she had t hought that might have been the case. This indicates to me that Mrs Jones had already taken the time to consider her options and the possibility that the tumour may not be removed, prior to the encounter with the consultant. Seymour (2001) proposes that the informed decision to refuse treatment may be about regaining control in a situation where there may be few desirable options. Radley and Payne (2009) suggest that the decision to refuse treatment, is not a rejection of medicine but a rejection of false hope or an acceptance of another sort of hope in which quality of life is preferred over quantity of life. Mrs Jones had undergone intensive treatment in the months leading up to this final prognosis and I now consider that the finality of this diagnosis may have given her not the opportunity to ‘give up’ but to spend quality time with her family without the side effects of a treatment which was not going to cure her. Therefore Mrs Jones was taking positive steps to safeguard the death she wanted. After Mrs Jones initially refused the treatment the consultant went on again to say that ‘it could add months to her life’. I thought at the time that Mrs Jones may take time to consider this again given that the consultant was to me the ‘expert’. From a medical viewpoint, death is seen as a failure, rather than as an important part of life (Smith 2000), so there may be a conflict when a patient chooses to make a decision that is likely to end in death. Physicians who are unable to keep patients alive may struggle to avoid experiencing an inevitable sense of failure (Clarke 2003) as it is widely accepted that medicine’s primary goal is to restore a person’s health (Heaney et al. 2007). By offering Mrs Jones a treatment to delay the inevitable the consultant was acting in a beneficent manner and tension can arise when beneficence and autonomy are in conflict. With advanced medicines today life can be sustained for longer periods, however Van Kle ffens et al (2004) found in their study that for the patients who refused the treatment, their decision was not based on the pros and cons of treatment from a medical perspective but a ‘circumstantial basis’. In a further study by Van Kleffens in 2005, the patients who decided not to accept further treatment said it was based on their own experiences, values and meanings in life. Voogt et al (2005) also proposed that physicians do not engage sufficiently with the world of the patient that extends outside of medicine. So although the consultant knew Mrs Jones well and had been involved in her care for many months, he had only been associated with her in the medical concept. Contemporary opinion suggests that where there is tension between autonomy and beneficence, autonomy should take precedence (Dimond 2005). Now What? Mrs Jones passed away how she wished, in hospital surrounded by her family. Consideration of the ethical and legal principles discussed required a depth of knowledge that I as a student did not hold for this particular situation which was to me personal, complex and difficult to define. From reflection on this incident I recognise now that I have gaps in interpreting theory into practice. Benner’s (1984) work proposes that nurses move from novice to expert as a result of both experiences and training. By analysing the situation with reference to theories and concepts, I have come to realise that only through experience, greater knowledge and confidence will these gaps begin to close. I now know that no one solution was correct nor was it incorrect. Nurses have a legal and moral duty to act in a beneficent way which at times may conflict with the autonomy of the patient. However, providing the patient is of age and has the capabilities to make informed and balanced decisions, in cases of conflict the law will favour autonomy over beneficence. I have come to appreciate that the patient is the only one who can decide what matters to them and what is good based on the information given and as a nurse I am in a position to recognise when patient autonomy is at risk of not being respected and help to restore it. This would then result in the principles of autonomy and beneficence working in partnership rather than in conflict, with the act of beneficence being the action that increases the autonomy of the patient. The process of reflection can bring up painful emotions again but if followed properly and supported appropriately, it can help the reflector to come to terms with their emotions and move on. I now know that the feelings I expressed were natural for a novice like me. Should this particular situation arise again I know I would be able to take this new knowledge with me but am unsure as to whether it would diminish my feelings of sadness, I am however confident that I could now put them to one side. Conclusion Reflection is an important aspect of nurse education and can assist student nurses in linking theory and practice and in developing self-awareness skills. Borton’s (1970 in Jasper 2003) reflective framework has assisted me in both reflecting on what was to me a difficult and personal experience and being able to structure an academic assignment based on it. Even though critics claim that Borton does not include the finer details of reflection or any guide as to how reflection is to be conducted within each stage of the process, I found that these omissions allowed me a wider scope and more freedom to analyse and challenge the situation and my own feelings. Had I used a model such as Gibbs (1988 in Jasper 2003), which consists of prompt questions, it may have restricted my reflection as I tried to answer the specific questions. I am aware of the negative elements of reflection but feel that by acknowledging these within my assignment I was able to conduct a reflection that was an honest and true account. The ethical and legal issues that arose in the incident were autonomy, beneficence, capacity and informed consent. All these issues are interlinked and have an impact on each other and I now understand that each must be considered both as individual components and together in order to gain an accurate perception of a situation and provide patient centred care. My professional knowledge and understanding of these issues and the importance of reflection in nursing has increased considerably by completing this reflective assignment. I understand that by reflecting on situations that occur within clinical practice I will gain new insights, knowledge and understanding therefore empowering me in my practice. This will enhance my nursing practice in future in variety of ways, in particular by assisting me in conti nuous professional development throughout my nursing career, as required by the NMC (2008). References ANDREWS, M.; GIDMAN, J., and HUMPHREYS, A., 1998. Reflection: does it enhance professional nursing practiceBritish Journal of Nursing 7, 413-417 ATKINS, S.; MURPHY, K., 1993. Reflection: a review of the literature. Journal of Advanced Nursing 18, 1188-1192 BEAUCHAMP, T.L.; CHILDRESS, J.F., 2001. Principles of Biomedical Ethics, 5th edition. Oxford: Oxford University Press BEGLEY, A.M., 2008. Guilty but Good: Defending voluntary active euthanasia from a virtue perspective. Nursing Ethics 15(4), 434-445 BENNER, P., 1984. From Novice to Expert. California: Addison-Wesley BORTON, T., 1970. Reach, Touch and Teach. London: Hodder Arnold cited in M. JASPER, 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD B, RE (adult: refusal of medical treatment).; 2002. 1 FLR 1090. Available from: http://www.bailii.org/ew/cases/EWHC/Fam/2002/429.html (Accessed 14th May 2011) BUKA, P., 2008. Patients’ Rights, Law and Ethics for Nurses: A practical guide. London: Hodder Arnold BULMAN, C.; SCHUTZ, S., 2004. Reflective Practice in Nursing, 3rd edition. Oxford: Blackwell Publishing LTD BURROWS, D., 1995. The nurse teacher’s role in the promotion of reflective practice. Nurse Education Today 15, 346-50 BURTON, A.J., 2000. Reflection: nursing’s practice and education panaceaJournal of Advanced Nursing 31(5) 1009-1017 CLARKE, J., 2003. Patient centred death. British Medical Journal 327, 174-175 CONWAY, J., 1994. Reflection, the art and science of nursing and the theory-practice gap. British Journal of Nursing 3, 114-118 DEPARTMENT OF HEALTH., 2007. Cancer reform strategy. London: Crown Publications DEPARTMENT OF HEALTH., 2008. End of life care strategy. London: Department of Health DIMOND, B., 2005. Legal Aspects of Nursing, 4th edition. London: Pearson Education Limited ELLIS, J.R.; HARTLEY, C.L., 2001. Nursing in today’s world: Challenges, Issues and Trends. Philadelphia: Lippincott GIBBS, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Blackwell Publishing cited in M. JASPER, 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD GREAT BRITAIN. Human Rights Act 1998: Elizabeth ll. Chapter 42. 1998. London: The Stationery Office. Available from: http://www.legislation.gov.uk/ukpga/1998/42/contents (accessed on 14th May 2011) Great Britain. Mental Capacity Act 2005: Elizabeth II. Chapter 9. 2005 London: The Stationery Office. Available from: http://www.legislation.gov.uk/ukpga/2005/9/contents (Accessed on 15th May 2011) GRIFFITH, R., 2007. Making decisions for incapable adults 1: Capacity and best interest. British Journal of Community Nursing 11(3), 119-125 HARGREAVES, J., 1997. Using patients: exploring the ethical dimension of reflective practice in nurse education. Journal of Advanced Nursing 25, 223-228 HEANEY, M.; FOOT, C,. and FREEMAN, W., 2007. Ethical issues in withholding and withdrawing life-prolonging medical treatment in the IC U. Current Anaesthesia Critical Care 18, 5-6, 277-283 HONG, L.P.; CHEW, L., 2008. Reflective practice from the perspectives of the bachelor of nursing students in International Medical University (IMU). Singapore Nursing Journal 35(3), 5-6,8-10,12-15 JASPER, M., 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD JOHNS, C., 1998. Opening the Doors of Perception. Oxford: Blackwell Science cited in C. Johns and D. Freshwater, 2005 (eds), Transforming Nursing through Reflective Practice. Oxford: Blackwell Science JONES, P.R., 1995. Hindsight bias in reflective practice: An empirical investigation. Journal of Advanced Nursing 21, 783-788 KELLY, B., 1991. The professional values of English undergraduates. Journal of Advanced Nursing 16, 867-872 KIM, H.S., 1999. Critical Reflective inquiry for knowledge development in nursing practice. Journal of Advanced Nursing 29(5), 1205-12 KRALIK, D.; KOCH,T., and WOTTON K., 1997. Engagement and detachment: Understanding patients’ experiencing with nursing. Journal of Advanced Nursing 26(2), 399-407 LARCHER, V., 2005. Consent, competence and confidentiality. British Medical Journal 330, 7487, 353-356. LAUDER, W., 1994. Beyond reflection: practical wisdom and the practical syllogism. Nurse Education Today 14, 91-98 MACKINTOSH, C., 1998. Reflection: a flawed strategy for the nursing professional. Nurse Education Today 18, 553-7 MB, RE (Caesarean Section)., 1997. 2 F.L.R. 426 cited in R., Griffith., 2007. Making decisions for incapable adults 1: Capacity and best interest. British Journal of Community Nursing 11(3), 119-125 NURSING MIDWIFERY COUNCIL, 2008. The code: standards of conduct, performance and ethics for nurses and midwifes. London: NMC PELLEGRINO, E., 2004. Ethical considerations in head and neck cancer. California: Addison-Wesley cited in L, Harrison., R, Sessions., W, Hong., 2008 (eds). Head and Neck Cancer: A Multidisciplinary Approach, 2nd edition. Philadelphia: Lippincott Williams Wilkins RADLEY, A.; PAYNE, S.A., 2009. A sociological commentary on the refusal of treatment by patients with cancer. Mortality 14(4), 309-24 REID, B., 1993. ‘But we’re doing it already!’ Exploring a response to the concept of Reflective Practice in order to improve its facilitation. Nurse Education Today 13(4), 305-309 ROLFE, G.; FRESHWATER, D.; and JASPER, M., 2001. Critical Reflection for Nursing. Hampshire: Palgrave Macmillan SAUNDERS, K.; CHALONER, C., 2007. Voluntary euthanasia: ethical concepts and definitions. Nursing Standard 21(35) 41-44 SAYLOR, C.R., 1990. Reflection and professional education: art, science and competency. Nurse Educator 15(2), 8-11 SCHON, D., 1983. The Reflective Practitioner: How professionals think in action. London: Temple Smith SEYMOUR, J.R., 2001. Critical moments: death and dying in intensive care. Buckingham: Open University Press SIDAWAY V BETHLEM ROYAL HOSPITAL.; 1985. AC 871, 1985 1 All ER 643, 1985 2 WLR 480. Available from: http://www.bailii.org/uk/cases/UKHL/1985/1.html (Accessed 14th May 2011) SMITH, A., 1998. Learning about reflection. Journal of Advanced Nursing 28(4), 891-898 SMITH, R., 2000. A good death: an important aim for health services and for us all. British Medical Journal 320, 7228, 129-130 STREET, A.F., 1992. Inside nursing- A clinical ethnography of Clinical Nursing Practice. New York: Albany TEEKMAN, B., 2000. Exploring reflective thinking in nursing practice. Journal of Advanced Nursing 31(5), 1125-1135 TINGLE, J.; CRIBB, A., 2007. Nursing Law and Ethics, 3rd edition. Oxford: Blackwell Publishing LTD VAN KLEFFENS, T.; VAN BAARSEN, B., and VAN LEEUWEN, E., 2004. The medical practise of patient autonomy and cancer treatment refusals: a patients’ and physicians’ perspective. Social Science Medicine 58, 2325–2336 VAN KLEFFENS, T.; VAN LEEUWEN, E., 2005. Physicians’ evaluations of patients’ decisions to refuse oncological treatment. Journal of Medical Ethics 31, 131–136 VOOGT, E.; VAN DER HEIDE, A.; RIETJENS, J.A.C.; VAN LEEUWEN, A.F.; VISER, A.P.; VAN DER RIJT, C.C.D., 2005. Attitudes of patients with incurable cancer towards medical treatment in the last phase of life. Journal of Oncology 23, 2012-2019 WILLIAMS, G.R.; LOWES, L., 2001. Reflective practice. Reflection: Possible strategies to improve its use by qualified staff. British Journal of Nursing 10(22), 1482-8 How to cite Developing practitioner, Essay examples

CBT Interventions or Strategies-Free-Samples -Myassignmenthelp

Question: Develop a treatment Plan for the specific Implementation of CBT Interventions or Strategies. Answer: Introduction Mental health nursing is a specialization in nursing that deals with mental illnesses and disorders in people of all age brackets. Some of these illnesses and disorders include; Schizophrenia, depression, dementia, bipolar affective disorder, and agoraphobia. There are several incidences that may lead to mental disorders. Such events may include; one losing a loved one through death, divorce, abuse of drugs and alcohol and changes that occur in ones life for example job. It is the role of a mental health nurse to facilitate the recuperation of individuals suffering from mental disorders (Cahil, 2013). The recovery process involves the patient in activities that will help them control their specific mental conditions. In mental health nursing, CBT (Cognitive Behavioral Therapy) refers to the coordination of a persons emotions, behavior, thoughts, and physical aspects. A CBT helps identify these interactions which later help the patient to know whether their thought and behaviors are a dequate or inadequate in adapting to the world. In this paper, we are going to focus on a case study of Japan. Current Presentation The case study of Japan indicated that out of all patients with mood and developmental disorders, those with Schizophrenia were the subject of the CBT. Schizophrenia occurs when an individual develops a series of problems relating to his/her emotions, cognitive ability, and overall behavior. Schizophrenia is of three types; paranoid schizophrenia, disorganized schizophrenia and catatonic schizophrenia. There are numerous symptoms and signs that are an indication of this mental disorder, but the common ones are; hallucinations, speech that is not organized and delusion (Haddock, 2014). Patients who have Schizophrenia hallucinate. Hallucination involves hearing or seeing non-existent things. Schizophrenic persons mostly hear voices that are not normal. Speech that is disorganized which is a common sign can be identified through the way in which the patient responds to questions. They may give unrelated or even incomplete answers. Sometimes, the patient may deliver statements with words that are meaningless or difficult to understand. A delusion which occurs in Schizophrenia patients involves beliefs that are false for example the individual may take a loving gesture from another person for harm due to poor interpretation (Robson, 2013). The symptoms of teenagers who have Schizophrenia may be evidenced by; performance drop in school, lack of sleep, separating oneself from friends and lack of motivation. In a comparison of symptoms in adults, the teenagers have a less likelihood of suffering from delusion but more probable to experience seeing- related hallucinations. The major problem for patients who have Schizophrenia is that they experience feelings and portray behaviors that are suicidal (Yoshinaga, 2017). It is therefore recommended that a family where one of the members suffers from this disorder stay in touch to make sure that the patient does not commit suicide. Other problems associated with this disorder are; self-injuries, inability to perform daily activities, aggressive character, social alienation, financial problems, legal problems and possible drug abuse. A case study of Japan that compared the level of stigmatization of mental disorders indicated that Schizophrenia was more stigmatized compared to others like depression (Williams Bates, 2015). Most Japanese had the belief that schizophrenia patients were more dangerous than those who suffered from depression. The Schizophrenic patients were also unpredictable compared to those suffering from depression. This belief extended even to the job market where by most employers failed t o employ individuals who have chronic schizophrenia. However, there was a partial exception for those suffering from early stages of schizophrenia. The statistics available showed that about60 % against 40 % of job seekers who have chronic schizophrenia and early schizophrenia respectively less likelihood of being employed. Formulation There are four risk factors relating to mental health disorders commonly known as the 4P factors. They include; predisposing risk factors, precipitating risk factors, perpetual risk factors and protective risk factors. Predisposing factors make an individual more prone to a certain mental disorder. A perfect example of a predisposing factor is a family history whereby schizophrenia is present (Happell, 2013). This increases the probability of family members to suffer the mental disorder. On the contrary, in a family where the disorder is not present in the history, the family members are less likely to suffer from the disorder. The precipitating factors are a series of precipitating events that increase susceptibility thereby contributing to a mental disorder. Some of the precipitating risk factors include; stressor, catastrophe, and stress related to adopting a new culture. One unique property about precipitating risk factors is that they occur before the disorder. Different people react differently to a similar precipitating event which is dependent on ones background and life experiences. The third risk factor, perpetual risk factor has a role in the prevention of recovery from a mental disorder. These risk factors contribute to progressive worsening of the patients symptoms. Perpetuating risk factors may include predisposing and precipitating factors that are not resolved, continuous bullying, social isolation, poor personal skills and low resilience to challenging life situations. The last factor in the 4P factor model is the protective risk factor which prevents or reduces the probability of occurrence of a certain mental disorder (Butler, 2014). A perfect example is a disorder in substance use could be prevented by not using the substance. Some protective factors may be generic for example good relationship with friends and family, personal attributes such as self-confidence and support from the society. Cognition plays a key role in the maintenance of mental disorders and symptoms. The major cognitions the effect mental disorders are; emotion cognition and motor cognition. Emotional cognition may lead to conditions such as depression and anxiety since for these disorders to occur there has to be dysfunction in cognition and bias in the processing of information. This contributes to starting and maintenance of a series of ceaseless symptoms. An anxiety literature indicates that those people who are anxious show little ability to regulate their emotions as reported by Yoshinaga (2015). Additionally, people who are anxious orient to harmful changes in the environmental very fast and hardly get out of the harmful situations. This difficulty to come out of the threatening stimuli plays a key role in the maintenance of anxiety as a mental disorder. This is what is referred to as attention bias. Attention bias may also occur in depression if an individual is exposed to changes in the environment for a long period. This is contrary to the literature of anxiety whereby the stimuli only covered short durations (Videbeck, 2013). A comparison reveals that attentio n bias in anxiety is an indication of the initial stages of processing whereas in depression it is an indication of later processing stages. From findings, it is right to deduce that depression and anxiety are products of abnormal cognition which is contributed by distractions in the environment. Interpretation bias is also brought by up by anxiety. Interpretation bias is supported by two major f MRI findings namely; PFC and responsivity of the amygdala. The PFC involves the process of developing a new interpretation of certain life situations. It is through an individuals effort to regulate emotions in an attempt to reduce the information that is negative where new interpretations arise. In the responsivity of the amygdala, anxious people over-interpret neutral stimuli and consider them harmful. One of the negative effects of interpretation bias is memory loss. It is not clear whether interpretation bias is related to depression. Apart from the earlier discussed emotional cognition, motivation cognition also plays a role in the maintenance of mental disorders and symptoms. Studies on psychophysiology and behaviors show that motivation has an active role in depression as reported by (Melynk B M, 2014). Deficits in motivation can be showed through poor response to environmental changes that are positive. Apart from these deficits, depression could also be attributed to avoidance of a certain behavior and hypersensitivity to punishments and chaos. There is a tendency with depressed individuals of responding abnormally to punishments and difficulty with coping with feedbacks that are negative. Motivation literature states that abnormality is not only an issue affecting people suffering from depression but also those suffering from anxiety. Treatment A study on the knowledge about recovery and treatment of schizophrenia showed general pessimism towards recovery from such a disorder. However later, an approximated percentage of 80% of people agreed that it was possible for the disease to be treated. It was also essential to note that out of the 80% of the public, only 40% who believed that full recovery would be possible (Robson, 2013). Adherence to medication for this mental illness was poor. This was related to lack of knowledge about the possible side effects of the illness. A similar study showed that a majority of the public did not acknowledge the psychiatrist help as a solution to full recovery. In any case, they recognized antipsychotics as persons of big help. In the stigmatization study, demographic characteristics were also considered especially age. Sex as a demographic characteristic did not have any regard. The study showed that older people were more pessimistic to schizophrenia and other mental disorders compared t o younger people (Struthers, 2015). This attitude may be attributed to inappropriate education, lack of opportunities for people suffering from mental illnesses and negative social perception of mental illness. The treatment of schizophrenia is based on CBT principles. In the treatment process, thoughts, emotions, and behavior are integrated. In the treatment plan, agendas are proposed and more flexible. It is important to note that in the traditional CBT agenda are not flexible. The period of recovery is different depending on the patients need. Normally, there are 12 to 20 sessions in the plan alongside other sessions that act as boosters. The CBT occurs in a series of steps which are; assessment, engagement stage, goal setting, normalization, critical collaborative analysis and finally the development of alternative explanation. In the assessment phase, the therapist actively listens to the patients as they share their thoughts based on their life experiences. This stage is monitored using scales of rating precisely the general and specific scales (Stevens, 2013). Any remarkable progress made by the patient through the monitor process is shared by the nurse to the patient. Other aids that are used in this stage are diagrams for those patients with a lifestyle that is disorganized. Additionally, information about symptoms, causes, and possible maintenance is shared with the patient. The second phase involves engagement whereby questions meant to pursue thoughts are applied. The Socratic questions gauge an individuals ability to understand his/her mental condition and the readiness to adapt to the world by coping with the condition (Townsend, 2014). The therapist tries to understand the specific distress and emotions of the patient in an empathetic process. This is a gesture to allow flexibility with the patient. The therapist then develops a vulnerability-stress model to educate the patient on the dynamic nature of vulnerability. In this model, vulnerability is attributed to some factors including; incidences taking place in life, physical illness and ability to cope. The therapist does not have the answers to all situations, but there is room for explanations if the patient cooperates. Some of the most important therapeutic aspects that are applied in this phase are; humor, transparency, warmth, and empathy. Alternatively, an ABC model can be applied. This mode l helps the patient to pick up the pieces by reordering experiences that are confusing as stated by Cahil (2013). The steps taken in an ABC model include; the therapist gives a rating of patient's distress, assessment of the consequences accompanying distress categorically based on emotions and behaviors, a patient's explanation of the possible causes of the consequences, feedback with the knowledge of A-C connection. The therapist then makes the patient believe that the A-C model lacks a personal meaning and in the final stage the belief of the patient is discussed and a feeling of acceptance is created. The third stage in a treatment plan involves goal setting. Goals set in in the therapy are realistic to the patient and the therapist. Distressing consequences are used to promote the changes needed to achieve the set goals (Haddock, 2014). At the beginning and end of the therapeutic process, the goals are reviewed. Normalization is the fourth phase of the treatment plan. In this phase, the therapist makes it clear to the patient that unusual experiences can occur to anybody due to experiences such as hunger, thirst, torture, stress, and hyperventilation. By gaining this understanding, anxiety reduces, and the patient develops a sense of belonging and social acceptance. This normalization of psychotic experiences enhances fast recovery among patients. A critical collaborative analysis forms the fifth phase of a treatment plan. The onset of this stage is often indicated or marked by the trust which was created between the therapist and the patient. In this stage, Socratic questions asked by the therapist are gentle which allows the patients to make personal deductions on the logic of positive psychotic change (Fortnash, 2014). The test to eliminate beliefs that slow down the rate of adapting to the world is conducted in distress free manner. This is only possible if the therapist is empathic, transparent and non-judgmental. In a homework setting, the misattributions identified are reattributed. This is done through cognitive distortions, for example, emotional reasoning and revisiting of antecedents like trauma which form the foundation for psychotic change to happen. The final stage in a treatment plan is the development of alternative explanation whereby patients are allowed to bring out the coping strategies in mind other than t he methods suggested by their therapists (Zugai, 2015). This is important since the explanations offered by the therapist may not suit some patients. A perfect real-life example of patients who benefited from CBT is the story of Jasmine, a 52 years old lady who had been suffering from schizophrenia for 31years. She had been hearing voices that were not existent for the 31 years following a bomb blast incident that she survived as a teenager. Jasmine had never accepted schizophrenia diagnosis but had been adhering to medication. She also complied with CBT with the argument that she enjoyed speaking the therapist who was a young and warm-hearted man. In the assessment stage, it was evident that the main problem of the patient was a lack of confidence and isolation from family and friends with the belief that the voices had an external source. The engagement phase was less problematic. In the first attempt, the therapist used the ABC model and continuum concept. This attempt was not successful since Jasmine rarely understood the message being conveyed. The therapist chose to use the example of temperature to create a better understanding in Jasmine. He explained the continuum concept using temperature. The therapist then used a plain paper sheet with a cube drawn on it. He raised it up and asked Jasmine to say what she observed. Jasmine realized that the diagram was in three dimensions. As Jasmine was making the observation, the therapist also applied normalization after considering her level of understanding. It was remarkable that Jasmine had gained self-confidence and stable mood though she reserved the belief that the voices were from external sources. Jasmine went through 22 sessions of the therapy, and the disturbing voices had turned into gentle conversations that reminded her of the cup of coffee she always had wit h friends before the bomb blast incidence. There are some specific CBT interventions that can be used in the treatment of certain symptoms. It is important to note that the possibility or degrees of recurring symptoms are different depending on the patient. Through a training program, patients can be educated on how to live a productive and social life. A successful treatment of schizophrenia does not involve only one treatment termed as the best. There are several treatments applied alongside support programs to aid quick recovery of the patients. Some of these treatments include; use of antipsychotic medication, psychiatric rehabilitation and training on social skills (Yoshinaga, 2017). The effect of antipsychotic drugs is not in the cure of schizophrenia rather it reduces the intensity of symptoms. By reducing the intensity of symptoms, the appearance of the patient is improved, and he/she can go on with daily activities as normal. Another benefit of using the psychotic drugs is that symptoms like poor concentration are reduced. It is important also to note that medications are not a lasting solution since they only help in the first step. Community support programs offer psychiatric rehabilitation to patients which instill instrumental and personal skills amid environmental support. These skills are necessary since they help an individual to fit in all kinds of environment. According to research, most people often develop schizophrenia during their career-performing years, the ages of 18 years to 36 years. This makes those who have the mental illness to have emotional problems, thinking difficulty and poor performance at work (Happell, 2013). Through psychiatric rehabilitation social skills training, this offers the solution to a better life. A program that involves social skill training equips the patient on the way to manage symptoms and live an independent life. The process of managing symptoms involves identification of warning signals, controlling symptoms that are ceaseless and prevention of possible causes of stress. In a bid to explain the cultural and other psychosocial aspects, we are going to consider the case study of China. Studies show that Chinese show less concern for health services related to mental health. A CBT model was modified to match the culture and behavior of clients in China. There are several personal and cultural expectations from the clients in China. These expectations from CBT were separately classified. Some of the expectations from clients include; a therapist who is authoritative, reduced ambiguity tolerance, brief therapy for large amounts of money and instant problem resolving (Lin, 2017). On the other hand, the cultural expectations included; use of Chinese medications, fast change into the mainstream culture and humility in the therapy process. Conclusion There are tireless efforts to use different interventions for the benefit of patients who suffer from mental illnesses by mental health nurses. A major intervention is in use of CBT (Cognitive Behavioural Therapy) which has proved to be an effective method for clinical application. For this therapy process to be realistic, it must be regarded to be of relevance to nurses and the general public. References Al?Zayyat, A. S., Al?Gamal, E. (2014). 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