Research Papper Paper Example | Topics and Well Written Essays - 1000 words

Papper - Research Paper Example The assembling division has likewise been intensely focused on and assaulted by digital fear mongers and hoodlums. This has been done particularly to get to data about assembling procedures and control process. Digital psychological militant may assault producing ventures frameworks to gain admittance to the information concerning the procedures and systems utilized in that industry. This data may then be utilized somewhere else to fabricate fake items. Digital psychological militant likewise assault the mechanized machine control forms in order to cause mishaps in that specific industry. These might be politically roused assaults. The other division that is focused by digital fear mongers is the medicinal services segment. The segment has been in danger since it has not put resources into cybercrime security strategies. These assaults may results into monetary misfortunes and even passings. These digital psychological oppressor can get to the emergency clinic information framework and for instance change the medication solution of a patient coming about into death of the patient (Krasavin, 2004). The vehicle division and the basic foundation of the nation are likewise top focuses of digital fear mongers. These digital lawbreakers can utilize their product to meddle with for instance flight plans for request to create turmoil in air terminals. Correspondence frameworks have likewise been assaulted by digital fear mongers prompting access of fundamental data and secret data of the American residents. Digital psychological militants have too focused on the instruction part in the United States of America. This has been for instance done through getting to the databases of different instruction foundations and changing the evaluations of the understudies or meddling with the educational program. These fear based oppressors have additionally utilized the web to doing digital harassing so as to scare understudies. Notwithstanding that, students’ work and assignments have additionally been assaulted and meddled with through spamming and different malwares. Digital wrongdoing

Janis Joplin Essay Essay Example

Janis Joplin Essay Example Janis Joplin Essay Janis Joplin Essay Perhaps Ralph Waldo Emerson was correct and may each piece great hold alluded to Janis Joplin as he was expressing this reference had he lived during Joplin’s cut. With her perish at a youthful age of 27. it had been a fleeting life the melodic driving force Janis Joplin had. We may non cognize whether or non her cousins can state nil about her however her life has the right to be remembered and I am here to make about it. An articulation into the setting wherein she lived will help give a superior trepidation of how an amazing class was impacted and came to be the way it was. Janis Joplin is one of the most extraordinary people in the sixtiess. an age viewed as an unrest of sorts. Beginnings On the forenoon of January 19. 1943. Janis Lyn was destined to be the oldest child of Seth and Dorothy Joplin. It was mature ages in this way that she would hold more youthful kin Michael and Laura doing them a working class family arrangement of five individuals. Turning up in a modern town called Port Arthur in Texas swarmed with petroleum treatment facilities. substance workss. plants. furthermore, lines of oil-stockpiling shielded battle vehicles with debilitates lingering palpably. it wasn’t the best topographic point to satisfy the splendid and theoretical little Janis as there wasn’t much space for exercises and redirections. Despite the fact that that was the example. she did great in school. holding an incredible inclusion and bent for perusing and picture. As a child. she previously had a notoriety for singing as one of the soloists in their congregation ensemble. Fitting to one of her companions. she had been famous in Port Arthur as a talented and shrewd little miss. Janis thought of her as adolescence as relatively charming. It was only at 14 years old. as admitted in a significant number of her varying meetings. that she felt like the universe turned on her. That was the clasp she put on weight and had skin inflammation employments. employments which implied most than anything for youths. The inevitable bound of her looks corresponded seriously with her entrance to the senior secondary school universe where the famous misss were the 1s with great articulations and Janis simply fell behind ( Echols. 2000 ) . While at the Thomas Jefferson senior secondary school. Janis took dismissal by chest ( Amburn. 1993 ) . Used to holding going to on her. she began moving out and while she started to have joining in. she even accentuated her being unique. She was resolved to keep up the going to on her regardless of whether it was a negative 1. She turned into a hipster miss who might streak her peculiar array runing from over the-knee skirts. dark or violet leotardss combined with wishing flighty and ‘different’ expansive humanistic orders and music. As Echols put it. â€Å"she was keen on going a blemish. an affront to everything the townsfolk had faith in. For sure. Janis was anxious to withstand the same number of cultural shows as she could. This made her folks troubled â€Å"she only changed entirely. overnight† refering to her female parent Dorothy. As a minor miss. her rebellious disposition was unnecessarily much that one occurrence happened influencing the constabulary after she took a drive with her male companions who were overage. This made her much more the subject of dealings and chatters around their Pleasantville of a town. She was much into music and soaking up. moving as though these two things are married. What's more, this ever gets her into issue. She was every now and again sent to the counselor’s office for trouble making and guzzling ( Echols. 2000 ) . Her folks were bewildered and felt defenseless. Joplin’s defiant inclination was immovable. she simply needed to appear as something else and be allowed to show herself. Much to their dismay that Janis’ insubordinate activities represent the start of an inescapable cultural upheaval and a â€Å"emerging coevals gap† that was going to come ( Echols. 2000 ) . The reality was: it wasn’t just Joplin ; it was making a trip to be a corporate movement. The Sixties was acceptable on its way. The Sixties† . as it is much of the time utilized in well known progress by certain columnists. historiographers and different academias. has seen many shifted compelling and changing inclinations in progress and political directions which can be portrayed as nil not exactly energizing. amazing. fanatic and even defiant. It was a clasp when individuals are looking to interfere with liberated from the solid and traditionalist cultural standards and cultural restrictions in chase for single opportunity ( Booker. 1970 ) . One might say that this time of history greatly affects Janis Joplin and more remote impacted non just her driving force however how her full life turned out. Melodic Inclination Music would at long last go an energy for Joplin. Beside singing in their neighborhood church ensemble. Janis built up her melodic inclusion more distant in the wake of become friends with a gathering of outsiders as a juvenile. She and this pack would tune in and adore Afro-american Blues inventive people, for example, Leadbelly whose collection was the main she guaranteed she ever bought ( Echols. 2000 ) . During senior secondary school she kept tuning in to blues music and tuned in to different blues inventive people like Bessie Smith. Enormous Mama Thornton and Odetta. What's more, considerably later on. she will get down singing blues and people vocals along with certain companions. replicating the artists’ Eskimo hound yet profound voices. Amburn. 1993 ) . She at any point had a gut feel about her cantabile capacity yet it wasn’t until she imitated Odetta and performed one of her vocals which paralyzed her companions that she affirmed. she so â€Å"has a voice. † Her initial endeavors remembered playing for java houses in their little town. Enrichment. Reputation and Fame In 1963. she left for San Francisco and ended up shacking in North Beach. She other than dared to other topographic focuses like Venice. the Village. New York and Haight-Ashbury geting more distant encounters and probing her music and imagination. It wasn’t simply a twelvemonth prior that she began taping her first vocal at a friend’s house and a twelvemonth after she would enter more vocals with her companions Jorma Kaukonen and Martha Kaukonen providing her concomitants. A collection called Typewriter tape will be discharged fusing seven ways including â€Å"Long Black Train Blues. † â€Å"Nobody Knows You When You’re Down and Out. † â€Å"Typewriter Talk. † Kansas City Blues. † â€Å"Trouble In Mind. † â€Å" Hesitation Blues. † and â€Å"Daddy. Daddy. Daddy† . As the Sixties headway. arranged movements are rising up out of the left and right. The counterculture and cultural transformation was circulating. A well known term developed as the bloom people groups. a young movement portrayed unequivocally by a relocation towards a progressively freed society. It incorporates the oppugning bunches made a movement toward discharge in the public arena. counting sexual upset. inquisitive of approval and specialists. fighting for the opportunity and privileges of the minimized gatherings including Negroes. grown-up females. homophiles. also, minorities. The utilization of marihuana. champion. LSD and arranged others medications and tuning in to hallucinogenic music were other than uncontrolled. Janis would non be abandoned and took parcel in these movements. Joplin’s waywardness proceeded with great into those mature ages. Around that cut. she expanded her medication use and took on a notoriety as an incessant courageous woman client and a rush monstrosity ( Amburn. 1993 ) . She was other than substantial on intoxicant and different alcohols and even occupied with sexual high. In 1965. she was depicted as skeletal. indeed, even starved because of the impacts of her energy pill use ( Amburn. 1993 ) . For some clasp. she was persuaded by her companions to go calm and to hold back from tranquilize utilization. An old companion thus chief Chet Helms of a gathering called Big Brother was pulled in by Joplin’s soul-filled voice. On June 4. 1966. Joplin formally joined the set. Their first open introduction was in San Francisco at the Avalon Ballroom. Her medication use was kept under control with the guide of her companions who she lived inside a shared level ( Friedman. 1992 ) . They marked an exchange with Mainstream Records on the 23rd of August of 1966. A twelvemonth after. the set discharged their presentation collection by Columbia Records. Joplin and her set a tiny bit at a time picked up big name after a few follow-up open introductions incorporating those in Monterey Pop Festival. visual angles in broadcasting, for example, The Dick Cavett Show. She got positive reappraisals from grouped magazines marking her as an incredible vocalist and a shocking grown-up female of stone and pivotal revolution. At last. she would go forward the Big Brother set and went for a performance calling and would in this way compose a set called the Kozmic Blues and another gathering. which she would name her as her ain called the Full Tilt Boogie Band. In the wake of hindering up again with the set. she recorded a few vocals which would be discharged after her expire and would go the most elevated selling collection of her calling. It incorporated the best hit individual †Me and Bobby McGee† . a screen of Kris Kristofferson’s who had been her ex-sweetheart. Janis Joplin kicked the bucket on October 4. 1970 at 27 years old mature ages. Inheritance Janis Joplin can be considered as the Queen of Rock and Roll in the late sixtiess. She was a music symbol which would follow up on the music scene in the mature ages to come. She was a set up female star who had achievement in a male-prevailing music scene. Fans and melodic specialists moreover would consider her to be as undying and contiunes to follow up on current twenty-four hours music and inventive people. She other than made parts to the way business. The way she dressed herself had been another road for her self-articulation. In meet after meetings. she would refresh the media of her most recent m

How to Develop a Leadership Philosophy that Inspires

How to Develop a Leadership Philosophy that Inspires Think about the most successful leaders in the world, past and present. If you were to compare them with inefficient leaders, the difference wouldn’t necessarily come from their skills. The more important factor would be how the successful leaders would be able to provide you with a clear and defined approach to how they lead other people: their leadership philosophy.In this guide, we’ll define what leadership philosophy is and the benefits of having one. We’ll explore the idea of publishing your statement and provide you the four steps required for creating a leadership philosophy to guide your leadership. WHAT IS A LEADERSHIP PHILOSOPHY?The combination of leadership and philosophy might sound rather odd. On the face of it, the terms don’t seem to have much in common. So, what does leadership philosophy mean? To understand it, it’s a good idea to first examine the two words separately, as it’ll allow you to understand how they can fit together to provide you with guidance in leadership.The definition of philosophyWhen you think about philosophy, you’ll probably first think about some of the greatest thinkers of our time, such as Voltaire, Plato and Descartes. Furthermore, you probably haven’t thought about using philosophy in your everyday life and the concepts and ideas might sound a little bit difficult to comprehend. But as one the oldest disciplines in the world, philosophy has plenty to offer and it’s part of our everyday experience whether we consciously think about it.The word philosophy literally translates to “the love of wisdom”. The Oxford Dictionary defines philosophy as, “a theory or attitude that acts as a guiding principle for behavior”. Indeed, the guiding idea of philosophy is to live a good life. It’s about striving for expertise and personal as well as collective fulfillment. Philosophy could be seen as the personal foundation or belief in human nature; for working to live your life to the fullest. Through philosophy, you create a system of thought to support your journey and obtain the guiding principles to use for action or non-action.Watch the intriguing video by the School of Life to understand why philosophy matters to all of us. The definition of leadershipWhat about leadership’s definition? Just like field of philosophy with its multiple thinkers and theories, leadership has a number of definitions. According to the Oxford Dictionary, the essence of leadership is “the action of leading a group of people or an organisation, or the ability to do this”. But as mentioned, the definitions have evolved out of this t echnical view, with different people viewing the topic through a slightly different viewpoint.At its core, leadership is about the ability to influence other people and to create a movement towards a specific objective. Having a vision to which the team moves forward to is crucial. Furthermore, the emphasis is on inspiration because leadership is not the same as bossing someone around to do what you want. A leader inspires through his or her vision and motivates by leading by example rather than telling and intimidating a desired action.The components of a leadership philosophyThe above definitions might already help you understand the connection between leadership and philosophy. When you combine philosophy, the guiding principles, and leadership, which is the model behavior for inspiring others, you create a theory or an attitude, which provides the norms for behavior and action. The definition is brought to life with four key components, which are:A theory â€" The way you define leadership and what’s it about.An attitude â€" Your mindset in regards of approaching leadership.Guiding principles â€" The principles and values you hold dear when you are thinking about leading others.Behavior â€" The behaviors you showcase in your journey to reach the desired results and outcomes.You could view leadership philosophy as a compass â€" it helps define your expectations, your values and provide the roadmap for actions. With a clear leadership philosophy, you create a focused thought system surrounding your leadership, and you define the behaviors and attitudes you want to cultivate in yourself, but also in others. Leadership doesn’t just provide focus for you personally, but it can allow the people around you to know what to expect from your leadership.Examples of leadership philosophiesJust as there are differences in what philosophers think and divergence in how leadership is defined, leadership philosophies also come in a number of different flavors and styles . Since the framework is based on personal values, leaders can approach it from different angles. There are plenty of options to choose from, but we’ve selected three unique frameworks to provide you an idea of the divergence.Laissez faire leadership philosophyDemocratic leadership philosophyAutocratic leadership philosophyLeader believes followers should have the power to make decisions.Leader believes in empowering followers through increased responsibilities.The framework is effective when followers are knowledgeable.Leader believes that everyone should have equal say within the team.Leader values participation, consultation and consideration.Leader emphasizes co-operation and support.Leader believes results are best achieved in a controlled system.Leader has clear vision, including how and when things should be done.Leader is accountable for the decision-making.You can use these generalized models as guidance for defining your own leadership philosophy. Nonetheless, you should n’t try to copy a specific leadership philosophy. While learning about other philosophies can be a solid way to identify useful qualities, you need to adopt an approach that comes from your heart. Later on in the guide, we’ll provide you with a systematic guide to drawing your unique leadership philosophy.WHY SHOULD YOU HAVE A LEADERSHIP PHILOSOPHY?Leadership philosophy has a foundational element to it. The different components included create a strong basis on which to build on and take your leadership forward. You are better-equipped to lead and to succeed in your leadership with a leadership philosophy due to three core benefits: character, consistency and collaboration.CharacterDrafting a leadership philosophy will provide clarity and focus in your character. Character matters because it influences your everyday decision-making and communication with other people. Without a proper understanding of your character and the traits you truly value, you are more likely to fall int o bad habits and to let emotions control you.By making a conscious decision with the help of a leadership philosophy, you outline the characteristics you want to strive for and which you value in other people as well. In a way, you become better at controlling your behavior and you strengthen the qualities required of a successful leader. ConsistencyThe above benefit directly relates to the second advantage of creating a leadership philosophy: consistency. The most important aspect of the philosophy is setting out and defining your values and objectives.Once you define these, you immediately create more consistency to your behavior and actions. You have guidelines, which help you make decisions and take action. You’ll always use the same defining values at the heart of your decision-making. Let’s assume your leadership philosophy is defined by sustainability.Whenever you are faced with a decision, you will evaluate the options based on how they relate to the value of sustainabil ity â€" Will it hinder or enhance it? This assures your actions and behaviours are consistent. You don’t flip-flop from one value to another, but you stick to your principles.CollaborationLeadership always requires a level of collaboration. Since you need followers to voluntarily to follow you, you can’t expect to achieve much without an understanding and focus on teamwork. Getting along with people will become much easier if you have a clear leadership philosophy to follow.Among the things you need to define with your philosophy is your approach to collaboration. The framework requires careful consideration of engagement, communication and accountability. Defining these, you create more consistency and improve your chances of more meaningful collaboration.People will know what your values are, they understand your approach to teamwork and thus they feel more comfortable because you follow these well-defined patterns of behavior. Essentially, people can trust you because they do n’t need to constantly be on their toes.Overall, leadership philosophy will provide clarity to your leadership. Business strategist and author John Spence has written a good blog post on the topic and in it, he gave a powerful example of the benefits of a leadership philosophy. He used the famous quote by Walt Disney to make a point about why successful leaders need to define the framework for action.The quote says, “When values are clear decisions are easy.” Spence flipped it around stating, “When values are not clear decisions are difficult.” By defining your leadership philosophy, you clarify your decision-making by enhancing your focus on the values and actions that truly matter.PUBLISHING YOUR LEADERSHIP PHILOSOPHYMy Philosophy of Leadership is to surround myself with good people, who have ability, judgment and knowledge, but above all, a passion for service. Sonny Perdue (American Politician)We will outline the four steps to developing a leadership philosophy in the next section, with one of the steps involving writing down your ideas. Before providing you with the format for your written philosophy, we are going to explain why having a published leadership philosophy matters.As you’ll see in the next section a written leadership philosophy statement can be useful in getting to the heart of your true values and ideas. By having a written statement, you are sure to have a reminder of the ideals you want to be pushing towards. But it can be more beneficial to have the leadership philosophy published or at least shared with a few people because it increases your accountability.If you are the only one aware of your leadership principles, you don’t need to worry about others calling you out on doing something against your values since no one has knowledge of them. On the other hand, if you are loosing your sense of direction, a person who has seen your leadership philosophy statement can nudge you back in the right direction. The objectives you want to deliver and the values you want to keep at the heart of your leadership will be known. Even the knowledge that people have access to your statement or your closest friends or mentors know it can be enough to keep you focused on following your path.Aside from accountability, publishing your leadership philosophy will provide another major benefit: the ability to reflect. While the philosophy must naturally be built around your actual values and objectives you want to achieve, bouncing these ideas with another person can provide an invaluable angle to your thinking. The ability to reflect on your ideas and to go them through with another person can add ideas to your thinking you hadn’t thought about before. The way you see yourself will always differ slightly from the experience of others and you can learn a great deal about your characteristics by asking questions from others.If you share your leadership philosophy, you’ll be able to reflect on your ideas from a complete ly different perspective. The feedback can be useful in ensuring your philosophy is the best roadmap for you to move forward. Don’t worry about the feedback being negative; a well-constructed leadership philosophy is sure to inspire others. Overall, the idea behind publishing or sharing your leadership philosophy is all about feedback. If you are criticized consider the words carefully and think whether there is some truth to them.How to publish your leadership philosophy? There are different ways to go about it. You could naturally share with a few close friends or colleagues and ask their opinions. If you have a leadership mentor or a coach, then it’s a good idea to talk about the statement with them. But you could go further than that and have your leadership philosophy on your personal website. This could potentially be a good idea even in terms of career progression, as future employers might get a better understanding of what your leadership looks like.Finally, don’t use publishing the statement just for feedback, ensure you have someone to keep a check on you to ensure you are following your values and objectives.THE STEPS TO DEVELOPING A LEADERSHIP PHILOSOPHYHopefully, the above would have convinced you about the importance of having a leadership philosophy. We’ve talked about the characteristics of the framework, but how do you develop it? Here are the four steps you need to take in order to draft a proper leadership philosophy, which will guarantee you succeed as a leader.Step 1: Define your values and prioritiesThe first, and perhaps the most important part of the process is defining your values and priorities. You need to look deep inside you to discover the values you want to highlight and which you think make leaders great. You need to be able to answer the following questions as part of this step:What are the values I think are the most important in life and business?What are my personal strengths and weaknesses when it comes to values a nd behaviors?What do I feel are the priorities of a leader?But how do you define the core values and priorities? It’s easy to create a list of things you think are important, but you need to dig deeper when it comes to a leadership philosophy. First, you need to actually understand why you think a specific value has value. Second, you can’t have a list of 20 values as this doesn’t truly clarify your position, but instead, you must focus on just a few core priorities. Entrepreneur and author Kevin Daum has written a great post on Inc. on how to define your values. Daum suggests taking the following steps:Identifying the following moments from your life and describing them in detail:Three greatest accomplishmentsThree greatest moments of efficiencyThree greatest failuresThree greatest moments of inefficiencyConsider the above moments and examine the possible common themes between them.Using these common themes, identify the advice/tips you would give yourself. For example, if yo u find yourself avoiding conflict situations, your advice might be “Don’t walk away from difficult situations.”Refine your advice into a value. For instance, the above advice could become “Confront difficulties”Furthermore, once you have these core values and themed outlines, it’s auspicious to take a moment to define them properly. Let’s say you realized ‘authenticity’ is a value you cherish. Define what you mean by it by writing down a few sentences. You can use the formula:“Authenticity to me means…” You can do this with all of your values, whether the value is ‘communication’, ‘family’, or ‘competitiveness’. It is definitely worthwhile doing this all on paper because it will help you better communicate your ideas to yourself.When you’ve selected your values, you need to prioritize them further. If you have around 3-7 values selected, you should consider which ones resonate the most with you or which you think are the most essential in terms of leadership. An effective way to prioritize your values is by comparing them with each other. You can do it by simply taking two values, such as ‘authenticity’ and ‘respect’, and make the following statements with your chosen values:Authenticity but NO respectRespect but NO authenticityWould you pick the first or the second sentence? The value you choose is the one you rank as more important. You can do this prioritization with all of your values by comparing them against each other. You should eventually have a value on top that beat all the others in comparison. Step 2: Define the desirable outcomes you want to achieveAs well as defining your values, you also need to examine the outcomes you wish to achieve as a leader. In order to do this, you need to study the outcomes you want to achieve in the light of your chosen values. First, you should identify the goals for your leadership and the possible operational goals your organization is looking to achieve.What are the ac tions you want to or should achieve as a leader? An auspicious way to set goals is by using the SMART method, described in the image below: Furthermore, once you’ve identified the objectives, you need to outline and write down the actions required to achieve these goals. The actions can range from finding tools to motivate your team to enhance innovation.When you have the goals defined, you must reflect on the ways your values relate to and impact these objectives. You can do this by answering the following questions:How do my values support the key goals of leadership? Remember leadership was about influencing others to follow your vision. You need to pick each value and examine how it would help inspire others and move you closer to your vision. If you value ‘honesty’, then you want to consider how it is demonstrated in influential leadership.How do my values support the operational goals? You should consider the same in terms of the specific organizational objectives you’ve identified.How can my values strengthen the actions required to achieve the objectives? Look at each action and consider the different way s your values would have a positive impact on it. ‘Honesty’ could be seen as a way to strengthen trust, which in turn would boost motivation, for example.How do my values show in the way I communicate with my teams? Think about the above and the positive or negative impact your values, actions and objectives will have on the team. You want to identify the routes that uphold your values, but create a meaningful partnership with your followers.What are the behaviors and actions I expect from my followers? Your followers don’t necessarily have to subscribe to the exact same values as you do or prioritize the values the same way. Nonetheless, you need to consider the behaviors and actions, which are in conflict with the objectives you want to achieve as a leader and as an organization, and the behaviors, which are not sustainable in terms of your own values.The above helps you to clarify what your leadership philosophy should look like in action. It makes the values turn into conc rete examples in terms of behaviors and actions.Step 3: Write down your leadership philosophyWith the above steps concluded, you can start putting your leadership philosophy on paper. We briefly mentioned the importance of having a written statement in the previous section. Writing down your philosophy helps clarify your ideas and makes it all just a bit more concrete. It can improve your focus and help you keep yourself more accountable, since you can always go back and read what you’ve created.To help you write down your leadership format, we propose using the  format below, although you can always just write a document in your own style. The format is based on the four core elements of leadership philosophy: theory, attitude, principles and behavior.Theory: I believe in _________________.Write the specific elements of leadership you believe are at the heart of being a good leader; the values you prioritize. An example sentence could be: I believe in confronting issues head-on i s the key to better communication.Attitude: My thoughts will ___________ and my words will ______________.These sentences refer to the attitudes you want to foster in the workplace; the example you want to set with your own attitude. The aim is to focus on the attitude you think will boost your success as a leader and help to achieve the objectives you’ve set out. You might say, “My thoughts will focus on finding solutions and my words will be based on honesty and integrity.”Principles: I will lead by/with ____________.The focus is on writing down the guiding principles you will use as part of your leadership. These are the top priorities to you as a leader; the principles you won’t negotiate on and which you’ll consider each time you make decisions. You’ll most likely end up writing a few of these and an example sentence might be: I will lead by understanding and embracing change and how situations and people can change over time.Behavior: I expect to ___________ and __ __________ in situations.Finally, you need to write down how you will behave and react in the workplace, no matter what the situation is. The behaviors should reflect your leadership philosophy and highlight the core ideas in action. The identification of your past successes and failures during Step 1 will help with the last point. You could state, “I expect to consider the different options and listen to feedback in challenging situations.”When it comes to drafting the document, there are a few things to keep in mind. First, keep it concise; you don’t want the document to be more than one page. You should be able to state the essence of your leadership philosophy in a few sentences. The other crucial point is to aim for clarity and this is why you also want someone else to have a look at your philosophy.You need to define the philosophy in a manner that will help others to understand it without the need to ask multiple questions. Even if you decide not to publish it, you want at least one person to view it. Aiming for clarity will guarantee you truly understand what you are looking for with your philosophy and this will guarantee you are focused on your intentions.Step 4: Evaluate your leadership philosophyFinally, it’s not enough to write your leadership philosophy and continue with your daily activities; you need to actively evaluate how well you are holding on to your ideals. You must regularly reflect on how well your actions and behaviors follow your statements. Essentially, you need to hold yourself accountable.Take time to review your leadership philosophy and go back to your previous actions. Are you practicing what you preach? What are the things you excel in and which behaviors and actions do you struggle to follow? You could look at these questions each week or every month. Write a list of the major actions you took that week; for example, consider the three successes for the weak and the three possible failures for the week.Reflect on whic h principles you held on to and which actions or behaviors went against what you believe in. As you identify the actions and behaviors where you didn’t follow your leadership philosophy, consider what were the reasons leading to this situation. Why didn’t you remember your philosophy at that moment or why did you reject it? This will help you understand what are the areas where you need to work harder on or even identify the values and priorities that might be unattainable for you.Furthermore, you should occasionally have a chat with people who know you or who work with you. Finding out what they think your guiding principles are can reveal a great deal to you about how they view you and whether your philosophy shows in action. If your followers identify values that are counter to everything you’ve written in your statement, then you are properly doing something wrong as a leader. On the other hand, if people relate values to you, which are at the heart of your philosophy, you get confirmation you are on the right path and achieving success as a leader.As eluded to earlier, evaluating your leadership philosophy will help you realize whether your philosophy is working or not. If it’s not, you need to carefully think about the reasons behind the failure. It might be that you are simply failing in staying true and you need more time to instill these values deeper into your actions. Just continue to be more mindful of your philosophy and think more about the ways you can stick to your principles. But your failures might not be due to lack of motivation.It could well be the actions and behaviors you chose are not truly you and do not fit into your leadership strategy. Therefore, you might have to re-evaluate each value and principle, adding in new ones and removing the ones that don’t reflect your philosophy. Successful leadership is a fluid strategy and the philosophy shouldn’t be too rigid either. As you gain more experience, both in business and in l ife, you will develop and grow as a person. This personal development might well change the way you approach leadership and therefore, you should be willing to make small changes to your philosophy if you feel like it.The video clip below on self-reflection is a valuable watch because it highlights the importance of being more aware of the impact of your decisions. It’s an important lesson to keep in mind when evaluating your leadership philosophy. FINAL THOUGHTSLeadership philosophy is a crucial element, as it acts as the foundation for your leadership. It helps you determine the guiding principles, behaviours and actions you want to put at the heart of your leadership. By carefully considering your values, priorities and objectives, you can create a framework for effective and focused leadership.Having a leadership philosophy creates clarity to your decision-making and your actions, which help you to inspire and to motivate the followers to support your vision. You will be a lea der with a clear mission and way of operating, which makes it easier for people to respect and trust you because they will always know where you are coming from.When it comes to drafting a leadership philosophy the key is to spend time analyzing yourself and writing down the things you believe in and value. Creating a document will ensure you are not only accountable, but can easily remind yourself to focus on the essentials. It ensures you aren’t just thinking about specific actions and behaviors, but to actually implement these in your leadership.Leadership philosophy is often based on intuition, but also a careful examination of what your strengths and weaknesses are. It’s about finding the voice that truly speaks for you rather than pretending to subscribe to things you don’t believe in or can’t achieve.

Biological Oxygen Demand ( Bod ) - 1720 Words

Other Parameters Biological Oxygen Demand (BOD) is also monitored to quantify the amount of oxygen needed to break down organic material in a water sample. BOD was generally higher and more variable at different locations around Abu Dhabi City and in Confined Areas, although mean BOD at all locations was generally lower from 2013–2015 than in previous years for which data are available. Total Suspended Solids (TSS) are solids in water that can be trapped by a filter and may include a wide variety of material, such as silt, decaying plant matter, industrial wastes, and sewage. In general, TSS has been higher in the past 5 years in Confined Areas than at the other stations. TSS has declined since 2011 at all locations except in MPAs, where the annual mean TSS was highest in 2013. Mean TSS in 2015 was highest in May in Confined Areas. Organic pollutants are chemical compounds that contain carbon and have a negative effect on one or more components of the environment. From 2011–2015, EAD monitored marine waters for two organic pollutants: total petroleum hydrocarbons (TPHs) and polychlorinated biphenyls (PCBs). TPHs is a term used to describe a mixture of several hundreds of chemical compounds that are derived from crude oil. Measurable background concentrations of TPH can be a result of excess oil contamination or in some cases the result of a natural petroleum seep. High levels of some petroleum hydrocarbons can cause adverse health effects, including benzene, which is aShow MoreRelatedAssessment Of Bod, Cod As Organic Pollution Indicator Levels Of Varhala Lake Essay1442 Words   |  6 PagesASSESSMENT OF BOD, COD AS ORGANIC POLLUTION INDICATOR LEVELS OF VARHALA LAKE ABSTRACT Lakes are of great importance both from the natural and economic point of view. Lake water is a source of drinking and domestic water supply for people living in and around the area. The present study was conducted to assess the organic pollution indicators like BOD, COD and DO. The sampling of water was based on human and aquatic activities around the lake. Water from five sampling stations of Varhala Lake wasRead MoreImportance Of Water Quality Analysis1596 Words   |  7 PagesAs a follow-up to the request for proposals for obsolete equipment replacement funds, from the Financial Services Division, I have assessed the current Biological Oxygen Demand (BOD) testing equipment used for water quality analysis by the Water Quality Research Laboratory Division. This memo describes the importance of BOD testing in water quality analysis for the lab’s current project with Jordan Vineyard Winery in Sonoma County, the problems the lab is facing using the current testing equipmentR ead MoreEssay On Effluent Discharge Requirements944 Words   |  4 PagesParameter Standard A (mg/L) Standard B (mg/L) COD 50 100 BOD 20 50 AAS: Cu Fe 0.2 1 1 5 TSS 50 100 Ammonia 10 20 Nitrate 20 50 3.1 CHEMICAL OXYGEN DEMAND (COD) COD content reflects the chemically oxidized organic matter. Hence, it includes refractory fractions of organic matter as well as reduced inorganic constituents present in the wastewater. The COD measurement offers quick estimate of carbonaceous material compared to conventional BOD measurement. Additionally, high COD reflects inert reducedRead MoreThe Two Arrangements of Water Quality Parameters753 Words   |  3 Pageshardness, alkalinity, salinity, and temperature are not affected significantly by activities of microorganisms. [30] Ammonia, nitrate, nitrite, total nitrogen, pH, phosphorous, dissolved oxygen, conductivity, total dissolved solids, chemical oxygen demand, and oxygen reduction potential which are affected by biological activity are considered as non-conservative. [30] [31] Now let’s discuss the crucial water quality parameters taking into consideration the importance of monitoring them in an aquacultureRead MoreAccounting Procedures For Problem Evaluation Essay1670 Words   |  7 Pagesfluctuating from 32.56 m3/d to 716.56 m3/d. The influent BOD5 is inconsistent and the average being 855 mg/l at the inlet of the aeration tank. The BOD5 to COD ratio at the inlet of the aeration tank is varying from 0.57 to 0.78, which suggests that the biological treatment provided in the existing treatment plant is justifiable. The overall efficiency is found to be 56.41% only. Hence it may be concluded that the CEPT performance is not in accordance with desired or designed efficiency. Sushil Kumar ShahRead MoreEvaluation Of Proposed Wastewater Treatment Facility For Sand Valley, Nevada3219 Words   |  13 PagesSummary This report provides analysis and evaluation of a newly designed wastewater treatment facility for Sand Valley, Nevada. Analysis will include Biological Oxygen Demand (BOD) along with total, volatile, and fixed suspended solids. Methods for analysis will include the Winkler Test for BOD and a Hatch test for the suspend solids. The report finds BOD levels meet the National Pollutant Discharge Elimination System (NPDES) permit renewal standards. Results for suspended solids shows an oppositeRead MoreA Report On The Buffalo Creek Basin1283 Words   |  6 Pagesselected for statistical analysis. The Biological Oxygen Demand (BOD), is the amount of oxygen consumed by bacteria in the decomposition of organic material. It also includes the oxygen required for the oxidation of various chemical in the water, such as sulfides, ferrous iron and ammonia. While a dissolved oxygen test tells you how much oxygen is available, a BOD test tells you how much oxygen is being consumed. BOD is determined by measuring the dissolved oxygen level in a freshly collected sampleRead MoreSewage Treatment Of Sewage Water Treatment Essay3390 Words   |  14 Pageswater and so on entered as an influent there and get separated to such reach out before it get released in a regular course with the goal that it ought not dirty a water body where it going to release, here fundamentally 5 parameters are checked COD, BOD. The gushing from a plant is release with mind so it ought not influences characteristic course. Sewage Water Treatment Plant to uproot all the synthetic, physical and natural waste present in it. A Sewage Treatment Plant procedure is same as a SepticRead MoreActivated Carbon is Used in Wastewater Treatments940 Words   |  4 Pageswastewater through symbiotic reactions. Several physical, chemical and biological processes occurring within wetlands removes suspended solids (TSS, total suspended solids), organic compounds (BOD, biological oxygen demand), chemicals (COD, chemical oxygen demand), phosphorous, nitrogen, metals and pathogens present in wastewater. Advantages: †¢ Water quality tests on wastewater efï ¬â€šuents from various wetlands in Nepal have shown that TSS, BOD, COD are removed by more than 95%. Similarly, coliform bacteriaRead MoreWaste Water Management1755 Words   |  8 Pagescrisis, both of quantity and quality, caused by continuous population growth, industrialization, food production practices, increased living standards and poor water use strategies. Wastewater management or the lack of, has a direct impact on the biological diversity of aquatic ecosystems, disrupting the fundamental integrity of our life support systems, on which a wide range of sectors from urban development to food production and industry depend. It is essential that wastewater management is considered

The Definition Of Illegal, Unethical And Immoral - 1152 Words

The Definition of Illegal, Unethical and Immoral Definitions are important in any piece of persuasive writing. In particular, it is important that both the writer and the reader understand the particular term that is being defined. This process makes sure that both the author and the reader have the same definitions. This paper attempts to provide definitions for three particular terms: illegal, unethical, and immoral and makes clear distinctions among them. According to the New Oxford American Dictionary, the term illegal refers to â€Å"something contrary or forbidden by law, particularly criminal law†. Although commonly confused with the word unlawful, which means not conforming or adhering to, permitted by, or recognized by law or rules, the term illegal refers to engaging in some sort of action or behavior that is not allowed by law. An example would be a doctor having a phone session with a patient who is in a different state in which the health practitioner has no license and employing the claim code to adjust the session to the insurance company. Immora To understand the term immoral, it is first important to understand the meaning of the word moral, from which the word is derived. From the traditional point of view, the term morals refers to â€Å"accepted principles that determine what is right and wrong behavior in general† (McGregor 262). From this, we can understand Immoral to imply the intentional breach of these generally accepted principles of right and wrong. AnShow MoreRelatedThe Moral Principles Of Business Essay1161 Words   |  5 PagesAs its simplest definition, ethics are a set of moral principles which affect the decisions that people make in every day life. In a sense ethics are the factors which determine what actions are good and moral compared to those that are deemed bad and immoral. Therefore, acting in an â€Å"ethical† way is differentiating between a right or wrong choice and choosing the â€Å"right† one. In terms of business, business ethics are these moral principles guiding the way that a business operates. In order forRead MoreAbortion And The Morality Of It921 Words   |  4 Pagesprocedure deliberately terminating a pregnancy. Abortions usually happen within the first 28 weeks of pregnancy and are considered an outpatient procedure. The first abortion laws were passed by Britain in 1803 and by 1880 most abortions in the U.S. were illegal, except for those that were performed to save the life of a woman. This exception to the rule gives insight into the battle that exists today and the ethical debate of abortion. 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Case Analysis of Mdd, Gad, and Substance Use Free Essays

string(98) " shown that the presence of a comorbid anxiety disorder may make MDD harder to resolve or manage\." Case Analysis of Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Substance Abuse Nicole Gapp University of Minnesota School of Nursing Case Analysis of Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Substance Abuse Major Depressive Disorder (MDD) is a mood disorder with symptoms that greatly affect the life of the individual. MDD could in fact be called a public health crisis, as it is projected that it will soon overtake heart diseases as the major worldwide health concern (Boyd, 2008). Diagnostic criteria for MDD are depressed mood or loss of interest or pleasure in nearly all activities, present for at least 2 weeks. We will write a custom essay sample on Case Analysis of Mdd, Gad, and Substance Use or any similar topic only for you Order Now Findings and behaviors associated with MDD are disruption of sleep, suicidal ideation, feelings of worthlessness and hopelessness, and fatigue and loss of energy. MDD is also associated with a high impairment in occupational, social, and physical functioning, causing as much disability and distress as chronic medical disorders (United States Department of Health and Human Services, 1999). MDD has been shown to be associated with increased medical illnesses. MDD can make everyday living a challenge, as research shows that depressive symptoms are associated with impaired everyday problem-solving ability directly and indirectly mediated through learning and memory, and reasoning (Yen, Rebok, Gallo, Jones, Tennstedt, 2011). It is important for MDD to be identified and treated early on, as MDD that is not treated appropriately results in recurrent depressive episodes, with each successive episode increasing in severity. As MDD is highly associated with suicidal ideation and suicide, it is imperative that MDD be treated to ensure patient safety. Risk factors for MDD are a prior episode of depression, lack of social support, lack of coping abilities, medical comorbidity, substance use, and presence of life and environmental stressors. In addition, major depression may follow adverse or traumatic life events, especially those that involve the loss of an important human relationship or role in life. Social isolation, deprivation, and financial deprivation are also risk factors (APA, 2002). Genetics play a role in the development of MDD, and deficiency or dysregulation of neurotransmitters are also thought to play a part in its etiology. Psychological theories of MDD hypothesize that an early lack of love and warmth may be involved with the development of depressive symptoms, while developmental and family theorists have proposed that parental loss, emotionally inadequate parenting styles, or maladaptive patterns in family interaction may contribute to the etiology of MDD. Women are twice as likely as men to be diagnosed with MDD, though it is believed that the incidence in men is under-diagnosed. Prevalence rates are unrelated to race (Boyd, 2008). Nursing responses to MDD should involve interventions to treat symptoms within the biologic domain, such as changes in appetite, weight, sleep, or energy, as well as symptoms within the psychological domain, such as changes in mood and affect, thought content, suicidal behavior, and cognition and memory. Many types of interventions are used to treat the varied effects and symptoms of MDD. Pharmacologic interventions, such as selective serotonin reuptake inhibitors, tricylic antidepressants, monoamine oxidase inhibitors, and other classes of antidepressants may be used to decrease or manage depressive symptoms. Medication should be continued for at least six months to a year after complete remission of depressive symptoms. Lifestyle patterns, such as good sleep hygiene, activity and exercise, and adequate intake of well-balanced meals should also be encouraged, as these patterns help the client move toward a healthy daily routine that supports remission or recovery. Psychotherapy, such as cognitive therapy, behavior therapy, and interpersonal therapy, has been shown to be effective in individuals with MDD, and a combination of psychotherapy and pharmacotherapy is recommended for patients with severe or recurrent MDD as a strategy to prevent relapse (Boyd, 2008). In addition, electroconvulsive therapy has been shown to be an effective treatment for MDD, especially severe MDD that has not responded to medications. Major depression frequently occurs in conjunction with ther psychiatric disorders, such as anxiety or substance use disorders, which can also affect antidepressant responsiveness. In such cases, the co-occurring mental health problem should be treated in addition to major depression (President and Fellows of Harvard College, 2011). The patient described in this case analysis has comorbid diagnoses of generalized anxiety disorder and substance abuse. Generalized Anxiety Disorder is a psychiatric disorder characterized by excessive worry a nd anxiety with an insidious onset. The anxiety of GAD persists for at least six months, with excessive anxiety and worry occurring for more days than not, and for some individuals, persisting daily. Risk factors for GAD are thought to be unresolved conflicts, cognitive misinterpretations, and multiple stressful life events (Boyd, 2008)). Few studies have examined the genetic basis of GAD, but it is thought to be moderately heritable. In clinical settings, the incidence of GAD is equally distributed in women and men. However, in wider studies GAD is twice as common in women. In no studies has the prevalence of GAD been related to race (Boyd, 2008). Patients with GAD often have associated depressive symptoms, and MDD is a common comorbid disorder. For this reason, there has been debate surrounding whether GAD is a separate disorder than MDD, or if GAD symptoms are part of the course of MDD. However, research shows that many patients with GAD do not present with a distinct MDD symptom profile. This does not support the hypothesis that co-morbidity between MDD and GAD is artificially inflated because of the similar symptom criteria required by the current diagnostic system. Instead, MDE and GAD may be thought of as two distinct diagnostic entities that frequently co-occur because of a shared underlying trait (Sunderland, Mewton, Slade Baillie, 2010). Current diagnostic criteria state that GAD exists when the excessive worry does not occur exclusively during a mood disorder, psychotic disorder, or pervasive developmental disorder. For example, a patient who experiences persistent excessive anxiety but has minimal or no depressive symptoms would be diagnosed with GAD (Boyd, 2008). However, research has shown that the presence of a comorbid anxiety disorder may make MDD harder to resolve or manage. You read "Case Analysis of Mdd, Gad, and Substance Use" in category "Essay examples" One particular study comparing individuals with MDD and individuals with MDD and a comorbid anxiety disorder showed that after adjusting for the severity of depression, those in the anxious depression group had significantly younger onset age, had been suffering from depression for a longer period, were more likely to experience a recurrence, and obtained lower scores on a scale assessing quality of life. The anxious depression group was also characterized by a significantly higher proportion of individuals reporting significant suicidal ideation and previous suicide attempts (Seo, Jung, Kim, T. , Kim, J. Lee, Kim, J. Jun, 2011). Patients with GAD are often highly somatic, with many complaints of physical symptoms. One study concluded that painful physical symptoms in patients with GAD are twice as prevalent as in the control group, which consisted of individuals with neither GAD nor MDD. The presence of comorbid MDD was associated with a significantly higher prevalence of painful p hysical symptoms. Painful physical symptoms were significantly associated with functioning and health status impairment both in GAD alone and in GAD and comorbid MDD compared with controls (Romera, Fernandez, Perez, Montejo, Caballero, F. Caballero, L. , Arbesu Gilaberte, 2010). In addition, those with GAD also often experience poor sleep habits, irritability, and poor concentration. Patients with GAD often feel frustrated, demoralized, and hopeless. They often feel restless and on edge and experience clinically significant distress or impairment of functioning resulting from anxiety, worry, or physical symptoms. GAD has a significant negative impact on work functioning, although smaller than the effect of MDD (Plaisier, Beekman, de Graaf, Smit, van Dyck Penninx, 2010). Interventions addressing symptoms of the biologic domain include eliminating caffeine, diet pills, amphetamines, ginseng, and ma huang, which have all been shown to be anxiety-producing substances (Boyd, 2008). In addition, good sleep hygiene should be promoted, as a common symptom of GAD is sleep disturbances. The nurse should teach the patient breathing control and progressive muscle relaxation as calming techniques, help the patient identify other positive coping strategies, and educate the patient on time management. Pharmacological interventions, such as the use of benzodiazepines, certain antidepressants, and other non-benzodiazepine anxiolytics may be effective in reducing anxiety. Roughly 75% of those with GAD have at least one additional current or lifetime psychiatric diagnosis, with MDD being one of the more common comorbidities. Alcoholism is also a significant problem associated with GAD. Patients may use alcohol, anxiolytics or barbiturates to relieve anxiety, and this may lead to abuse and dependency. Such is the case of the patient described in the case analysis, who also has a substance-related disorder. The DSM-IV-TR defines substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress. This impairment may be manifested by recurrent use, resulting in failure to fulfill major role obligations at work or home, recurrent use in situations that are physically hazardous, recurrent substance related legal problems, or continued use despite feeling persistent or recurrent effects of the substance. To constitute substance abuse, three or more of these manifestations must be present within a 12-month period. In general, men consume more alcohol and abuse drugs more than women, though women are more likely to abuse prescription medication. Substance abuse and dependency are not correlated so much with gender as with an early age of initiation of substance use (Boyd, 2008). Comorbid mental disorders occur often with substance dependence and abuse. For some, comorbid mental disorders are byproducts of long-term substance abuse. Other people have mental conditions that predispose them to substance abuse, with substance abuse becoming a comorbid problem as they use drugs and/or alcohol to self-medicate existing mental illnesses. There is a well-documented association between depression and alcohol abuse and dependence which cannot be explained solely by the random overlapping of these two conditions. A systematic review of 35 studies estimated the prevalence of current alcohol problems in depressed patients to be 16%, as compared to 7% in the general population. The three most commonly described causal hypotheses for this comorbidity are as follows: 1) an independent depressive episode (e. g. he self-medication theory), 2) alcohol induced depressive symptoms and 3) the existence of shared biological and environmental factors that predispose persons to both (Cohn, Epstein, McCrady, Jensen, HunterReel, Green Drapkin, 2011). In addition, men with at least four heavy drinking occasions were found to be 2. 6 times as likely to be classified as being depressed as men who drank heavily less than four times in the previous 28  days (Levola, Holopainen Aalto, 2011). Specific substances that have been abused by th e patient who is the subject of this analysis are alcohol, cocaine, heroin, and the prescription drugs oxycodone and Valium. At the time of admission, the patient was no longer regularly using drugs or alcohol, but his history of substance abuse, including overdose, is extensive. Thus, although the patient is already withdrawn from drugs and alcohol, his long-term substance use has significant physical and mental consequences. The depression of the central nervous system by alcohol causes relaxed inhibitions, heightened emotions, mood swings, and cognitive impairments such as reduced concentration and attention, and impaired judgment and memory. In particular, this patient engages in periodic binge drinking, drinking up to 15 drinks in one evening. This alcohol use would result in several days of intoxication, which were interspersed with periods of sobriety. The amount of alcohol consumed in an episode of binge drinking can cause severely impaired motor function and coordination difficulties, emotional lability, stupor, disorientation, and in extreme cases, even coma, respiratory failure, or death. Long-term abuse of alcohol can adversely affect all body systems, and research has shown a connection between alcohol dependence and increased risk for diabetes mellitus, gastrointestinal problems, hypertension, liver disease, and stroke (Smith Book, 2010). Cocaine users typically report that cocaine enhances their feelings of well-being and reduces their anxiety. However, long-term cocaine use leads to increased anxiety. Severe anxiety, restlessness, and agitation are all symptoms or cocaine withdrawal. Withdrawal causes intense depression, craving, and drug seeking behavior that may last for weeks (Boyd, 2008). Valium, a benzodiazepine, is a prescription drug that this patient abused. Patients who abuse benzodiazepines often feel hyperactive or anxious after using them. Often, patients who abuse these drugs combine them with alcohol, putting the patient at risk of coma or death. Symptoms during benzodiazepine withdrawal include anxiety rebound, such as tension, agitation, tremulousness and insomnia, as well as symptoms of autonomic rebound, sensory excitement, motor excitation, and cognitive excitation, such as nightmares and hallucinations (Boyd, 2008). Opiates are powerful drugs that can quickly trigger addiction when used improperly. Heroin is an opiate that was abused by this patient. Heroin is the most abused and most rapidly acting of all opiates. It can be injected intravenously, and such was the method of delivery for this patient. Heroin produces profound degrees of tolerance and physical dependence. Withdrawal from opiates should be tapered, and if abruptly withdrawn from someone dependent on them, severe physical symptoms may occur, along with nervousness, restlessness and irritability (Boyd, 2008). In addition to heroin use, the patient attempted to commit suicide by overdosing on oxycodone, a prescription opiate. Overcoming substance abuse and preventing relapse can be especially difficult as denial is common in substance abusing patients. Denial is defined as the patient’s inability to accept his loss of control over substance use, or to accept the consequences associated with the substance use (Boyd, 2008). Because many patients find it difficult or impossible to believe they have a serious problem with drugs and alcohol, many do not seek treatment, or stop treatment prematurely. Motivation is a key predictor of whether individuals will change their substance abuse behavior. Several effective modalities are used effectively to treat addiction, such as 12-step programs, social skills groups, psychoeducational groups, group therapy, and individual and family therapies. Depending on the individual, different treatment techniques will be more or less helpful. History of Present Illness The patient is a 58-year-old Caucasian male who was participating in a partial hospitalization program (PHP) at Hennepin County Medical Center (HCMC) for the treatment of severe major depressive disorder. He has been involved in PHP since his last discharge from the HCMC psychiatric inpatient unit in early March. The patient was cooperative with treatment and medication compliant. He was put on a 72-hour hold after becoming angry and hostile during the PHP group and threatening to hang himself that evening when he got home from PHP. He eventually committed himself voluntarily to the HCMC psychiatric inpatient unit. Upon introduction, the patient appears to be clean, casually dressed, and of normal weight. He is alert and oriented. His attention, cognition, and abstract reasoning are intact, and his thought content is appropriate and organized. In conversation, he is pleasant and cooperative, exhibiting a stable mood and a slightly blunted affect. The patient will talk to staff members but interacts minimally with peers and does not attend groups unless encouraged by staff. The patient has a normal gait but moves quite slowly. In addition it appears that his thought processes are slowed, as he is slow to respond during conversation and seems to have difficulty finding the words to express what he wants to say. The patient appears to have intact recall, short-term, and long-term memory. He appears to be an adequate historian though he exhibits poor judgment due to his depressive and anxious symptoms, as evidenced by his extensive history of drug and alcohol abuse and dependency. The patient has psychiatric diagnoses of severe and recurrent major depressive disorder, generalized anxiety disorder, and polysubstance abuse. The patient has been suffering from MDD with chronic suicidal ideation since age 15. His first suicide attempt was at age 15, and he began abusing drugs and alcohol at approximately the same time. His extensive history of substance abuse includes use of alcohol, cocaine, and IV heroin. His alcohol abuse as a teenager led to a DWI charge. He has participated in mental health outpatient treatment and has undergone chemical dependency treatment numerous times. He completed high school without apparent difficulty. The patient seems to be of average intelligence, though his IQ is not listed in the record. He does not have a history of violent or sexual crime. He has a history of five suicide attempts. He began smoking as a teenager and currently smokes one pack of cigarettes per day. In 1983, the patient married and remained so until his wife died 25 years later, in 2008. He had no children. According to the patient, he was happily married, and he called his relationship with his wife â€Å"the best thing that has ever and will ever happen to me. † While he was married, he got completely clean from drugs and alcohol, remaining drug free and sober for 12 years. Though he struggled with episodes of depression and suicidal ideation, he was able to manage his symptoms with medication and mental health outpatient treatment. Most of my problems faded into the background,† said the patient. During this time, he and his wife bought a condo, and the patient was employed as a janitor and handyman, working at the Minneapolis-Saint Paul airport. He remained at this job for over a decade and was promoted to the position of supervisor. He had, as he said â€Å"everything I ever wanted. † In 2007, his wife became very ill and eventually died in 2008 after co mplications from a surgery intended to prolong her life. The patient reports that as his wife got sicker, he became increasingly depressed. Unlike in the previous 12 years, medication and outpatient treatment did not seem to manage his symptoms. In addition, he started experiencing extreme and persistent anxiety, feeling â€Å"like I was always one second away from a panic attack. † He was diagnosed with generalized anxiety disorder and was prescribed benzodiazepines to manage this condition. As his wife got sicker, he slowly began to self medicate with alcohol and admitted to â€Å"popping an extra pill† occasionally to decrease his anxiety. When his wife died, the patient became so depressed and anxious that he was unable to concentrate at work. He had to give up his job as a supervisor, and said, â€Å"I couldn’t even manage myself, how was I supposed to handle anyone else. † As his depression and anxiety got worse, he turned increasingly to alcohol and drugs. He reported binge drinking, consuming up to 20 drinks in one evening. He would remain intoxicated for several days, and would switch to using drugs as the alcohol cleared his system. He reported being either drunk, high, or both almost every day. Although he used cocaine and heroine, which were the drugs he used as a teenager, he also became dependent on prescription benzodiazepines to manage his increasingly severe anxiety. The increase in anxiety may be explained by his cocaine use, which, though it reduces anxiety while high, causes increased anxiety with long term use. Additionally, though proper use of benzodiazepines decreases anxiety, benzodiazepine abuse or dependency results in increased anxiety levels. When his request for more prescription benzodiazepines was denied due to drug seeking behavior, he gained possession of Valium illegally and continued abusing them. He was arrested for illegal Valium possession in 2009, and received two DWIs between 2008 and 2011. His medical record notes that he has a history of antisocial behavior, though it does not expand on this statement beyond the mention of his previous arrests. With no income coming in and increasing amounts of money used to fuel his drug and alcohol addiction, he lost his condo and all of his savings and was living at the Salvation Army homeless shelter by June 2008. His depression grew in severity as the major life losses piled up and his substance dependency problem worsened. In 2008, he lost consciousness due to heroin intoxication. In August of that year, the patient overdosed on oxycodone, intending to kill himself. He was brought to HCMC, and for the past several years has experienced being in and out of the psychiatric inpatient. In 2010, he moved from the homeless shelter to Alternative Homes in Minneapolis. Following his latest psychiatric hospitalization in March, he began the partial hospitalization program at HCMC. Upon discharge from the current hospitalization, he will be returning o Alternative Homes and participating again in the PHP program. A common finding associated with a diagnosis of either MDD, GAD, or substance abuse is the presence of sleep disturbances. Such is the case with the patient described. These sleep disturbances may present themselves as difficulty falling asleep, trouble maintaining sleep, or waking up too early (National Insititute of Health, 2005). This patient currently experiences insomnia, getting only 3-4 hours of sleep per night. Reportedly, this insomnia has been a chronic issue. The insomnia the patient experience sets him up for a negative cycle. Because of his depression and anxiety, it is difficult for the patient to sleep. This lack of sleep, in turn, exacerbates his anxiety and depressive symptoms. As his symptoms progress in severity, he turns to substances to self medicate. The use of substances results in a worsening of his insomnia. Thus, finding a way for the patient to get adequate sleep is important. He has tried a variety of medications to promote sleep, but none have been effective. He can no longer be prescribed many of the medications for insomnia because of his history of abuse and overdose using prescription drugs. Thus, the options available to him for sleep promotion lie in the realm of sleep hygiene promotion. The patient might also consider participating in a sleep study, as this may reveal additional factors that prevent him from getting the sleep he needs. In addition to his mental illnesses, the patient also has significant medical problems. He has been diagnosed with hypertension, hepatitis C, diabetes mellitus, osteoarthritis of the left shoulder, and acid reflux. Research shows that diabetes mellitus, gastrointestinal problems, hypertension, liver disease are correlated with substance abuse (Moffitt, Caspi, Harrington, Milne, Melchior, Goldberg Poulton, 2010). Indeed, the patient’s hepatitis C is a direct consequence from his use of street drugs. Interestingly, multiple studies have revealed that not only are depressive symptoms a risk factor for the development of type 2 diabetes, but they have also been shown to contribute to hyperglycemia, diabetic complications, functional disability and mortality among diabetic patients (Moffitt et al. 2010). Also, as previously discussed, patients with GAD and MDD report more painful physical symptoms than the general population, and the patient’s osteoarthritis pain could well be exacerbated by the presence of these psychiatric conditions. Thus, it is possible that with improved management of his psychiatric conditions, his medical problems may improve as well. Family and Social History The patient’s social and family history is somewhat lacking. The patient was adopted at a young age. He has three non-biological brothers and he reports that he is estranged from all of them, and is not willing to contact them until he has â€Å"my life back together. † In addition, both of his adoptive parents are dead. The patient was not keen on discussing his adoptive family or his childhood and adolescence, but stated that this adoptive family â€Å"were good people, and tried hard to give me everything I needed. † He denies any history of physical, emotional, or sexual abuse. According to the social history, there is no history of mental illness in his adoptive family. This does not mean that environmental or social factors play no role in the etiology of his mental illness, but that these factors may be less obvious. Information on the patient’s biological mother and family history is unavailable. The patient was given up for adoption at birth, and remained a ward of the state, living in various foster homes, until he was adopted at age 3. As the patient was given up for adoption and adopted at such a young age, he has he has no recollection of his biological family or his time in the foster care system. Any instances of abuse, neglect, or trauma in his early years are thus unknown. Because there is no available family history, it is impossible to know if any of the patient’s first-degree relatives suffered from mental illnesses, or if the biological mother used drugs or alcohol during her pregnancy. This lack of information is unfortunate, as it is impossible to conjecture whether, or to what degree, the patient’s mental disorders have a basis in genetics or in disturbed fetal development. Because MDD, GAD, and substance abuse have all been shown to have a moderate to high degree, of heritability, it is very plausible that mood, anxiety, or substance related disorders were present in his biological family. The patient seems to have very limited social support, as he is estranged from his adoptive siblings and has no communication with his biological family. The patient also has a history of limited social interactions and close friendships. He reports that he has felt disconnected from others for as long as he remembers, and that he had few close friendships throughout his childhood, adolescence, and adulthood. In addition, the patient reports that most of the relationships that he would call the closest have been with people who have substance abuse problems, as he spent â€Å"years and years running with the wrong crowd. † The basis of most of these relationships was a shared interest in drug and alcohol use, and he does not think that these friends would be of any support to him in pursuing and maintaining recovery. During the time that he was sober, he states that his wife was â€Å"the only friend I really needed† and as a result, he did not form many close friendships with his peers. He states that he currently has no supportive relationships. Furthermore, he has little desire to form such relationships. Application of Developmental Theories Viewing the patient and his family and social history through the lens of attachment theory provides a possible framework for viewing the patient’s development of mental illnesses. Attachment theory, a biologically based framework first proposed by John Bowlby in the mid 1950s, is the theoretical approach used to describe the importance of stable and secure relationships of all infants, especially those in foster care (Bruskas, 2010). This theoretical approach reasons that infants and children have a need to belong and to experience secure relationships with a small number of consistent â€Å"preferred† primary caregivers in order to successfully develop into normal healthy adults who can actively and emotionally participate in social life (Boyd, 2008). In particular, a child should receive the continuous care of this single most important attachment figure for approximately the first two years of life. If the attachment figure is broken or disrupted during the critical two year period the child will suffer irreversible long-term consequences of this deprivation, which might include delinquency, reduced intelligence, increased aggression, depression, and affectionless psychopathy–an inabilityto show affection or concern for others. Research, such as the Adverse Childhood Experiences Study, correlates untreated childhood adversity with an increased risk toward poor developmental health and other major diseases seen later in life such as cardiac disease, depression, and even premature death (Felitti Anda, 2010). Studies reveal that infants in foster care are among the most vulnerable because of their complex and immense brain development, and the importance of attaining developmental milestones. The onset of brain development begins soon after conception and will continue to mature well into adulthood, but the most abundant and dramatic time of growth is during the first few years of life, specifically within the first three years. The primary and most important developmental milestone for any infant is to establish a relationship, especially one with a primary caregiver. This period presents sensitive â€Å"windows of opportunity† for the development of particular parts of brain structure and circuitry influenced and dependent on social experiences for optimal brain development (Bruskas, 2010). The majority of children entering foster care are infants, and the impact of not addressing mental health needs of preverbal children can have deleterious effects (National Research Council Committee on Integrating the Science of Early Childhood Development, 2000). Although an infant may not be able to articulate losses because of their preverbal age, they nonetheless experience grief and loss, and for many, these experiences will be forever embedded in their memory (Felitti Anda, 2010). Moreover, the consequences of unresolved losses have a much more devastating affect in infancy than adulthood because of the potentially permanent psychological impact on the developing brain of an infant or child (Bruskas, 2010). Infants and children in foster care who are not afforded supportive primary caregivers to help them develop an internal ability to regulate their own will continue to use whatever coping methods they can. Under stress-provoking adversities such as abuse, neglect, and relationship disruptions, children’s coping strategies to manage such circumstances may present as hostility, frustration, and anxiety with underlying feelings of fear, abandonment, and powerlessness (Bruskas, 2010). The relationships infants and children develop while in foster care are crucial; relationships characterized by trust and commitment help an infant or child become more resilient toward the challenges and obstacles that all humans face in life; conversely, a lack of such relationships in life can result in long-term dysfunction socially and physically. Attachments and â€Å"templates† of the world are significantly developed by the time a child reaches a year old (Bruskas, 2010). Efforts to address behavioral problems later in life may prove to be more difficult and costly as brain structure becomes permanent and behavior becomes more difficult to change. Due to the patient’s experience of foster care as an infant and toddler, it is likely that he was unable to form a secure attachment with a primary caregiver. Although this disruption in attachment is not the sole contributor to his problems with depression, anxiety, and substance abuse, it is very possible that the chaotic structure of his early years play a large role in the development of these conditions. Applying the concepts of Erikson’s model of psychosocial development allow for a greater understanding of the patient’s current state. Because of the disruption of relationships early in life, the patient may not ever have resolved the developmental conflict of basic trust vs. mistrust, which is often resolved in infancy. This may be one reason behind his feeling of disconnectedness from others. According to Erikson, this inability to resolve this developmental conflict results in a decreased sense of drive and hope. It is also likely that the patient was able to resolve the developmental conflict of autonomy vs. hame and doubt, which is often resolved in toddlerhood (Boyd, 2008). This may explain the patient’s reliance on his wife as the sole supportive relationship in his life, as well as his fast descent into previous behaviors after his wife’s death. As the patient was never able to develop a sense of autonomy, it seems that he became extremely emotion ally dependent on his wife. Because of this relationship, he was able to progress at his job and maintain his recovery. However, with the death of his wife, he was brought back to the conflict of autonomy vs. shame and doubt. Really, it was through the presence of his wife that he was able to take initiative, be industrious, and have an intimate relationship, all of which are successful outcomes of developmental conflicts. The marriage provided him with hope, purpose, a sense of devotion and fidelity, as well as affiliation and love. In short, it seems that his wife was his mental and emotional anchor. The recurrence of symptoms of his mental disorders after the loss of the anchor of his life threw him back into the early developmental conflicts that he was unable to resolve due to his unstable childhood. According to Erikson, in order for the patient to move forward from his regressed state he must tackle and resolve the conflicts of trust vs. mistrust, autonomy vs. shame and doubt, initiative vs. guilt, industry vs. inferiority, identity vs. role diffusion, and intimacy vs. , isolation to reach the adulthood stage of generativity vs. stagnation. Ultimately, with the resolution of all these conflict, the patient will reach a mature state in which he is able to attain ego integrity instead of falling into despair. Patient Prognosis and Treatment Recommendations It is important to remember that the patient was seeking help and trying to recover prior to his most recent hospitalization. He was enrolled in and regularly attending the partial hospitalization program. In addition, he was no longer abusing drugs or alcohol. PHP staff report that he had been medication compliant, cooperative, and was motivated to change. The patient’s recent hospitalization was precipitated by a change in drug dose and type. He reported that it was only after the medication change that the suicidal ideation intensified. Thus, an important goal for this patient is to find the drug types and dosages that will successfully manage his depression and anxiety. However, because the patient has such an extensive history of addiction, primary care providers are hesitant to prescribe large dosages of often highly addictive medications. This hesitation is especially understandable given the patients past abuse of prescription drugs, including an overdose with the intent to commit suicide. However, the types and dosages of the drugs he is currently receiving are not enough to manage his symptoms. The severity of the patient’s depression and anxiety necessitates the use of powerful antidepressants and anxiolytics, but his past substance abuse and dependency make the prescription of these drugs a last resort. Appropriate pharmacotherapy is also complicated by the fact that this patient has tried various classes and types of drugs to manage his symptoms, but no drug therapy has been effective enough to prevent the periodic recurrences of major episodes of depression and anxiety. To manage his depression, the patient has tried typical and atypical antipsychotics, anticonvulsants, tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors, as well as other classes of antidepressants, such as Serotonin Norepinephrine Reuptake inhibitors, Norepinephrine Dopamine Reuptake Inhibitors, Alpha-2 Antagonists, and Serotonin-2 Antagonist/Reuptake Inhibitors. Although the apparent failure of all these drugs to manage his depression might cause one to suspect that he is exhibiting purely drug seeking behaviors, the depressive symptoms he xperiences impair and affect him so severely that a denial of the reality of these symptoms would be unsafe and unethical. Electroconvulsive therapy has been recommended to treat his depression, but the patient has refused to undergo this treatment modality. The patient’s anxiety is more easily managed than his depression, and benzodiazepines have proven effective. However, his past abuse o f benzodiazepines make his primary care providers reluctant to give them to him, and they have prescribed non-benzodiazepines, such as Buspar and Zolpidem, instead. Unfortunately, these medications have not been effective in controlling the patient’s anxiety. As a result, the patient has been asking repeatedly for benzodiazepines, while promising that he will use them responsibly. Ultimately, for the patient to achieve effective maintenance of his comorbid mental disorders, he must be able to take medications as prescribed. Due to his history of substance abuse and his still unstable depression and anxiety, it is unlikely that the patient will be able to take his medications as prescribed. It is recommended that a staff member have control of his drugs while he is attending the PHP, and that once discharged, a home health nurse be sent to administer his medication. This would reduce the potential for abuse. In addition, the use of coping mechanisms besides substance abuse may help the patient adhere to the prescribed drug regimen, as well as decrease his depression and anxiety. Coping skills the patient has identified as helpful are watching television and spending some quiet time alone. However, interaction with others should also be encouraged, as too much time spent alone will only reinforce depressive symptoms of isolation. An increase in the quantity and quality of sleep will also aid the patient in his recovery, as sleep deprivation is positively correlated with depressive symptoms and anxiety levels. The patient’s prognosis is one of cautious hopefulness. Though the patient has experienced severe recurrences of MDD, GAD, and substance abuse in recent years, the patient had maintained a long period of sobriety prior to this, during which he was happy, productive, and high functioning. The patient’s ability to achieve remission from his mental illnesses during his marriage to his wife shows that investing in a supportive relationship is an important and powerful coping skill for this patient. Thus, if the patient is able to form and maintain new supportive relationships, his chance of recovery will improve substantially. It is also important to remember that he was doing very well until his wife died. According to the Holmes and Rahe Index, the death of a spouse is the number one most stressful event that occurs in the life of an individual (Perry Potter, 2009). It is not an exaggeration to say that with his wife’s death, life as he knew it ended. Many people experience periods of long and severe depression following the death of a loved one. For this patient, his descent into depression, combined with the resurgence of his anxiety sent his life into a complete tailspin. Under the severe stress of not only his wife’s death but also his inability to keep working, he returned to his former coping mechanisms of drug and alcohol abuse. These habits detracted him from working through the grief of his wife’s death, and furthermore caused him to lose his house and his savings, thus increasing his depression and anxiety, thus perpetuating the substance abuse. Now that the patient has withdrawn from drugs and alcohol and is in a safe environment, he can continue his grief work. As a result, his depression may begin to subside, and he may be able to get closer to his previous level of functioning. DSM-IV-TR Axis I: Major Depressive Disorder, Generalized Anxiety Disorder, Polysubstance Abuse Axis II: Cluster B traits Axis III: Hypertension, Hepatitis C, Diabetes Mellitus, Type 2, Osteoarthritis of the left shoulder, Acid Reflux, Bilateral hearing loss Axis IV: Chronic mental illnesses, chronic medical conditions, death of spouse, family estrangement, lack of social support, unemployment, financial insecurity, acute hospitalization, Axis V: 35 (current), 75 (potential) Patient Goals: †¢ I want to find medications that will help my depression and anxiety †¢ I want to keep from abusing my medications †¢ I want my grief over my wife’s death to get better †¢ I want to take one day at a time †¢ I want to feel less alone †¢ I want to get better sleep Nursing Goal: Patient will be safe during hospital stay. Interventions: †¢ Assess for suicidal ideation every shift. †¢ Perform rounds every 15 minutes to ensure patient safety. †¢ Ensure that the patient has no access to potentially harmful objects and/or substances. †¢ Observe, record, and report any changes in mood or behavior that may signify increasing suicide risk and document results of regular surveillance checks. Nursing Goal: Patient will seek help in dealing with grief-associated problems. Interventions: †¢ Develop a trusting relationship with the client by using empathetic therapeutic communication (Eakes, Burke Hainsworth, 1998). Educate the client that grief resolution is not a sequential process and that the positive outcome of grief resolution is the integration of the deceased into the ongoing life of the griever (Matthews Marwit, 2004). †¢ Identify available community resources, including grief counselors and community or Web-based be reavement groups. †¢ Focus on enhancing coping skills to alleviate life problems and distressing symptoms such as anxiety and depression. Nursing Goal: Patient will practice social and communication skills needed to interact with others. Interventions: †¢ Discuss causes of perceived or actual isolation. Assess the patient’s ability and/or inability to meet physical, psychosocial, spiritual, and financial needs and how unmet needs further challenge the ability to be socially integrated. †¢ Use active listening skills to establish trust one on one and then gradually introduce the patient to others. †¢ Provide positive reinforcement when the patient seeks out others. †¢ Encourage the client to be involved in meaningful social relationships and support personal attributes (Gulick, 2001). Nursing Goal: Patient will use effective coping strategies instead of abusing drugs and alcohol. Interventions: †¢ Assist the client to set realistic goals and identify personal skills and knowledge. †¢ Use verbal and nonverbal therapeutic communication approaches including empathy, active listening, and confrontation to encourage the client to express emotions such as sadness, guilt, and anger, verbalize fears and concerns, and set goals. †¢ Offer instruction regarding alternative coping strategies (Christie Moore, 2005). †¢ Encourage use of spiritual resources as desired. Nursing Goal: Patient will identify actions that can be taken to improve quality of sleep. Interventions: †¢ Obtain a sleep-wake history, including history of sleep problems, changes in sleep with present illness, and use of medications and stimulants. †¢ Encourage the patient to develop a bedtime ritual that includes quiet activities such as reading, television, or crafts. †¢ Encourage the patient to use soothing music to facilitate sleep (Lai Good, 2005). †¢ Teach the patient sleep hygiene guidelines for improving sleep habits (ie. go to bed only when sleepy, avoid afternoon and evening naps, use the bed only for sleeping, get up at the same time every morning). Use relaxation techniques to decrease anxiety before going to sleep. †¢ Refer to a sleep center if interventions are ineffective. Analysis of Interaction Before interacting with the patient, I read the patient’s medical record and notes. I paid particular attention to ways the patient said he learned best, which for my patient was one on one conversation. Prior to approaching the client, I asked myself if I had any beliefs, biases, or limitations that would affect my interaction with the patient or prevent the formation of a therapeutic relationship. In order to set the tone of a professional therapeutic relationship, I introduced myself to the client, saying that I was a student nurse and shaking his hand. I made some small talk with him about such topics as sports and the patient’s hobbies in order to show interest in the patient and develop rapport. During this conversation, the patient grew more visibly at ease. His face became less taut, his answers became longer and less forced, and he moved from an erect posture so a somewhat more relaxed position in his chair. The patient spoke slowly and eemed to have difficult finding the words he wanted to use. Such a speech pattern is characteristic of depression, one of the patient’s psychiatric diagnoses. This first conversation was punctuated with the start of morning group. After morning group, I gave the patient some space, as I did not want him to feel overwhelmed or threatened by my questions. About a half hour later, I asked the patient if we could continue the c onversation we were having that morning, and he agreed without hesitation. In this second interaction, I began with a few open-ended questions about how group had been. I then started asking the patient some more questions about his readmission into the hospital and precipitating events. I asked open-ended question, and often responded to his answers by asking further open-ended questions. For example, after asking the patient if he was having suicidal thoughts, he responded that he did not want to hurt himself right now. I replied with the open-ended question, â€Å"So are you feeling safe? † using reflection to redirect the idea back to the patient and allow him to explore whether or not he felt safe. I focused on actively listening to the patient, following the patient’s lead and sometimes asking clarifying questions. Because of the patient’s slower rate of response, I employed the use of silence to allow him to gather his thoughts and proceed at his own pace. As the patient told me more about recent events in his life, including the death of his wife, the loss of his job and his descent into substance abuse, he began to look away more and more. This decrease in eye contact might be the result of the patient feeling ashamed, embarrassed, or guilty about his feelings and behaviors. In order to maintain connection with the patient and assure him of my nonjudgmental view of his situation, I used empathy and restatement, saying, â€Å"It sounds as though you have had a very difficult past couple of years. † Upon saying this, the patient looked up, maintained eye contact, and agreed. He then began to expand on his current feeling of hopelessness, saying, â€Å"I wonder if life is worth living, and sometimes I just want to go to sleep and not wake up. † As he explored and expanded on his feelings I alternated between using silence and validating what he said. The silence allowed him to express intense feelings without interruption, while statements of restatement and interpretation, such as â€Å" It sounds like you have been feeling pretty hopeless,† demonstrated empathy and a nonjudgmental attitude toward what the client was feeling. At one point, the patient put his head in his hands, saying â€Å"I had so much going for me, and after my wife died, everything went to pot. † I felt that in this moment, what the client needed was neither a cheery reassurance that things would get better, nor dispensation of advice, but rather a person to understand and acknowledge his current misery. I replied that sometimes life gets you down, and sometimes when it rains it pours, and it’s ok to be sad about that. The patient seemed appreciative of the acknowledgment of his pain and the justification of his sadness. I sat silently with him for 2-3 minutes, as I felt it was important for him to feel, sit with, and process these emotions for a short period of time. During these periods of silence, I continued to lean forward slightly, as I had done throughout the interaction, to show that I was still interested and engaged despite the lack of verbalization. Because I had acknowledged the patient’s hardships and thereby connected with him, I felt that I was in a good position to explore with him goals he had for the future, and ideas that could help him reach these goals. I made sure to approach this topic not by giving advice or suggestions, but by asking him open-ended questions about what things made him feel less sad or anxious and what things he wanted to work on during his stay. These open ended questions elicited the response of his goals for the future, and his verbalization that he needed to find better coping mechanisms, because his old ones didn’t seem to work. He also stated that he knew he needed to â€Å"continue grieving my wife, because the drugs and alcohol kept me from doing that. † I thought that this realization of substance abuse as inhibitory to his grief process was very insightful, and told him so. He made a small smiling expression and responded that he wanted to â€Å"get back on the straight and narrow† and take his medications â€Å"the way I’m supposed to—no more, no less. † The patient’s elucidation of his goals and his insight into helpful and hindering coping devices was a very positive outcome of this therapeutic conversation. The patient seemed less burdened after the opportunity to talk about his recent losses in life, and more hopeful after verbalizing his goals and ways to meet them. References Ackley, B. J. Ladwig, G. B. (2008). Nursing Diagnosis Handbook (7th ed. ). St. Louis, Missouri: MOSBY Elsevier. American Psychological Association. (2002). Boyd, M. A. (2008). Psychiatric nursing: contemporary practice (4th ed. ). New York: Lippincott Williams Wilkins. Bruskas, D. (2010). Developmental health of infants and children subsequent to foster care. 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Investigating differential symptom profiles in major depressive episode with and without generalized anxiety disorder: True co-morbidity or symptom similarity? Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 40(7), 1113-1123. doi:http://dx. doi. org/10. 1017/S0033291709991590 United States Department of Health and Human Services. (1999). Yen, Y. , Rebok, G. W. , Gallo, J. J. , Jones, R. N. , Tennstedt, S. L. (2011). Depressive symptoms impair everyday problem-solving ability through cognitive abilities in late life. The American Journal of Geriatric Psychiatry, 19(2), 142-150. doi:http://dx. doi. org/10. 1097/JGP. 0b013e3181e89894 Case How to cite Case Analysis of Mdd, Gad, and Substance Use, Essay examples