Conquering Dyslexia Dissertation

Beneficial Methods for Conquering Dyslexia

This paper considers the treatments that work most effectively for teaching people with dyslexia how to read confidently. I will begin by reviewing the background of dyslexia. Relying heavily on sources I surveyed, I will briefly explore the benefits of early intervention while providing hope of treatment for those the system already failed. Finally, I will examine treatments that successfully aid young dyslexics in conquering their disease and suggest implementing these in all kindergarten classes.

Introduction and Diagnosis

Dyslexia is a major problem for many children who desire to read but cannot break the reading code. Peer pressure that results from the inability to decipher words into speech can even lead third graders to contemplate suicide (Berninger, 2000, p 183). Yet, Shaywitz estimates twenty percent of all school age children have the disorder. Sadly, in the same experiment she discovered only one-third of these children were in special education programs (Shaywitz, 2004, p 30). Every child who desires to read has the right to learn; however, many children on the edge of reading disabilities never receive remedial treatment until they fail multiple times. While the older dyslexic has the ability to conquer the disease, intervention at earlier ages is more effective and saves the child from stigmatization.

Although early diagnosis is a key factor in recovery, many disagree on how to identify children with the disability (Scruggs, T., Mastropieri, M., 2002; Stanovich, K., 2005). This delays treatment, reducing the chances of remediating the child to fluent reading. Intelligence tests and multiple years of academic failure are the most widely used methods of diagnosing dyslexia, but lead to widespread over- and under- diagnosis (Scruggs, T., Mastropieri, M., 2002). Genetic research is more accurate, but it is an expensive method of identification. However, researchers have not identified all the genes responsible for dyslexia. Additionally, while genetic influence exists (Taipale, M., Kaminen, N., Nopola-Hemmi, J., Haltia, T., Hannula-Jouppi, K., Kere, J., 2003), twin studies show it is not a determining factor as to whether or not a child will develop dyslexia (Shaywitz, 2004, p 99), and children without any genetic markers develop the disease from poor instruction.

MRI imaging is one of the most accurate diagnostic tools, but it also is costly and only available to researchers. It allows one to see which areas of the brain are active during language processing. The pictures clearly show the difference between those who have broken the code, dyslexics and dyslexics that have compensated for the disease. However, the benefit of an accurate diagnosis does not outweigh the cost in time and money of performing the test.

When children are unruly in class or difficult to teach, teachers often refer them for testing. Shaywitz points out the large percentage of boys diagnosed with dyslexia while very few girls receive this identification. Her reassessment of children in several schools found the number of boys was actually equal to the number of girls (Shaywitz, 2004, p 32). This creates more of a problem by placing children in classes where they will bore easily or by leaving children in classes that do not meet their needs.

Dyslexia Dissertation
Dyslexia Dissertation

In addition to under- and over- diagnosis, one also finds the problems of late diagnosis and not seeing the need for diagnosis. Some believe students must be over the age of eight before a proper identification of dyslexia is possible. Shaywitz argues that between four and five are the ideal ages for intervention. Conflicts arise over whether the learning disabled label will brand the child for life with a negative image, or whether the child will be allowed to fall through the cracks once labeled as dyslexic.

The school told the mother of a girl I once tutored that she should not have her child tested to eliminate the possibility of the child being stuck with the label. Additionally, because dyslexics and average readers learn on the same curve, some in education still assert children outgrow the disease or that there is no reason to change the child’s current reading program. While it is true that the curve is similar and dyslexics even make a slight gain on their peers, dyslexics always score far below good readers (Shaywitz, 2004, p 34).

Important Terms

Before addressing the question of how to solve the problems of diagnosis and treatment, we must first explore some terms common in dyslexia. The term as defined by the International Dyslexia Association is:

Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge (August, 2002).

The phoneme is “the smallest unit of speech that distinguishes one word forms another” (Shaywitz, 2004, p 41). The phonological module is “the functional part of the brain where sounds of language are put together to form words and where words are broken down into their elemental sounds” (Shaywitz, 2004, p 40). Because the major problem with dyslexia is a breakdown in the ability to recognize phonemes contained in words, these terms are all important to any discussion of the disease.

If dyslexia is a breakdown in the ability to distinguish phonemes, it logically follows that increasing the amount and quality of phonemic instruction will aid the child in overcoming the disease. Parents and educators must realize the need for intervention and actively pursue it. Important to consider are the dyslexic’s developmental age at the time they begin supplemental instruction. Equally as important is to develop a program that focuses on the child’s strengths and interests.

To begin to aid a child in understanding the relationship between sounds and words, one must introduce the child to the sounds of language. Books filled with rhyme and alliteration such as Chicka Chicka Boom Boom or One Fish, Two Fish, Red Fish, Blue Fish are excellent choices (Shaywitz, 2004, p177 – 182). After spending time reading these books for pleasure, it is important for the teacher or parent to draw attention to which words rhyme and what rhyme is. They should have the child think of other words that begin or end in the same way. Children need to realize that words are related through sound before identifying that those sounds are represented alphabetically. All elementary teachers should spend time each day reading to their students just as parents should spend time each day reading to their children. Connecting words we speak to the phonemes that create them is essential to all readers.

Once the child can rhyme, the program must begin to help the child break words into all their sounds. Beginning with two sound words like key, bee, or it, the educator can teach the child to break the words into their respective phonemic units. Introductory work on syllables can begin. After the child realizes that words separate into smaller parts, the adult may teach three sound words like cat, seat, or call. At the same time, it will be useful to reinforce what the child already learned by asking questions like “What do you get if you put the /s/ sound in front of the word key?” or “What does /m/… /o/ …/m/ make?” All these things build phonemic awareness and are useful to all children learning to read.

Once the child has a basic understanding of phonemes, the instructor should introduce decodable texts that use relatively few phonemes to create stories. These books, such as the “Bob Book” series, slowly build confidence in the child’s reading ability. As the child begins to enjoy their ability to read, new books and sight words should be introduced. Sight words must be memorized. Children can make their own flashcards with words like is, are, was, one, and two. This allows them to read and write the word.

The child must practice writing to build legible handwriting and further establish phonemic awareness. Practice is the only way to learn. The more a child practices making letters correctly and sounding out words on paper, the better the child will become at it. All children should be given many chances even at the beginning of kindergarten to practice writing. Word cards with tracing paper clipped to them will aid in early instruction. In writing, having the child practice forming the letters correctly should be stressed. Allowing children to write four pages of a’s (for example) backward is not as useful as having the child trace one page of the letters correctly.

By the end of kindergarten, children should be practicing spelling skills. While children at this level should not be expected to spell well, invented spelling is an important step on the road to recognizing the phonemic roots of words. The more chances children are given to attempt to sound words out for themselves, the more they will master breaking words apart into their letters, and in return, the better ability they will have to decode written words.

As with all kindergarten children, teachers need to read enjoyable books and surround children with literacy. When children recognize the joy of reading, they desire to read. When teachers and parents read to children, they encourage larger vocabularies. Children who know the meaning of words like “ink” will have a better time decoding it when they come across it in texts they are reading (Shaywitz, 2004, p192).

Finally, it is important for children to develop self-confidence. Children should make progress as they go through an intensive phonics program. Tests can be performed to make sure they understand what was taught, but tests are teaching tools that evaluate teachers not students. When a student does not understand something, it should cue the teacher to reintroduce it in a new way. Additionally, children should not repeat a grade if they have failed to decode reading by the end of kindergarten (Shaywitz, 2004, p196).

Conclusion

Many teachers will look at the plan for educating dyslexic kindergarteners and think, “That is what I do for my class already.” This is because what Shaywitz proposes is an intensive phonics program. Others like Beringer (2000) utilize the same style of reading program to teach dyslexics. The two major differences between intervention reading and a standard kindergarten program are that many kindergarten programs try rushing phonics training and that intervention work is created around a theme of interest among the students.

Implementing this program for all kindergarten students would not lower the education they receive. However, if all schools focused on intensive phonics training for their kindergarten students, dyslexia could be conquered without extensive testing to discover which children have the disorder. When schools use tests to evaluate what they need to teach instead of how well students are learning, they can resolve many learning issues. Some may argue that children without learning disabilities will become bored with intensive learning, but often the children that learn to read too quickly develop other learning problems later on that could be corrected by skills learned from intensive phoneme training (Shaywitz, 2004, p196).

While dyslexia is a major problem that needs to be addressed, it can easily be eliminated from the classroom. Shaywitz and others have show through MRI’s that even dyslexics can conquer the disease and rewire their brains if they are instructed in intensive phonemic awareness. Because of the difficulty in recognizing the disease early and intervening, it is imperative schools adapt an aggressive stance on this learning disorder.

References

Berninger, V.W. (2000). Dyslexia the Invisible, Treatable Disorder: The Story of Einstein’s Ninja Turtles. Learning Disability Quarterly, 23(3), 175-195

Glenn, H.W. (1975). The Myth of the Label Learning Disabled Child. The Elementary School Journal, 75(6), 357-361

Lyon, G.R. (August 2002). International Dyslexic Association. Washington, D.C.

Scruggs, T.E., Mastropieri, M.A. (2002). On Babies and Bathwater: Addressing the Problems of Identification of Learning Disabilities. Learning Disability Quarterly, 25(3), 155-168.

Shaywitz, S. (2003). Overcoming Dyslexia. New York: Knopf. Qtd. Lyon

Stanovich, K.E. (2005). The Future of a Mistake: Will Discrepancy Measurement Continue to Make the Learning Disabilities Field a Pseudoscience?  Learning Disability Quarterly, 28(2), 103-106.

Taipale, M., Kaminen, N., Nopola-Hemmi, J., Haltia, T., Mylltluoma, B., Lyytinen,

H., Muller, K., Kaaranen, M., Lindsberg, P.J., Hannula-Jouppi, K., Kere, J. (2003). A Candidate Gene for Developmental Dyslexia Encodes a Nuclear Tetratricopeptide Repeat Domain Protein Dynamically Regulated in Brain. Proceedings of the National Academy of Sciences of the United States of America, 100(20), 11553-11558.

Temple, E., Deutsch, G.K., Poldrack, R.A., Miller, S.L., Taillal, P., Merzenich, M.M., Gabrieli, J.D.E. (2003). Neural Deficits in Children with Dyslexia Ameliorated by Behavior Remediation: Evidence from Functional MRI. Proceedings of the National Academy of Sciences of the United States of America, 100(5), 2860-2865

Torgesen, J.K., Wagner, R.K., Simmons, K., Laughon, P. (1990). Identifying Phonological Coding Problems in Disabled Readers: Namin, Counting, or Span Measures? Learning Disability Quarterly, 13(4), 236-243

Dyslexia Dissertation

Did you find any useful knowledge relating to Dyslexia and Learning Disabilities in this post? What are the key facts that grabbed your attention? Let us know in the comments. Thank you.

Eating Habits Adult BMI

Health Studies Dissertation Examination of Eating Habits That Affect Adult BMI

The dissertation will determine whether or not there is a close relationship between the identified dependent (i.e. the adult students’ actual BMI level) and independent variables (i.e. the habit of eating in fast food restaurants, adult students’ wealth or disposable income, and heavy marketing activities and advertisements on fast food logo/brand). The dissertation accurately determine whether or not there a close relationship between the identified dependent (i.e. the adult students’ actual BMI level) and independent variables (i.e. habit of eating in fast food restaurants, the adult students’ disposable income or wealth, and heavy marketing activities and advertisements on fast food logo/brand), a total of 50 adult students will be invited to participate in the actual quantitative research study. After requiring each of the 50 research participants to complete the research survey questionnaire, the researcher will gather and analyse the gathered data. As such, a regression analysis was performed in this study. Some of the quantitative data was analysed based on multiple regression, R Square (R2), t stat, P-values, and significance F values. Regression analysis result shows no direct relationship between increase in the adult students’ BMI level and factors such as the habit of eating in fast food restaurants, the adult students’ wealth or disposable income, and heavy marketing activities and advertisements on fast food logo or brand.

Adult BMI
Adult BMI

Dissertation Objectives

The main objective of this study is to examine the perception of students with regards to the relationship between the identified dependent and independent variables. In this study, independent variables include habit of eating in fast food restaurants, adult students’ wealth or disposable income, and heavy marketing activities and advertisements on fast food logo or brand whereas dependent variable is the adult students’ actual BMI. Based on the students’ perception, is there a close relationship between the identified dependent and independent variables? As such, this study will focus on testing the following research hypotheses:

H1 = There is a relationship between the students’ actual BMI and the adult students’ wealth or disposable income;
H2 = There is a relationship between the students’ actual BMI and heavy marketing activities and advertisements on fast food logo or brand; and
H3 = There is a relationship between the students’ actual BMI and the habit of eating in fast food restaurants.

Becoming overweight and obese can lead to the development of controllable diseases. Therefore, it is necessary to continuously examine and identify all factors that can contribute the increase in the student’s weight and adult BMI level. The adult students’ increase in adult BMI level is highly dependent on so many factors. Poor eating habits, sedentary lifestyle, and poor socio-economic factors such as low income could increase a person’s risks of becoming obese. It appears that the coupling between energy intake and energy expenditure is at the heart of the obesity epidemic, both of which are greatly influenced by psycho-social factors and the environment in which we live and work. Currently the evidence points to changes in the level of physical activity and food system, which is producing more processed, affordable, and effectively marketed high-energy food. These changes in my opinion have led to a positive energy balance causing the obesity epidemic. Policies that encourage and promote physical activities and a change towards healthier food are needed to reverse the epidemic.

View This Dissertation Here

I do hope you enjoyed reading this post on eating habits and how it affects adult BMI. There are many other titles available in the health studies dissertation collection that should be of interest to construction management students and building professionals. There are many dissertation titles that relate to other aspects of health and nursing such as project management within the NHS, midwifery, nursing techniques and treatment of mental health to name a few. It took a lot of time to write this post and I would be grateful if you could share this post via Facebook and Twitter. Feel free to add your thoughts in the comments section. Thank you.

 

Autism Spectrum Disorder

Autism Spectrum Disorder

A person may never realise of his/her gift unless he/she sees a person who lacks a certain normal ability. Autism is an in-born condition that can occur to any child. Autism refers a group of complex disorders associated with brain development (Heather, 2010). The main characterizations of these disorders are difficulties in social interaction, communication (both verbal and nonverbal) and repetitive behaviours. Autism has many sub-types that are closely associated with Autism Spectrum Disorder (Jeri, 2009). Autism Spectrum Disorder is associated with intellectual disabilities and motor coordination difficulties. Autism Spectrum Disorder has also been associated with some cases of gastrointestinal and sleep disturbances. This paper is dedicated to exploring all aspects of this disorder.

A few years ago it was not well known about the causes of this condition. This prompted the need for research, and consequently a logical explanation can be given at the causes of this condition. Generally, there is no cause of autism. Genetic studies have revealed that in autistic people, there are rare genes changes, simply mutant genes. The number of these genes in an individual determines the extent of autism in that person. It is the combination of these genes and environmental factors that are responsible for causing most cases of this disorder. It is usually during early brain development that environmental factors are able to impact largely on the condition and this makes autistic people resistant to change.

In addition to environmental factors, non-genetic stresses also appear to contribute to the risk of a child’s autism. Factors such as the parents’ advanced age, birth difficulties particularly those that deprive oxygen to the brain and mother’s illness during pregnancy may contribute to some degree. These factors do not pose the threat of autism. It is the presence of the mutant genes in the presence of these factors that are responsible for higher risks of autism (Heather, 2010). A recent research showed that birth of autistic children can be reduced by administering prenatal vitamins that contain folic acid or the woman should eat at least 600mcg of folic acid in diet during the preconception and post conception period (Jeri, 2009).

The Spectrum

Autism varies among different individuals and each case is unique. Majority of those on the autism spectrum have shown remarkable abilities in academic skills, visual skills and music. About 40 percent of autistics have less than 70 score in IQ, and as such they can be termed as intellectually disabled (Simon and Patrick, 1993). Many people on the spectrum are proud of the extraordinary abilities and normal perspective of viewing world issues. Others experience high levels of autism and they are unable to leave on their own. About a quarter of all autistics are unable to speak, but they can learn by subjecting to the necessary medications and therapies (Simon and Patrick, 1993).

Autism is one of the largest disabilities to affect children, and it is estimated that five in every ten thousand births are autistic. Autistics vary in different ways and degrees. The condition is noticeable by age 3 even though from birth a child may indicate signs of autism. An autistic child may show discomfort when being held, resists affection and arches back more than a normal child. Most of The autistic children are easy to parent until they start showing difficulties in social skills and communication that the parents realize the variation (Simon and Patrick, 1993).

In diagnosing the condition, the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorder-4th Edition) is used (Simon and Patrick, 1993). This is a text that is psychologically tailored to identify the varying degrees of autism. I mainly focus on pervasive developmental disorders also has autism. In the autism diagnosis, six symptoms from three key areas: social skills, communication and repetitive behaviours must be noticeable before age 3 (Heather, 2010). There must be at least 2 symptoms associated with social skills and at least one in communication and repetitive behaviour.

Characteristics of people with autism may include resistance to touching, pain insensitivity, cold and heat insensitivity, self-induced behaviours, unexplained reactions such as weeping or laughing for no reason and emotional unawareness. Autistic people may do what a normal person fears such as diving in a cold pool of water. Self-induced behaviours are defined as repetitive movements of an object. These behaviours can be divided into five senses. A person with autism finds it hard to understand other people’s feelings. Their ability to empathize with others is feeble than that of normal people. Autistics conversation is not engaging. Of course, a person may talk about an idea or thought, but there is less exchanging than if the conversation was held between two normal people (Simon and Patrick, 1993).

Autism Spectrum Disorder
Autism Spectrum Disorder

Visual self-stimulatory is the first sense, and individuals tend to stare at lights and flapping hands. Flapping of hands, in most cases results in self-injuries behaviour or injurious behaviour towards other people. It should be noted that behaviours vary and that hand flapping does not necessarily precede violence. Auditory behaviours vary from tapping of the ears to making of senseless noises (Allison). The most common of this is the vocal noises made by autistics during times of extreme excitement of fear. Tactile stimulation is also common in autistics, and it is common to find autistics scratching, rubbing objects with hands and even rubbing skin (Allison). Most of these behaviours are performed for pleasure or to overcome cases of anxiety or excitement. It may be difficult to differentiate between self-stimulatory and self-injurious behaviours since the two may overlap. Self-injurious behaviours include head-banging, scratching to the point of bleeding and hand-biting. Since some of the autistic people may be insensitive to the pain, they may injure themselves in the process of trying to calm themselves from anxiety or excitement. Autism characteristics are universal but differ among individuals. However, the diagnosis guidelines are different across the globe depending on the country.

There are treatments that have shown success in dealing with the disorder. Since the condition varies among individuals, medicines prescribed for one individual may fail to work for a different person. Therapies such as Anti-yeast therapy, food supplements and Dimethyglycine aid in healing of the disorder. These are administered to help modify the behaviour of an autistic. There is also a Japanese program that focuses on the individuals around an autistic person and the roles that they should play to moderate his or her behaviour. Other therapies include Facilitated Communication and Mega-Vitamin Theory (Jeri, 2009).

Dr. Bernard Rimland conducted a research on the effect of vitamins in dealing with the condition, and he concluded that vitamin B6 was effective in dealing with over forty percent of the cases. This is after parents to autistic children noted that some foods made a difference in their children. The vitamin generally improves behaviours in speech, decreases self-stimulatory behaviours, sleeping patterns and attention span. This treatment takes two to three months for any observable changes. It has been noted that after application of the vitamin, children who previously could not pay attention during an address by either teachers or parents they are able to listen keenly and even follow instructions (Jeri, 2009).

Facilitated communication involves giving help to an autistic individual to express him/herself via some object such as typewriter or board once given physical support to an arm or a finger. Even though there is a facilitator, it is the autistic individual who types since he or she is intelligent. Autistic individuals may express anger through this means since they may be aware of all that is happening to them, but they cannot express their feelings and thoughts. This method is tailored to enables autistic individuals to emotionally and cognitively bring out them.

Since this condition has no sound cause, varying characteristics and varying medications, it is still a mystery to many people.

Myths about Autism

Autism can be cured. All the above named therapies help autistics develop social, and communication skills, but they cannot treat the core symptoms of the disorder. All they do is reducing problematic behaviours such injurious behaviours.

Autism is caused by vaccines. There is no scientific link between vaccines and autism. This perception came about after a scientific paper wrongly linked vaccines and autism, but there is no evidence of this claim. Childhood immunizations are meant to help reduce the risks of conducting childhood diseases such as Polio.

Unfriendly parents may cause autism. It is true that non-genetic factors and environmental factors may contribute to the degree of autism, but these on their own cannot cause the condition. The condition is as genetic mutation.

Occurrence of an Autism Epidemic

The current high numbers of autistics may be attributed to the increased public awareness or even redefinition of the term autism. As such, one cannot claim that there is an epidemic related to this disorder.

Autism leads to improved math ability and memorization. Stories about autistic individuals being highly gifted in memory are untrue and baseless. Autistics do not show extraordinary math ability however children with Autism Spectrum Disorder may exhibit intense interests in a particular subject and as a result has a lot of information regarding that subject.

Autistics have no emotions. This is quite untrue as the condition is characterized by the inability to express thoughts and feelings, and so it should not be assumed that they don’t have emotions (Myths about Autism, 2013).

Conclusion

Autism is a developmental and lifelong disability. The characteristics of the disorder vary among different individuals. There is no single identified cause for autism, and this makes this disorder a mystery. The theoretical causes that include genetic mutation prove that this disorder may truly be a disability. With available treatments, it has been shown those that suffer from this condition may be modified but not cured. High doses of vitamin B6 and other therapies such as Facilitated Communication may allow autistic individuals a chance to express themselves without frustration due to the inability to communicate. Autistic individuals as well as parents to autistic children need to be supported and accorded help as they really need it. This is due to the fact that for every individual born normal, it is by chance, and there is no guarantee for normal birth.

Work Cited

Baron-Cohen, Simon, and Patrick Bolton (1993) Autism: The Facts. Oxford: Oxford University Press.

Freedman, Jeri. Autism Spectrum Disorder (2009) New York, NY: Rosen Pub.

Heather B. Autism. (2010) New York, NY: Chelsea House.

Child Mind Institute (2013) “Myths about Autism Spectrum Disorder” Oxford.

Click Here To View Health Studies Dissertation Topics

Nursing Operating Budgets

Essay Nursing Operating Budgets

Synopsis

The capital budget will be defined. The non-labor operating budget will be explored. The labor budget for a thirty bed telemetry unit with a nurse to patient ratio of 1.6: 1 will be examined. Line items on a capital budget, non-labor operating budget and labor budget will be examined. The elements which compose a staffing mix will be examined. The ramifications of operating with a marginal staff will be examined.

Labor Budget

Research has demonstrated that increased levels of patient staffing are directly related to improved teamwork in health care facilities.  Increased levels of staffing are a causal attribution of the quality of care and lower staff turnover. Lower vacancy rates and staff turnover have been linked to increased levels of patient staffing. Nursing teamwork is directly related to the physical characteristics of the health care facility such as number of beds, case mix index and nurse staffing. The type and level of nurse staffing is related to patient outcomes .The relationships which will be demonstrated in this research paper are the relationship to nurse staffing, nurse teamwork, staff confidence, team orientation, back up, a collective mental model and effective team orientation (Kalisch et al., 2011).

In budgets, the labor costs for a thirty bed telemetry unit, 1.15 FTEs are allocated per nurse staffing personnel. A thirty bed telemetry unit and a 1.6:1 nurse to patient ratio would require thirty RNs, eighteen nursing assistants, one director of nursing and unit secretary. The salary staffing mix is 70% RN, 25% nursing assistants. The shifts would be 60% with rotating shifts (Kalisch et al., 2011).

The approximate salary for a director of nursing is $140,000 per year. The director of nursing is required to have five years of experience in nursing administration, a BSN and critical nursing experience (ihirenursing.com, 2013). The total salary for a registered nurse is between $40, 157 and $79, 759 per year. The duties of RN care are the following: teacher, healer, administrator and counselor. A nimble mind is required in addition to an associate’s degree, a diploma or a bachelor’s degree. Registered nurses with BSN degrees are offered the opportunity to move into management and augment their salary (payscale.com). The annual salary of a nursing assistant is $18,995- $31, 719. The nursing assistant composes approximately 25% of the labor budget for a thirty bed telemetry unit (payscale.com). Unit secretaries and directors of nursing compose approximately 5% of the staffing mix. The unit secretary salary is between $20, 164- $36,362.

Calculating the Labor Budget

In calculating the nursing budget, we must analyze the average daily census (ADC). The ADC is calculated by totaling the number of patients in a year and dividing by the number of days in a year. The ADC is multiplied by the Average Nursing hours per patient day (NHPPD).  This gives us the average NHPPD per year. The average total nursing staff direct care FTEs divided per 2080 hours gives the number of nursing staff direct care FTEs. 2080 divided by the number of productive hours of each FTE gives the percentage of productive hours per FTE. 2080 divided by the number of productive hours gives the actual number of FTEs. Two week  vacation which total eighty hours, ten sick days which total eighty hours, eight holidays which total forty eight hours and two education days must be included. The total staffing budget for a thirty bed telemetry unit, including director of nursing, unit secretary is $2,446,000 (see attached spreadsheet line 8). An example of a line item in the thirty bed telemetry unit nursing budget is benefits for the nursing staff is $611, 500. This is another example of a labor budget line item (hrsonline.org).

Nurse staffing is very important because of the influence that it has upon patient safety and patient perceptions of quality care. Urinary tract infections, shock, upper gastro intestinal hemorrhage and pneumonia are very sensitive to nursing care. The majority of the negative patient outcomes have been documented due to the premise that a negative patient outcome is more likely to be recorded. Lower nurse to patient ratios have been linked to higher incidences of non-fatal adverse patient outcomes. This research has not d3emonstrated that lower nurse staffing levels are associated with increased mortality. Higher nurse staffing is related to a 2% decrease in adverse patient outcomes. Research has demonstrated that a 21% increase in hospital patient acuity between 1991 and 1996. A decline of 14.2% in the ratio of licensed nursing staff to acuity related patient day of care has been realized within the five years from 1991 to 1996. Research has also demonstrated that;

  • 40 % of nursing professionals are unhappy with their working conditions.
  • 35.7 % of nursing professionals classified the quality of care in their health care facility as outstanding.
  • 44.8% of nursing professionals have noticed a decrease in the quality of care at their health care facility.
  • 83 % of nursing professionals reported an increase in the average daily census (ADC).
  • 34.4% of nursing professionals perceive that there is enough RN to supply high quality care.
  • 33.4% believed that their health care facility has enough staff to accomplish the assigned tasks (Stanton, 2012)

A Markov cohort simulation is applied in determining the cost effectiveness of suggested staffing versus median staffing in patients requiring acuity based treatments. The cost effectiveness of suggested staffing versus median staffing is $321,000 per discounted quality of life year gained. This aspect is especially important in patients who require acuity based treatments from the health care facility (Ganz et al., 2005).

Various budgets are applied by health care organizations. These budgets are implemented in order to coordinate the situation of a program or initiative. The operating budget is implemented in order to coordinate to the daily transactions over an accounting period (Danna, 2011). An example of a line item in an operating budget is revenue. A salary operating budget would contain benefits as a line item. Capital budgeting is the method by which the finance team decides whether or not to invest capital resources in particular projects or assets.  An example of a capital budget line item is clinical furnishings (hrs.online.org)

The elements of a capital budget decide which capital equipment will be purchased and which facilities will be renovated, constructed, or rented. These components enable the finance management team to ascertain the depreciation costs which will need to be included in the following accounting period. Depreciation costs compose part of the operating budget. Capital budgeting decisions will be realized before the operating budget finalization. Items which are included in the capital budget are major pieces of clinical and office furnishing. These items include but are not limited to office equipment, X-ray machines, magnetic resonance imaging (MRI), computerized topographical devices (CT scanners) and positron emission tomography scanners (PET scanners). The facility and fixed improvements (i.e., plumbing and wiring) are also elements of the capital budget (gehealthcare.com).

The operating budget includes the expenses related to equipment (i.e., capital equipment maintenance and financing). Labor and staffing expenditures are also part of the operating budget; In addition, education supplies, medications and printing supplies are elements of the operating budget.

Nursing Operating Budgets
Nursing Operating Budgets

In the strategic planning process, the quantity of capital equipment will be decided. Details which must be considered are the depreciation expense which remains on existing equipment and the objective of the health care facility in its development. The primary purpose of the capital budget is to classify the capital items to be procured in the following accounting period. These items require a capital proposal which must be received six to twelve months prior to acquisition. The department administrator will usually compose the initial draft of the request. This draft will be refined and submitted to the finance managers for viability. The elements of the capital budget are the following;

  • Specifications of the item which requires capital funding.
  • Conditions which require the acquisition and implementation of the capital item.
  • The financial influence of the acquisition on the target market, unit, patients and nursing personnel.
  • Initial price estimates.
  • Decision making standards which approach the strategic mission and objective of the health care organization (gehealthcare.com)

The annual capital and operating budget required by a thirty bed telemetry unit with a nurse to patient ratio of 1.6: 1 can be classified into the capital budget which considers equipment, building and other initiating expenses and the operational budget which will provide for continuing expenses. These continuing expenses may include medical supplies, salary and benefit expense. The establishment of a twenty four hour, seven day a week should include the following line items as capital expenditures.  This is an example of a justification of a line item in the nursing capital budget:  The cost of thirty beds is $212,000. In order to justify the expense of the beds, the following must be considered;

  • Increase in nursing efficiency.
  • Decrease the application of specialty beds.
  • Decrease the number of accidents.

The beds which are to be incorporated in the thirty bed telemetry unit must have the following:

  • Exit notification system.
  • Scale.
  • Inflatable and deflate mattresses.
  • Ability to be adjusted to a ninety degree sitting position.
  • Ability to be raised and lowered from the floor.
  • Ability to automatically disengage the headboard in order to facilitate the administration of CPR.

In a thirty bed telemetry unit, the savings of acquiring thirty beds is $12,645.00. The benefits of this acquisition result in the elimination of two specialty beds which cost $23,400.00. The acquisition of the thirty beds will also result in the reduction of injury to staff and patients (Hardy, 2004).

The expense of new hospital construction programs vary from $900,000.00 to $1,300,000.00 per bed. This strategy must be well considered in order not to bring the health care organization to bankruptcy. If these changes are well implemented, the project is designed to improve the facility’s ability to attract patients, increase long term operational performance and to realize a return on the capital expense (Rich & Hosking, 2013).

Research has demonstrated that increased levels of patient staffing are related to improved teamwork in health care facilities. Increased levels of patient staffing are also related to the quality of care and staff turnover. Lower staff turnover and a lower vacancy rate have been linked to increased levels of patient staffing. Nursing physical teamwork is related to the characteristics of the health care facility. These physical characteristics are: the number of beds, case mix index and nurse staffing. The level and type of patient staffing is directly related to the following;

  • Patient results.
  • Patient safety.
  • Diminishing the patient fall rates.
  • Clinical mistakes
  • Better nursing staff performance (Kalisch et al., 2011)

Hospital

Bed Size

Units In Study

Age > 35   Years

Gender Female %

BSN> Educational   Level

Experience >   2 Years

Occupation  (%RN)

Full Time (%)

Rotating Shift   (%)

1

760

15

51

90

51

72

65

88

60

2

317

12

69

87

31

75

61

82

55

3

304

7

78

92

37

89

59

83

55

4

913

18

54

90

55

69

84

80

59

Total

52

60

89

46

74

70

83

58

The HPPD rates for which the units participated in the survey varied from 6.27 to 21.30. The average was 11.02. The average RN rate was 8.91 with values varying from 3.75 to 20.89. The average skill mix is 0.79 with values varying from 0.53 to 1.00. The average case mix index (CMI) was 2.28 with values varying from 0.83 to 6.93. A positive relationship between the number of hospital beds and the nursing teamwork ratings was established. The higher the level of HPPD, RN HPPD and skill mix, the higher the level of nursing teamwork (Kalisch et al., 2011)

The concept of assisted living is defined as a philosophy which is different from other types of residential care. This system supports autonomy, privacy and respect. Many health care facilities divide their beds into wars or designated areas. The Nursing Home Reform Act is also known as the Omnibus Budget Reconciliation Act of 1987 (OBRA, 1987). This legislative act requires that a health care facility supply a level of care which facilitates the patient “to attain and maintain the highest practicable physical, mental and social wellbeing”. As defined by these legislative acts, the number of square feet required per bed is sixty square feet.

The number of direct care FTEs multiplied by the actual FTEs;

  1. Ascertain the ratio of nursing staff classification to the nursing staff mix. Multiply the percentage of each nursing staff classification.
  2. Ascertain the cost of the nursing staff by entering the salary and benefits for each nursing classification.
  3. Ascertain the ratio of the staff that would be appropriate by shift. Divide this ratio of the staff required by each shift to ascertain the FTEs in each nursing classification.
  4. Ascertain the percentage of full time staff compared to the part time staff. Divide this ratio by the number of FTEs by the full time or part time percentage.

The elements of a capital budget determine which capital equipment will be purchased, which facilities will be renovated, rented or constructed. These components will enable the finance management team to ascertain which capital budget decisions will be made before the operating budget finalization. Items which are included in the capital budget as line items are major clinical furnishings, including office equipment. The facility and fixed improvements are elements of the capital budget (gehealthcare.com). The non-labor operating budget includes the expenses related to equipment, labor and staffing expenditure. Educational supplies, medications, medical supplies and printing supplies compose the operating budget (see lines 10 – 19 on spreadsheet). The annual operating budget includes RNs (70%), technicians (25%) and support staff (5%). In calculating the budget 1.15 FTEs is allocated to each registered nurse (hrsonline.org). Research has demonstrated that increased staffing levels are related to improved teamwork in health care facilities. Increased staffing levels are directly related to the quality of patient care and lower staff turnover. Nursing teamwork is related to the physical characteristics of the health care facility. These characteristics include the number of beds, case mix index and nurse staffing (Kalisch et al., 2011). A Markov- cohort simulation is applied in determining the cost effectiveness of suggested staffing versus median staffing in patients requiring acuity based care. The cost effectiveness of suggested staffing versus median staffing is $321,000.00 per discounted quality of life years gained. This aspect is especially important in patients who require acuity based treatments from the health care facility (Ganz et al., 2005).

Bibliography

Assisted Living Facilities. Encyclopedia of Everyday Law (2013)

Danna, D. (2011) Learning and Mastering the Operating Budget  Strategies for Nurse Managers.com.

Dunham- Taylor, J. (2009) Financial Management for Nurse Managers. Merging the Heart with the   Dollar. Jones and Bartlett Publishers

Ganz, D. (2005) Cost effectiveness of recommended nurse staffing levels for short stay skilled nursing facility patients  BMC Health Serv Res 5:35

GE Health Care Financial Service (n.d.) Capital Analysis Self Tutorial Module 1. How Decisions are Made

Hardy, P. (2004) The impact of nursing care and other health care attributes on hospitalized patient Satisfaction and behavioral intentions Journal of Health Care Management May, 2004

Heart Rhythm Society (2012) Education Women’s Leadership

I Hire Nursing (2013) Director of Nursing Oakland, CA

Kalisch, B. (2011) Nurse Staffing Levels and Teamwork: A cross Sectional Study of Patient Care Units in Acute Care Hospitals Journal of Nursing Scholarship, Vol. 43(1)

Rich, D & Hosking A (2013) First the strategy, then the bricks, 3rd Edition

Stanton, M. (2012) Hospital Nurse Staffing and Quality of Care Research in Action 14 March 2012

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Borderline Personality Disorder

Borderline Personality Disorder

According to DSM-IV-TR (the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision) personality disorders are defined by maladaptive personality characteristics which begin during early years of life and have serious and consistent effects on functioning (Diagnostic and statistical manual of mental disorders, 2000). Borderline personality disorder (BPD) is a common reason to visit a psychiatrist (Skodol, Gunderson, Pfohl, Widiger, Livesley & Siever, 2002). BPD affects 2 percent of adults (mostly young women) (Swartz, Blazer, George & Winfield, 1990). Patients with BPD present a high rate of self-injury (without intent of suicide) and a significant rate of suicide attempts and completed suicide (Soloff, Lis, Kelly, Cornelius & Ulrich, 1994).

The patients of BPD are many times in need of mental health services and approximately 20 percent of hospitalizations in the psychiatric department are of BPD patients (Zanarini, Frankenburg, Khera &. Bleichmar, 2001). A patient with depression or bipolar disorder mostly endures the same mood for weeks while a patient with BPD may experience angers (intense bouts), anxiety and depression that may endure for only hours or at the most for a day (Zanarini, Frankenburg, DeLuca, Hennen, Khera & Gunderson, 1998). A study performed by Zanarini & Frankenburg (1997) showed that most of the patients with BPD report a history of neglect, separation (as young children) or abuse. Another study performed by Zanarini (2000) concluded that 40 % to 71% of Borderline Personality Disorder & Attachment Theory.

Origin of Borderline Personality Disorder

Children who have been exposed to psychological and physical neglect, sexual and physical abuse and maltreatment are at risk of developing BPD. The mental trauma faced by these children is due to neglect and abuse by a primary caregiver. This trauma disrupts the normal and healthy development of secure attachment. And as a result these children develop disorganized attachment (anxiety and depression). The children who are neglected are at risk of social rejection, incompetence feeling and social withdrawal. Neurobiological dysfunction can be caused because of abuse and neglect by primary caregiver. In order to develop a capacity of regulating emotions and developing a coherent sense of self the child has a requirement of attachment from the primary caregiver.

Attachment Theory and Borderline Personality Disorder

As per the ethological perspective of John Bowlby (1977, 1980, 1991) BPD can be considered as a condition of significant insecure attachment (with significant oscillations between detachment and attachment & between yearning and longing). The working models present in affect regulation and a lack of coherence (mainly in relationships with others) (Bowlby, 1973). The sorrow of detachment faced in early childhood negatively impacts the psychology of the person and this result in heightened sensitivity to loss and separation. It is also important to note here that since these feelings and thoughts are disconnected to the happenings in early childhood these individuals are unable to understand the reason behind their reaction. Research scholars (Melges & Swartz, 1989) have compared the fluctuations in the behaviour of BPD patients to prickly porcupines – they are of the opinion that patients with BPD are in need of someone but when someone comes close to them they drive themselves away as a result of fear. Thus BPD patients are looking for secure attachment but they fear rejection, anxiety and anger that could result (Bowlby, 1979). Melges and Swartz (1989) are also of the opinion that patients with BPD are preoccupied with regulating space. They do not feel the “invisible elastic” of attachment (Bowlby, 1969, p. 45). Also they are unable to protect themselves from anxiety of separation (Adler & Buie, 1979). The influence of certain types of experiences as related to family can be the cause of separation anxiety (Bowlby, 1988). John Bowlby’s “The seminal developmental theory” for treatment of BPD patients (Bowlby, 1969; Bowlby, 1973; Bowlby, 1980) has gained great attention. Bowlby proposed that human beings face pressures of natural selection in order to evolve behavioural patterns (example, clinging, smiling and proximity seeking ), that evoke in adults the caretaking behaviour (example, soothing, holding and touching).

These behaviours are reciprocal and encourage the development of an affective and enduring tie between caregiver and infant, which forms attachment. It is the result of these parental responses that internal models of the self and others are developed in infants which act as templates in the functioning of relationships later in life (Bowlby, 1973).

The Findings and Proposals of Bowlby the Following Is True In Case Of Attachment (Bowlby, 1973)

1. Model Of Self: The Internal Working Of It Is Related To The Degree Of Acceptance And Love One Has In The Eyes Of Primary Attachment Figures.

2. Model Of Others: The Internal Working Of It Is Related To How Available And Responsive Attachment Figures Are Expected To Be.

Attachment plays a very crucial role in the development of an external environment from which the child develops a safe and secure internal model of the self. Security on the grounds of attachment as perceived by the child results in his or her exploration of the world with confidence; this confidence springs by the availability of the caregiver. Security in attachment thus promises consistent, coherent and positive self-image. It also provides a feeling of being worthy of love and expectation that the important ones to him or her will be responsive and accepting. We here note that Bowlby has presented to the scientific mind the importance and need of attachment as essential to infants and children. Thus, attachment can be considered as an essential ingredient in the production of a psychologically healthy life. Now let us consider BPD patients, it is a case where the security in attachment is absent and there is a split and malevolent representation of self and others (Kernberg, 1967). In the life of BPD patients we usually observe angry, manipulative and needy relationships (Benjamin, 1993).

A number of scientific studies and intellectual thoughts have considered that intolerance of aloneness is the main defining characteristic of BPD and it is essential to note here that the descriptive criteria of DSM are also of the same opinion (Adler & Buie, 1979). Thus, the concepts and theories of attachment in many ways relate to DSM diagnostic criteria. Gunderson (1996) proposed that the early attachment failures actually constitute the cause of intolerance. He noted that in times of distress and sorrow patients with BPD are unable to invoke a “soothing interject” and this is due to unstable and inconsistent attachments to early caregivers. The above proposed scientific thoughts of Gunderson (1996) are same as that of Bowlby’s concept of insecure attachment.

The Scientific Observations Of Gunderson (1996) The Following Points Are True In Case Of Patients With Borderline Personality Disorder:

A Feeling of Insecurity on Grounds Of Attachment, Especially Pertinent To:

  • Plea for Attention
  • Pleas for Help
  • Checking For Proximity
  • Clinging

A Feeling of the Following in Borderline Personality Disorder Patients:

  • Denial Of
  • Dependency Needs
  • Fearfulness About

Based on the comparison of theories of object relations and attachment (Lyons-Ruth & Jacobvitz 1999) distinguished between normal processes (in early development) of separation individualization from the disorganized conflict behaviour (for attachment figures) by toddlers who are at significant risk for development of psychopathology. She identified that in infants the disorganized insecure attachment as a risk factor in the later development of BPD. Thus, we can state that as per the findings of Lycos-Ruth those infants who are victims of insecure attachments during the early years of life are at risk of developing BPD during later years of their life.

Borderline Personality Disorder
Borderline Personality Disorder

Attachment Therapy

In 1990, ATTACh (Association for Treatment and Training in the Attachment of children) was created in order to address the need of society and families to deal with critical attachment and bonding issues. ATTACh has cited important principles of attachment therapy and this includes the following:

1. Attachment therapy can be defined as a therapeutic process that is designed with the aim to define, develop and promote reciprocal attachment relationship and that which completely meets the criteria of that therapeutic process as defined and developed by ATTACh.

2. The aim of treatment by attachment therapy is to address the attachment problems and enable patients with healthy attachment relationships.

3. The emphasis in attachment therapy is laid on touch, physical and emotional closeness, reciprocal behaviours, empathy, atonement, communication, playfulness and humour. The attachment and bonding therapists are therefore required to treat with attention to the physical and psychological safety and wellbeing of the children and adults.

4. Family systems approach is of prime importance in attachment therapy. Thus there is need to correct child’s relationship with his or her primary caregiver.

5. It is essential to assess and study the following;

  • Psychological history
  • Educational history
  • Treatment history
  • Medical history
  • Attachment & Social history (including breaks in attachment)
  • Developmental history (including prenatal and birth)
  • Intellectual and Cognitive skills and deficits
  • Family functioning
  • Differential diagnosis (including DSM and ICD diagnoses)

6. Parents and children form the most active group of treatment regimen. Attempts are made to develop healthier patterns of interaction and communication.

7. To assist parents to develop parenting strategies in order to support positive attachments.

8. Description of any shortcomings attachment therapy might have for treating this issue and what else could be fused with attachment therapy to meet these needs.

Criticisms of Attachment Therapy

1) The application of attachment therapy for treatment of patients with BPD is equated with rebirthing or holding therapy and the techniques used to achieve the results are dangerous.

2) During the treatment of patients with BPD the attachment therapists make use of criteria that are even beyond those provided by the DSM-IV-TR (Zeanah 1996; Boris et al 2004). The strong correlation between insecure attachment and pathological parent-child interaction as shown by attachment therapy are beyond the symptoms listed in the DSM criteria (Bowlby 1944, 1973).

3) The attachment therapists many times over diagnose BPD.

  • Almost 87% to 96% of the children, who experience abuse, neglect or both, show an insecure attachment (Crittenden, 1988).
  • Between 50% and 80% of the adopted children have attachment disorder symptoms (Carlson, Cicchetti, Barnett & Braunwald, 1989).
  • Approximately 20% of children living in homeless shelter and nearly two thirds in foster care are identified with attachment disorders (Boris, Wheeler, Heller & Zeanah, 2000).

4) Attachment therapy is not supported with “empirical evidence” While attachment therapy can provide treatment of BPD, studies have revealed the effectiveness of other therapeutic methods as well. These methods have been briefly described below:

1. Psychotherapy

Randomized controlled studies have presented the efficacy of dialectical behaviour therapy and psychodynamic / psychoanalytic therapy (Bateman & Fonagy, 2001). The treatment provided in these trials comprises of three key features;

  • Meetings with an individual therapist (once a week)
  • Group sessions (one or more in a week)
  • Meetings of therapists for supervision or consultation

The psychotherapist’s approaches include a building of a strong therapeutic alliance and monitoring the suicidal or self-destructive behaviours. Other essential component of effective treatment plan for patients with BPD includes managing feelings, promoting reflection action (and not impulsive action), reducing patient’s splitting tendency, and limiting the behaviours related to self-destruction. There is some empirical data that supports individual psychodynamic psychotherapy.

2. Group Therapy

Group therapy for BPD patients is supported with research findings that indicate that it can be helpful (Greene & Cole 1991). Note: However, the benefit of family therapy in the treatment of BPD patients is not evaluated yet with research studies.

Descriptions of how dimensions of cultural context impact the issue you are discussing. How might this inform your treatment? I strongly believe that psychologists should not be racists. Today we are required to treat patients of different ethnic groups and countries during our clinical practice. Even an expression of detachment or neglect can hurt hard the patients with BPD. As discussed above the patients with BPD are in need of love and acceptance, care and attachment, understanding and touch, soothing approach and closeness. If a psychologist will distinguish on the grounds of colour, race, region and country then s/he won’t be able to perform well because for the treatment of BPD patients with attachment therapy it is essential to shower true attachment. Roentsch (1985) defines racism as: “Let there be no misunderstanding. A racist is anyone who accepts the existence of racial collectives”. Amongst doctors there is a belief in the a priori inferiority of non-white (Eysenck, 1990: pp. 215-220). The facts on racism reveal that we divide the world into ‘in-group and out-group’ or ‘us and them’ (Baron and Byrne, 1994: pp. 228-229). An important study first conducted by Clark and Clark (1947, in Baron and Byrne, 1994: 256) showed that a significant proportion of non-white children had internalized the attitudes of white racist. Thus the reaction of non-white adolescents towards white psychologists can be considered to be different from the reaction towards non-white psychologists. These racists’ feelings need to be addressed with maturity and patience. The dealings, behaviour and communication need to be such monitored that the feeling of racism is absent.

Self-issues that may impact a clinician’s conceptualization and treatment of this issue from an attachment perspective. How might one’s cultural context inform what they see and how they see it? What should clinicians be cautious of? Bonus points for examination of your own “self” in relation to treating this issue from an attachment perspective.

During my school times I lost my best friend because of racial differentiation attitude of a teacher. I was very much in harmony with my non-white friend. We had a high level of understanding and we loved spending time together. We were best friends for 3 years. However, my teacher did not like us being friends. She was white and disliked non-white people. Though she did not show it openly but it was obvious by some of her remarks at different times about non-white people. My teacher asked me to quit my friendship with the non-white girl. At first I was very much hurt by my teacher’s approach but then I agreed to it. This is because my teacher said that she will assure that I will get better grades in school if I agreed to what she said. My friend was very much hurt when I broke friendship with her. And after doing this I felt guilty for doing something really wrong. Even several years after quitting friendship with her, I feel sorry for my decision. Actually for some part of my life I had started thinking the way my teacher thought. I use to respect my teachers and had a feeling that they are always right. This is the reason why I started feeling that my teacher’s attitude towards non-white people was right. However, my thoughts have changed to good after leaving school. Now, I am equally friendly towards both non-white and white. I have both non-white and white as my friends. But sometimes the thought that I was once a racist makes me feel guilty. When I recollect that I was once a racist, I lose confidence in dealing with non-white people. I noted this when I was working on the treatment of a BPD patient who was non-white. I need to be more confident in my dealing with non-white people. I need to feel sure that I no more differentiate between non-white and white. I think I will gain this confidence when as a result of my sincere work several non-white BPD patients will get healed.

Describe what the early, middle and ending phases of therapy might look like for treating this issue based on what you have learned. Please also include some possible interventions and assessment methods. Attachment theory has been applied to both children and adults suffering from detachment. Bowlby (1969) formed a lifelong attachment behavioural system which encourages secure attachment. The attachment thus begins with the child’s requirement of secure attachment from the primary caregiver. The behaviour of attachment is organized and revolves around primary care giver. The feelings of attachment are elicited during the period of mental or physical discomfort or stress (1969). As per Bowlby’s (1969) perspective BPD can be considered as a condition of significant insecure attachment. There exists number of oscillations between detachment and attachment. The early childhood experiences of BPD patients are that of detachment, neglect, abuse, separation and loneliness. Thus the systems that mediate the feelings of attachment and positive behaviour are distorted and deactivated. In addition to this BPD patients have intense fear linked with loss and separation. However, since BPD patients do not remember their childhood time when they were neglected and abused they are unable to understand the reason behind their behaviour. I think a therapist is required to develop a secure and genuine attachment relationship with the BPD patients. The patient should feel completely secure in his or her relationship with the therapist. S/he should have no fear of loss or separation as related to relationship with the therapist. Development of a ‘secure’ attachment can help establish happiness in the life of the patient.

BPD patients are in need of love but the fear of loss and separation drives them away from people. It is therefore crucial that this fear of loss and separation should be dealt in the first phase of treatment. The patient with BPD should be counselled in such a manner that s/he starts gaining confidence in building secure relationships. The approach of the therapist should be driven by ‘attachment’ and ‘love’. Thus, while attempting to heal the BPD patient of the fear of separation, the therapist should try to build his or her own place in the heart of the patient. The approach should not only aim to heal the fear but also to open ways for love and attachment. The therapist should make the patient feel that s/he really cares for him. That it is not just a routine responsibility or duty to address the need of the patient. The therapist should show that s/he has started loving the patient and has become attached with him. S/he has started caring for the needs and essential requirements of the patient. A feeling of attachment should spring from within the heart of the therapist and should touch the emotions of the patient. Parents of the patient should be educated on the basics of attachment.

They should be taught the need of touch, eye contact, motion, love, compassion, care and attachment. The issues related to behaviour should be addressed and the pitfalls should be examined. The treatment should include a review of the attachment issues of the parents’. The parents should be educated on good ways to bring up the child. The attachment from parents and primary care taker are essential for answering the need of BPD patients. Gregory C. Keck states that holding the child or adolescent gives rise in an emotional response and intensity that cannot be achieved by any other medicine or therapeutic regimen. Therapist should educate the parents or the primary caretaker to hold the child or adolescent. The therapist should work to build in attachment between the child/adolescent and the parents/primary caretaker. Building of relationship and providing security and affection from parents or primary caretaker should be assured.

The therapist should also spend time to build in attachment between the child/adolescent and himself

The therapist should also work to repair the relationship that has been broken. S/he should try to develop more peaceful and lovable feelings between the child/adolescent and the parents/primary caretaker. The therapist can also do the holding of the child/adolescent and then s/he can transfer the responsibility to the parent or primary caretaker. The therapist is also required to make an important clinical judgment with regard to the suitability of the primary caretaker or parent for such an attachment. Guidance and education as related to the attachment should be provided by the therapist. In addition to holding ‘eye contact’ is an important part of attachment therapy. Eye contact opens the door to the heart of the person and builds attachment.

In conclusion, the therapist should believe in building relationships of attachment. A feeling of security should be the base of such attachments. Broken attachments should be repaired and new attachments should be built-in. The therapist should form attachment of the patient with himself or herself. In addition to this attachment should be built between the parent/primary caretaker and the child or adolescent. Education should be imparted on developing attachment. Today, in the modern days parents find little time for their children. Many times they forget to care for their own child. The child gets hurt each moment by a lot of anxiety, depression, neglect and loneliness. The child loses the charm of attachment and feels that s/he won’t get attachment from anyone. I believe that in order to begin with attachment therapy it is essential for the therapist to first build attachment between himself and the child/adolescent. Therapist should also build in attachment between himself and the parents of the child/adolescent. This is because the parents who feel attachment from the therapist will be more responsive and agreeable to treatment.

Attachment Can Create Wonders in the World of Therapy and Therapeutics

Attachment speaks to the heart and touches the emotions to bring forth a feeling of recovery. I strongly believe that attachment therapy is the best suit for patients with BPD. This is because attachment can repair the broken hearts, the fading hopes, the dying relationships and the detached home. I would strongly recommend attachment therapy as a method of choice for the treatment of patients with BPD. Children and adolescents want someone to speak to their heart, someone who understands their need of attachment and addresses to their requirement of love, touch, care and affection. During all the phases of treatment this should be kept in mind and should be reflected in approach and practice of the therapist.

Conclusion

Attachment theory is a good addition to the knowledge of psychology and its application can be beneficial for the treatment of BPD patients. While dealing with patients of BPD the psychologist should not have racist attitude and his or her approach should be confident.

References

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