ABC Healthcare Company Essay

Healthcare companies, like ABC Healthcare, that operate as for-profit entities, are facing a multitude of challenges. The regulatory environment is becoming more restrictive, viruses and worms are growing more pervasive and damaging, and ABC Heathcare’s stakeholders are demanding more flexible access to their systems. The healthcare industry is experiencing significant regulatory pressures that mandate prudent information security and systems management practices. Furthermore, the continued pressure to reduce cost requires that management focus on streamlining operations, reducing management overhead and minimizing human intervention. The regulatory focus at ABC Healthcare is on the Health Insurance Portability and Accountability Act (HIPAA) and Sarbanes-Oxley (SOX). Both pieces of legislation highlight the need for good systems administration and controls, but focus on different aspects of the business. The main focus of HIPAA is to protect personally identifiable health information while SOX is concerned with data that impacts financial reporting. Violations may be met with both civil and criminal penalties. Therefore, the company must be ever watchful of new threats to their systems, data, and business operations. The most prevalent security related threat to on-going business operations is the continued development and propagation of viruses and worms. Virus and worm prevention or containment is a vital component to the overall risk mitigation strategy. Virus and worm outbreaks have multiple cost aspects for the company including lost patient charges due to system unavailability, lost productivity because of recovery efforts due to infection, and potential regulatory impacts depending on the virus or worm payload. However, the company must balance risk with opportunities in order to serve the stakeholders and grow the business. ABC Healthcare’s stakeholders include multiple groups that depend on or need access to clinical and/or financial systems in order to help support and grow the company. The access requirements and associated risk model varies by user group. The main access groups are internal only users (i.e. nurses, hourly employee, etc.), internal/remote users (i.e. salaried employees, doctors, etc.), and business partners (i.e. collection agencies, banks, etc.). Risk mitigation solutions must be developed for each user group to help ensure that the company recognizes the benefit that each group brings and to minimize the risk to business operations. The high-level management goals of the network design implementation are as follows: †¢Support the business and balance security requirements without introducing significant overhead and complexity; †¢Maintain and enhance security without significantly increasing management overhead or complexity; †¢Implement systems that are industry supported (standards where appropriate), scalable, and fault-tolerant; †¢Ensure that the design is implemented to help ensure compliance with any and all applicable regulations; †¢Proper management of access control for legitimate users and malicious users is of the utmost importance for the security of the ABC Healthcare management system. The threat is not limited to outside malicious users but also legitimate users engaged in illegitimate activity. Based on the above description you are to provide a recommendation of how you would address each of the following ABC Healthcare’s computer network security requirements. Note, whereas cost is typically an important factor, this is not a consideration for this case analysis. Therefore, you do not need to include cost estimates. Your solution should have the â€Å"right feel†, despite the lack of depth or details necessary to be accepted by upper management. Be specific in your answers. Write them as if you were writing a proposal to your boss. You do not need to include citations. Since you are developing a solution to a specific circumstance, material that is copied from an outside source will not likely fit so everything should be in your own words. 1.Describe your vision for addressing the security requirements in the  overall technical design of the ABC Healthcare network. This should include both internal and external (untrusted and trusted) aspects. Untrusted would include user connectivity to the Internet. The â€Å"trusted† network has the main purpose of supporting the business functions of known entities (i.e. partners, suppliers, etc.) which have a business relationship with the company. Note that you are to concentrate on the high level, and you are not expected to provide low level details for your recommended design. (40 points) A threat is defined as â€Å"a potential for violation of security, which exists when there is a circumstance, capability, action, or event that could breach security and cause harm† (Stallings & Brown, 2008, p. 13). In essence a threat is a possible danger that may reveal vulnerabilities. There are many threats associated with online services especially when you add in personal information. The first threat to ABC Healthcare that should be identified is the â€Å"continued development and propagation of viruses and worms† In the development phase of the network design program managers has to ensure not only that there will be antivirus software which will be ran continuously (maybe a network scan done daily after hours) but also ensure there are intrusion prevention and intrusion detection systems (IPS/IDS) in place that would identify network intrusions. A simple antivirus software like McAfee is easy to use and will not drastically increase their budget which in my opinion would be the first balanced approach. Although they may have to pay a little more for other services to ensure a proper IPS or IDS many companies (including the Navy, uses SNORT which is an open source product). Another area that will have to be identified deals with both trusted users and untrusted users and that is unauthorized disclosure which in essence is the ability for someone to gain access to information which they shouldn’t be allowed to view. This does not always have to be malicious in nature as it could simply be a glitch in the system which allows a user the ability to view others information indirectly. We also can’t rule out the threat of deception, when dealing with medical information you want to ensure a patients privacy is kept as just that, private. To gain access hackers can pose as someone who should have access to a system. This could be accomplished by simply calling a help desk and providing them with  information and having them reset your password (which is one reason why I am glad we finally did away with the infamous â€Å"mothers maiden name† security question†¦well for the most part). The third threat would be disruption which would challenge system availability and in some cases the integrity of the system. This threat could be carried out in numerous ways; one would be a denial of service attack which would prevent users from accessing the website. Some more basic disruption techniques could be simply damaging network devices or even theft. Overall to prevent or reduce such threats ABC Healthcare will have to take the different defense-in-depth strategy (people, technology, operations) into consideration. Vulnerability is â€Å"a flaw or weakness in a system’s design, implementation, or operation and management that could be exploited to violate the system’s security policy† (Stallings & Brown, 2008, p. 13). One example of a vulnerability to this system would be system performance. A slow running network is just a useless as one that is unavailable and as such will usually result in users opting to find other means to conduct business. Although I can understand the importance of keeping the cost of network security low at times you will have to remind yourself that you get what you pay for. It is paramount that ABC ensures they have well trained and qualified IT personnel to run their networks (hence my further education into the cybersecurity field) Not only do you have to ensure you have qualified and well trained IT support personnel you have to ensure that each user (employee) that is operating the system is well trained. The biggest threat to a network system is the end user as such they should be trained as to what to look out for such as social engineering. Social engineering could be simple questions asked to a user that they feel are innocent in nature but really provide information to someone who they think would be using the information to help them but in essence be using the information to deceive the user to gain access to network resources or patient information. Additionally, I would first ensure there is some type of disclaimer provided that the user would have to acknowledge stating something to the effect of: the passing of medical records or privacy information is not recommended  unless you can for certain ensure the person you are passing it to will use the information as agreed. Though I am sure it could be written a tad bit better it’s important that users know even though they’re on a secure site their information could still be leaked and disseminated. By having this in place, if something were to happen IT personnel can refer back to this acknowledgment page as issues arise. To protect patients or other groups that utilize the network outside of the ABC Healthcare organization such as collection agencies and banks, along with the above disclaimer I would ensure that the website utilized port 443 for secure connectivity. Although it can still be breached and users can still become victimized, it adds an extra level of security and prevents sniffer attacks. 2.Discuss the way you will address requirements for system monitoring, logging, auditing, including complying with any legal regulations. (15 points) The first thing ABC Healthcare IT personnel should consider when conducting security checks is starting with a checklist. This will allow the administrator to ensure they are able to catch all necessities. This is where risk management should come into effect. According to Kathy Schwalbe, there are six major processes involved in risk management: †¢Planning risk management involves deciding how to approach and plan the risk management. †¢Identifying risks involves determining which risks are likely to affect a network and document the characteristics of each. †¢Performing qualitative risk analysis which involves prioritizing risks based on their probability and impact of occurrence. †¢Performing quantitative risk analysis which involves numerically estimating the effects of risks on objectives. †¢Planning risk responses involves taking steps to enhance opportunities and reduce threats. †¢Monitoring and controlling risk involves monitoring identified and residual risks, identifying new risks, carrying out risk response plans, and evaluating the effectiveness of risk strategies. (Schwalbe, 2010, p.427). With auditing it is a good practice if using Microsoft to utilize the â€Å"Event Viewer† which would allow you to track events that occur on your system. Eckert and Schitka states that â€Å"events that occur on a system are tracked and recorded in different log files, and you can use Event Viewer to view  the contents of these logs. For example, you can use Event Viewer to view the contents of the Systems log to determine when and possibly why, a specific service failed to start† (Eckert, J. & Schitka, M. 2006). It would also be a good idea to have a disclaimer on the login screen informing all users that they are subject to monitoring when using the IT asset that way the user (although it may not always help) will be aware that what they do on the network can be traced and the user has the potential to be brought up on disciplinary charges if the matter warrants. Another thing ABC Healthcare IT administrators should be doing is reviewing files and folders for accuracy. All common server operating systems provide the capability to specify access privileges individually for files, directories, devices, and other resources. By carefully setting access controls and denying personnel unauthorized access, ABC Healthcare IT personnel can reduce intentional and unintentional security breaches. For example, denying read access to files and directories helps to protect confidentiality of information, and denying unnecessary write (modify) access can help maintain the integrity of information. Limiting the execution privilege of most system-related tools to authorized system administrators can prevent users from making configuration changes that could reduce security. It also can restrict an attacker’s ability to use those tools to attack the server or other hosts on the Healthcare’s network. 3.Describe how the system will identify and authenticate all the users who attempt to access ABC Healthcare information resources. (15 points) ABC Healthcare administrators should consider Group Policies. According to Microsoft (2003) â€Å"Group Policy is an infrastructure that allows you to implement specific configurations for users and computers.† Additionally, Microsoft (2003) states that: Group Policy settings are contained in Group Policy Objects (GPOs), which are linked to the following Active Directory service containers: sites, domains, or organizational units (OUs). The settings within GPOs are then evaluated by the affected targets, using the hierarchical nature of Active Directory (Microsoft, 2003). Active Directory in this case would be an added benefit to ABC Healthcare as it allows for the deployment of the Group Policy feature which in turn will allow network  administrators the ability to manage each user and computer object. By creating security GPOs an administrator can apply settings to affect the whole network and not just a standalone computer. This saves time and allows an administrator to affect multiple computers. Another benefit to using GPOs is the ability to define settings for wireless network connectivity. GPOs allow you to configure which wireless networks’ workstations can connect to, and automatically configure Wireless Encryption Protocol (WEP) (Aubert & McCann, 2006). If ABC Healthcare ensures GPOs are set up and followed correctly, users will not be allowed to alter many functions without having advanced administrator privileges and with auditing in place if foul play is suspected it will be quickly noticed. The best form to ensure that a site is available to authorized users would be to enforce the use of a username and password. This would ensure that the right person is accessing their appropriate material. Some security concerns would be that a hacker may try to access a user’s account without the appropriate credentials. There would be steps in place that would prevent access from repeated incorrect password attempts; many times this is covered by having a lockout function. Additionally the ability for users to be able to utilize the â€Å"forgot username and password† function will be readily available. Another option that can be utilized (much like that in the military) would be the use of Common Access Cards (CAC) and Public Key Infrastructure (PKI) which will carry the â€Å"non-repudiation† clause that states that what is sent or uploaded is indeed authenticated by the user and as such cannot be disputed. 4.Discuss how the system shall recover from attacks, failures, and accidents. (15 points) In order to safely ensure that you will be able to maintain information that is stored on your network it is key to ensure IT personnel are conducting backups. Backing up the system is another quality assurance feature that should be viewed by the management personnel. It is paramount that IT management personnel ensure administrators are conducting daily, weekly, and monthly backups of their network. A full backup should be conducted at least once a week with daily differential backups and, with maybe an incremental backup being performed mid-week. This will ensure that in the  event of a data loss IT personnel can restore lost material with minimal downtime. Ensuring there is a baseline in place that has all the original configurations is another way to ensure data safety. When looking at attacks if the system has the IPS/IDS and antivirus software installed the risk could be minimized. Michael Goodrich and Roberto Tamassia also states that administrators should ensure to have checksums and data correcting codes in place. â€Å" Checksums are the computation of a function that maps the contents of a file to a numerical value. A checksum function depends on the entire contents of a file and is designed in a way that even a small change to the input file is highly likely to result in a different output value. Checksums are like trip-wires, they are used to detect when a breach to data integrity has occurred. Data correcting codes are methods for storing data in such a way that small changes can be easily detected and automatically corrected. These codes are typically applied to small units of storage, but there are also data –correcting codes that can be applied to entire files as well† (Goodrich & Tamassia, 2011). 5.Discuss how the system will address User Account Management and related security improvements. (15 points) ABC Healthcare would have to ensure they had proper polices, procedures, standards and guidelines in place to ensure user account management and the improvement of their network security. Although many times in conversation we tend to think that policies, procedures, standards, and guidelines are coupled together. Policies are set rules established by a company or organization. A policy usually is the stepping stone for the creation of standards, guidelines and procedures. A policy would not have to incorporate the other three whereas it would be virtually impossible to create standards, guidelines or procedures without the reference of a policy which is your governing documentation. Having a standard in a way would be a rule used to measure as to how something should be. In the military we have what is called ‘Standard Operating Procedures’ which are rules that provide step-by-step instructions as to how to accurately operate equipment. This  prevents users from using the â€Å"I didn’t know excuse†. ABC Healthcare would have to have policies in place if they want to create a governing document that should be followed. This would establish rules that are to be followed by the organization. In order for a policy to be changed it must first be approved by leadership personnel. Having something like the military’s standard operating procedures wouldn’t be a bad idea either. The procedures would be the instructions that a user would follow to ensure something is operating appropriately. Like stated in question 4 for base-lining they should also have standards. So it would be understood how something is to be completed. For security improvements ABC healthcare can for example create a policy stating that the use of USB drives on computer systems are no longer authorized (as evident by military policy). This is a governing documentation that if not followed could have punitive damages associated with it. References Aubert, M. and McCann, B. (2006). MCSE Guide to Microsoft Windows Server 2003 Active Directory, Enhanced. Boston, MA: Course Technology. Eckert, Jason W. and M. John Schitka. (2006). Linux+ guide to linux certification (second edition). Boston, MA.: Course Technology. Goodrich, M.T. & Tamassia, R. (2011). Introduction to Computer Security. Boston, MA: Pearson Education INC. Microsoft TechNet. (2003). Windows Server TechCenter. Retrieved Nov. 29, 2012. from: http://technet.microsoft.com/en-us/library/cc779838(WS.10).aspx Stallings, W. and Brown, L. (2008). Computer Security: Principles and Practices. Upper Saddle River, NJ: Pearson Educations, Inc. Schwalbe, K., (2010). Information Technology Project Management (sixth edition). Boston, MA: Course Technology.

A Critical Evaluation of the Engagement and Psychosocial Asessment of a Client Living with Psychosis in the Health and Social Care Practitioners Work Setting.

INTRODUCTION This assignment is a critical evaluation of the engagement and psychosocial assessment of a client living with psychosis in the community. It provides a critical and analytical account which encapsulates assessments, psycho education, problem solving, implementation and evaluation of strategies used. I will also use Gibbs (1988) model of reflection to reflect on my assessment process and how learning can be taken forward in terms of my own practice development and that of the service setting. My client l shall call Emily a pseudo name used to maintain confidentiality in accordance with the Nursing and Midwifery Council (NMC) 2002 Code of Professional Conduct that outlines guidelines of confidentiality. Emily was initially on the acute ward where l started the process of engagement with her before she was discharged under our team in the community to facilitate early discharge. Emily was suitable for psychosocial based interventions (PSI) and this was identified as part of her care plan in order to provide support in adapting to the demands of community living and managing her illness. PSI should be an indispensable part of treatment and options of treatment should be made available for clients and their families in an effort to promote recovery. Those with the best evidence of effectiveness are Cognitive Behavioural Therapy (CBT) and family intervention. They should be used to prevent relapse, to reduce symptoms, increase insight and promote adherence to medication, (NICE 2005). Emily is 33 year old woman with a diagnosis of schizophrenia. She was referred to my team to facilitate early discharge from the ward as part of her discharge. She lives in supported housing and had had several hospital admissions and some under the mental health act. Emily was being maintained in the community on medication but it was felt that there was still an amount of distress in her life and that her social functioning was suffering as a result. Emily presented with both delusional and hallucinatory symptoms and as part of her treatment cognitive approaches were considered to help alleviate the distress and modify the symptoms. Emily was brought up in a highly dysfunctional family. Both her parents had problems with drugs and the law. Emily had been introduced to drugs at an early age but due to her illness she had stopped using them at the age of 30 when she went into supported accommodation. There was family history of schizophrenia as her grandfather had it and he had killed himself. Emily identified that her problems started in 2007 when her grandfather passed away as she was close to him and had lived most of her life with her grandparents. I completed a time line to look back at while she talked about her life history (see Appendix 1). It is vital that the client is allowed to tell their story with the minimum intervention from the practitioner and the timeline can be used to examine if there are any links to their relapses and psychotic episodes (Grant et al 2004). In the community setting we have a variety of patients with different diagnosis of mental health problems. The rationale for choosing this patient is that she had had various interventions such as medication changes and a lot of experience with the mental health professionals including compulsory treatment under the mental health act (1983). All these factors are likely to have an impact on the individual’s degree of willingness to engage in psychological interventions (Nathan et al, 2003). Hence initially it was a challenge to engage Emily and establish a relationship and build rapport. (Nelson 1997) states rapport is built by showing interest and concern and be particularly careful not to express any doubts about what the patient tells you. The development of a therapeutic relationship is critically important in work with persons with schizophrenia, which maybe difficult with patients struggling with mistrust, suspicion and denial (Mhyr, 2004). Rapport took some time to develop and was established by core conditions of genuineness, respect and accurate empathy (Bradshaw 1995). I met with Emily to set the agenda and explained to her that she was free to terminate the session anytime should she feel it necessary. It was also vital to ensure that the sessions were neither confrontational and totally compliant with Emily’s view of the world ( Kingdom & Turkington, 1995) I encouraged Emily to describe her current problems and to give a detailed description of the problems and concentrate on a more recent problem. l was directive, active, riendly and used constructive feedback, containment of feelings to develop the relationship(Tarrier et al,1998). l used her interest in Christianity to engage her and because l showed an interest this became a regular point of conversation and strengthened the connection. I also demonstrated some flexibility in response to Emily’s needs and requirements at different stages of the t reatment and intervention. It is not possible to maintain a sound collaborative therapeutic relationship without constant attention to the changing situation and requirements of a patient (Gamble and Brennan, 2006). Since the development of antipsychotic medication and dominance of biomedical models during the 1950`s mental health care has changed and evolved. The dependency on the sole use of medication was found to have left patients with residual symptoms and social disability, including difficulty with interpersonal skills and limitation with coping (Sanford&Gournay, 1986). This prompted the return of PSI to be used in conjunction with medication management. The aim was to reduce residual disability and to include in the treatment process social skills and training rehabilitation (Wykes et al, 1998). As part of my assessment process l carried out a comprehensive assessment using CPA 1, 2, and 4 in conjunction with the Trust Policy. This was to establish what her problems were and formulate a clear plan. A process of structured, comprehensive assessment can be very useful in developing an in-depth understanding of issues surrounding resistance to services (Grant et al 2004). I carried out a Case Formulation (CS) using the 5W`s What? , Where? , When? , With Whom and Why, and Frequency, Intensity, Duration and Onset ( FIDO) model to explore and get a detailed explanation of the problem and explore the `Five aspects of your life experiences` (Greenberger and Padesky 1995) (see Appendix 3). CS maps out the relationship on how the environment impacts on your thoughts, emotion, behaviour, physical reactions (Greenberger and Padesky,1995). While the assessment helped to form a picture of Emily’s suitability for PSI it also provided a scope for further work on her coping skills. Given the assumption that a person may feel reluctant to give a particular way of coping as this maybe the only means of control (Gamble & Brennan, 2006), the exploration was collaborative. From the assessment and case formulation Emily’s goal was to go out more and reduce the frequency and intensity of her voices or even have them disappear. l explained to Emily that we had to be realistic about her set goals and having voices disappear was unlikely. Kingdom (2002) states that though patients desire to make voices disappear are unlikely since voices are, as far as reasonably established, attributions of thoughts as if they were external perceptions. Goals are positive, based in the future and specific (Morrison et al 2004) and the golden rule in goal setting is to be SMART, Specific, Measurable, Achievable, Realistic and Time Limited. Emily then rephrased her goal statement to that she wanted to reduce the intensity of her voices in the next few weeks by using distraction techniques that she had not tried before. I used the KGVM Symptom Scale version 7. 0 (Krawieka, Goldberg and Vaughn,1977) to assess Emily’s symptoms which focuses on six areas including anxiety, depression, suicidal thoughts and behaviour, elevated mood, hallucinations and delusions. A KGV assessment provides a global measure of common psychiatric symptoms (feelings and thoughts) experienced with psychosis. The framework ensures that important questions are asked and a consistent measure of symptoms is provided. The KGV is a valid tool with a considered level of high reliability (Gamble and Brennan, 2006). Assessment is a process that elicits the presence of disease or vulnerability and a level of severity in symptoms (Birchwood & Tarrier, 1996). This gathering of information provides the bases to develop a plan of suitability of treatment, identifies problems and strengths and agree upon priorities and goals (Gamble & Brennan,2006). l also used the Social Functioning Scale (SFS appendix 6) (Birchwood et al,1990) which examined Emily’s social capability and highlighted any areas of concern. Emily was a loner and though living in supported accommodation she was hardly involved with the other residents or joined in with community activities. She expressed that she was afraid people could hear her voices and were judging her at all times and used avoidance as a coping strategy. On using the KGV assessment and from the results (see Appendix 2) Emily scored highly in four sections hallucinations, delusions, depression and anxiety. It appeared during assessment that her affective symptoms were econdary to her delusions and hallucinations, which were initiated and exacerbated by mostly stressful events in her life. Her hallucinations were noted to be evident at certain times and were followed by sleep deprivation. Emily expressed fleeting suicidal thoughts but denied having any plans or intentions. She also experienced sporadic moments of elation which appeared to be linked to stress. It was important for Emily to understand how life events had an impact on her difficulties an d the use of the Stress Vulnerability Model SVM (Zubin and Spring 1977) demonstrated this (see Appendix 4). Practical measures arising from an assessment of stress and vulnerability factors seek to reduce individual vulnerability, decrease unnecessary life stressors and increase personal resistance to the effects of stress. One of Emily’s highlighted problems was a lack of sleep and this could be linked to the stress vulnerability and her psychotic symptoms. Normalisation was used to illustrate this to Emily. Her increase in psychotic symptoms could then be normalised through discussing about the effects of sleep deprivation on her mental state and reduction of the associated anxiety. Emily was able to recognise how stress impacted on her psychosis. Emily identified the voices as a problem from the initial assessment. She was keen to talk about them but listened to suggestions l made to tackle the voices. The assumption of continuity between normality and psychosis has important clinical implications. It opens the way for a group of therapeutic techniques that focus on reducing the stigma and anxiety often associated with the experience of psychotic symptoms and with diagnostic labelling. Kingdom and Turkington(2002) have described such approaches as normalising strategies, which involve explaining and demystifying the psychotic experience. They may involve suggesting to patients that their experiences are not strange and no one can understand, but are common to many people and even found amongst people who are relatively normal and healthy. Normalising strategies can help instil hope and decrease the stigma and anxiety which can be associated with the experience of psychotic symptoms. This rationale emphasises the biological vulnerability to stress of individuals with schizophrenia and the importance of identifying stresses and improving methods of coping with stress in order to minimise disabilities associated with schizophrenia (Yusupuff & Tarrier, 1996). (Grant et al 2004). The problem l encountered when applying and using this model with Emily was that she realised and understood that she was not the only one experiencing voices but she wanted to find out why she experienced the voices. I used the belief about voices questionnaire (BAVQ-R appendix 5) which assesses malevolent and benevolent beliefs about voices, and emotional and behavioural responses to voices such as engagement and resistance (Morrison et al 2004). We identified the common triggers of her voices such as anxiety, depression and social isolation. During my engagement with Emily l emphasized enhancing existing coping strategies (Birchwood& Tarrier, 1994); (Romme &Escher 2000). The idea was to build on Emily’s existing coping methods and introduce an alternative. We agreed upon distraction as a coping strategy. The plan was for Emily to listen to music or carryout breathing exercises when the disturbing voices appear and to start interacting with them by telling them to go away rather than shout at them. Emily used this plan with good effect at most times as it appeared to reduce the psychological arousal and helped her gain maximum usage of these strategies in controlling the symptom (Tarrier et al, 1990). To tackle Emily’s social functioning we identified activities that she enjoyed doing and she enjoyed going to church but had stopped due to her fears that people could hear her thoughts and found her weird. I suggested that she could start with small exposure, like sitting in the lounge with her fellow residence and going on group outings in the home as these were people she felt comfortable with as she knew them. This would then hopefully lead to Emily increasing her social functioning and enable her to attend church. Emily expressed that she felt more in control of her voices REFLECTION My work with Emily was made easy as she agreed to work with me although l did face some reluctance initially. As my intervention and engagement with Emily started while she was on the ward this made it easier for me to engage her in the community. We developed good rapport and she felt she could trust me, which made the process of engagement easier. Through my engagement and assessment process l improved on my questioning and listening skills. Emily was clearly delusional at times and working with the voices present proved a challenge at times, but l realised that l had to work collaboratively with her and gain her trust and not question her beliefs. At times though l felt l was interrogating her and did not follow a format and also because of the constraints on time l did not allow much time to recap and reflect and could never properly agree the time of next meeting. I also worked at her existing strengths and coping strategies that she had adapted throughout her life and this empowered her and made her feel like she was contributing. At times though l felt we deviated from the set goals and l lost control of sessions. On reflection this is an area that l will need to develop and improve on and be able to deviate but bring back the focus to the agreed plan. My interventions were aimed at Emily’s voices and increasing her social functioning. This l discovered was my target areas and not necessarily Emily’s. n future l will aim at concentrating more on what the client perceives as their major problem as this will show client involvement in their care. This will also help me have a clear and rational judgement and appreciate every improvement the client makes no matter how small. I did not focus much on Emily’s family which l realised was a topic that she wanted to explore but l felt l was not equipped in exploring this part of her life in relation to her illness. The other difficulties l faced was because of my working pattern l had to cancel some of our meeting appointments. As part of the set agenda l had to reintroduce myself and the plan and goals that we had set out in the initial stages and this always proved to bridge the gap. It was also difficult for continuity in the team that l work in as one did not carry a personal caseload so delivering interventions was not always easy and there was not always continuity as some of my colleagues were not familiar with some applications of PSI. This highlighted as a service that there was a need for us as nurses in the team to have PSI training in order to continue with the work if the main practitioner was away and also as a team we hardly ever sed assessment tools and were therefore not confident and competent in their use. l also had difficulties in completing assessment in time due to constricted time frames. l could not always spend as much time with Emily because l had other clients to see in a space of time. In future l will have to negotiate my time and improve on my time management. In this assignme nt l had to carry out a critical evaluation of the engagement and psychosocial assessment of a client living with psychosis and carry out a critical self reflection on the assessment process and how this could be improved on. From my case study l deduced that use of some applications of PSI remains highly experimental and requires considerable research and more theoretical models. Furthermore discussion is also lacking on the details as to ways in which symptoms improved or social functioning enhanced in behavioural terms in relation to social context. However the interventions used in this case study highlighted considerable strength in supporting claims that PSI can work and does help reduce symptoms of psychosis. REFERENCES Birchwood M and Tarrier N (eds) (1996) Psychological Management of Pschizophrenia. Wiley Publishers Bradshaw T (1995) Psychological interventions with psychotic symptoms; a review. Mental Health Nursing. 15(4) Birchwood, M, Smith, J, Cochrane, R, Wetton, S, Capestake, S (1990) The social functioning scale: development and validation of a scale of social adjustment for use in family interventions programmes with schizophrenia patients, British Journal of Psychiatry,157, 853-859 Chadwick, P, Birchwood, M, Trower ,P (1996) Cognitive Therapy for Delusions, voices and paranoia, Wiley & Sons. Gamble,C, Brennan,G (2000) Working with serious mental illness:a manual for clinical practice. Grant, C, Mills, J, Mulhern, R, Short, N (2004) Cognitive Behavioural Therapy in Mental Health Care, Sage pub. Greenberger,D, Padesky,C A(1995) Mind over mood: A Cognitive Therapy Treatment Manual for clients. Guilford Press. Krawieka, M, Goldberg,D, Vughn,M (1977) A Standardised Psychiatric Assessment scale for rating chronic psychotic patients. Acta Psychiatrica Scandinavica 1977;55: 299-308. Kingdom , D and Turkington,D (1994) Cognitive Behaviour Therapy of Schizophrenia. Hove Lawrence Erlbaum. Kingdom, D and Turkington (2002) The Case Study Guide to Cognitive Behaviour Therapy of Psychosis. Wiley. Mhyr, G(2004) Reasoning with Psychosis patients; Why should a general psychiatrist care about Cognitive Behavioural Therapy for Schizophrenia. Morrison,AP, Renton, JC, Dunn, H, Williams, S, Bentall, RP (2004) Cognitive Therapy for Psychosis, Brunner- Routledge. Nathan, P, Smith, L, Juniper, U, Kingsep, P, Lim, L (2003) Cognitive Behavioural Therapy for Psychotic Symptoms, A Therapist Manual, Centre for Clinical Interventions. Nelson H (1997) Cognitive Behavioural Therapy with Schizophrenia. A Practice Manual. Stanley Thornes. National Institute for Clinical Excellence (2003) Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care, NICE publications. Nursing & Midwifery Council, Code of Professional Conduct (2002). Romme M and Escher A Eds (1993) Accepting Voices. MIND Publications Sanford T and Gournay K (1996) Perspectives in Mental Health Nursing. Bailliere Tindall. Tarrier, N, Yusupoff, L, Kinney C, McCarthy E, Gledhill A, Haddock G and Morris J (1998) Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. British Medical Journal 317,303-307. Zubin, J, & Spring, B (1997) Vulnerability: A new view on schizophrenia. Journal of Abnormal Psychology, 86, Topic: Students will carry out a critical evaluation of the engagement and psychosocial assessment of a client living with psychosis in the health and social care practitioner`s work setting. Word Count: 2826

Another Story Began On Show †Creative Writing Story

Another Story Began On Show – Creative Writing Story Free Online Research Papers Another Story Began On Show Creative Writing Story Time ran very fast. The Grade Nine’s lessons have been taught. Someone said, â€Å"Time is the best medicine to cure your broken heart.† Alice became ration than before. At the same time, my lessons were the heavier in the whole Junior Time. I couldn’t go bed until 12:00 every night. Everybody was busy in prepare the big test that relate to high school. Everyone felt tons of pressure on the shoulder. Because my classmates and I participated in the big test, which also is a test to schools quantify teaching quality. So my teacher and principle managed us very strict, especially the couple. In this hypersensitive time, Cathy made a boyfriend. Another story began on show. â€Å"Cathy, don’t you scare that the teacher would know it?† â€Å"I don’t know, but I know my parents would do something crazy to me if they know that.† So Cathy’s issue only Alice and I knew I don’t know and even been her good friend, I still didn’t know who her boyfriend was. It became a top national secret. Under our teacher rigorous stakeout, Cathy only hoped she could last this relationship for this year. Unfortunately, the teachers would know that. Three days after we knew Cathy had a boyfriend, I was called into the teacher’s office. â€Å"Michelle is Cathy’s roommate?† my headmaster’s voice was even colder than the robot, without any emotion. â€Å"Yes.† â€Å"So do you know she has a boyfriend?† Was he a spy? I was astonishing. How could he know that? â€Å"I know you won’t say anything even you give me an answer, I won’t trust. However, you had better tell Cathy that stop making this dirty thing, or I will call her parents and expel her out of school!† his tones were still frozen. â€Å"When I saw her again, she was packing her luggage. â€Å"Where are you going, Cathy? Stop!† I was moving said. â€Å"Michelle, I was expel by the school.† â€Å"Shit!† Cathy said with a sorrow smile. â€Å"Shit happened every day. Don’t feel frustrate. Michelle, you should know that you are a lucky girl. Actually, I was quite jealous you, because your mark always in the top 10 of our grade and you don’t make any big mistake. I am different from you. School said my mark was too low and broke the school rule. What I did was influence school’s image. So they asked my parents to take me home. Tell Alice that I am history. Don’t miss me. Michelle, you’re my good roommate, I’ll miss you guys. Bye.† â€Å"What about him?† â€Å"He is still in here, but we are†¦game over.† She pretended degage said. â€Å"Why he can stay here, but not expel from school?† â€Å"Because his mark is higher than mine!† When I am writing here, my story is close to the end. However, I still want to write more about them, especially Cathy’s story, there are many details that worth me to continue moving my pen, but I find that’s a tough job, because their unfair treatments are full of my mind. I don’t know why the adult always treat us as the puppet. When we seek for more freedom, they would say that â€Å"I have already given you broad space.† But they never teach us how to manager our lives or how to make a rational decision, but once we make a mistake, then they would immediately dominate you again and we just like the chick, can’t fight for ourselves. They didn’t teach us some useful things, except engraft a thought that we need to get a high mark. The reason I choose to talk about my roommates’ love story is because their stories are the mark’s tragedy. Yep, the textbook is not my life, in our lives, we still have many things need to learn. Like how to work and communicate well with other people, how to manager our own money. These skills will follow us until the moment we die, but textbook cannot be as useful as these skills. Unfortunately, we can’t learn this from my textbook. Cathy’s leaving gave me a big shock. I used to think that school was a place can develop a person, now when I though about it again, my though used to be so childish. Chinese school is only a place can upgrade your mark, but only the practical skill. That’s Chinese education’s tragedy. Do you think a student who often gets a high mark would be an outstanding person and contribute more than the other student whose mark is not as high as him? Love is a blooming flower. My friends often say that the first love is a saline immature apple. It’s a foredoom failure’s love from the beginning. I wonder why people see the love in a negative attitude. Now that each girl dreams to meet her Mr. Right and have a romantic love, why we are so sorrow? I felt hurt when I saw Cathy leaving. She didn’t do anything wrong. Why school can’t be use a soft and human way to educate her? Why school can’t give student a correct attitude to treat it? I wanna tell Cathy: Seeking for love is right. You are not the study machine. You are young and you still need to figure out many things. Please bravely seek for your love. Good mark can’t follow you forever, but your lover can beside you and walking with you to the end of your life. I will support you forever. 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Free Essays on Nutcracker

The Nutcracker ballet is an essential part of the holiday season. The story and the music never change from year to year but people are always enchanted by it. This year I attended a performance of The Nutcracker by the American Repertory Ballet at McCarter Theater. The music for the ballet was composed by Peter Tchaikovsky during the Romantic era. Tchaikovsky was asked to compose music for a ballet based on a story called â€Å"The Nutcracker and the Mouse King.† However, at this performance there was not a live orchestra, the music was recorded but still sounded professional. While most people in attendance focused on the dancers on stage, my main focus was on the music coming out of the speakers. I’ve heard the music from the Nutcracker Suite before while watching the ballet but had never given much thought to the music that the dance is derived from. The instruments I could recognize consisted of flute/piccolo, oboe/bassoon, trumpets, castanets, tambourine, triangle, harp, and a xylophone (which I later learned was actually a celeste). The entire suite had homophonic texture. There were many shifts in dynamics and mood which the characters reflected in their movements. For example in the opening piece the music was light, bouncy, had instruments playing higher notes, and children were dancing on the stage. When the music changed to a more serious tone with a slower tempo, key shifted down, less flute and more use off lower sounding instruments, during that time the adults were dancing. Different instruments also represented separate characters. Military drums and horns often signaled the presence of the Nutcracker. When the Mouse King appeared the violins created a sense of urgency and danger when his army began fighting with the Nutcracker’s. The Sugar Plum Fairy danced to the music of the celeste which has a very light and dainty tinkling sound as opposed to the marching beat of the Nutcracker’s military drum.... Free Essays on Nutcracker Free Essays on Nutcracker The Nutcracker ballet is an essential part of the holiday season. The story and the music never change from year to year but people are always enchanted by it. This year I attended a performance of The Nutcracker by the American Repertory Ballet at McCarter Theater. The music for the ballet was composed by Peter Tchaikovsky during the Romantic era. Tchaikovsky was asked to compose music for a ballet based on a story called â€Å"The Nutcracker and the Mouse King.† However, at this performance there was not a live orchestra, the music was recorded but still sounded professional. While most people in attendance focused on the dancers on stage, my main focus was on the music coming out of the speakers. I’ve heard the music from the Nutcracker Suite before while watching the ballet but had never given much thought to the music that the dance is derived from. The instruments I could recognize consisted of flute/piccolo, oboe/bassoon, trumpets, castanets, tambourine, triangle, harp, and a xylophone (which I later learned was actually a celeste). The entire suite had homophonic texture. There were many shifts in dynamics and mood which the characters reflected in their movements. For example in the opening piece the music was light, bouncy, had instruments playing higher notes, and children were dancing on the stage. When the music changed to a more serious tone with a slower tempo, key shifted down, less flute and more use off lower sounding instruments, during that time the adults were dancing. Different instruments also represented separate characters. Military drums and horns often signaled the presence of the Nutcracker. When the Mouse King appeared the violins created a sense of urgency and danger when his army began fighting with the Nutcracker’s. The Sugar Plum Fairy danced to the music of the celeste which has a very light and dainty tinkling sound as opposed to the marching beat of the Nutcracker’s military drum....

Viracocha and the Legendary Origins of the Inca

Viracocha and the Legendary Origins of the Inca Viracocha and the Legendary Origins of the Inca: The Inca people of the Andean region of South America had a complete creation myth which involved Viracocha, their Creator God. According to legend, Viracocha emerged from Lake Titicaca and created all of the things in the world, including man, before sailing off into the Pacific Ocean. The Inca Culture: The Inca culture of western South America was one of the most culturally rich and complex societies encountered by the Spanish during the Age of Conquest (1500-1550). The Inca ruled a mighty empire that stretched from present-day Colombia to Chile. They had complicated society ruled by the emperor in the city of Cuzco. Their religion centered on a small pantheon of gods including Viracocha, the Creator, Inti, the Sun, and Chuqui Illa, the Thunder. The constellations in the night sky were revered as special celestial animals. They also worshiped huacas: places and things that were somehow extraordinary, like a cave, a waterfall, a river or even a rock that had an interesting shape. Inca Record Keeping and the Spanish Chroniclers: It is important to note that although the Inca did not have writing, they had a sophisticated record-keeping system. They had a whole class of individuals whose duty it was to remember oral histories, passed down from generation to generation. They also had quipus, sets of knotted strings which were remarkably accurate, especially when dealing with numbers. It was by these means that the Inca creation myth was perpetuated. After the conquest, several Spanish chroniclers wrote down the creation myths they heard. Although they represent a valuable source, the Spanish were far from impartial: they thought they were hearing dangerous heresy and judged the information accordingly. Therefore, several different versions of the Inca creation myth exist: what follows is a compilation of sorts of the major points on which the chroniclers agree. Viracocha Creates the World: In the beginning, all was darkness and nothing existed. Viracocha the Creator came forth from the waters of Lake Titicaca and created the land and the sky before returning to the lake. He also created a race of people - in some versions of the story they were giants. These people and their leaders displeased Viracocha, so he came out of the lake again and flooded the world to destroy them. He also turned some of the men into stones. Then Viracocha created the Sun, Moon and stars. People are Made and Come Forth: Then Viracocha made men to populate the different areas and regions of the world. He created people, but left them inside the Earth. The Inca referred to the first men as Vari Viracocharuna. Viracocha then created another group of men, also called viracochas. He spoke to these viracochas and made them remember the different characteristics of the peoples that would populate the world. Then he sent all of the viracochas forth except for two. These viracochas went to the caves, streams, rivers and waterfalls of the land - every place where Viracocha had determined that people would come forth from the Earth. The viracochas spoke to the people in these places, telling them the time had come for them to come out of the Earth. The people came forth and populated the land. Viracocha and the Canas People: Viracocha then spoke to the two that had remained. He sent one to the east to the region called Andesuyo and the other to the west to Condesuyo. Their mission, like the other viracochas, was to awaken the people and tell them their stories. Viracocha himself set out in the direction of the city of Cuzco. As he went along, he awoke those people who were in his path but who had not yet been awakened. Along the way to Cuzco, he went to the province of Cacha and awoke the Canas people, who emerged from the Earth but did not recognize Viracocha. They attacked him and he made it rain fire upon a nearby mountain. The Canas threw themselves at his feet and he forgave them. Viracocha Founds Cuzco and Walks Over the Sea: Viracocha continued to Urcos, where he sat on the high mountain and gave the people a special statue. Then Viracocha founded the city of Cuzco. There, he called forth from the Earth the Orejones: these big-ears (they placed large golden discs in their earlobes) would become the lords and ruling class of Cuzco. Viracocha also gave Cuzco its name. Once that was done, he walked to the sea, awakening people as he went. When he reached the ocean, the other viracochas were waiting for him. Together they walked off across the ocean after giving his people one last word of advice: beware of false men who would come and claim that they were the returned viracochas. Variations of the Myth: Because of the number of conquered cultures, the means of keeping the story and the unreliable Spaniards who first wrote it down, there are several variations of the myth. For example, Pedro Sarmiento de Gamboa (1532-1592) tells a legend from the Caà ±ari people (who lived south of Quito) in which two brothers escaped Viracocha’s destructive flood by climbing a mountain. After the waters went down, they made a hut. One day they came home to find food and drink there for them. This happened several times, so one day they hid and saw two Caà ±ari women bring the food. The brothers came out of hiding but the women ran away. The men then prayed to Viracocha, asking him to send the women back. Viracocha granted their wish and the women came back: the legend says that all the Caà ±ari are descended from these four people. Father Bernabà © Cobo (1582-1657) tells the same story in greater detail. Importance of the Inca Creation Myth: This creation myth was very important to the Inca people. The places where the people emerged from the Earth, such as waterfalls, caves and springs, were venerated as huacas - special places inhabited by a sort of semi-divine spirit. At the place in Cacha where Viracocha allegedly called fire down upon the belligerent Canas people, the Inca built a shrine and revered it as a huaca. At Urcos, where Viracocha had sat and given the people a statue, they built a shrine as well. They made a massive bench made of gold to hold the statue. Francisco Pizarro would later claim the bench as part of his share of the loot from Cuzco. The nature of Inca religion was inclusive when it came to conquered cultures: when they conquered and subjugated a rival tribe, they incorporated that tribes beliefs in their religion (although in a lesser position to their own gods and beliefs). This inclusive philosophy is in stark contrast to the Spanish, who imposed Christianity on the conquered Inca while attempting to stamp out all vestiges of native religion. Because the Inca people allowed their vassals to keep their religious culture (to an extent) there were several creation stories at the time of the conquest, as Father Bernabà © Cobo points out: With regard to who these people may have been and where they escaped from that great inundation, they tell a thousand absurd stories. Each nation claims for itself the honor of having been the first people and that everyone else came from them. (Cobo, 11) Nevertheless, the different origin legends have a few elements in common and Viracocha was universally revered in Inca lands as the creator. Nowadays, the traditional Quechua people of South America - the descendants of the Inca - know this legend and others, but most have converted to Christianity and no longer believe in these legends in a religious sense. Sources: De Betanzos, Juan. (translated and edited by Roland Hamilton and Dana Buchanan) Narrative of the Incas. Austin: the University of Texas Press, 2006 (1996). Cobo, Bernabà ©. (translated by Roland Hamilton) Inca Religion and Customs. Austin: the University of Texas Press, 1990. Sarmiento de Gamboa, Pedro. (translated by Sir Clement Markham). History of the Incas. 1907. Mineola: Dover Publications, 1999.

Ancient Egyptian Religion Research Paper Example | Topics and Well Written Essays - 1250 words

Ancient Egyptian Religion - Research Paper Example While studying ancient religion of Egypt it is clearly understood that most of the concepts of that religion was due to the people’s observation of environment surrounding. The basis of the religion was based on the concepts like attraction and worship of sunlight, satisfaction gained by changing tones of the nature (Watson). Agriculture due to changes in flow of river Nile was also in the core concepts of the ancient religion of Egypt. Every aspect of Egyptian culture like laws, medicine, arts and crafts carried a clear image of religious concepts. Another concept greatly raised during those days of Egypt was concept of gods. It is very difficult to differentiate between gods worshipped by Egyptians. There was a time when Egyptians worshipped 2000 gods. Gods of Ancient Egypt Gods worshipped by ancient Egyptians were evolved and diminished with time. These gods had some individual properties and they also used to fight one another to get hold of the powers possessed by each ot her. One God was used to split into multiple forms of gods at a time like Amun-em-Opet, Amun-Ka-Mutef, and Amun of Ipet-swt (Teeter,  E., & Brewer, 2004). Every God had a specific role to play for the people used to worship them. Gods were in human form, they were used to born and die after a certain age and some of them had rebirth. They were like human males and females and families. One of the common such case is Amun, his wife Mut and their child Khonsu. Ancient Egyptian civilization was over the era of 3000 years. Creation of World Egyptians used to have different concepts regarding creation of the world. According to one of the beliefs the whole world was a part of a big dark ocean. Suddenly a large portion of land appeared with reappearance of Sun god. Sun as a god is of great importance in ancient Egyptian religion as it created all things. This Sun god had many versions one of them is the emerging of Sun god from a large piece of mud. This concept was believed by most of ancient Egyptians. One of the great evolutions the ancient Egyptian civilization gave to mankind was place of worship to gods (Brown, 2007). Temples were considered as sacred places where Gods should be worshiped by the people. There was a time in ancient Egypt when every city had its own god and its own temple for the worship of that god. These were the places where communications with those gods was supposed to happen. Priest was an essential part of society. Priest was responsible for taking care of god and fulfilling the needs of god. Also these priests used to advise people for their problems. One example that needs to be mentioned for such case was ancient Egyptians thought Nile as a god. Each ever a virgin girl was sacrificed to keep god Nile happy by drowning her in river Nile. In return Nile irrigated crops of the people. Concept of Life and Death. Ancient Egyptians having unique civilization also had a unique concept of life. They believe in life after death and considered life as a preparation period for the life after death. Many civil laws of ancient Egypt were based on this concept of life. It is amazing to note that in present day modern world this concept of life after death is adapted or believed by followers of major religions of the world (Parsons, 2011). Ancient Egyptians considered death as a transfer to life after death. This concept of death is an important part in the funerals that took place at that time. The body was preserved for the next life with help of â€Å"Natron† and placed in a coffin. These bodies are now known as mummies. After 70 days the final ritual performed on the mummy was â€Å"

Entrepreneurship & Small Business Management Essay - 2

Entrepreneurship & Small Business Management - Essay Example I am hopeful that the company I would be working with would also be willing to fund my MBA for me. Thus in these two fruit-ful years I will not just be taking home a fat income but would also have completed by MBA. While pursuing my MBA , I would also be doing my cost savings. I am not keen on being head to mouth by the time I retire. I want to save up for investment later on in a business of mine. I will be saving 40 percent of my salary and it should be possible as I have no obligations at that moment. Thus at this rate in the next five years, I would have savings of above 2 Lakh dollars. I will invest this money in gold as the gold market is enjoying a huge boom these days and it is stipulated that the boom will continue for a while. By the time I graduate, I would expect my salary to have multiplied by atleast 2 folds. I would continue to keep a low-key lifestyle and would spend $60,000 per year only. The remaining amount will go in savings. I feel that all this compounded would give me more than 3 lakh dollars in the next two years. It is then when I will opt for an early retirement with the goal of getting into and starting my own business. By then I would have around 8 lakh dollars in s avings, gold and and other things. With the capital that I would have saved, I will start my own venture of a computer franchise company. The income through this company will increase by 40% every year and I would become a millionaire in just two years with net value of above 3 million in five years after