Social Work Counselling in Social Work

Social Work Counselling in Social Work The Role and Applicability of Counselling in Social Work Practice Introduction and Overview Social work originated as a community help measure in the 19th century and has since then become an organised discipline that aims to support and empower those who suffer from social unfairness. Apart from helping the disadvantaged to live with dignity, social work aims at achieving social inclusion and has been found to be effective in correcting disparities and in helping individuals to overcome impediments that arise from different aspects of life; apart from those that require knowledge of the physical and medical sciences. Social work practice has, over the years, become integral to Britain’s working life and current estimates put the number of active social workers in the country at significantly more than one million. (Parrott, 2002) Whilst social workers can be called upon to assist all sections of the community, the majority of their assignments concern helping individuals in stressful situations and those experiencing difficulties with issues that relate to emotions, relationships, unemployment, work, disabilities, discrimination, substance abuse, finances, housing, domestic violence, poverty, and social exclusion. Such a range of applications has necessitated the development of (a) a variety of skills and techniques, (b) methods to transfer these skills to social workers, and (c) procedures for the delivery of social work in a variety of settings, which include schools and colleges, households, hospitals, prisons and secured homes, and training and community centres. (Parton, 1996) Social work practice focuses on dealing with the problems of service users. The maintenance and improvement of their social, physical, and mental states is often dependent upon the effectiveness of social work intervention. (Miller, 2005) Users of social work services are largely economically and/or socially disadvantaged, and the vulnerabilities, which arise from these circumstances, frequently contribute to the nature of their relationships with service providers. (Miller, 2005) Social work makes use of a broad range of knowledge and incorporates information obtained from several disciplines; it empowers social workers in practice to use their acquired knowledge and skills first to engage service users and then to bring about positive changes in undesirable emotional states and behavioural attitudes, or in positions of social disempowerment. (Miller, 2005) Counselling forms one of the main planks of social work practice and constitutes the chief mode through which social workers directly engage service users; it is considered to be the public face of the activity and is an integrative course of action between a service user, who is vulnerable and who needs support, and a counsellor who is trained and educated to give this help. Face to face and 121 interactions between social workers and service users take place mostly through counselling activities. Apart from the directly beneficial effect that occurs through counselling, much of the social work approach that needs to be adopted in specific cases for other interventionist activity is decided on the basis of feedback provided by counsellors. This assignment aims to study and analyse the importance of counselling in social work practice. Commentary and Analysis Social work practice, in the UK, has evolved along with the development of the profession, and with the progression of social policy, ever since the first social workers were trained at the London School of Economics, at the beginning of the 20th century. (Parton, 1996) Whilst social policy, formulated at the level of policy makers, defines the broad routes taken to alleviate social inequalities, the actual delivery of social work occurs through social work practice, an activity carried out by thousands of social workers all over the United Kingdom. (Harris, 2002) Social work makes use of a range of skills, methods, and actions that are aligned to its holistic concentration on individuals and their environments. (Harris, 2002) Social work interventions vary from person-focused psychosocial processes that are focused on individuals, to participation in social policy, planning and development. (Harris, 2002) These interventions include counselling, clinical social work, group work, soc ial academic work, and family treatment and psychotherapy, as well as efforts to assist people in accessing services and resources within the community. (Harris, 2002) Social workers, in their everyday activity, need to assume multiple roles that aim to balance empowerment and emancipation with protection and support. (Harris, 2002) Balancing this dilemma is often a difficult process; it depends upon the needs of service users and requires social workers to assume more than one role. (Harris, 2002) These roles, whilst being versatile and flexible, broadly consist of seven broad categories, namely those of planners, assessors, evaluators, supporters, advocates, managers, and counsellors. (Harris, 2002) Whilst social work practice is spread over these broad functions, this assignment aims to examine and analyse the significance and application of counselling in social work, especially with reference to (a) the complexities involved in its practice, (b) combating oppression and discrimination, and (c) from the viewpoint of service users. Counselling, whilst being a catch-all term, used for describing of various professions, is, an important component of social work practice. (Rowland, 1993) It is a developmental process in which one individual (the social work counsellor) provides to another individual or group (the client), guidance and encouragement, as well as challenge and inspiration, in creatively managing and resolving practical, personal and relationship issues, in achieving goals, and in self realisation. (Rowland, 1993) Whilst the relationship of social work with poverty and deprivation necessitates that most counselling activities relate to such issues, counselling has now become an active and interventionist method to achieve change in social situations and empower people to improve the quality of heir lives. (Rowland, 1993) The activity depends upon client-counsellor relationships and includes a range of theoretical approaches, skills and modes of practice. The British Association for Counselling defined the activity thus in 1991: â€Å"Counselling is the skilled and principled use of relationships to develop self knowledge, emotional acceptance and growth, and personal resources. The overall aim is to live more fully and satisfyingly. Counselling may be concerned with addressing and resolving specific problems, making decisions, coping with crisis, working through feelings or inner conflict or improving relationships with others. The counsellors role is to facilitate the clients work in ways that respect the clients values, personal resources and capacity for self determination.† (Rowland, 1993, p 18) Part of the confusion regarding the actual nature of counselling activity stems from the fact that the phenomenon is of recent origin and is becoming increasingly popular both as a widely sought service and as a professional career. (Dryden Mytton, 1999) Whilst social researchers have floated a number of theories to explain the growth in counselling in social work, most experts ascribe its increasing usage to the diminishing impact of religion, the breaking and scattering of family life, and the removal of previously existing family and community social structures. (Dryden Mytton, 1999) Priests have ceased to become confidantes and advisors; New modes of disempowerment have also led to the creation of a vast range of emotional and physical stresses with adverse effects on the psycho-emotional states of numerous people and their consequent need for counselling. (Dryden Mytton, 1999) Counselling has its origins, both in the past, and as an up-and-coming discipline, in various professions. It fills the intermediate gap between psychotherapy and amity, and thus becomes a particularly useful tool for intervening and touching upon the private, societal, professional, medical, and educational aspects of people. (Rowland, 1993) Whilst it grew organically, its effectiveness in diminishing distress led to its progressive assimilation in social work practice. Again the idea of the social worker as a person, who works with or counsels persons, has been a persistent concept in social work all through its emergence. (Pease Fook, 1999) Counselling has also been connected with some of the critical principles of social work, particularly with regard to recognising the innate value of the individual and respecting the human being. (Pease Fook, 1999) Counselling and casework also find favour with those who look at social work, in its entirety, as a process where different compo nents work synergistically with each other in helping and supporting individuals. (Pease Fook, 1999) Also inherent in the role of the social worker, as a counsellor, is the idea that change will be involved in the behaviour or outlook of the service user. It is in fact the diminution on the role of counselling role, which has been one of the major apprehensions regarding provision of social work through services. (Pease Fook, 1999) Counselling, in its basic form, involves the meeting of a counsellor and a service user in a private and confidential setting to investigate the emotional and mental difficulties, and distress, the service user may be having because of varying person-specific reasons. (Rowland, 1993) Counselling, as is evident from its increasing usage, has been found to be of great help in a variety of situations; in treating people with mental problems of varying severity; in helping those suffering from trauma, anxiety or depression; and in aiding people with emotional or decision making issues. (Rowland, 1993) Whilst it has been found to be applicable across different locales, for example, in schools and colleges, disturbed domestic settings, and in workplaces, it has also proved to be effective in helping people afflicted with serious illnesses like cancer and aids, victims of road and industrial accidents, and people in various stages of rehabilitation. (Coney Jenkins, 1993) Counsellors meet the requirements of people who experience traumatic or sudden interruptions to their life development and to their social roles. (Dryden Mytton, 1999) Prominent among these counselling functions are those in areas of marital breakdown, rape and bereavement. (Dryden Mytton, 1999) The work of the counsellors in such cases can be clearly seen to arise from social problems, namely from shifting social perceptions of marriage, reassessments of male and female roles, and new patterns of marriage and family life. (Dryden Mytton, 1999) Counselling provides a route to helping individuals to negotiate this changing social landscape. Counselling has also been found to be helpful in the area of addictions. Specific counselling approaches have been developed to assist people with problems related to substance abuse, gluttony and for giving up smoking. (Pease Fook, 1999) In some areas of counselling, which deal with addiction, for example, with users of hard drugs, counsellors engaged in social work practice, function side by side, with sets of legal restrictions and moral issues. (Pease Fook, 1999) The possession and use of cocaine, for example, is not just viewed to be morally incorrect but also a criminal activity. (Pease Fook, 1999) â€Å"The counsellor working with a heroin addict, therefore, is not merely exploring ‘ways of living more satisfyingly and resourcefully’ but is also mediating between competing social definitions of what an acceptable ‘way of living’ entails.† (Pease Fook, 1999, p72) Some of the different objectives counsellors try to achieve in their dealing with service users relate to (a) providing them with an understanding of the origins of emotional difficulties, (b) enabling them to build meaningful relationships with other people, (c) allowing them to become more aware of blocked thoughts and feelings, (d) enabling them to develop a more positive attitude towards their own selves, (e) encourag ing them to move towards more fulfilment of their potential and (f) helping them in solving particular problems. (Pease Fook, 1999) The following example provides an instance of how counselling helps individuals to overcome serious personal traumas. â€Å"Paula had been driving her car. Her friend, Marian, was a passenger. Without any warning they were hit by another vehicle, the car spun down the road, and Paula thought ‘this is it’. Following this frightening event, Paula experienced intense flashbacks to the incident. She had nightmares which disturbed her sleep. She became irritable and hyper vigilant, always on the alert. She became increasingly detached from her family and friends, and stopped using her car. Paula worked hard at trying to forget the accident, but without success. When she went to see a counsellor, Paula was given some questionnaires to fill in, and he gave her a homework sheet that asked her to write about the incident for ten minutes each day at a fixed time. In the next counselling session, she was asked to dictate an account of the event into a tape recorder, speaking in the first person as if it was happening now. She was told to play the trauma tape over and over again, at home, until sh e got bored with it. In session 3, the counsellor suggested a way of dealing with her bad dreams, by turning the accident into an imaginary game between two cartoon characters. In session 4 she was invited to remember her positive, pre-accident memories. She was given advice on starting to drive her car again, beginning with a short five-minute drive, and then gradually increasing the time behind the wheel. Throughout all this, her counsellor listened carefully to what she had to say, treated her with great respect and was very positive about her prospects for improvement. After nine sessions her symptoms of post-traumatic stress had almost entirely disappeared, and she was able to live her life as before.† (Starkey, 2000, p37) Counsellors need to keep in mind that socialisation leads to the development of perspectives on issues like race and gender. (Moore, 2003) Many of these perspectives are assimilated to such an extent that people have little control over them and are bound to impact the working of counsellors if not understood, isolated and overcome. (Moore, 2003) â€Å"In an anti-oppressive framework, these views are broken into six main lenses; racism, sexism, heterosexism, ableism, ageism, and class oppression.† (Moore, 2003) People are regularly excluded on account of their colour, gender, sexual orientation, abilities, age, and class. (Moore, 2003) Most of these factors do not occur in isolation and thus lead to multi-oppression, for example an aged female from a minority background could face oppression because of three factors, the whole of which becomes stronger than the sum of individual components. Oppressive perspectives occur through a common origin, namely economic power and contro l, and employ common methods of limiting, controlling, and destroying lives. The PCS model developed by Thompson, in 2001, argues, in similar vein that inequalities, prejudice and discrimination operate at three levels, Personal, Cultural, and Structural, and by constantly strengthening each other, create powerful mental biases and prejudices against members of out-groups, people who are disadvantaged by way of colour, race, ethnicity, religion and language. Individual views, at the personal level, interact with shared cultural, historical and traditional beliefs to create powerful prejudices. (Thompson, 2001) Dominant groups within society constantly reinforce their superiority by driving home the inferiority of other groups through a number of overt and covert methods. (Harris, 2002) Whilst movements that aim to dismantle such stereotypes are emerging slowly, the biggest conflict is still within. (Harris, 2002) Internalised oppression is the oppression that we impose on our own selves due to environmental pressures. (Harris, 2002) The oppression is internal ised from the prevailing society’s message through various institutions like the media, existing religious infrastructure, and other forms of socialisation. (Harris, 2002) Examples of such oppressive practices are the pressure put on working mothers to run an efficient household, in addition to putting in a full day at the office, or expecting mothers who stay at home to work from dawn until late night. (Harris, 2002) These prejudices are further strengthened by structural discriminations that are created by social and governmental structures, (as evinced by diminished employment opportunities for people with histories of substance abuse or the refusal of landlords to rent houses to members of certain communities), and create a complex web of mutually reinforcing social processes. Counsellors are prone to be oppressive because of assimilated perspectives, stereotyping, and because they hold power over service users. It is imperative that they recognise these imbalances and wo rk towards eliminating them in their work as well as in the promotion of change to redress the balance of power. Looking at social issues through the perspectives of service users is thus critical to counselling activity. Social workers often face ethical challenges in their dealing with service users. There are many instances in social work where simple answers are not available to resolve complex ethical issues. Clients, for example, can inform counsellors about their intention to commit suicide or inflict physical harm on their own selves, ask for reassuring physical contact in the nature of hugs, and confide about their intentions to harm others. (Langs, 1998) There is a strong possibility of sexual attraction developing between counsellor and service user. (Langs, 1998) Such situations can lead to the development of dichotomies between personal and professional ethics, and to extremely uncomfortable choices. (Langs, 1998) Conclusion Counselling is a complex and demanding activity that demands knowledge, experience and people skills, as well as compassion, empathy and understanding. Above all counselling activity, as an integral component of social work, requires commitment to social good. Counselling theories have evolved over the last half century; they have multiple origins, are complex in their formulation, and whilst having common features, need to be individually adapted to the needs of service users. Whilst it is not easy to grasp and apply these theories, their comprehensive understanding and application are essential to the effectiveness of counselling work. Counsellors, by virtue of the nature of their work and their power in counsellor-service user relationships exercise enormous influence over the decisions of service users. The diversity and heterogeneity of counselling reflects the sensitivity of counselling to the enormous variations in human experience. Whilst understanding of theory helps in discharging of responsibilities, counsellors are also limited by assimilated perspectives on oppression, career and money demands, and their own emotions. Their responsibilities are manifold, and include duties towards service users, towards the profession, and towards the wider community. Apart from being challenging, satisfying and rewarding, counselling also provides the opportunity to make profound differences to the lives of other human beings. References Bond, T, 2000, Standards and Ethics for Counselling in Action, Sage Publications Ltd. London Corney, R. Jenkins, R, (Eds.), 1993, Counselling in General Practice. London: Routledge Counselling saves British business millions every year, 2003, British Association for Counselling and Therapy, Retrieved December 3, 2007 from www.instituteofwelfare.co.uk/downloads/welfare_world_24_full.pdf Dryden, W, 2006, Counselling in a nutshell, Sage Publications Ltd. London Dryden, W., Mytton, J, 1999, Four Approaches to Counselling and Psychotherapy, London: Routledge Feltham, C, 1995, What Is Counselling? The Promise and Problem of the Talking Therapies, Sage Publications Ltd. London Harrow, J, 2001, Working Models: theories of counselling, Retrieved December 3, 2007 from http://www.draknet.com/proteus/models.htm Harris, J, 2002, The Social Work Business /. London: Routledge Hornby, G., Hall, C., Hall, E. (Eds.), 2003, Counselling Pupils in Schools: Skills and Strategies for Teachers, London: RoutledgeFalmer Langs, R, 1998, Ground Rules in Psychotherapy and Counselling. London: Karnac Books Miller, L, 2005, Counselling Skills for Social Work, Sage Publications Ltd. London Moore, P, 2003, Critical components of an anti-oppressive framework, The International Child and Youth Care Framework, Retrieved December 3, 2007 from www.cyc-net.org/cyc-online/cycol-1203-moore.html Nelson-Jones, R, 2000, Six key approaches to counselling and therapy, Sage Publications Ltd. London Noonan, E, 1983, Counselling Young People. London: Tavistock Routledge Now Youre Talking; Counselling Has Become a Big Business Employing Thousands. but Is It a Job for You? Bonnie Estridge Talks It through London Jobs/Opportunities, 2004, October 14, The Evening Standard (London, England), p. 61 Parrott, L, 2002, Social Work and Social Care, London: Routledge Parton, N. (Ed.), 1996, Social Theory, Social Change and Social Work, London: Routledge Pease, B. Fook, J. (Eds.), 1999, Transforming Social Work Practice: Postmodern Critical Perspectives. London: Routledge Retail Therapy: Beauty So Tell Me, Whats the Problem? Laura Davis Investigates the Growing Trend for Counselling, 2004, October 28, Daily Post (Liverpool, England), p. 8 Rowland, N, 1993, Chapter 3 What is Counselling? In Counselling in General Practice, Corney, R. Jenkins, R. (Eds.) (pp. 17-30) London: Routledge Shardlow, S. (Ed.), 1989, The Values of Change in Social Work. London: Tavistock/Routledge Starkey, P, 2000, Families and Social Workers : The Work of Family Service Units, 1940-1985 /. Liverpool, England: Liverpool University Press Thompson, N (2001) Anti-Discriminatory Practice, Third Edition, London: Palgrave Urofsky, R. I., Engels, D. W, 2003, Philosophy, Moral Philosophy, and Counselling Ethics: Not an Abstraction. Counselling and Values, 47(2), 118+

Dialectal Awareness in the Reeves Tale Essay -- Reeves Tale Essays

Dialectal Awareness in the Reeve's Tale Throughout any given period of human history, language has been the highest expression of observable and transmissible culture. Individuals generally affiliate themselves with those of like culture and characteristics and tend to shun those who express qualities and beliefs that are different from what is commonly accepted or familiar. Wedges are often driven in the midst of identical groups of people with common beliefs, simply because one particular dialect of their language is strange to the ear of another group, or is difficult for that other group to understand . The differences between the Northern and Southern Middle English dialects of the late 1300's were, for many valid reasons, so distinct that over time lines of demarcation were conceived, as were stereotypical views of the people who spoke the language of the North. But fourteenth century poet Geoffrey Chaucer saw beyond the divisions to the heart of the matter; he recognized the efficacy and validity of the Northern dialects, considering them as no less proper forms of English than his own native "Londonese"-- a mixture of Southern and East Midlands dialects. It is by capitalizing upon these well-known stereotypical views through his distinct dialectal differences that Chaucer helps Oswald the Reeve get "one up" on the impertinent Miller through his own savvy, satirical Canterbury tale. In order to understand the implications that dialectal differences would have had upon the Southern view of a Northern speaker of Middle English, one must first investigate the individual differences that clearly existed between the two forms of the language. As there was no standardization of the ... ...frey. The Canterbury Tales: Nine Tales and the General Prologue. Ed. V. A. Kolve and Glending Olson. New York: W. W. Norton, 1989. Clark, Cecily. "Another Late Fourteenth-Century Case of Dialect Awareness." Review of English Studies 40 (1989): 504-505. Ellis, Deborah S. "Chaucer's Devilish Reeve." Chaucer Review 27 (1995): 150-161. Geipel, John. The Viking Legacy: The Scandinavian Influence on the English and Gaelic Languages. London: David & Charles, 1971. Hughes, Arthur and Peter Trudgill. English Accents and Dialects : An Introduction to Social and Regional Varieties of British English. Baltimore: University Park P, 1979. Mossà ©, Fernand. "Introduction." A Handbook of Middle English. Trans. James A. Walker. Baltimore: Johns Hopkins UP, 1952. Woods, William F. "The Logic of Deprivation in The Reeve s Tale." Chaucer Review 30 (1996) : 150-161.

Media Violence Outline Essay

I. Introduction A. Thesis Statement You are what you watch. Easy to say, and not too difficult to imagine either. A little over a decade ago, two boys who later became household names in America, Eric Harris and Dylan Klebold walked into Columbine High School in Colorado and went on a mass murdering spree where they killed 12 students, 1 teacher and injured 23 others before shooting themselves (Anderson & Dill, 2008). While their motives behind doing so cannot be ascertained, one possible contributing element which did surface was the influence of violent video games. At the risk of oversimplifying what is possibly a complex psychological minefield, Harris and Klebold did enjoy playing a game called Doom, which is licensed by the American military for the purpose of training soldiers to kill effectively. Harris had customized his own version of this game and put it up on his website, which was later tracked by The Simon Wisenthal Center (Anderson & Dill, 2008). This version of the game had two shooters with an unlimited supply of weapons and ammunition, and their targets lacked the ability to retaliate. A class project required them to make a video of themselves similar to the game, and in it, they dressed in trench coats, armed with weapons, and conduct the massacre of school athletes. Less than one year had gone by when Harris and Klebold played their videotape out, in real life, and became the protagonists of the deadliest high school shooting in U.S. history (Anderson & Dill, 2008). II. Body paragraph #1 There is nothing new about the presence of violence in our tools of entertainment. Whether they were ancient Greek dramas, theatre in the Elizabethan era or the modern electronic dramas of today, a healthy dose of violence was never missing. In Macbeth for instance, Shakespeare showed Macbeth’s head being brought on stage at the end of the play (Bushman & Anderson, 2001). The Great Train Robbery, an 11-minute film directed by Edwin S. Porter was the first firm considered to tell a story in a systematic manner. In one scene, he shows an intense scene where a cowboy fires a pistol directly at the camera, which when first showed to audiences, had them running out of the theaters in disarray and fear (Bushman & Anderson, 2001). A. Since the advent of media itself, there have been countless studies on the connection between depiction of violence in media and its occurrence in real life. B. Discussions, debates, conclusions and grey areas have all been further examined and while television is the most prominent target of accusations, comic books, jazz, rock and roll music and video games have not escaped blame either. C. Research on this topic started as early as the 1960s when television was a recent entrant in the media fray and a causal connection has been derived between media violence and aggressive behavior. III. Body paragraph #2 Opponents fuss over the definition and measurement of media violence, does actual physical bodily harm constitute violence or can a threatening statement also be deemed so? Then, does media violence cause aggression, or are the two simply associated? Consistency of the relationship also causes doubts over agreed upon data when the example of Japan is quoted, where violent media is extremely common, yet crime rates are significantly low  (Anderson & Dill, 2008). Then is media solely to blame for violence in society? Doesn’t that take the blame away from a lot of other contributing factors in society itself and make the argument generally unrealistic? A. All these issues and thorny areas can be settled by the simple logic of the social learning theory which proposes that when people see that a certain behavior causes positive or desired results, there is a high probability of them imitating and enacting that behavior (in this case, violent) themselves (Anderson & Dill, 2008). B. So while the strength of the relationship and the presence of other factors and the measurement of violence itself can be debated till the end of time, the fact remains, when children view aggressive behavior and violence in cartoons, video games, movies, as well as on the internet, it encourages similar tendencies in them and these children are more likely to be aggressive as children and later as adults. C. Research started as early as 1956 when researchers analyzed and compared the behavior of 24 children, half of whom had watched an episode of the cartoon Woody Woodpecker with distinct depictions of aggressive behavior, while the other half were exposed to the cartoon The Little Red Hen which did not depict any violence at all (Huesmann. 2003). IV. Body paragraph #3 Studies have also shown that the kind of violence which affects their psyche and causes them to model their behavior as depicted in media is when they can associate real life with the situation depicted, because they can identify with the character responsible for the violence and observe him/her/it getting rewarded for the violence. A. Research conducted by Boyatzis, Matillo and Nesbit (Gunter & McAleer, 1997) proved earlier theories about media violence getting encoded in the cognitive map of viewers and subsequently instigating violent thoughts and acts upon repeated viewings. B. The popular children’s series Mighty Morphin Power Rangers was used to prove that after watching a single episode from this show, children incorporated more aggression into their play with other children. C. Results showed that children who had seen the episode became significantly more aggressive at play the following day as compared to the children from the control group: V. Body paragraph #4 TV is not the sole culprit in this regard. Other mediums and tools of entertainment have an equal role to play. In â€Å"Effects of Video Games on Aggressive Thoughts and Behaviors During Development†, Koojimans (2004) explains the General Aggression Model – the name coined for the phenomenon which explains how video games and their depictions of violence influence people and make them more susceptible of indulging in violent behavior themselves. This model elaborates on how various situational and personological factors combine to influence a person’s internal state which includes his thoughts, feelings and physical arousals (Koojimans, 2004). A. Research conducted on video games by Nicoll and Kieffer, presented to the American Psychological Association as â€Å"Violence in Video Games: A Review of the Empirical Research† found that youth upon playing a violent video game, if only for a short while, displayed more aggressive behavior than before (Nicoll & Kieffer, 2005). B. Another study was conducted with more than 600 students of 8th and 9th grade as participants and showed that children who played more video games also had more of a tendency to get involved in arguments with their seniors and other teachers, and they would also be more likely to get into physical rows with their peers (Nicoll & Kieffer, 2005). C. Not only that but it was also found that children who spent more time watching video games imitate the characters they acted out in the video game and their moves while playing with their friends. VI. Conclusion The plethora of research knowledge available about the effects of violence in the media definitely supports initial concerns about media violence as well as the efforts to control its harmful effects. While causality can be debated till time eternal, what can’t be denied and what should absolutely not be brushed under the carpet for any longer is that a steady diet of violence does in fact instigate violent tendencies in viewers, be it through violent television programs, movies, cartoons, video games or any other forms of entertainment which incorporate violence in various forms. Media today plays a key role in nourishing children’s minds, and for the larger case of public health and societal betterment, we need to ensure that we provide more nourishing fare for our children and youth. Reducing their exposure to violent media is definitely the first step in the right direction, with the potential to yield positive benefits. An intervention is needed before we start reaping the seeds of aggression and rebellion that have been planted in young minds owing to careless media policies. References Anderson, Craig and Karen Dill. â€Å"Video Games and Aggressive Thoughts, Feelings, and Behavior in the Laboratory and in Life.† Journal of Personality and Social Psychology 78 (2008): 772-790. Bushman, Brad and Craig Anderson. â€Å"Media Violence and the American Public: Scientific Fact Versus Media Misinformation† American Psychologist 56 (2001): 477-489. Gunter, Barry and Jill McAleer. Children and Television (second edition), Routledge: London, 1997. Huesmann, L. Rowell, Jessica Moise-Titus, Cheryll-Lynn Podolski, and Leonard Eron. â€Å"Longitudinal Relations between Children’s Exposure to TV Violence and their Aggressive and Violent Behavior in Young Adulthood: 1977-1992.† Developmental Psychology 39 (2003): 201-221. Kooijmans, Thomas. â€Å"Effects of Video Games on Aggressive Thoughts and Behaviors During Development†. Rochester Institute of Technology. 2004 Nicoll, Jessica and Kevin M. Kieffer. â€Å"Violence in Video Games: A Review of the Empirical Research.† Presentation to the American Psychological Association, August 2005.

Is there a Real Choice in Where Patients with Cancer Wish to Die or is this a Myth - Free Essay Example

Sample details Pages: 12 Words: 3559 Downloads: 7 Date added: 2017/06/26 Category Medicine Essay Type Research paper Level High school Did you like this example? Introduction Recently, the concept of patient autonomy has become more prevalent within the healthcare field with the government and the NHS promoting patient choice and providing assurance that individuals will have full control over their care and patient journey. However, a recent publication from Macmillan Cancer Care (MCC) (2013a, pp. 1-27), suggests that there is very little choice available for individuals suffering from terminal cancer with regards to where they spend the end of their lives. Don’t waste time! Our writers will create an original "Is there a Real Choice in Where Patients with Cancer Wish to Die or is this a Myth?" essay for you Create order Figures provided within the MCC (2013a, p. 8) report suggest that 81% of cancer sufferers would prefer to die at home whilst in reality, 48% of these die in a hospital with only 23% of patients dying within the comfort of their own homes. For individuals who are approaching the end of their lives, the option of being cared for and dying within their own home with the familiarity and comfort that this brings, is often very important. The National Bereavement Survey (NBS) (Office for National Statistics, 2012, np) showed that that the loved ones of those who had died in hospital often considered the standard of care as being poor when compared to those who died at home, in a care home or within a hospice. Indeed, the NBS (ONS, 2012, np) showed that 53% of loved ones whose friend or family member had died at home and 58% of those who had died in a hospice, rated the standard of care as outstanding or excellent compared to just 34% for those who had died within a hospital. This ess ay will consider the barriers that cancer patients are presented with when making their end of life choices and will make recommendations for improvement of service to ensure that these individuals are allowed to make and receive their final choice. However, the essay will begin with a brief overview of the benefits that end of life patient choice can bring to both the individual and to the wider society. The Benefits of End of Life Patient Choice According to the National End of Life Intelligence Network (2012, p.7) 89% of patients who die in hospital are brought in as emergency admissions. However, a large number of these individuals have already expressed their desire to die at home, therefore representing a poor patient outcome and negative experiences. In addition, these unnecessary emergency admissions place a costly strain on accident and emergency departments and the patients take up hospital beds that could be used for other cases. When one considers that the number of people in this country is increasing with the elderly becoming the most prevalent age group, it is not unfeasible to believe that the number of individuals dying from terminal cancer over the next few decades is also going to increase. This increase in numbers is likely to cause the current model of care to become unsustainable. However, promoting choice and delivering end of life care choices can actually save money by reducing the number of emergenc y admissions. According to MCC (2013a, p.9), there is a net saving of just under  £1000 for every individual who dies in the community rather than in a hospital bed. Barriers to End of Life Care Choices Evidence suggests that there are multiple barriers that prevent individuals from being cared for and ending their lives in their chosen place. The first barrier is the identification of people approaching the end of their lives. According to MCC (2013a, p.10), 38% of cancer patients approaching their end of life were unaware that they were dying, whilst figures from Marie Curie Cancer Care (2013, p.7) show that only 26% of individuals with a palliative care need are placed on the palliative care register. One of the main reasons for this appears to be a lack of confidence in the health professionals over instigating conversations with individuals over their end of life journey. A study carried out by Revill (2010, p.11) found that 60% of GPs were not confident about discussing death or dying with their patients. This lack of identification and lack of professional confidence therefore prevents many people from being able to make their end of life choice in a timely fashion, therefo re increasing the number of emergency admissions that have previously been discussed. However, another issue that has been raised is that of poor planning and coordination between services. When one considers the needs of a terminally ill cancer patient, it is clear that there is a requirement for multiple health and social care providers to work together to provide a joined up service delivery. Unfortunately, the MCC (2013a, p.11) report suggests that this joined up service is not occurring with 45% of respondents thinking that community services worked well together and only 33% stating that GP and other services outside of the hospital worked well together. The reason for this poor service is considered to be a lack of coordination and communication between the different care entities. Indeed, the MCC (2013a, p.11) report suggests that it is often a requirement of the close family and friends of the dying loved one or the actual patient to coordinate care between health and so cial care departments. The report suggested that information needed to be repeated to the different professionals suggesting that there is a lack of communication between the different departments and that patient information is not being recorded or shared in an appropriate manner. Nevertheless, there is evidence to suggest that Advance Care Plans (ACP) are a successful way in which a persons end of life choices can be successfully achieved. Abel et al (2013, pp.168-173) followed 969 terminally ill patients, 550 of whom had made an ACP. 75% of these individuals successfully achieved their dying wishes with regards to the location that they had chosen. In addition, a study published by the NHS (2012, pp.3-4) suggests that the Electronic Palliative Care Coordination Systems (EPaCCS) where patient information, including their end of life choices, can be stored and shared, is an effective way of achieving pro choice for the patient with up to 80% of individuals living in areas where the EPaCCS system is implemented achieving their preferred choice of location to die. In addition, the NHS (2012, p.12) report shows that the implementation of this system has resulted in savings of  £133,200 where it is implemented. Another positive study has been published by Gao et al (2013, np) who found that the number of individuals being able to die either at home or in a hospice has increased since 2005 when the National End of Life Care Programme was first launched. However, the percentage change was only marginal (0.8%) therefore suggesting that more needs to be done to ensure patient autonomy is at the top of the list for terminally ill patients. Another barrier that is likely to prevent an individual from dying within their own home is lack of skills and resources within the community workforce. In these cases, the role of the community nurse is vital, however, the number of community nurses is steadily declining (Royal College of Nursing, 2013, np). This redu ction of the workforce further dilutes the available skill mix, therefore having a detrimental impact on the quality of care provided to those who choose to die at home. According to the MCC (2013a, p.13) report, only 19% of individuals who chose to die at home received adequate pain relief during their last 3 months of life. Indeed, the lack of 24/7 access to community services forced a large number of these individuals to contact emergency services resulting in admittance to hospital. In 2010, nearly half of the UKs primary care trusts did not provide 24/7 community nursing services for end of life patients with little progress being made following the subsequent change to Clinical Commissioning Groups (MCC, 2013a, p. 13). Another report published by MCC (2013b, pp. 1-15) suggests that a lack of access to social care services also restricts the ability of an individual to make end of life care choices. Whilst it is obvious that the right amount of social support is needed in or der for a terminally ill individual to be able to remain at home during their last stages of life, this support is often not provided. The MCC (2013b, p. 3) report suggests that this is not always due to the service not being available, but more often being the result of the complex assessment process and the lack of coordination between health and social services. Indeed, 97% of healthcare professionals stated that the complexity of the social care needs assessment is a substantial barrier to gaining the right amount of home care for terminally ill patients. As such, the care for these terminally ill individuals is often left to family members as informal carers. However, only 5% of these individuals actually receive a carers allowance despite them taking on the majority of the personal care responsibilities of these terminally ill patients. Thomas et al (2002, p.531) asserted that the needs of cancer patient carers were greatest as the cancer progressed to end stage; however, a di stinct lack of support for these informal carers is prevalent throughout the UK (Soothill et al, 2001, p.468). MCC (2013b, p.6) found that 47% of these informal carers felt that they needed support but were unable to get any. Therefore it is not surprising that this lack of carer support is resulting in many cancer patients being admitted to hospital in the days or hours before death despite it being their wish to die at home. Recommendations for Improvement As studies have shown that the local implementation of the EPaCCS has been successful, there should be a renewed commitment by the Department of Health and the NHS to ensure the national implementation of this scheme. Indeed the National End of Life Care Strategy (DOH, 2008, np) made a commitment to pilot and establish end of life care registers that would ensure the coordinated care of terminally ill patients and also ensure that every organisation involved in the care of that individual were aware of their end of life choices. As such, it is asserted that NHS England need to prioritise the roll out of these systems. When this system is implemented on a national basis, EPaCCS will not only coordinate care but will also provide considerable data that can be used to compare outcomes for end of life patients throughout the UK. In addition to this system, it is vital that health care professionals involved with terminally ill cancer patients encourage them to fill out an ACP as a rout ine part of the care package. A randomised control trial carried out by Detering et al (2010, np) followed 309 terminally ill patients for a period of six month, 154 of whom had completed an advanced care plan. Of the 56 patients who died during the study period, 29 of them had made an ACP with 86% of these achieving their end of life choices compared to just 30% of those who had not made an ACP. This shows that it is vital to document end of life choices to ensure that they are followed by all those involved in the final days of the patients care. Another recommendation is to make end of life care training mandatory for all health professionals who are likely to be involved in palliative care. This includes making a timely identification of individuals who are approaching the end of their lives and providing these professionals, including GPs, with the right training to boost their confidence in instigating end of life discussions with terminally ill patients. This will enable t hese terminally ill individuals and their families to come to terms with their disease progression and make appropriate plans for their end of life care. It is also recommended that all terminally ill individuals have a named professional who is responsible for the coordination of their care and who will ensure that their end of life choices are met whenever possible. This was a key recommendation of the UK Governments (2013, pp. 1-62) review of the Liverpool care pathway, which stated that a named consultant or GP should take overall responsibility for a patients end of life care, whilst a named registered nurse would have day to day responsibility for the care of that individual and for the communication of information between the patient, family members and other members of the care team. The UK Governments (2013, p. 57) review also recommends improving access to community services by increasing funding to ensure that there is a consistent 24/7 access to all social care servic es throughout the UK. This is considered to be a priority, as without access to 24/7 care, a large number of individuals are not having their pain managed adequately, forcing them to take further action by attending an emergency department. In addition, the government needs to commit to implementing free social care to terminally ill patients and to simplifying the social care assessment to ensure that all those who need social support are able to access this service in a timely fashion. Whilst the UK government has recognised that there is much merit in the proposal of free end of life social care (MCC, 2013a, p. 19), they are yet to offer a firm commitment to this proposal. The continued complexity of the social care assessment and the confusion over who is able to receive social care needs to change if patients wishes to die at home are to be honoured. Indeed, Taylor (2012, p.1297) asserts that there is a need to change the way in which all health and social care is provided to e lderly patients and suggests a combined health and social care assessment to ensure a proper joined up and coordinated service for these vulnerable patients. It is also recommended that improved support for carers is instigated to ensure that all those who are caring for a terminally ill patient are recognised as informal carers and are in receipt of a carers allowance. In addition, it is vital that these carers a given the right level of support by health professionals; this support should include having 24/7 access to help and advice, being given regular respite and having adequate information with regards to the progression of their loved ones disease to enable them to encourage the patient to make end of life care plans. Joyce et al (2014, p.1150) found that out of 120 caregivers who were responsible for delivery of medications to their terminally ill relative, only 27 (22.5%) of them received any formal support. This often led to confusion over dose rate and fear that the pa tient was receiving too much or too little of the medication provided. This issue is compounded by the fact that many of these informal carers are elderly themselves and often have their own health problems (Jack et al, 2015, p.131). Finally, it is considered that delivering choice for end of life care should be focused on giving that patient a good death, regardless of where they chose to die. As such, it seems logical that there is a need to understand the experiences of terminally ill patients towards the end of their lives in order to deliver adequate care. As such, it is considered vital to explore how the experiences, concerns, fears and feelings of people approaching the end of their lives can be recorded and used to improve future patient outcomes. Whilst it is accepted that the National Bereavement Survey (ONS, 2012, np) provided a large volume of useful information, the current lack of nationally collected information from end of life patients needs to be addressed. As such, it is recommended that future study be directed in this way. Conclusion In conclusion, it is clear that whilst having a genuine choice over where to spend the last few days and hours of your life is hugely important to terminally ill patients, there are significant barriers to achieving these choices. Current figures suggest that nearly three quarters of cancer patients chose to die at home but less than 29% of them actually do so. The MCC (2013a, p. 3) report estimate that this amounts to 36,000 patients dying in hospital when they had chosen to die at home. A number of barriers exist that are currently preventing the individual from achieving personal choice at the end of their lives; these include poor identification of individuals entering the end of life stage, poor communication from health professionals, poor planning and coordination between health and social services, lack of skills and resources in community nursing and lack of universal access to social care resources. Nevertheless, despite these current barriers, none are insurmountable if current services are simplified and organised in a way that sees the needs of the individuals and their families and carers brought to the forefront. Whilst the government has funded reports and strategies to improve end of life care, it is clear that not enough is being done to change the way in which end of life care is provided. Significant change is required in order to move care and resources out of hospitals and into the community so that peoples preferences can be delivered. However, this can only happen if there is a clear commitment given by all the players involved in end of life care to share the same ambition, that being to deliver a coordinated and integrated care package that meets the needs, wishes and preferences of end of life patients and their carers. A number of recommendations on how this can be achieved have been included in this essay. These recommendations include simplify the social care assessment, providing free social care to end of life patients, improvi ng support for informal carers and ensuring that these carers are recognised, improving the training of health professionals in recognising the transition to end of life stages and encouraging them to instigate discussions over end of life choices, improving access to social services by ensuring a 24/7 service across the UK and implementing the roll out of the EPaCCS across the whole of the UK to ensure that end of life choices are recorded and shared between all the relevant care providers. As it stands at present, whilst end of life patients do have a choice over where they die, these preferences are often not honoured. They do not have full control or autonomy over their end of life care. 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