Reflective Essay on Smoking Cessation

Reflective Essay on Smoking Cessation This essay provides a reflective account of the delivery of an opportunistic smoking cessation intervention. In constructing this account, Gibbs (1988) model of reflection has been utilised, which incorporates the following components: description; feelings; evaluation; analysis; conclusion; and action plan. Description Whilst shadowing a practice nurse, I was provided with the opportunity to implement a brief smoking cessation intervention with a patient. The patients name will not be used, in respect of confidentiality (NMC Code, 2008; NHS Confidentiality Code of Practice, DH 2003), however, for the purpose of this reflection she will be referred to by the pseudonym Sarah. Sarah is a 65-year old female presenting with a number of health issues. She is an overweight smoker who has recently been diagnosed with chronic obstructive pulmonary disease (COPD), a lung disease characterised by the narrowing of the airways. COPD also refers to chronic bronchitis and emphysema, the latter of which Sarah has been diagnosed with. It is emphysema that is Sarahs primary health problem at present. The health promotion strategy adopted was a brief intervention comprising motivational interviewing (Rollnick, Miller and Butler, 2007), which took place within the practice surgery as part of Sarahs consultation. Motivational Interviewing is a directive patient-centered style of counselling designed to help people resolve ambivalence about behavior change, such as smoking cessation. Alongside motivational interviewing, some specific props and teaching aids were utilised, including the provision of evidence-based information, the creation of a COPD self-management plan (British Lung Foundation, 2010), and details of helpful resources Sarah could utilise for further support. This included the Surrey NHS Stop Smoking Service (www.surreyquit.net), which offers free NHS support tailored to the individual (i.e. weekly clinic visits or telephone contact). Feelings I was initially quite anxious about this health promotion opportunity, as I was not confident in my ability to provide constructive support in the limited time we had. However, on initiating a conversation with Sarah, using open questions as recommended within motivational interviewing, the anxiety disappeared as I listened to Sarahs story. Active listening requires concentration, which in turn focused me on how I might be able to help Sarah. In establishing that Sarah was concerned for her grandchildren, who stayed with her quite frequently and were thus around second hand smoke, this provided an anchor to facilitate the development of Sarahs motivation to change. In turn, this anchor also provided me with a patient-centred method for relieving my fears, since I had found a way of engaging Sarah in the process. Interestingly, as Sarahs motivation grew, so did my own motivation to ensure that Sarah gained as much from this brief intervention as possible. With every question that I could answer, I gained in confidence and enjoyed my role as educator and learner within the collaborative partnership between myself and Sarah. In this sense, the collaborative approach that underlies motivational interviewing and much of healthcare practice today can benefit both the patient and healthcare provider. My overall feelings regarding the interaction with Sarah are one of fulfilment. I feel I positively contributed to this patients increased resolve to stop smoking for both herself and her family. Evaluation Motivational interviewing was selected as the most appropriate health promotion intervention for Sarah for a number of reasons. Firstly, evidence regarding behaviour change and, in particular, smoking cessation, shows that level of motivation is an important factor in devising the best health promotion method or teaching plan for a patient (Prochaska, DiClemente, and Norcross, 1993). This approach takes into consideration humanist learning theory and the principles of self-directed learning. According to Prochaska et al.s (1983) five stages of behaviour change, Sarah currently resides in stage 2 of the following stages: Stage 1 (pre-contemplation) is when the individual does not intend to change behaviour; Stage 2 (contemplation) is when an individual is considering change; Stage 3 (preparation) is serious resolve to embark on smoking cessation; Stage 4 (action stage) is the first few crucial weeks and months where an individual is actively taking positive actions towards smoking cessation; and Stage 5 (maintenance) is about 6-months to 5-years after the initiation of the smoking cessation decision, where behaviour change has been sustained. Being in the contemplation stage suggests that Sarah still has some unresolved ambivalence about change and thus needs help moving to stage 3, where she can start to prepare for smoking cessation. If I had started to help Sarah plan for smoking cessation before she was ready, this could have been detrimental in both the short- and long-term. For example, it has been shown that overcoming the hurdles associated with smoking cessation can increase an individuals self-efficacy (i.e. confidence) in their ability to succeed at their quit attempt, which in turn acts to reduce the likelihood of a relapse and increase the likelihood of long-term sustained smoking cessation (Schnoll et al., 2010). If Sarah was pushed towards a quit attempt before prepared, her risk of relapse would have been high; this would have ultimately reduced her self-confidence to try again. The transition from the contemplation stage to the preparation stage has been cited as being critically important to the outcome of quit attempts (Prochaska, DiClemente, and Norcross, 1993), as has the fact that healthcare professionals can be extremely influential at this stage Long et al., 1996). I considered motivational interviewing to be key to influencing Sarahs decisions regarding smoking cessation since it was designed specifically to help people resolve ambivalence about behavior change, which is the main characteristic of people in the contemplation stage of motivation. Motivational interviewing can achieve the resolve of ambivalence by avoiding confrontation and guiding people towards choosing to change their behavior themselves. I was aware that motivational interviewing would need to be accompanied by detailed education about smoke-related health issues and the likely course of COPD, together with possible complications and its association with increased morbidity and mortality. Sarah is an intelligent individual and keen to receive such information and reading material. Unfortunately, however, I was unable to answer all of her questions. In particular, I could not answer her questions regarding the pathophysiology of smoking. Unanswered questions can act as a barrier to progress, something which I do not wish to produce in a patient who requires such barriers removing. Fortunately, I was able to answer Sarahs questions whilst referring to an educational information leaflet. I do, however, feel that I would have been able to engage with Sarah more effectively if it had not been necessary for me to focus my attention on the leaflet before me. It became apparent throughout the consultation that although Sarah was most certainly considering quitting smoking, she possessed some traits that might hinder her efforts. In particular, Sarah appeared to have an external health locus of control. This means that she attributes control over her behaviour to external factors as opposed to internal factors. It is well documented within the literature that an internal locus of control is more productive to behaviour change and healthier lifestyle choices (Wallston and Wallston, 1978; Tones et al., 1992). Taking this into consideration, I was mindful to acknowledge Sarahs control over her choices. In one instance, I used her husband as an example since Sarah had informed me that her husband had quit smoking. I asked her how he managed to achieve this and in recognising her husbands role in his own smoking cessation, Sarah appeared to be adjusting her locus of control towards a more internal one. Nevertheless, Sarahs self-efficacy remained low throughout the consultation despite attempts to boost her confidence. It is believed that increased self-efficacy, which can be achieved via motivational interviewing, is an important factor involved in the success of smoking cessation (Brown et al., 2003; Karatay et al., 2010), thus I felt this was an important aspect to include in Sarahs self-management care plan to set herself an achievable goal each week that would gradually build her confidence. Analysis The Department of Health have been working with the NHS, patients, and healthcare professionals since 2005 to develop a strategy to improve the care and outcomes of people with COPD (DH, 2010). This strategy places a large focus on the prevention and treatment of smoking, as well as the importance of providing patients who have COPD with behavioural support and access to stop smoking services. The Department of Health (2009) have produced guidance on effective stop smoking services, offering three levels of behavioural intervention: brief interventions (level one); intensive one-to-one support and advice (level two); and group interventions (level three). In terms of level one, brief interventions, the National Institute of Clinical Excellent (NICE) have published guidelines and recommendations for smoking cessation (NICE, 2004). Furthermore, previous UK guidance has emphasised the importance of offering opportunistic, brief advice to encourage all smokers to quit and to signpost them to resources and treatments that might help them (West, 2005). They Department of Health guidance states that all smokers should be advised to quit and asked if they are interested in quitting; this is unless there are exceptional circumstances such as other medical conditions that might hinder smoking cessation. Those who are interested in quitting should then be offered a referral to an intensive, level two, support service such as NHS Stop Smoking Services. Sarah was referred to the Surrey service and informed of the success rates found for NHS Stop Smoking Services. There is evidence that such services are effective in the short-term (4-weeks) and the long-term (52-weeks); indeed, between 13-23% of successful short-term quitters remain abstinent at 52-weeks (NICE, 2007). Conclusion Approximately 900,000 people in England and Wales have been diagnosed with COPD (NICE, 2004) and it is the fifth most common cause of death in the UK, resulting in over 30,000 deaths annually (National Statistics, 2006). By 2020, it is estimated that COPD will be the third most common cause of mortality worldwide (Lopez et al., 2006). Smoking is the largest risk factor for developing COPD, with 20% of long-term smokers eventually developing clinically significant levels of the disease and 80% developing lung damage (Garcia-Aymerich et al., 2003). These statistics highlight the urgency of grasping opportunistic health promotion and utilising brief intervention skills to help deliver the DH strategy and improve the care and outcomes provided to people with COPD. Delivering brief opportunistic interventions for smoking cessation requires an approach that does not create defensiveness but develops a patient/provider partnership conductive of the patient making their own decisions, with support, as to their lifestyle. Motivational interviewing and consideration of individual patient characteristics and traits (i.e. locus of control, stage of readiness to change, etc.) provides a method of achieving this partnership within limited time and resources, as is often the case in busy healthcare environments. Learning the skills within motivational interviewing will add to a healthcare professionals repertoire of techniques for supporting patients through behaviour change, as I found in the case reflected upon within this essay. Action Plan The UKCC Code of Professional Conduct (1992) proposes that nurses should maintain and improve her professional knowledge and competence. In relation to my own knowledge and competence in opportunistic health promotion, I have recognised that I need to increase my skills for nurturing patient self-efficacy. Patient confidence is fundamental to successful behaviour change and although I feel satisfied with my approach to Sarah, it would have been useful to have possessed a larger repertoire of techniques for enhancing self-efficacy. I could also benefit from a greater understanding of the pathophysiological mechanisms by which smoking causes COPD. Sarah was particularly interested in the physiological effects of smoking and whilst I could offer her basic information verbally, I needed to refer to information leaflets for more detailed insight, which disrupted the flow of conversation. I have started to explore these issues via a search of the literature on behaviour change and health promotion. As part of this search, I have come across the concept of implementation intention (Gollwitzer, 1999). The theory behind this concept is that in order for someone to implement a desired behaviour, it is necessary for them to devise a specific plan that will increase their intention to pursue that behaviour (Gollwitzer and Sheeran, 2006). This is an interesting technique that could be integrated into motivational interviewing and health promotion via the self-management care plans currently provided. I intend to explore this further and to discuss it with a superior. Using Gibbs reflective model to structure this account has helped me to recognise my strongest skills and those that require further development. I will endeavour to take a proactive approach to utilising this greater insight into my professional abilities.

Iroquois Clan – Essay

Iroquois Clan ANT 101 December 5, 2011 There are many different cultures, each having their own values, and rules. The Iroquois are an association of several tribes, of indigenous people of North America. The Iroquois have many different ways about their way of living such as rules involving marriage. What contributes to the way an Iroquois react and think? Is it kinship, religion, and beliefs, or is it something else? The Iroquois have a very well-known culture. Iroquois are indigenous tribes across North America. The Iroquois lived in longhouse, which are structures made to house the whole family in different sections (Nowak & Laird, 2010). Matrilocal, or post marital residency, was when the husband moved to live with the wife’s community (Nowak & Laird, 2010). In the Iroquois the eldest woman in her matrilineage had the most influence in decision making, and distributing the resources and property (Nowak & Laird, 2010). Iroquois selection of marital partners are chosen by kinship because, Iroquois marriage must be exogamous, meaning marring outside their lineage and clan (Nowak & Laird, 2010). Iroquois kinship program only recognizes two groups: The first is parents and siblings, which are too closely related to marry. The second group is potential spouses and in-laws (Nowak & Laird, 2010). In the Iroquois it is considered wrong to marry parallel cousins because they are too closely related. On the other hand cross cousin marriage is accepted and encouraged (Nowak & Laird, 2010). The Handsome lake religion combined traditional Haudenosaunee religious beliefs with a revised code meant to bring consciousness to the Haudenosaunee, or Iroquois, after a long period of cultural disintegration ollowing colonization. The Iroquois people believed that spirits changed the seasons. Key festivals coincided with the major events of the agricultural calendar, including a harvest festival of thanksgiving. After the arrival of the Europeans, many Iroquois became Christians. The Code of handsome lake outlawed drunkenness, witchcraft, sexual promiscuity, wife beating, quarreling, abortion, gay marriage, single parents and gambling. The Iroquois men were propositional on a balanced reciprocity. Iroquois could only trade with other tribes in the Iroquois confederacy. Items traded included surplus corn and tobacco, fur pelts, and wampum. Later, Iroquois received implements including guns and metal axes from the British, which made their work easier (Nowak & Laird, 2010). Their culture is matriarchal- they trace lines through Clan Mothers. This is in direct contrast to European society, especially at time of contact. Europeans were paternalistic- the fathers line. This would cause different reactions from other kinships. The Iroquois people have a lot of the same values, beliefs, and rules, as many Americans living in the current century. In my culture, it is not acceptable to marry close relatives including first cousins. The handsome lake religion is very much similar to the Christian religion. Kinship impacts almost each and every one of these behaviors. Iroquois have a very understandable and compatible way of living. But what makes them think and act the way that they do? I would have to say that the religion is a main point in the actions and reactions of the Iroquois. The other major point would be the matriarchal tracing of the clans. Nowak, B. & Laird, P. (2010) Cultural Anthropology. San Diego, CA Bridgepoint Education Inc. Retrieved from: https://content. ashford. edu/books/AUANT101. 10. 2/sections/copyright Your paper is well developed and follows the APA guidelines correctly. Your paper is well written with an effective analysis. You have addressed the topic and assignment. Your grammar is correct with well-constructed sentences. Your conclusion could be improved. Good job! You received 9/10 points for this assignment.

St. John Bosco (1815-1888)

A man with a vision, with an awareness of the good that lives in people, with an ability of dreaming dreams of beauty for those he met along his way, this is John Bosco. St. John Bosco (1815-1888) was born to poor parents in Recchi, Italy, the Piedmont area of northern Italy. When John was two, his father died prematurely. As a boy, John lived on a farm with his family doing the only thing they knew how, farming. Poverty and a lack of formal education in the home did not stop the growth of John Bosco as a person. His mother was for real, realizing the importance of God in life. This friendship with God became powerful and slowly John prepared for the priesthood. In 1841 at the age of 26, John was ordained priest at Turin, and immediately gave himself to that work, finding shelter for neglected youth and instructing them in religion. He was now ready to make his contribution toward the poor and homeless. He rented an old barn in a field which he called â€Å"The Oratory.† This was the first of many oratories John Bosco founded for helping poor boys who needed a home. He believed that prayer and Holy Mass and Communion and confession are the best ways for children to attain a sense of personal responsibility. In a short time, other priests joined him in his work and by 1852 they were caring for over 600 boys. John dealt with them by using a minimum of restraint and discipline, lots of love, keeping careful watch over their development and encouraging them personally and through religion. John†s preaching and writing, as well as the charitable support of wealthy and powerful patrons allowed for expansion of his work. The need for dependable assistants led to the founding of the society of St. Francis de Sales in 1859, and it continues to work today. To provide similar care for the poor and neglected girls, John Bosco founded, in 1872, the Daughters of Our Lady, Help of Christians. The life of St. John Bosco was full and his zeal contagious. He never got tired of talking and writing about his work for the young and their care. On this feast day the Church has chosen for the Office of Readings an excerpt from one of his letters. It expresses his concern and is applicable for our time when children suffer from neglect in broken homes and in less than ideal welfare situations. John wrote: â€Å"If we wish to appear concerned about the true happiness of our foster children and if we would move them to fulfill their duties, you must never forget that you are taking the place of the parents of these beloved young people. I have always labored lovingly for them, and carried out my priestly duties with zeal. And the whole Salesian Society has done this with me. Juggler, magician, acrobat, tailor, teacher and writer, John Bosco became all of these in his efforts to lead boys and girls to God. A prayer was the price of admission to his shows; a friendly contest to match skill or strength was his answer to the hoodlums who laughed at him. As a priest he was known as Don Bosco and built churches and schools. John Bosco would be pleased with the concern that the Church has today for education. This concern is expressed in the II Vatican Council†s Decree on Christian Education. John Bosco died on January 31, 1888 and was canonized in 1934 by Pope Pius XI. His work was continued by a group of dedicated people called the Salesians. His feast day is celebrated on January 31. St. John Bosco is honored by us as an outstanding teacher and father to the young, and we ask that we be filled with love like his.

Tim OBriens The Things They Carried An Analysis

Student Network Resources Inc.  ©2003-2010 ________________________________________________________________________ Tim OBriens The Things They Carried is a short story told in the form of a catalogue. OBriens title provides both an accurate description of how the story is organized mainly by lists, with the narrative seeming an almost accidental intrusion but also as a sort of recurrent musical refrain in the text itself. The title phrase is repeated at semi-regular intervals in the text, and encourages the reader to understand the catalogue of items as adding up to something larger than the mere objects described. It is important to recognize, however, that the objects are in fact described with painstaking accuracy, and not impressionistically; as Kaplan notes of OBriens style in this story, all of the things are depicted in a style that is almost scientific in its precision. We are told how much each subject weighs, either psychologically or physically, and in the case of artillery we are even told how many ounces each round weighed. (Kaplan 44-5) I hope to demonstrate through an examination o f OBriens repetitions of the title phrase that the overall intent of the story is metaphorical. We are asked to understand the young soldiers in Vietnam through an analysis of the narrators lists of the things they carried. It is worth noting at the outset that OBrien quite specifically encourages the reader to understand the soldiers burdens as more thanShow MoreRelatedCharacter Analysis: Tim OBriens The Things They Carried962 Words   |  4 Pages One of the main characters in the short story â€Å"The Things They Carried†, written by Tim O’Brien, is a twenty-four year old Lieutenant named Jimmy Cross. Jimmy is the assigned leader of his infantry unit in the Vietnam War, but does not assume his role accordingly. 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