Dissertation – A Critical Evaluation of the Effectiveness of Cognitive Behaviour Therapies for Children and Adolescents with Anxiety Disorders
Research into the effectiveness of cognitive behavioural therapy for anxiety disorders has previously mainly focused on adults. However, there has been an increase of research into the effectiveness of cognitive behaviour therapy for children and adolescents, albeit studies remain scarce. This dissertation aims to examine the effectiveness of cognitive behavioural therapies available to children and adolescents with anxiety disorders.
This critical literature review analyses the available literature, offering a critical evaluation of the most used forms of cognitive behaviour therapy: group and family cognitive behavioural therapy, individual cognitive behavioural therapy and computerised cognitive behavioural therapy.
Cognitive Behaviour Therapy
Furthermore, this research outlines a range of key findings, identifying numerous difficulties found in treating children and adolescents with anxiety disorders as well as considering what is needed for cognitive behaviour therapy to be effective. Some of the issues found to affect the overall effectiveness of cognitive behaviour therapy include non-compliance, parental involvement, drop-out and the strength of the therapeutic relationship. The main conclusions propose that cognitive behavioural therapies for children and adolescents with anxiety disorders are effective from the outset, but upon further analysis, may not be as effective as many professionals suggest.
The aim of this dissertation is to examine the effectiveness of cognitive behavioural therapy (CBT) in children and adolescents with anxiety disorders. Through carrying out an extensive literature review using secondary data, this piece of research will gather and critically analyse evidence for and against the effectiveness of cognitive behaviour therapy for children and young people with anxiety disorders.
More specifically, this dissertation will critically analyse the effectiveness of the most widely used forms of CBT: family and group based cognitive behaviour therapy, individual cognitive behaviour therapy and computerised cognitive behaviour therapy. A comparison between approaches will be made in the discussion whereby suggestions will be made upon which form of CBT is the most effective for children and adolescents with anxiety disorders.
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Diversity, Adaptation, and Inclusion in Nursing Education
This annotated bibliography will present analysis and review of some sources relating to adaptation, diversity, and inclusion in nursing education. Globalization has resulted in nursing schools experiencing diverse students’ population with learners who are culturally and linguistically diverse. The annotated bibliography will present measures that would enhance the adaptation of learners from culturally and linguistically diverse setting, challenges faced by these students and measures to improve the learning experience and performance. Also, the annotation will address diversity issues, policy implications and intervention measures for promoting workforce diversity through a diverse learning environment for nursing learners.
Gerrish, K. (2004). Integration of overseas Registered Nurses: Evaluation of an Adaptation Programme. Journal of Advanced Nursing, 45(6), 579–587.
Gerrish (2004) conducted a study to investigate adaptation program for nurses working oversea. These nurses normally experience challenges before adapting to new environment featured by different cultural setting and operational standards for nurses. With the current globalization trends, there has been increasing oversee nurse recruitment to address the significant staff shortage in United Kingdom healthcare sector that has resulted in theemergence of adaptation programs for nurses from other countries seeking experience and allow them to be acknowledged by the Nursing and Midwifery Council. Gerrish (2004) article collects data from different previous studies on independent evaluation of the adaptation programs for the overseas Registered Nurses who are offered by large acute healthcare facilities. Basing on the review, the study reported evaluation programs by focusing on objectives, overall success rate and outcomes from the stakeholders’ perspective.
Gerrish (2004) integrated a pluralist evaluation research model developed to facilitate the identification of the criteria that interested parties used in the judgment of success rate of adaptation programs. After identification of the success of the program, it is used in judging the program in question. Due to the nature of the study, a qualitative research method is applied to address the challenges faced in implementation of the program and measures to address the success of the program. A focus group approach is preferred in data collection where in-depth interviews were set to collect the data for analysis. Gerrish (2004) targeted oversea nurses, senior nurse managers, educators and ward managers. The study took a period of 12 months to complete data collection where the analysis was done through the development of principles for dimensional analysis. Criteria of success approach were crucial in identifying the views from the stakeholders that guided in the development of overall success of the adaptation program. After the analysis of data, results of the study were developed which helped in creating a holistic view of the adaptation programs in the United Kingdom.
The results indicated that five success meanings were developed comprising of gaining professional registration, reducing the nurse vacancy factor, fitness for practice, promoting the organizational culture that is based on diversity value and equality of opportunity. Gerrish (2004) also found that organizational context, features of their work environment and level of support influences the ease of gaining United Kingdom registration and their integration into the nursing workforce. From the article, Gerrish concluded that developed countries should take into account support for nurses sourced from the global market to facilitate their adaptation to environment featured by different social and cultural settings. This article is crucial in research involving nurses’ sourced from oversea by presenting challenges, opportunities and threats faced by the oversea nurses. The study provides crucial information relating to factors that are essential in enhancing the adaptation of these nurses through the provision of the necessary support. The article is also relevant in presenting different considerations that should be taken into accounting supporting adaptability of these nurses to the new environment.
Jeong, S. Y.-S., Hickey, N., Levett-Jones, T., Pitt, V., Hoffman, K., Norton, C. A., & Ohr, S. O. (2011). Understanding and enhancing the learning experiences of culturally and linguistically diverse nursing students in an Australian bachelor of nursing program. Nurse Education Today, 31, 238–244.
Jeong et al. (2011) conducted a study investigating measures of enhancing learning and performance of nursing students in a culturally and linguistically diverse environment.Nurses and nursing students are faced with the different cultural setting, which influences their adaptation and performance. The article review experience of nursing students in Australia who are from different cultural backgrounds. The challenges do affect not only the nursing learners but also the academic and clinical staff. A pilot study is conducted to review the perceptions from learners’ approach and another school academic and clinical staff perspective. This is crucial in identifying the challenges faced by clinical staff, academic staffs, and learners.
To attain the study objectives, Jeong et al. (2011) applied qualitative research methodology in collection and analysis of data. The article had its target as learners from culturally and linguistically diverse (CALD) backgrounds. The participants in the study comprised of learners classified as CALD who were attending their education in Australian universities. Academic staff who taught CALD learners were also integrated into the research. The study had a total of 18 participants comprising of 11 CALD students, four academic staff members, and three clinical facilitators. Qualitative research is appropriate when investigating aspects that require understanding the feelings and perception of the participants through a face to face interview where in-depth data is collected.
Jeong et al. (2011) developed interesting findings relating to measures that can address challenges faced by nursing students, clinical staff and educators with experience in learning or teaching in culturally and linguistically diverse environment. Focus groups were integrated into data collection process to enhance the quality of data collected. After the research Jeong et al. (2011) found that there were four themes crucial in addressing challenges under investigation. These themes comprise of English language competence level, isolation feelings and perception, limited opportunities in the learning process and inadequate of the university support. The effects of these challenges comprised of financial, social and intercultural contexts and political setting that learners experience. The article is significant when addressing the challenges faced by students from culturally and linguistically diverse backgrounds.
Additionally, the article utilizes an adequate number of participants which helps in identification of appropriate research data for analysis. The research is crucial to educators, clinical staff and policy makers relating to insights that facilitate the development of effective learners’ adaptation initiatives to promote an efficient environment for all culturally and linguistically diverse learners. The sample size for this article was efficient considering that qualitative studies require in-depth analysis, which is possible with a small sample of participants. The choice of research method in the article presents an opportunity for addressing challenges that students may suffer in silence, which would lower the productivity and performance of nursing students during practice. The article forms a foundation for further studies on the perspective of adaptation initiatives for learners in a cultural and linguistically diverse environment to aid both learners and academic staff.
Boughton, M. A., Halliday, L. E., & Brown, L. (2010). A tailored program of support for culturally and linguistically diverse (CALD) nursing students in a graduate entry Masters of Nursing course: A qualitative evaluation of outcomes. Nurse Education in Practice, 10, 355-360.
Boughton, Halliday, and Brown (2010)conducted a study investigating the significance of support programs for learners from culturally and linguistically diverse setting. The article defines the common support programs initiated to address the challenges faced by learners and teaching staff. Nursing learners enrolled for a program in culturally and linguistically different environment experience challenges that affect their learning outcomes and performance. The target population in the article were nursing students who were enrolled in 2-years accelerated Master of Nursing program from the faculty of nursing, University of Sydney. Also, the article aimed at examining the pedagogical aspects that affect the delivery of educators and nursing clinicians. The research identified gaps in the literature relating to the integration of CALD training in the learning process to improve the learning outcomes of learners from culturally and linguistically diverse environment.
Boughton, Halliday and Brown (2010) identified that learners from culturally and linguistically diverse settings are sometimes entitled to a program to facilitate their adaptation to the new environment. For the purpose of the article, the authors integrated their research into a program involving CALD interventions that took place during semester 1 in 2008 run by three academic staff members from series of workshops aimed at addressing challenges faced by learners from CALD setting. The article drew findings from both primary and secondary sources taking account evidence in existing literature. Selection of the research participants was on a voluntary basis where a total of 34 participants from different countries who were willing to join the program. A qualitative research method in collection and analysis of data allow the researcher to collect non-verbal feelings of the participants that help in the acquisition of crucial data regarding the participants. The qualitative method requires in-depth analysis that helps in establishing reality concerning the research aim and objectives. Positive results were collected relating to the impact that CALD program had on students’ adaptation to the Australian culture and language. To evaluate the impact, the researchers grouped the participants depending on the benefits that they got from the CALD program regarding enhancing their academic potential, students learning experience and clinical placement initial experience.
In the discussion, Boughton, Halliday and Brown (2010) integrated results from the primary data and critical analysis of existing studies. The in-depth literature review from the article helps in the acquisition of data that from secondary sources, which is crucial in the analysis. Integrating literature review to empirical evidence facilitates in identifying deviation of the primary results by using the previous studies as a datum. Additionally, qualitative studies involve in-depth analysis of data. This method was appropriate for this study to determine the significant impact that perception and feelings have on the research. Furthermore, the choice of the interview as data collection tool facilitates in seeking clarifications from the participants in case of an ambiguous answer and questions during the research process.
Bleich, M. R., Macwilliams, B. R., & Schmidt, B. J. (2015). Advancing Diversity Through Inclusive Excellence In Nursing Education.Journal of Professional Nursing, 31(2), 89–94.
Bleich, Macwilliams and Schmidt (2015)conducted a study investigating the measures of promoting diversity through enhancement of nursing education. With increased global movement of professionals in search of employment and nursing education, there is need to develop a diverse workforce that can serve employees from different cultural settings. However, only a few studies integrate the inclusion during recruitment and retention strategies for the improvement of academic learning outcome. The article addressed the organizational initiatives that promote diversity and inclusion in nursing education as supported by Association of American Colleges and Universities. The article addresses the inclusive excellence that builds an effective learning environment for diverse learners’ needs. There are six strategies for diversity and inclusion that are investigated basing on the authors’experiences, behavioral and structural concerns such as admission processes, community absence, invisibility, tokenism, promotion and tenure, and exclusion. The article was aiming at identifying behavioral and structural adaptations that are within the nursing education setting for the advancement of inclusion and diversity. Identifying different factors that inhibit or enhance an organization with diverse learners is significant in the current study.
The study integrates secondary data retrieved from previous studies in drawing the discussion and conclusions. In-depth analysis of the factors that influence diversity in the nursing education are analyzed. The study integrates step by step procedure of development an inclusive setting for nursing education. The study is crucial in presenting the step-to-step procedure of development of the effective framework for implementation of diversity in nursing education. Bleich, Macwilliams and Schmidt (2015) presented strategies for promoting diversity and inclusivity comprising of improving the admission process, reduction of the inevitability of the underrepresented cohorts, the establishment of support community, enhancing equity in the promotion and the tenure structures, and discouraging tokenism. These initiatives are drawn from different past studies that took into account the crucial elements of diversity.
Even though recent studies play a critical role in the research process, it should be accompanied by empirical results that improve the quality of data presented. Reliance on previous studies maybe misleading since the earlier studies could measure different elements that are not significant in the current study. Despite these challenges in the article, it present information that is crucial in the development of a foundation for more in-depth studies that incorporate primary sources of data. In studies relating to measures of enhancing diversity and principles in nursing education, the article by Bleich, Macwilliams and Schmidt (2015) is crucial in determining gaps in the previous studies that future research should address. In addition, the article could be effective in the presentation of effects of failing to integrate diversity principles in nursing education where diverse cultures are present. Strong self-awareness and self-esteem are crucial for learners within a diverse society to be incorporated into an efficient learning environment and demonstrate effective learning and productive environment.
American Association of Colleges of Nursing. (2015). The Changing Landscape: Nursing Student Diversity on the Rise. Washington, DC: American Association of Colleges of Nursing.
American Association of Colleges of Nursing(AACN) (2015) present review of policy on diversity in American nursing colleges. The report compiles evidence based on recent studies and available policies on the significance of cultural diversity understanding in the nursing workforce in the development of culturally sensitive patient care observing crucial patients’ safety and service quality. The data and analysis are dependent on the U.S. Census Bureau that classified differential cultural settings in the United States where groups that are racially underrepresented forms more than a third of the entire population. The report expresses the commitment of American Association of Colleges of Nursing in promoting diversity and inclusion in all nursing colleges.
The report presents a valuable source of data from primary sources like government websites relating to diversity in nursing education. To ensure the validity of data submitted, the AACN present results of previous reports from reliable sources that cite issues relating to diversity in American nursing colleges.
To address the initiatives by the government, AACN present two reports compiled by NAS in 2004 addressing measures to improve the diversity in the healthcare sector. Also, AACN also reviewed a report by NAS in 2010 on advancing nursing through enhancement of its leadership role through the development of the competent and diverse workforce. The research also presents the trends in changes in the level of diversity across learners undertaking Baccalaureate, Masters,Ph.D. and DNP programs in nursing for the period between 2011 and 2015. Also, the report presents diversity trends across all the states in the US. This helps the future studies in identifying the diversity trends across the American States diversity commitment in promoting the needs of all learners.
Apart from variations in diversity from 2011-2015 and regional diversity levels, ACCN report took into account variations in diversity across programs, which is crucial in informing researchers and policy makers on the degree of diversity in nursing education in the United States depending on the extent of learning. Furthermore, the report presents the diversity on gender-based variations. The report also illustrates the measures that the Federal and local governments would integrate into nursing schools to promote diversity in learning institutions for nurses. From 2006 to 2015, the research cites that there has been a drop in grant funding programs. Understanding these challenges and opportunities relating to diversity in nursing education will enhance in effective decision-making regarding policy interventions appropriate to address the diversity issues in nursing education. This report is essential in developing valid arguments relating to interventions for diversity in American nursing education. The report presents a valuable source of information on trends based on annual grants allocation, gender, and level of study, which will guide the development of policy measures to encourage diversity in nursing education.
In conclusion, the five studies identify the nursing discipline as a complex profession that entails the harmonization of work culture, private life, societal obligations, and work schedule. Collectively, the authors concur that professional nurses and nursing students specialize in a demanding profession. The health care industry demands that the practitioners commit themselves to the responsibilities by preparing to work for extended hours under congested schedules. Therefore, the work environment prompts the governing institutions to consider improving expertise and the support infrastructure in order to enhance the efficacy of the healthcare service providers. In spite of the incongruousness in specific and general objectives, the studies converge into a common point of focus involving manipulating the parameters of interest to improve the performance of nurses. Jointly, the authors view the quality of nursing as a function of dedicated endeavors to establish support institutions, education programs, and cultural learning.
Nurses are mobile in nature as the occupation dictates. The interventions would enable the medical professionals to adapt new environments and avoid culture shock. New work environments expose the nurses to challenges in learning the ways of life of the inhabitants. The situation grows severe in workstations where the health care seekers subscribe to a foreign language. At this point, intervention programs and special education programs tailored to specific settings are vital to improving the performance of the personnel within the restrictive workplace. Additionally, the studies venture into using qualitative approaches to explore the parameters of interest. The commonality portrays a similarity in the five research works highlighting that most elements in nursing are non-quantitative.
As long as the authors agree on the complexity of the discipline, discrepancies emerge pertaining to the most suitable intervention strategies. The influence of the studies on the nursing practice significantly relies on an integrated method of implementing the findings. In other words, the observations made from each of the studies are solely dependent on the contributions of the rest. Furthermore, the authors base the studies on different scopes and parameters. Focusing on culture, education, and support programs exposes the incongruousness underlying the pursuit of knowledge. Through the principal areas of focus, the general objectives of the research works differ considerably from one study to another. The specialization undermines the view of mutual relationships in the rudiments of nursing.
The five articles are exclusively vital in enabling efficient nursing services. The diverse objectives pursued by the researchers present nursing practice as a multi-disciplinary subject comprising of equally important parameters. In a real sense, nursing profession describes a collection of medical subjects that equip the facilitators with immense knowledge essential for dealing with a myriad of scenarios in the healthcare industry. More important are the elements that the articles discuss as significant in enhancing nursing. Education denotes one of the traditional methods of knowledge acquisition. Training remains a viable approach to improve professionalism. Nursing professionals require excellent training to improve the quality of the service.
The education programs enhance the adaptation mechanisms of the medical personnel to various environments. As nurses move from one workstation to another, the environmental setting changes drastically prompting swift adjustment. Cultural learning denotes one of the most vital considerations since nurses interact with culturally diverse populations. The support institutions formulate and implement policies and programs aimed at enhancing the workplace for nursing professionals. Therefore, the articles discuss valuable factors essential for facilitating exemplary therapeutic services.
American Association of Colleges of Nursing. (2015). The Changing Landscape: Nursing Student Diversity on the Rise. Washington, DC: American Association of Colleges of Nursing.
Bleich, M. R., Macwilliams, B. R., & Schmidt, B. J. (2015). Advancing Diversity Through Inclusive Excellence In Nursing Education. Journal of Professional Nursing, 31(2), 89–94.
Boughton, M. A., Halliday, L. E., & Brown, L. (2010). A tailored program of support for culturally and li nguistically diverse (CALD) nursing students in a graduate entry Masters of Nursing course: A qualitative evaluation of outcomes. Nurse Education in Practice, 10, 355-360.
Gerrish, K. (2004). Integration of overseas Registered Nurses: evaluation of an adaptation programme. Journal of Advanced Nursing, 45(6), 579–587.
Jeong, S. Y.-S., Hickey, N., Levett-Jones, T., Pitt, V., Hoffman, K., Norton, C. A., & Ohr, S. O. (2011). Understanding and enhancing the learning experiences of culturally and linguistically diverse nursing students in an Australian bachelor of nursing program. Nurse Education Today, 31, 238–244.
If you enjoyed reading this post on diversity, adaptation, and inclusion in nursing education, I would be very grateful if you could help spread this knowledge by emailing this post to a friend, or sharing it on Twitter or Facebook. Thank you.
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.
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).
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).
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.
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.
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
The many aspects of mental health education among mental health consumer groups or their families; case study of Schizophrenia
The traditional format of the health care involves a clinician or a health worker being the major decision making factors on the modality of treatment, with a relatively insignificant proportion of inputs from the consumers. However, in modern settings such inputs from the targeted consumer population are highly appreciated, especially in chronic and debilitating disease management, where concerted efforts of the clinical staff, patients and their families is essential in tackling the disease. A key to such inputs and interactions is to raise the awareness of the targeted consumers or their families on the various aspects of the disease, its monetary and social costs, as well as to raise the psychological acceptance of the patients in the society. Mental health is one such area where beneficiary interactions between the patients/caretakers and the providers of health services on the many aspects of the decision making could be of maximum utility. This is because of mental health disorders are not only generally chronic in nature, but also because social interactions play equal role as much as medicine in the successful treatment of the disease.
Schizophrenia is a chronic and debilitating mental health disorder, with an abnormal social behaviour and failure of objective thinking. Confused state of mind, hallucinations, abject thinking and lack of motivational thinking are some of the general symptoms of the disease. There is also a higher rate of suicidal thinking among the schizophrenic patients. While both a genetic makeup as well the conditions of upbringing have been shown to influence the disease, the general understanding is that schizophrenia is a syndrome, with multiple or complex causative factors. Due to the complex and the chronic nature of the disease, prolonged or even lifelong treatment is essential. In addition, social rehabilitation as well as sympathetic public perception and counselling are extremely necessary for the successful management of the disease condition. Due to the generally poor social interactions and abject thinking, it is important that the patients and associated family members or caregivers are aptly educated on the various available modalities of therapy as well as being provided with the necessary moral support of the institutions and health workers who are involved in the treatment of the patient.
Benefits of educating the consumers of schizophrenia treatment
Close observation, sympathetic care, timely therapeutic interventions are extremely essential for schizophrenia cases and it is important that the care givers are also educated on the many aspects of successful and prolonged care. In many developing countries, the family of the patient is the primary effectors for the care of the patient due to constraints of money, lack of physician’s effective attention time and poor number of supporting staff. In such a scenario proper education of the consumers not only ease the process, but also helps in relieving the psychological distress of the patient. Proper education also helps in dealing with the caregiver’s stress and maintaining a healthy environment around the patient who needs a social support more than the medicines. If the family of a patient is properly educated, they are well informed about the illness and are more “skilled” to deal with their deceased relative. Moreover, it also helps in a smooth process of settling insurance claims, money management and availing welfare benefits from the designated agencies. At a national level, there should be a streamlined education program and a process so that each care giver knows which physician to consult, how to reach the hospital for consultation, and how to mange the initial expenditure. It is essential to consider the psycho-sociological impact of the nature of this syndrome.
Potential barriers to effective education with the selected group
Schizophrenic patients generally have poor social interactions, and some of the symptoms such as suicidal instincts, auditory hallucinations and abject thinking, make the sufferers alienated from the general population where the patients form part of. Such alienation at work place, educational institutions or close societies could be detrimental for the patient and could in turn lead to increased social reticence and suicidal tendencies. Similarly, like other chronic mental health disorders, the family members of schizophrenic patients face unfriendly behaviour from close societies, in addition to the difficulties in managing the patients. In totality, a schizophrenic patient’s family is itself not in a healthy frame of mind and hence special concerns or skills should be employed to properly educate them. Caregivers at hospitals, mostly have to deal with a higher number of patient’s per head basis and are already under stress. Money is another potential barrier and the caregivers also point to the need of proper transport, medical insurance and food in developing countries. Most of the time in a developing country, it is a cultural problem, the family is not highly educated and if the case is the first in their family, they do not know how to proceed at the first hand. Effective communication skills to a larger group with different social background are another potential barrier in a multiethnic, multilingual society such as India and Australia. Education cannot be provided to each and every individual on a personal basis in highly populated societies where the patient load is higher. Hesitation to participate in a community based rehabilitation program is another constraint as you have to convince maximum number of the individuals to get educated and participate in such an event. ‘Self determined medical discontinuation’ is another hindrance as many patients would stop consulting the physician and discontinue taking their psychotic medication. Hence, the patients should be educated on a recurrent basis and should be informed well that even if they think they are healthy they should continue their follow up management. Schizophrenia patients also suffer from a vocational impairment due to various reasons and according to the social drift hypothesis they are driven towards are social backwardness. This has to be addressed not only by proper education from therapy point of view, but also from the point of view of vocational empowerment. Psychosis and Schizophrenia in children poses an additional barrier as it shows a worse prognosis and educating the consumer in such cases needs special skills.
Skills required by the nurses
Schizophrenia cases involved an enhanced psychological stress and many a times the situation gets complicated by the family attitude, patients’ failure to adhere to the treatment regime, tolerability issues, embarrassment and recurrence. In such a scenario the educating nurse should exhibit an exceptional degree of restraint, compose in their behaviour and control of their own stress.
Since the patient itself and its family have an educational gap with respect to the medical field, a nurse should have the ability to bridge the gap between a layman and a professional. The nurse should have exceptional communication skills, should be available during off hours, should be willing to tolerate seemingly off the subject queries and should be able to understand the needs of the consumer. Most of the needs of the consumers are related to money, medical reimbursement and insurance issues and as such the nurse should be well acquainted with the relevant subject, although not directly related to medicine. Many a time’s patients are unwilling to adhere to the schedule. The severity of the side effects of the schizophrenia treatment such as sedation, weight gain or pain etc is the major concern of the patients. The nurse should in such cases educate the patient as well as their family about the alternative methods such as long acting injectable (LAIs) instead of oral therapy, etc. Nurse should be able to identify the patient’s strength area and make use of that strength for proper counselling approach. It has been observed that the preferences of patients and their family doctors vary, say for example, patient does not like the idea of shared care records while the health practitioner advocate for it. In such case the responsibility of the educating nurse is to ensure that patient and their family members are educated in the benefits of community participation. In many cases of patients undergoing treatment with the second generation antipsychotics, we have to induce them for a regular exercise schedule. Nurses should be able to motivate the patients and hence a nurse should also have motivational skills. Proper fitness is also required as the nurse should lead by example, that regular exercise is beneficial.
Schizophrenia is not only a medical problem, but a socioeconomic crisis. It not only harms the patient per se, but also affects its family as well as the whole community. Consumer education that involved counselling of the patient as well as educating the family and involving the whole community is an important tool for improved outcome. It not only reduces the stress environment, but also helps in improving adherence to the treatment regime, delaying the reduction in the social attainment, delay in the loss of cognitive skills and improve the overall status. Nurses imparting the education hence have an added social responsibility in addition to their medical duty and thus should be equipped with special communication skills. Controlling the stress, inspirational and motivational behaviour and above all a positive attitude is the most important requirement.
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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.
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.
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.
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;
Diminishing the patient fall rates.
Better nursing staff performance (Kalisch et al., 2011)
Units In Study
Age > 35 Years
Gender Female %
BSN> Educational Level
Experience > 2 Years
Full Time (%)
Rotating Shift (%)
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;
Ascertain the ratio of nursing staff classification to the nursing staff mix. Multiply the percentage of each nursing staff classification.
Ascertain the cost of the nursing staff by entering the salary and benefits for each nursing classification.
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.
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).
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