Counseling the Dying Patient Essays

Counseling the Dying Patient Essays Counseling the Dying Patient Paper Counseling the Dying Patient Paper Death is certain to come. It is only a matter of time and how we face it. Ironically, it is part of life. There is no fearful human experience than going through the anguish of dying. Attitudes toward death are not completely positive or negative; rather, they are on a continuum. At one end of the continuum is the perception of death as humanitys mortal enemy†¦ at the other end is accepting and even welcoming death as a passage to a more blissful state of being. (Aiken, 2001, p. 5). Dr. Elisabeth Kubler-Ross, in her years of caring for the dying patients, described death as a wonderful experience. In her book On Death and Dying, she cited five stages wherein terminally ill patients undergo during their final moments. The First Stage is Denial and Isolation. Due to the terrifying as well as stressful effects of dying both physically and emotionally, the patient usually refuses to accept the reality that his life will end soon. He thinks that there must have been some mistakes and that this is not happening to him. The patient still thinks that life is normal recalling more often happy memories with his loved ones. The Second Stage is Anger. Realizing that the situation is no longer controllable and that he is helpless, the patient demonstrates emotional outburst of anger with himself and his surroundings. Feeling that there is no choice but to die, the patient experiences a sense of loss that is unbearable to him. The Third Stage is Bargaining. Realizing that death is imminent after all the medical measures have been done, the patient now tries to make a compromise in order to make his remaining days fruitful and memorable like making peace with God or settle grudges with the family, friends and other people he has hurt before. If given more time, he promises to do good deeds and attend an important family event like his children’s graduations or birthdays. The Fourth Stage is Depression. Knowing that you are dying adds up to your misery after battling the deadly disease that ends up for nothing. The patient feels that all his efforts and struggles are all useless. Angry and incapable knowing that death is near, the patient develops these guilt feelings he thinks causing so much pain to him and his loved ones. The Fifth Stage is Acceptance. This comes after the patient has explored all possibilities available and dealt with all the struggles and conflicts in his final moments that he now realized this is really happening. With less emotions, tired and weak, he comes to terms with reality that it is okay to die. The battle is over and he is ready. With these thoughts, he accepts death as part of life and that the world will continue even without him. Counseling the Dying Patient. A number of health institutions are now integrating care for the dying patients. From the foregoing it is evident that the terminally ill patient has very special needs which can be fulfilled if we take the time to sit and listen and find out what they are. The most important communication, perhaps, is the fact that we let him know that we are ready and willing to share some of his concerns. (Ross, 1989, p. 240). This special therapy is known as Hospice that focuses mainly on caring rather than curing. Specifically, it pays attention to the patient’s physical, emotional, social and spiritual aspects trying to ease pain and suffering that will prepare him and his family for death. This is provided wherever the dying patients are mostly in their homes but it is also available in nursing homes and hospitals for long-term inpatient care. Hospice care is a comprehensive interdisciplinary program of care designed to provide hope, care and comfort to terminally ill people and their families or loved ones in the familiarity of their own communities. (Hospice Hawaii, 2004,  ¶2). In home settings, two family members are assigned shared responsibilities of care giving. Hospice staff visits the home on a regular schedule to assess the patient and provide support for the whole family. They are on call 24 hours a day seven days a week. However, if there is some difficulty or symptoms that would require continued professional care a short-term inpatient solution could be provided. The team composing the hospice care includes doctors, registered nurses, social workers, chaplains/clergies, home health aides, and trained volunteers. The team’s major responsibilities are: manages the patient’s pain and symptoms; assists the patient with the emotional and psychosocial and spiritual aspects of dying; provides needed medications, medical supplies, and equipment; coaches the family on how to care for the patient; delivers special services like speech and physical therapy when needed; makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and provides bereavement care and counseling to surviving family and friends. (Caring Connections, 2006,  ¶4). The patient’s physician continues to be in-charge of his medical care. The team formulates care plan designed to suit the needs of the patient for pain management and to control symptoms. Counseling the dying patient and his loved ones is an important service of hospice care. Bereavement support is offered to families for at least a year after death by way of visits, support groups, telephone calls, and literature on grieving. This approach is covered by health insurance and is given to those who are only willing to undergo. Dr. Kubler-Ross in her own experiences with dying patients came to realize that death is simply a shedding of the physical body like the butterfly shedding its cocoon. It is a transition to a higher state of consciousness where you continue to perceive, to understand, to laugh, and to be able to grow. (EKR, 2006,  ¶15). Reference Aiken, L. R. (2001). Dying, Death and Bereavement. Lawrence Erlbaum Associates, Inc. ; 4th edition. Mahwah, NJ. ISBN: 0805835040 Ross, E. K. (1989). On Death and Dying. Routledge; Reprint edition. London. ISBN 0-415-04015-9 Hospice Hawaii, AssistGuide, Inc. (2004). Creating Comfort Giving Hope Connecting Lives. Retrieved October 20, 2006, from hospicehawaii. org/home/default. asp? PF= Caring Connections. ((2006). How Does Hospice Work? Home Advance Care Planning. National Hospice and Palliative Care Organization. Retrieved October 20, 2006, from caringinfo. org/i4a/pages/index. cfm? pageid=3467 EKR (Elisabeth Kubler-Ross) Foundation. (2006). Selected Quotes. Life, Death, Compassion. Retrieved October 20, 2006, from http://dying. about. com/gi/dynamic/offsite. htm? zi=1/XJsdn=dyingzu=http%3A%2F%2Fwww. ekrfoundation. org

The Dangers of Prompt Dependence

The Dangers of Prompt Dependence Prompt dependence comes when a student needs a prompt in order to initiate a skill or activity. Often the skill is mastered, but prompting  is so much a part of the students expectations that they will not initiate and sometimes complete an activity without adult prompting.  Often this happens because the parent, therapist, teacher or teachers aide lays on the verbal prompting thick and consistently. Example Case of Prompt Dependency Rodney would sit and wait for Miss Eversham to tell him to start before he would begin the papers in his folder. Miss Eversham realized that Rodney had developed prompt dependency, relying on her giving verbal prompts for him to complete his folder. Dont Talk Too Much Prompting is an important part of scaffolding success with special education students, starting small and working toward more complex academic, functional or vocational skills. More often than not, children who become prompt dependent are those whose classroom aides are not always attentive to the fact that they give verbal prompts for everything. In other words, they talk too much. Too often, students get stuck on the continuum of prompts at the verbal prompt level and require the teacher to verbally direct them in order for them to complete the task or skill. Students can even be stuck at the hand over hand level some  students even need to take the teacher or aides hand and place it on their own hand before using scissors or even attempting to write with a writing utensil. Fading for Independence In each of the cases above, the problem was the failure to attend to the level of independence the child has developed and promptly fade out the prompts. If you start with hand over hand, as soon as you can loosen or relax your grasp, move toward the next level, moving your hand from the students hand to their wrist, to their elbow and then simply tapping the back of the hand. For other kinds of activities, especially for students have mastered the component parts of a larger skill (such as dressing) it is possible to begin with a higher level of prompting. It is important to avoid verbal prompting if possible.  Ã¢â‚¬â€¹Visual prompts are best, such as pictures of the student completing the activity, step by step. Once your student has clearly mastered the component parts, then employ gestural prompts alongside the verbal prompts, then withdraw or fade, the verbal prompts to finally leave only the gestural prompts, ending with independence. Independence should always be the goal of any educational program, and moving form prompting to independence is always the goal of an ethical and proactive teacher.   Be sure you are providing the kind of support that leads to independence.

Partnership Accounting Coursework Example | Topics and Well Written Essays - 1000 words

Partnership Accounting - Coursework Example Capital - William $ 87,500 Capital - Frank $ 87,500 Capital - Sammy $ 175,000 4. General Partnerships is that all partners have unlimited liability. This means that if a business is not able to pay back its debts, the partners are held responsible to pay the debtors back and they can be forced to sell of their personal assets in order to repay the debt. Only under certain circumstances, there can be a partner with limited liability; however that partner does not take part in the management of the business. Under Limited Partnerships there exist some partners whose liability is limited to the contribution of capital in the business. The resignation, retirement or death of such partner does not cause the dissolution of the firm. However, one partner has to have unlimited liability while the partners with limited liability do not take part in the management of the business. Also, such a partnership has to be registered. Joint Venture Partnership is similar to a general partnership, howe ver it lasts for only a certain time period or for a certain project. Usually two companies share the costs, risks and benefits by running a project. However, a written agreement is not necessary. 5. The two methods of recording changes in the membership of a partnership are Bonus Method and Goodwill Method. Under bonus method, the assets accounts increases by the amount of capital contributed by the new partner. Any access amount paid to acquire the interest in the business is credited to the respective partners account. However, under goodwill method, a goodwill account is opened to account for this access amount. It is an intangible asset. 6. A. The list of provisions is: 1) Nature of the  partnership   2) Contributions to the partnership 3) Allocation of profits and losses 4) Interest on Capital 5) Interest on Drawings 6) Management Duties 7) Policy upon admission or retirement of partners. 6. B. The articles of partnership are very significant as it outlines the nature of t he business, the names of the partners, their addresses, the address of the business. Also it includes the duties of each partner, their profit and loss sharing ratios, any salaries if applicable. It has clauses relating the percentage of interest of capital or interest charged on drawings. It may also contain the policy upon admission or retirement of a partner. All the partners and witnesses sign the articles of partnership agreement. Apart from highlighting the various factors relating to the business, it can serve as a legal document. Many partners contribute their capital, labor and skills to the business which has high risk associated with it. Therefore, there is a possibility that there is disagreement among the partners over assignment of duties, division of profit or loss or the admission of a new partner. In case a partnership agreement has not been framed and signed, this can lead to lawsuit. However, if a lawyer is involved and the articles of partnership are stated, it resolves conflict easily as all partners can refer to it. For instance, a dispute arises among distribution of profits among partners, it can be served as a legal document in the court and the conflict can be easily resolved. To avoid legal implications, it is always better to have a partnership agreement to prevent any partner from violating the agreement. It is signed to protect the interest of all partners. Discussion Board The partnership agreement is a legal document that not only serves in the interest of the partners but the government as well. The agreement not only covers the type of the business that it will carry but other important aspects. Many a times the profit and loss sharing ratio is different from the capital ratio, in such cases partnership agree

How comprehensive and abstinent only sex education differ and how Research Paper

How comprehensive and abstinent only sex education differ and how comprehensive is more informative and can help decrease the te - Research Paper Example However, differences on how to approach this subject have also emerged as a result as one group argues for the more traditional promotion of abstinence before marriage while the other advocates for a more direct approach of teaching where the youth are educated on all aspects concerning sex including protection against pregnancies and sexual transmitted diseases (Cook & Clarke 228). Though the more orthodox promoters of sex education are worried that too much information at an early age may not be the wisest decision, the question remains what withholding information on topics such as safe sex will have on the youth as overall as studies have shown that more and more teenagers are engaging in sexual activities and thus if this trend cannot be stopped would it not be better to ensure that they are taking the needed precautions to protect them from unplanned pregnancies and contraction of STIs (Sexually Transmitted Infections). Statistics have shown that the average age that individual s are losing their pregnancy is between 14 – 16 years of age which means that sex education will need to be introduced at an early age if it is to have the desired effect. This statistic is alarming considering that in the earlier years, studies conducted had shown that the average age at which virginity was lost was between 16 -18 years. This shows that a decrease of two years has taken place between the times these two studies were conducted; there is also fear that the age may continue decreasing which is a disturbing thought (Ott & Santelli 425). Abstinence only programs involve sex education with regard to its avoidance until one reaches the age of maturity (18-21 years) or preferably until one is married. This program focuses on encouraging the youth to shun any form of sexual interaction and teach on the dangers of unprotected sex such as unplanned pregnancies and incurable STIs in a bid to scare the youth straight so to speak. They do not offer any alternatives on how one is able to practice safe sex if they do decide to engage in such activities and mostly paint a scary picture on the consequences of having sex at an early age. The program has mostly been promoted by the conservative groups in the country including most religious factions as they feel any other mode of sex education will be in effect promoting the engaging of sexual activities among the youth (Cook & Clarke 236). Comprehensive sex education son the other hand focuses on all aspects involving sex education including its biology, human sexual behavior and the practice of safe sex as an alternative option. This type of sex education though considered unorthodox by the conservative groups have proved to be more effective within the schools as compared to the abstinence only programs in terms of preventing teen pregnancies. Comprehensive sex education includes teaching the use of condoms and other prevention

Effective Instructional Strategies For Adult Learners

Effective Instructional Strategies For Adult Learners College and universities across America are experience a change in student demographics from traditional to adult students. The adult student (those 25 and older) population in higher education continues to grows (Palazesci Bower, 2006; ODonnell Tobbell,2007; Giancola, Grawitch, Borchert, 2009; Vaccaro Lovell, 2010). The U.S. Department of Education reported an increase in nontraditional students from 28% in 1970 to 39% in 1999. Today, the U.S. Department of Education reported in its National Center for Educational Statistics(2006) reported that first-time full-time students are now in the minority in higher education. This growing population of adult learners bring unique characteristics to the learning environment. One might then expect to observe significant difference in instructional strategies of instructors of traditional and adult students. However, despite the unique characteristics of adult learners, the traditional approach to instructional strategies, in particular the lecture method, used in many traditional classrooms is utilized in the adult learning environment as well. While there are no inherent negative outcomes associated with the lecture method (Masikunis, Panayiotidis, Burke, 2009; Giers Kreiner, 2009; Revell, Wainwright, 2009), characteristics of adult learners may provoke the investigation of alternative instructional strategies. Adult Learning Malcom Knowles first introduced the idea that adult and children learning differently due to developmental and experiential differences in the 1970s (Knowles, Holton, Swanson, 2005). Prior to Knowles work, pedagogy was the focus of instructional strategies in higher education. The pedagogy model required the instructor to be in control of the learning and was the main focus of Knowles coined the term andragogy to describe a core set of principles of adult learning to build a more effective learning process for adults (p. 2). The six principles of andragogy are: The learners need to know; Self-concept of the learner; Prior experience of the learner; Readiness to learn; Orientation to learning; and Motivation to learn. (p. 3) Knowles stressed andragogy as a process model rather than the content model characteristic of pedagogy. The difference is not that one deals with content and the other does not; the difference is that the content model is concerned with transmitting information and skills whereas the process model is concerned with providing procedures and resources for helping learners acquire information and skills. (Knowles, Holton, Swanson, 2005, p. 115) Knowles maintained these principles, or assumptions, as foundational in designing meaningful learning experiences for adult learners (Merriam, Caffarella, Baumgartner, 2007). In addition to considering the characteristics of adult learners, Merriam, Caffarella, and Baumgartner (2005) emphasize the importance of recognizing learning in an adults life occurs in structured and informal learning environments. This recognition allows educators of adults to take into consideration the vast experience and knowledge adult students bring to the learning environment. Prior knowledge then becomes foundational to the learning experience. Also, the recognition that learning occurs in multiple arenas of life enables educators to assist adult learners in understanding they are lifelong learners. This may lessen the adults anxiety of entering a formal educational setting. The learning environment may be new, but the experience of learning new knowledge or skills is not. Lifelong learner is part of the adults life. Brookfield (1986) addressed the social aspect of adult learning. the acts of teaching and learning and the creation and alteration of our beliefs, values, actions, relationships, and social forms that result from this are ways in which we realize our humanity (p. 1). From this belief, Brookfield (1986) presented six principles for facilitating learning: Participation in learning is voluntary; adult engage in learning as a result of their own volition. Effective practice is characterized by a respect among participants for each others self-worth. Facilitation is collaborative. Facilitators and learners are in a cooperative enterprise in which, at different times and for different purposes, leadership and facilitation roles will be assumed by different group members. Praxis is placed at the heart of effective facilitation. Learners and facilitators are involved in a continual process of activity, reflection upon activity collaborative analysis of activity, new activity, further reflection, and collaborative analysis, and so on. Facilitation aims to foster in adults a spirit of critical reflection. The aim of facilitation is the nurturing of self=-directed, empowered adults. While Knowles advocated that adults learn differently than children, he understood the application of andragogy assumptions were dependent on the learning situation. In all learning situations, the needs of the learner are paramount in designing an effective learning experience. Knowles (as cited in Knowles, Holton, Swanson, 2005) stated: My intention, therefore, was to present an alternative set of assumptions to those that had been traditionally made by teachers of children, so that others would have another choice. I saw them as assumptions to be tested (not to be presumed), so that if a pedagogical assumption was the realistic condition given situation then pedagogical strategies would be appropriate. For example, if I were now, at age 66, to undertake to learn a body of totally strange content (for example, the higher mathematics of nuclear physics), I would be a totally dependent learner. I would have very little previous experience to build on, I probably would have a low degree of readiness to learn it, and I dont know what developmental task I would be preparing for. The assumptions of pedagogical assumptions would be appropriate. (p. 146) However, with that said, in many learning situations adult learners do bring a readiness to learn, do have experiential background, and XXXXXXXXXXXXX. In this context, learning strategies appropriate to the adult learner should be considered. Institutional Reaction to Adult Learners Despite the continual struggle of adult learners for voice and value in higher education (Sissel, Hansman, Kasworm, 2001), institutions appear to acknowledge the unique population of adult learners (Simpson, 2004). Institutions offer degree programs specifically addressing the need to provide alternative student services, multiple delivery modes (in-seat and online), and flexibility in scheduling (Durey, 2007). Matkin (2004) identifies two distinct markets in higher education: the residential student (traditional students) and the nonresidential (nontraditional student). The members of the two markets have different reasons for seeking education, different backgrounds, different service needs, and different pathways through which they are attracted (recruited) to education (p. 62). While, some in higher education academy may still harbor distrust in these nontraditional programs for adult learners, Tweedell (2007) contends many programs that target the adult population have been mor e deliberate in planning and implementing quality than other education programs whose theories and practices are rooted only in tradition (p. 5). In addition to addressing opportunities for adult students to pursue higher education opportunities, educators must investigate and implement instructional strategies that address the needs of adult learners. Instructional Strategies Several models of adult learning inform best practices in adult learning. Knowles (as cited in Brewer, 2005) provided guidelines for development and practice in adult learning programs. Central components of Knowles theory are self-directedness , a focus on experiential learning, learner reliance on past experiences, adult motivation to learn, and goal orientation associated with problem solving (p. 23). Effective instructional strategies for adult learners: Incorporates learners goals and objectives Provides opportunities for content to build on past experiences and knowledge Focus on problem oriented and practical strategies Require active learner participation Provides opportunities for application of new knowledge and skills Provide opportunities for both independent and collaborative learning Implications for Faculty Development Conclusion

Early Intervention in North Carolina

Early Intervention In North Carolina â€Å"Early intervention is a term that often is used to describe specific agencies, programs, services, and resources. In North Carolina, early Intervention has been described as a system of services provided by many different agencies and programs for children birth to five and their families. The system is for students who are having difficulties In the general education classroom but has not been placed Into the special education class. This comprehensive, interagency system is called TogetherWe Grow. Together We Grow has two parts 1) – the Infant-Toddler Program for children birth to three & 2) the Preschool Program for children ages three to five. † The early intervention system of services is provided under federal law, the Individuals with Disabilities Education Act (IDEA). Part C of the IDEA provides the federal mandate for services for young children. North Carolina Early Intervention Branch (NCEI) Is a part of the N. C. Di vision of Public Health and is the lead agency for the Infant Toddler Program (ITP).Research has found this to be the critical time to offer positive opportunities for child development. The state of North Carolina offers eighteen Children's Developmental Services Agencies (CDAs) across the state and they work with local services to improve the children success. Together We Grow (ITP) serves families whose children have certain levels of developmental delay or conditions. They offer Service Coordination Physical, occupational and speech-language therapies Family support Special instruction Assistive technologyOther services Basic safeguards are providing to secure confidentiality of the passing of the child information. Together We Grow Preschool Program: â€Å"In February 2010, Superintendent June Atkinson created NCDPIS Office of Early Learning to implement a strategic focus on the Pre-K – Grade 3 learning continuum and its impact on high school graduation. NCDPl's focus o n Pre-K through Grade 3 alignment of standards, curriculum, Instructional practices and assessment maximizes learning gains for children throughout these early grades, providing a trong academic foundation that leads to improved high school graduation rates. There are many services that are offered within the Early Intervention program.

Surrogacy and Kant - 1558 Words

Ethical Decision Making Paper The following case involves a seventy one year old male patient who told his family if the time ever came when he could not sustain life on his own he didn’t want measures taken to do so. This patient found out in the late summer of 2008 he had stage four pancreatic cancer. The doctor gave him about four weeks to live. At this point he took things into his own hands and made his daughter durable power of attorney for his healthcare needs. Over the next few weeks he became very week and could no longer walk. He stopped eating and drinking due to the mixture of him not feeling well and the medication he was taking. Eventually Hospice was called in to help assist with him and provide some comfort†¦show more content†¦The daughter of the patient also thought she was doing well by following her father’s wishes. At this point with the patient is in the last few days of his life the best thing at this point would be to honor his last wish and do nothing to sustain his life any longer. The second of the ethical theories we are looking at is Utilitarianism which is an act that Is right if it helps bring about the best balance of benefits over burdens (Purtilo 73). Utilitarianism is an effort to provide an answer to the practical question â€Å"What ought a man to do?† Its answer is that he ought to act so as to produce the best consequences possible (Hamric, : Spross, and Hanson, 2000)... There are not many consequences of taking out the IV line because the end result is still terminal. Step 4: Exploring the Practical Alternatives: Option 1- The patient stated to his daughter his wishes regarding the issue of his healthcare. The patient clearly stated when the time came for him to die if he could not sustain life on his own he wanted no steps taken to prolong his life. Therefore while he was still in sound mind he made his daughter Durable power of attorney over his healthcare needs. The patient should have signed a DNR to insure his wishes were followed through with. In that situation there would have been no doubt or second guessing by the family on what he wanted. Option 2- The family had aShow MoreRelatedEthical Dilemmas Of Utilitarianism And Deontology1368 Words   |  6 PagesConsidering Ethical Dilemmas through Utilitarianism and Deontology Kant’s theory of deontology and Mill’s theory of utilitarianism provide starkly different approaches to assigning moral value to ethical dilemmas, two modern dilemmas being commercial surrogacy and physician-assisted suicide. This essay will expound upon the process of deciding moral value within each ethical theory and then apply this decision process to the two ethical dilemmas. Arguments will be posited in support or in opposition toRead MoreCommercial Surrogacy : A Current Complex Issue That Evokes Strong Moralistic Response1327 Words   |  6 Pagesbehavior. Though it is impossible for these legislative decisions to please every single individual in a society, these governs are passed in morality of the thousands of elected parties in charge. Commercial surrogacy is a current complex issue that evokes strong moralistic response. Commercial surrogacy takes away the childbearing element in the reproductive period for individuals looking to have or extend a family. It has opened the doors for many who cannot bear children of their own though this behaviorRead MoreEthical Dilemmas for Nurses on End of Life Issues5633 Words   |  23 Pagesdown by Beauchamp and Childress in 1979, and form the framework within which medical ethics is now normally taught to student doctors and nurses as reported in (Warnock, 2005). In autonomy we respect a patient’s right to self-determination, but surrogacy may be invoked where a patient loses the capacity to express their wishes. While in Beneficence-we should promote good for our patient, always. In the Ethical principle of Non-maleficence states ‘First do no harm’ while the justice principle