Stigmatization A Mental Health Clinical Case Analysis Nursing Essay

Stigmatization A Mental Health Clinical Case Analysis Nursing Essay During my mental health clinical rotation at Karwan-e-hayat, I encountered a 45 year old female patient with the diagnosis of Obsessive compulsive disorder and depression in her rehabilitative phase. She gave Rs 50/- to the nursing assistant to bring nimco for her which costed Rs 25/-. The nursing assistant returned with the nimco but did not returned the rest Rs 25/- to the patient by saying that no money was left. When the patient reported the incident to the nurse, the nurse did not pay any attention to the patient. In the beginning the nurse said that she dont have time to talk about it followed by the statements such as Unlike you, I have too much work to do and then when the patient went to another nurse, she ignored the patient also by saying that The nursing assistant would not have been lying. Patients like you come and go from here every day saying these kinds of things. Go and do your work. The patient went away quietly looking down. Later she verbalized Nobody takes us se riously as we are mentally ill patients. So we cant do anything. Furthermore she said Does being mentally ill means we are not humans? Stigma is a Greek word meaning mark, and is derived from the verb stizein to tattoo, to prick, to puncture. Stigma is usually a mark of disgrace or infamy, which leads to action: discrimination against the stigmatised person (Arboleda-Fl ´orez Sartorius, 2008, P.69). stigma occurs when leading social group diminishes the qualities of a less influential group. Stigma in health care is a very common entity for many groups of the community. One of which is psychiatric patients. People identified as having mental health problems are one of the most marginalised groups in society (Martin, 2009, p.6) The above mentioned case is an example of such cases whereby a mentally ill patient was stigmatized in the hospital settings by the health care professional. Many patients and surveys have highlighted this sheer reality that health care professionals themselves display stigmatizing behaviors and practices (Hinshaw, 2007). Moreover, they depict dehumanizing behavior and lowered expectation towards mentally ill. In this case scenario, the health care professional directly passed on stigmatizing comments to the client. According to Hinshaw, (2007), the health care providers sometimes use frequent comments which are hurtful jokes for the clients. They often use judgmental terms for the patients with one another in the presence of the patient, as though the patients were not even present there. This behavior from the side of the health care provider makes the patient doubt their own self, leading towards self-stigmatization (Hinshaw, 2007). This self-stigmatization in turn makes the patie nts doubt their own self-esteem, lowering their own self-image (Hinshaw, 2007; Link, Struening, Todd, Asmussen, Phelan, 2001). One of the accounts presented by Hinshaw in 2007 clearly states that a kid has internalized the belief that his grandmother punishes him because of his misbehavior as a child and self-blaming himself for the adult psychiatric episodes which he was having. In this way, public stigma makes the patients think that there is something wrong with them and they dont deserve to exist in this world. Many mentally ill people want to get settled in the society but are unable to do so because the world stigmatizes them, the health care professionals stigmatize them and then they doubt their own credibility ending up in self-stigmatizing their own selves. According to former U.S. surgeon David satchers report on mental illness of 1999, he clearly concluded that stigma leads to low self-esteem, isolation, and hopelessnessà ¢Ã¢â€š ¬Ã‚ ¦, it deprives people of their digni ty and interferes with their full participation in society. (Satcher, 1999) That clearly highlights the effected abilities of the individual on the grounds of mental illness. According to the writer, self-stigma is inevitable. This highlighted effect of self-stigma is clearly evident in the case scenario presented above by the action of the patient herself, which she has looked down and moved away. This lowered self-esteem in turn brings out hopelessness in the clients (Link, Struening, Todd, Asmussen, Phelan, 2001). Like the client in the given case scenario says that nobody takes us seriously. We cant do anything. That clearly identifies the notion of hopelessness that the patient has no hopes from life and has accepted clear defeat because of the stigma associated with mental illness. The next question is how does stigma affects the rehabilitation of the mentally ill patients. How does it affect the coping skills of the mentally ill patients? What are the coping mechanisms of the mentally ill patients which they use in stigma? What are the coping mechanisms of the patients with neurosis who are well aware of the reality and understand this notion of stigma, as opposed to the psychosis patients. According to literature, many a times, the stigma posed is due to many of the bizarre symptoms caused by psychosis and the patients with neuroses also have to take it as they all fall under the category of mental illness for the laymen regardless of psychosis and neurosis (Hinshaw, 2007). According to the ethical principle E of the American psychiatric association, the patients have the right of dignity and respect regardless of any differences; that implies to both psychosis and neurosis (Lowman, 2005). The psychotic patient as mentioned earlier is away from the reality co ntent but they surely understand that they are being treated wrongly. (Levine Levine, 2009) They are not able to think rationally but surely they are human beings and are witnessing what is going on with them. Many a times we witness that they cry over small things which are going wrong with them. They are witnessing the behavior of the health care provider but are unable to interrelate it to their past experience. Regardless of the psychosis, it is wrong to treat them any bad so how bad can it be for the neurosis client whose reality content is intact and who can rationalize everything that is going on with them and who can interrelate these aspects with their past and then can feel the shame (Hinshaw, 2007). The patient in the above mentioned case scenario would be forced to think if something is wrong with her resulting in feelings of shame and guilt. This guilt in turn takes the patient in the situation of self-stigmatization which leads on to hopelessness which clearly affects the coping mechanism of the individual since if the person would be hopeless towards his illness, the reconstitution would be delayed (Hinshaw, 2007). Stigmatization affects the personal response of the patient which is a vital part of process of coping. The personal responses are individualized and can change over time. Many a times, the strategy which patients use to avoid stigma and to preserve their self-esteem is secrecy, which preserves their self-esteem but isolates the individual from social support (Satcher, 1999; Hinshaw, 2007). stigma has an important part in determining public health consequences by revealing stigmatized individuals to health-harmful conditions, by aggregating stress, declining coping, and by putting a barrior to receiving health care (Link Phelan, 2006). According to Corrigan and Watson (2002) as cited in hinsaw, 2007 there are many new reasons emerging to justify the reason for some individuals to respond with anger whereas some to nerely ignore the stigma and move on with their lives whilst some internalize the negative message while hurting their self-image. If stigma-related threat is believed to be of greater magnitude than ones coping responses, several types of voluntary and involuntary reactions can come about, like lowered self-esteem, reduced achievement, and compromised physical health. (Hinshaw, 2007) Several questions arise Looking upon the behavior of the health care professional such as is the attitude of the nurse justifiable? Would she have had the same stigmatized responsein the case of another pfysically ill patient? If she would have then she is not following the ethical principle E of the American psychological association of respect of peoples right and dignity. This principle clearly states that the regardless of the awareness of the disability, the health care provider has to maintain the respect of the patient. For the violation of this ethical principle, who is responsible? The nurse or the society to see all the mentally ill patients on a single wavelength and stigmatize them. Who is accountable for it? The nurse or the hospital settings or either the society to be accountable for such stigmatization? Would the same behavior have happened in the western settings? If the patient would have sued the in the court, whose statements would be more valued and listened to t he nurses or the mentally ill clients who is savaged and stigmatized in the community by the names of irrational and unthinkable. Many accounts of the depressed patients state the fact that they are not been taken seriously while giving some statements because of the stigma associated whereas if some other person of pathological chronic condition gives the same statement, it is taken seriously (Shaw, 1998). In the settings of the above mentioned case scenario, would anyone have had listened to her that her rights are being violated or would this all be given the name of mental illness and let go of? One more side of stigmatization comes when we tease normal people by the names of the stigmatized people to embarrass them. In everyday life, language patterns indicates an anxiety with mental disorder across all age groups with a host of terms related to mental illness used to scapegoat and humiliate those who violate social norms. They are associated with mentally ill and words like psycho and wacho are used to compare people who go against social norms in the western community (Hinshaw, 2007). Whereas, no literature is to be found for the usage of such words due to the lack of researches in this field. Usage of variants of such terms at young ages signals the pervasiveness of the criticism of persons with mental disorders. Indeed, judgmental tags of retard or crazy are among the first terms used by children who havent even started their schoolings yet to relegate socially rejected friends in the west. (Hinshaw, 2007) Media also plays important role in stigmatizing the mentally ill . Media differs in east and west which directly effects pattern of stigmatizing. People with psychotic-level disorders, as well as milder disturbances, were portrayed as ignorant, dangerous, dirty, unkind, and unpredictable. (Hinshaw, 2007, p.118) The model which could best be incorporated in this is Link and Phelans model of stigma. In this model stigma is processed by many different components. First one is on distinguishing and labeling differences(Link Phelan, 2001). Most of the differences are usually ignored but sometimes they are not overlooked at and thus labeled. In my clinical case scenario, the patient was labeled as mentally ill having no work to do. The second component is on associating human differences with negative attributes(Link Phelan, 2001). This occurs when the labeled differences are linked to stereotypes and so my patients mental illness was stereotyped as workless people. The third component is of on separating us from them which brings the notion of stigmatization(Link Phelan, 2001). In the above mentioned case scenario also, the patient was referred to as out group as evidenced by the statement patients like you come and go each day but we have work to do, clearly defining the notion of us versus them. The last component is status loss and discrimination(Link Phelan, 2001). In the status loss, patient is connected to undesirable characteristics that reduce his or her status in the eyes of the stigmatizer. In this case, the undesirable characteristic was that mentally ill patients are laid off and redundant where as we are working people so we are higher than them and in this way stigmatized people are put down at the bottom of the hierarchy. Keeping in view the principles of American psychiatric association, the strategies which I would like to pose in this context is the nurse should look in the matter and confirmed the case with the nursing assistant as well as to the shop from which the nursing assistant got the nimco from. Moreover, nursing assistants should be taught all the rights of the patients so that being a health care provider; they would follow all the ethical principles. On an institutional level, a system should be made in which patients can have some responsible person to take care of these things instead of asking anyone they can get their hands on to. To conclude, not much research has been done on this issue of mental health and proper awareness does not exist in this society. More researches needs to be done to address this issue as stigma in mental health persists all around the world. Strategies needed to be thought about to remove this factor of stigma. More education sessions about this needs to be done on the clinical side to make the nurses and other health care providers aware of what the rights of the patients are and a check and balance system should be there to acknowledge either those rights have been followed and fulfilled or not. (word count: 2201 words) References Arboleda-Fl ´orez, J., Sartorius, N. (Eds.). (2008). Understanding the Stigma of Mental Illness: Theory and Interventions. New Delhi, India: Aptara. Hinshaw, S. P. (2007). The Mark of Shame. New York, USA: Oxford University Press. Husted, J. H., Husted, L. G. (2008). Ethical Decision Making in Nursing and Health Care (4th ed.). New York, USA: springer publishing company. Link, B. G., Struening, E. L., Todd, S. N., Asmussen, S., Phelan, J. C. (2001). Stigma as a barrier to recovery-The consequences of Stigma for the self-esteem of people with mental illnesses. Psychiatric Services, 52(12), 1621-1626. Link, B. G., Phelan, J. C. (2006). Stigma and its public health implications. Lancet, 367, 528-529 Link, B. G., Phelan, J. C. (2001). Conceptualizing Stigma. Annual Reviews, 27, 363-85. Levine, J., Levine, L.S. (2009). Schizophrenia for dummies. Canada: Wiley Publisher. Lowman, R. L. (2005). Respect for Peoples Rights and Dignity. Journal of Aggression, Maltreatment Trauma, 11(1), 71 77. Martin, N. (2009). From Discrimination to Social Inclusion. Australia: Queensland Alliance. Shaw, F. (1998). Mistaken identity. Lancet, 352, 1051. Satcher, D. (1999). Mental Health: A Report of the Surgeon General. Washington, DC: Department of health and human services.

Phyllis Hunter on Reading Rockets: Reaction Paper

Reaction Paper to Phyllis Hunter on Reading Rockets The podcast of Phyllis Hunter on Reading Rockets: Meet the Experts titled Teaching Reading demonstrated the importance of teaching children to read right the first time. According to Hunter (2008) reading is the first civil right because without being able to read well and strategically, one is unable to access his or her other civil rights and that teaching children to read is a schools first mission. Children need to be reading at grade level or above before completing the third grade (Hunter, 2008). I agree with Hunter’s statement that good is not good enough when we can do better. Teaching children to read is one area where we cannot afford to settle for good, we must strive for best. Reading is a fundamental skill that is necessary for all future learning. Hunter (2008) discussed the need to use the research and not teach with the method that he or she feels is the right thing. Teachers need to be able to read and evaluate research to find what will be of value and has creditable in classroom instruction. Teachers must be committed to being a lifelong learner. Learning must then be incorporated into the classroom teaching practices. Stanovich & Stanovich (2003) contend that â€Å"scientific research about what works does not usually find its way into most classrooms. † Teachers must be committed to making proven methods a part of their daily instruction techniques. According to Hunter (2008) the best schools use the proven research methods in their classroom. Taylor (2002) referenced the following characteristics of teachers who are effective in teaching children to read: Maintaining instructional balance, spark higher-level thinking by discussing what was read, teach how to transfer skills and strategies to independent reading, coaching as children are reading and writing, foster a sense of responsibility in children for their own learning, provide motivating instruction with many opportunities for reading and writing, teachers have high expectations that their pupils can do well, manage their classroom, foster strong parent relationships. If one agrees with Hunter that our children deserve the best in reading education, then one must develop the best characteristics in ones teaching style. Just as it is best to teach reading right the first time, it is best to start out on the right path using proven methods than to try to correct latter. References Hunter Phyllis, (2008). Phyllis Hunter (Teaching Reading). Reading Rockets present Meet the Experts. Retrieved September 2, 2008, from http://www. readingrockets. org/podcasts/experts Taylor, B. M. (2002). Characteristics of teachers that are effective in teaching all children to read. National Education Association. Retrieved September 2, 2008. Stanovich, P. J. , & Stanovich, K. E. (2003). Using Research and Reason in Education. National Institute for Literacy. Retrieved September 2, 2008, from http://www. nifl. gov/partnershipforreading/

life-changing influence

There are two people who have had a significant influence in my life like. These are my father and my best friend, Timothy. I consider both of them to be my heroes because they helped me to become more enthusiastic about my studies. They also taught me how to live without being fearful especially being fearful of failing. Particularly during my elementary and junior high school years I was not particularly motivated to excel nor attempted to perform as well as the other students in my classes. This began to change, however, when I met Timothy, my very good friend, during my very first year in high school. He is person who has had an alarming impact on my life and influenced me to change my negative attitude. I now refer to him as my soul mate. In a number of ways Timothy has helped me to adopt a more positive attitude towards my school work and life in general. Timothy encouraged me to study hard and helped me believe that I could perform as well as or even better than the students who were usually at the top in my class. Prior to meeting Timothy I did not see the value of studying or revising work covered in class. When I was faced with tests I depended solely on my small recollection of what transpired in class and this prevented me from succeeding or excelling. Timothy taught me to study on a continuous basis not only as it approached exams. He helped me to prepare more effectively for exams by teaching me to study bit by bit prior to the exam rather than just a night or two before. He showed me that by re-reading the material which had been explained in class it would be easier for me to recall information whenever I had a test. Timothy even encouraged me to challenge him on our various tests. Most importantly I remember him saying to me â€Å"never give up, before you try first† so I took on the challenge to aim for the skies. As a result of his influence and encouragement and my heeding his advice, my relative rank in the class improved and so did my interactions with my classmates and friends. My friends started inviting me to study with them as a team. They began to see me as a diligent and clever student and I was accepted into their clique. Finally I began to feel as if I belonged. Even though Timothy and I are now pursuing different educational goals (he chose electrical engineering while I choose business) after having graduated from high school, I will never forget the considerable influence he had in transforming my life. Besides Timothy, my father has also had a significant influence on my life extends. Prior to knowing Timothy I was not goal-oriented and had little prospects for my future. When I began to see that I could actually be successful I also began to think about a future occupation. My father has been instrumental in helping me to decide on a career. Currently I have chosen to pursue Business administration as my major with a particular interest in entrepreneurship and finance because of the exposure I got to these fields by my father. My father, working in business himself, allowed me to accompany him on several occasions on business trips and I even attended several business conferences and negotiations with him. The perspective and knowledge I gained from these sessions have encouraged me to choose this same field to pursue as my career goal. Additionally the financial aspect of business administration has particular appeal to me. I had often heard my father discussing Indonesian stocks, such as Telkom, Indosat as well as American stocks, such as Dow Jones. The Stock Exchange is, I believe, a lucrative avenue through which companies can maintain their business and even bring in profits. In choosing business administration as my major I hope to learn to essentials of managing a business. What I look forward to most is developing my communication skills so that I could become an effective and efficient businessman. Since I plan to operate my own business I hope to learn essential business communication skills such as how to communicate effectively and respectfully in both in written and spoken forms, how to motivate others particularly employees, how to foster good interpersonal relations, how to use various communication tools to assist in carrying out the functions of my future enterprise, the skills of making presentations among other skills that are essential to the proper administration of any business venture. Besides my father and my personal business interests, my cousin has also inspired and my interest in the business field. Some time ago he delivered an address at an Indonesian University. The title of his presentation was â€Å"Simulation Stock Competition.† Listening to his speech encouraged me to enter a university competition that was open for students to invest in the Stock Market. Of course even though the competition was in the form of a simulation and we were not investing with actual money, my interest in the Stock Market was peeked. For the two months I was involved in this program I became exceedingly excited about the strategy of business investment. Overall both my father and Timothy have motivated me to aspire for greater things. Indeed they both encouraged me to be confident in my own abilities rather than being dependent on my friends. I began to believe that, like my friends who were performing well, I too could become successful and make a significant mark in society. I am, therefore, fortunate to have had a friend and a father to encourage me to change my perspective and to help me get rid of certain negative attitudes and attributes that were very unprogressive. My vision for my life has now broadened from having absolutely no interest in my future, to being excited about a particular career option and working on fulfilling my goal of becoming a businessman. Barring such influence I may have still been stuck in the rut of mediocrity.   

Case Analysis Enbridge Inc. - 1401 Words

Enbridge Inc. is a Canadian energy company intending to build two opposite flowing parallel pipelines, transporting crude oil westbound from the rich Athabasca tar sands, and natural gas condensate eastbound from the coast of British Columbia. The purpose of transporting bitumen to the west coast is in order to have an outlet to the Pacific Ocean and subsequently export to the growing Asian oil markets via oil tankers. Alberta’s tar sands are estimated to have 166 billion barrels of proven reserves as of 2014, and production capacity has reached 2.3 million barrels per day (Government of Alberta, 2014). The â€Å"gateway† to the subsequent Asian markets will thus lead to the intensification of oil extraction to a projected 6.2 million barrels†¦show more content†¦The project is high risk, high reward for all the stakeholders involved, which is why Enbridge is being held to such a high standard of safety and security, with the National Energy Board approving the project under 209 conditions. Costs of constructing the pipeline are estimated to range from $5.5 to $7.5 Billion. Figure 1- Proposed route of Northern Gateway Pipeline in relation to the Alberta tar sands and the Douglas Channel. Alberta’s tar sands are considered one of the largest crude oil deposits in the world, and remain largely untapped. Out of all Canada’s current oil exports, 99% of it goes to the United States (Government of Canada, 2015). This high dependence leaves the Canadian oil industry susceptible to the (lack of) demand in American markets. The necessity for the emergence of new oil markets is an imperative concern for Canada, considering the proposed Keystone XL pipeline faces substantial opposition in the U.S that threatens their reliance on the Canadian oil sands. Investment in the project is mostly from foreign entities, as Enbridge makes up less than half of the partnership. Major investments are coming from Asia’s largest refinery company Sinopec Corp, China’s National Offshore Oil Co. that bought out Calgary’s Nexen for a reported $15.1 billion in 2013, and PetroChina, which have a large stake in the new oil sands