1) As a student in field placement, even if you have read extensive literature on a particular disease, would you feel comfortable suggesting a possible diagnosis of your client having that particualr disease, to your field instructor?
2) Has your field instructor ever spoken or acted offended by the suggestion that they might have missed something or erred in some way?
3) Did you ever read about an illness and then incorectly diagnosed yoursel or someone else with the illness you read about?
Sunday, April 3, 2011
Tuesday, March 22, 2011
A Snapshot of Practice
Geoffrey MellonProcess Recording #10
Marilyn Best LMSW
Process Recording #10
Mr. F
Geoffrey Mellon
Jan 26, 2011
Today Mr. F said goodbye to the Alzheimer’s/dementia unit. Late last night, my field instructor came to my office and alerted me to the fact that Mr. F had an opportunity to move into a private room that just opened up on a less confused floor. Being that this was such a unique opportunity, we immediately went to show Mr. F the new room, in order to get the transfer process started before someone else tried to claim the open room.
The nurse told me that when they moved Mr. F to his new room, he had no recollection of our trip the day before. I was surprised but I probably shouldn’t have been so surprised because forgetting things has become common for Mr. F, since he came back from the hospital.
I went up to Mr. F’s new room about a half an hour before our scheduled meeting. The door was closed, so I knocked and waited for a response before entering. Mr. F was lying on his bed relaxing when I entered his room. Slowly he sat up and then he gestured for me to sit next to him on his bed, so I did. He thanked me for getting him this new room. I explained to him that I did nothing deserving of thanks. He worked hard all his life to earn what he now received and my field instructor was the one who found him his awesome new room. Nonetheless, Mr. F continued to thank me, profusely, throughout our meeting. After the third time, I gave up explaining why I didn’t deserve thanks and I just accepted it with a smile and a nod.
We sat together for a few minutes enjoying the view and commenting on the majestic nature of freshly fallen snow. Mr. F asked me where I live, so, I pointed it out to him. He sounded comforted by the fact that I don’t live so far away. At the same time that I found this comforting, I also found myself a little uneasy considering that the termination phase is nearing.
Mr. F showed me a wooden necklace with a cross that he had found in his new room. He shared with me his profound feelings of divine providence after having found what he believes to be a gift from G-d. I am pretty sure that the resident who lived in that room before him left it behind, but I encouraged him in his beliefs, nonetheless, because he seemed strengthened by the experience.
Mr. F asked me to tip him off if I find a job opportunity for him. Once again he thanked me for the room but this time he emphasized that he would like to be able to afford some coffee to offer his guests. I reminded him that he has a savings account and that we had taken out money from his account for a candy bar, just the other day. I suggested to him that we could do the same thing if he wanted to get a cup of coffee. He seemed comforted because he smiled widely.
I explained to Mr. F that I would certainly continue to meet with him every week, even though he switched floor, but that we had to switch our day from Wednesday to either Thursday in the afternoon or Friday in the morning. He had no preference because both days and times suited him so he asked me which one I preferred. I told him that I was not sure which suited me best and that I would let him know which one I have chosen at the beginning of next week. I explained to Mr. F that I had to end our meeting abruptly in order to make it to my class. He was fine with my leaving abruptly but as I left he encouraged me to come visit him again, as if I hadn’t already assured him that I would continue to meet with him every week. So, once again I assured him that I would see him next week and tell him when we would have our weekly meeting.
Before I left the room, I asked Mr. F, regarding the self anchoring scale for contentment that we have been using, how he rated himself over the last week. We have been using a scale of 1 to 10, where 10 represents contenment and 0 represents a lack thereof. Mr. F said he felt like a five overall. As usual, he said that he felt like a 10 today because we had the opportunity to converse. He added that felt particularly happy today in his new room.
I came back later in the week to visit with Mr. F. I printed out a copy of Mr. F’s credit balance and showed it to him, but he couldn’t read it. So, after lunch I brought my magnifying glass from my apartment, to work. I put a label with Mr. F’s name on my magnifying glass and I brought it up to give to him. I also printed a larger copy of his credit balance, which I took with me as well. Once again, I explained to Mr. F that he actually has some money in the bank. I have noticed that each time I have to repeat something Mr. F, it gets a little easier for him to remember it the next day and he remembers things for longer after I have repeatedly explained them to him as well.
After Mr. F remembered/realized that he had some money, which he could be spending on things that he could use, he told me that he wanted two things. The first thing was a watch. He slapped his wrist enthusiastically and told me that he doesn’t like searching for a clock. He doesn’t even have a clock in his room. Mr. F told me that he needed a watch.
There was one more thing that Mr. F felt like he needed, but he couldn’t remember what it was. As Mr. F contorted his facial expression into one of frustration, I realized that he seemed to feel as if he would only have one opportunity to request my help for this type of endeavor. I quickly tried to address this by telling Mr. F that we could go shopping as many times as he wanted. I tried to explain further that I would even prefer to make more trips with him than get everything at once. So I encouraged him to relax and not to worry about the second thing that he wanted to get because eventually he will remember and will have many more opportunities to make other trips together. Mr. F was delighted to hear me offer to go on more trips with him and so again he thanked me profusely.
During my lunch break I had checked the prices of watches at a few nearby locations and the cheapest watches were just under twenty bucks. When I got back to work I went to the gift store and found that not only were their watches less expensive but they also had features that were perfect for Mr. F. The watch’s numbers were very large, the glass cover magnified their visibility even more and there was a button to light up the watch for nighttime visibility.
So, I walked with Mr. F to the finance office. I explained what we were doing to Mr. F, thinking that it might help him remember that he has some money. Lately he has been nervous about not having any money on him. He has asked me a few times if I could help him find a job because he wants some spare cash to buy candy or treat a guest to coffee. Each time I have explained to why he doesn’t need a job; but I feel like the most effective way of helping him remember that he actually has some money is by showing him. For the sake of clarity I have been calling the finance office Mr. F's 'bank' because it essentially serves that purpose for him. After he took out money, we went to the gift shop. Mr. F bought the watch that he liked best and then we rested for a minute before going back upstairs. While we rested, I asked Mr. F how his exercise classes were going. He complained that the residents were crazy and the staff refused to let him do a lot of the exercises. I assured him that I would discuss the matter with the staff and that i would look for other residents who are more interested in taking his exercise class. In his words, Mr. F told me that he "didn't want to force anybody to do anything", he just wanted to make "recommendations" from his "experience". I think what he was trying to say is that he has been trying to interact with other residents; unfortunately, he has not had much success even after I helped develop this class. Again, for the millionth time, I asked Mr. F to rate how well he felt he has been interacting with others, but he never answered the question. Mr. F thinks that the other residents are the ones with the problem. I have tried unsuccessfully to use CBT to help Mr. F realize his problem, but eventually I gave up on that because his dementia has been progressing.
This account accurately portrays my interventions. I found Mr. F a private room because he was being tortured by the annoying behavior on my advanced dementia unit. I helped him move there and adapt to the new environment. Furthermore, since I will not be able to continue my weekly sessions with Mr. F, once I move on to my next placement, I have been trying to empower Mr. F to become more independent. I keep trying to bolster his understanding of his finances as well. Furthermore I have been trying to find opportunities for Mr. F to interact with other residents in spite of the fact that Mr. F thinks every other resident is crazy.
Marilyn Best LMSW
Process Recording #10
Mr. F
Geoffrey Mellon
Jan 26, 2011
Today Mr. F said goodbye to the Alzheimer’s/dementia unit. Late last night, my field instructor came to my office and alerted me to the fact that Mr. F had an opportunity to move into a private room that just opened up on a less confused floor. Being that this was such a unique opportunity, we immediately went to show Mr. F the new room, in order to get the transfer process started before someone else tried to claim the open room.
The nurse told me that when they moved Mr. F to his new room, he had no recollection of our trip the day before. I was surprised but I probably shouldn’t have been so surprised because forgetting things has become common for Mr. F, since he came back from the hospital.
I went up to Mr. F’s new room about a half an hour before our scheduled meeting. The door was closed, so I knocked and waited for a response before entering. Mr. F was lying on his bed relaxing when I entered his room. Slowly he sat up and then he gestured for me to sit next to him on his bed, so I did. He thanked me for getting him this new room. I explained to him that I did nothing deserving of thanks. He worked hard all his life to earn what he now received and my field instructor was the one who found him his awesome new room. Nonetheless, Mr. F continued to thank me, profusely, throughout our meeting. After the third time, I gave up explaining why I didn’t deserve thanks and I just accepted it with a smile and a nod.
We sat together for a few minutes enjoying the view and commenting on the majestic nature of freshly fallen snow. Mr. F asked me where I live, so, I pointed it out to him. He sounded comforted by the fact that I don’t live so far away. At the same time that I found this comforting, I also found myself a little uneasy considering that the termination phase is nearing.
Mr. F showed me a wooden necklace with a cross that he had found in his new room. He shared with me his profound feelings of divine providence after having found what he believes to be a gift from G-d. I am pretty sure that the resident who lived in that room before him left it behind, but I encouraged him in his beliefs, nonetheless, because he seemed strengthened by the experience.
Mr. F asked me to tip him off if I find a job opportunity for him. Once again he thanked me for the room but this time he emphasized that he would like to be able to afford some coffee to offer his guests. I reminded him that he has a savings account and that we had taken out money from his account for a candy bar, just the other day. I suggested to him that we could do the same thing if he wanted to get a cup of coffee. He seemed comforted because he smiled widely.
I explained to Mr. F that I would certainly continue to meet with him every week, even though he switched floor, but that we had to switch our day from Wednesday to either Thursday in the afternoon or Friday in the morning. He had no preference because both days and times suited him so he asked me which one I preferred. I told him that I was not sure which suited me best and that I would let him know which one I have chosen at the beginning of next week. I explained to Mr. F that I had to end our meeting abruptly in order to make it to my class. He was fine with my leaving abruptly but as I left he encouraged me to come visit him again, as if I hadn’t already assured him that I would continue to meet with him every week. So, once again I assured him that I would see him next week and tell him when we would have our weekly meeting.
Before I left the room, I asked Mr. F, regarding the self anchoring scale for contentment that we have been using, how he rated himself over the last week. We have been using a scale of 1 to 10, where 10 represents contenment and 0 represents a lack thereof. Mr. F said he felt like a five overall. As usual, he said that he felt like a 10 today because we had the opportunity to converse. He added that felt particularly happy today in his new room.
I came back later in the week to visit with Mr. F. I printed out a copy of Mr. F’s credit balance and showed it to him, but he couldn’t read it. So, after lunch I brought my magnifying glass from my apartment, to work. I put a label with Mr. F’s name on my magnifying glass and I brought it up to give to him. I also printed a larger copy of his credit balance, which I took with me as well. Once again, I explained to Mr. F that he actually has some money in the bank. I have noticed that each time I have to repeat something Mr. F, it gets a little easier for him to remember it the next day and he remembers things for longer after I have repeatedly explained them to him as well.
After Mr. F remembered/realized that he had some money, which he could be spending on things that he could use, he told me that he wanted two things. The first thing was a watch. He slapped his wrist enthusiastically and told me that he doesn’t like searching for a clock. He doesn’t even have a clock in his room. Mr. F told me that he needed a watch.
There was one more thing that Mr. F felt like he needed, but he couldn’t remember what it was. As Mr. F contorted his facial expression into one of frustration, I realized that he seemed to feel as if he would only have one opportunity to request my help for this type of endeavor. I quickly tried to address this by telling Mr. F that we could go shopping as many times as he wanted. I tried to explain further that I would even prefer to make more trips with him than get everything at once. So I encouraged him to relax and not to worry about the second thing that he wanted to get because eventually he will remember and will have many more opportunities to make other trips together. Mr. F was delighted to hear me offer to go on more trips with him and so again he thanked me profusely.
During my lunch break I had checked the prices of watches at a few nearby locations and the cheapest watches were just under twenty bucks. When I got back to work I went to the gift store and found that not only were their watches less expensive but they also had features that were perfect for Mr. F. The watch’s numbers were very large, the glass cover magnified their visibility even more and there was a button to light up the watch for nighttime visibility.
So, I walked with Mr. F to the finance office. I explained what we were doing to Mr. F, thinking that it might help him remember that he has some money. Lately he has been nervous about not having any money on him. He has asked me a few times if I could help him find a job because he wants some spare cash to buy candy or treat a guest to coffee. Each time I have explained to why he doesn’t need a job; but I feel like the most effective way of helping him remember that he actually has some money is by showing him. For the sake of clarity I have been calling the finance office Mr. F's 'bank' because it essentially serves that purpose for him. After he took out money, we went to the gift shop. Mr. F bought the watch that he liked best and then we rested for a minute before going back upstairs. While we rested, I asked Mr. F how his exercise classes were going. He complained that the residents were crazy and the staff refused to let him do a lot of the exercises. I assured him that I would discuss the matter with the staff and that i would look for other residents who are more interested in taking his exercise class. In his words, Mr. F told me that he "didn't want to force anybody to do anything", he just wanted to make "recommendations" from his "experience". I think what he was trying to say is that he has been trying to interact with other residents; unfortunately, he has not had much success even after I helped develop this class. Again, for the millionth time, I asked Mr. F to rate how well he felt he has been interacting with others, but he never answered the question. Mr. F thinks that the other residents are the ones with the problem. I have tried unsuccessfully to use CBT to help Mr. F realize his problem, but eventually I gave up on that because his dementia has been progressing.
This account accurately portrays my interventions. I found Mr. F a private room because he was being tortured by the annoying behavior on my advanced dementia unit. I helped him move there and adapt to the new environment. Furthermore, since I will not be able to continue my weekly sessions with Mr. F, once I move on to my next placement, I have been trying to empower Mr. F to become more independent. I keep trying to bolster his understanding of his finances as well. Furthermore I have been trying to find opportunities for Mr. F to interact with other residents in spite of the fact that Mr. F thinks every other resident is crazy.
Tuesday, March 8, 2011
Assignment # 3
My client’s memory has unfortunately debilitated to the point where it has become very unreliable. So I have changed my goal from trying to help improve his memory, to trying to help him improve his level of overall satisfaction. I have devised three interventions, in light of the recent changes in my client. My first intervention involves meeting with my client for weekly therapy sessions. I have found that my client is most confused when he wakes up in the morning. Interestingly enough, even when my client is in his most confused state (that I have observed), he remains oriented as far as his understanding of who he is and who I am. However, in the mornings he has a tendency to be disoriented in regards to his whereabouts and location. I have also noticed that immediately after a meal, my client seems to be the most interested in meeting with me. As a result, I have scheduled our therapy sessions in the afternoon, following lunch.
In our future sessions I would like to use CBT to address some issues that I have noticed in my client. My client has discussed a number of his tragic experiences with me. Most of theses tragic experiences have involved a friend, relative and even my client’s spouse lying and taking advantage of my client. After recounting such experiences, my client often remarks “don’t trust anybody”. The odd part about these conversations has been that my client doesn’t seem irritated or paranoid and doesn’t exhibit much anxiety. I was under the impression that my client has issues with trusting people. But he seems to trust me wholeheartedly, so it seems to me that my client doesn’t have trust issues that interfere in his life. I would even go so far as to suggest that the trust issues were not my client’s but rather they were problems created as a result of the fact that my client has had a long history of having a healthy trust in mankind.
Unfortunately, it seems that my client just had a lot of bad experiences with untrustworthy characters. The sad result of this is that my client doesn’t really talk to anyone other than myself. However, this phenomenon could also be the result of the fact that my client lived on a dementia unit for his first few months and now he believes that all of the resident’s at my field agency are crazy. During our therapy sessions I would like to investigate this issue more and try to find out why exactly my client doesn’t interact with the other residents
During our past sessions, I was assessing my client. I assessed him for his strengths as well as his risks. One of the obvious risks that everyone living in an institution faces is that of becoming institutionalized. Individuals living in an institution have everything done for them by the institution’s staff. This effectively takes a lot of power and control, over their lives, away from the individual. A sad eventuality for many people who are institutionalized is that they become powerless and dependant because they get used to having everything done for them. (Stephens, 1991)
Another risk that my client faces is his lack of a social support system. He has no family or friends that visit him. I have been trying to find ways of using my client’s strengths in order to empower him. One of my interventions has been to create a synthetic social support system around my client. It has been suggested that amongst the aging population there are very few protective buffers against developmental risk; however self efficacy and social support are the two exceptions because they have been shown to be quite effective buffers that are present in the aging demographic (Zimmerman…et el., 1999).
One of the things that I have done to try and create a social support network is that I have tried to engage my client in conversations with others. Every Friday, there is a fancy breakfast in the coffee lounge. The coffee lounge environment was created to look more similar to reality than having breakfast with all of the other residents in the institution’s dining room. So, I will take my client there for breakfast, in order to try and create a more realistic and less institutionalized atmosphere for my client to interact within and use as a medium for reorientation.
Hopefully, starting the day in a more realistic setting will empower my client to take control of his life and encourage him to be more outgoing. Hopefully this will lead to two things. A stronger sense of coherence and the establishment of a rapport between my client and other residents and eventually turn into meaningful relationships that compose a healthy social support system for my client.
In 1996, Rak and Patterson developed the buffering hypothesis, which detailed four conditions that provide a buffer against the risks associated with childhood development. In its primitive stages, research related to resilience theory was primarily focused on the developing child, the adolescent and the young adult. However, resilience theory has also been demonstrated to be applicable to the aging demographic.
“By acknowledging older adults’ resiliency and spiritual resources in light of past and present risk factors, care providers can focus on capabilities, assets, and positive attributes rather than problems and pathologies….a conceptual and practical framework for teaching strengths perspective counseling for older clients in which resiliency and spirituality best describe the application or operationalization of strengths” (Lewisa, 2007)
Many scholars maintain that the developing individual continues to develop throughout his or her entire lifespan. Since individuals are repeatedly faced with both normal and abnormal changes in themselves and their environment, throughout their lives, it is necessary for the developing individual to maintain his or her ability to adapt to the consistently changing circumstances, which they may find themselves in, in the most productive or beneficial way possible; and since those variables could potentially change at any point during the individual’s entire lifespan, the individual must continue to maintain his or her ability to adapt to the consistently changing circumstances for the entirety of her or his life.
In my field work at Isabella Geriatric center, I have been witness to similar demonstrations of resilience within another demographic, the aging population. In particular, one of my clients seems to be able to live contently despite the fact that he is constantly faced with overwhelming hardship. However, I am extremely impressed with many of my clients who are able to cope with difficulties of being institutionalized. Many of them exhibit the ability to accept very difficult circumstances and to adapt to those circumstances in constructive ways. Resilience theory states that there are environmental and personal factors that act as a buffer between at-risk individuals and the developmental obstacles that they are faced with, which provide the developing individual with the resilience to overcome hardship in regards to their human development.
Through my understanding of resilience theory I came to appreciate the strengths perspective. The protective buffers, as described by Rak and Patterson (1996) are good examples of the types of strengths that I have been looking for in assessing the qualities connected with my clients’ resilience. I have used the resilience theory in conjunction with a strengths based intervention model to assess my clients. In doing so, I have focused on ascertaining the qualities that have helped my clients overcome developmental obstacles in the past. I composed lists of all of the strengths of each of my clients. Then I compared each client’s strengths with the obstacles that they were facing.
I will attempt to increase my client’s awareness of his strengths and encourage him to use and develop those strengths that account for the resilience he has clearly displayed by surviving so many years and hardships. A strengths based intervention is supposed to help my client overcome developmental obstacles and adapt constructively to changing circumstances. When I first began meeting with this client, he would talk about his profession as a dance teacher quite a lot. He spoke about his experiences, with the fire and passion of a ‘true artist’; which was also how he referred to himself, a number of times.
Since my client uses a walker, I was saddened by the fact that his life used to be all about his ability to dance and now he could no longer do dance well. But, I quickly realized that my client was also a teacher of dance for many years and he still enjoyed teaching me during our conversations. I organized a group of residents who were interested in having an exercise class and proposed the idea, of teaching an exercise class, to my client. My client was very excited at the prospect of returning to teaching.
If not for resilience theory and the application of the strengths perspective, I would not have noticed the potential of the intervention that I am attempting. Thus it is clear that resilience theory has certainly proven to be helpful for informing my assessment of my client and formulating intervention strategies.
Finally, it is important to note that the Friday morning breakfast with my client also serves another purpose. By putting my client in a more realistic setting and engaging him in more lifelike rituals, hopefully he will also come to reorient himself with who he was when he lived normally in the community. Such interventions have been shown to have a positive effect on the sense of coherence felt by the individual, which, in turn, has been proven to be particularly compatible with the strengths based perspective (Langer, 1997).
Works Cited
Langer, N. (2004) Educational Gerontology, Resiliency and Spirituality: Foundations of the Strengths Perspective Counseling with the Elderly. 30: 611–617. New York.
Lewisa, Judith S. (2007) Journal of Gerentological Social Work : Sense of Coherence and the Strengths Perspective with Older Persons. P. 316-372. New Orleans, LA 70118 (http://www.informaworld.com/smpp/title~content=t792304007)
Rak, C.F. & Patterson, L.E. (1996) Promoting resilience in at-risk children. Journalof Counseling and Developmen, 74, 368-373.
Stephens, M. A. P., Ogrocki, P. K., & Kinney, J. K. (1991). Sources of stress for family caregivers of institutionalized dementia patients. Journal of Applied Gerontology, 10, 328-342.
Zimmerman, H., Gruber-Baldini, A., Fox, K., Hebel, J., Kenzora, J., (1999) Social Work Research: Short-Term Persistent Depression Following Hip Fracture: A Risk Factor and Target to Increase Resilience in Elderly People Vol. 23
Interventions
My client’s memory has unfortunately debilitated to the point where it has become very unreliable. So I have changed my goal from trying to help improve his memory, to trying to help him improve his level of overall satisfaction. I have devised three interventions, in light of the recent changes in my client. My first intervention involves meeting with my client for weekly therapy sessions. I have found that my client is most confused when he wakes up in the morning. Interestingly enough, even when my client is in his most confused state (that I have observed), he remains oriented as far as his understanding of who he is and who I am. However, in the mornings he has a tendency to be disoriented in regards to his whereabouts and location. I have also noticed that immediately after a meal, my client seems to be the most interested in meeting with me. As a result, I have scheduled our therapy sessions in the afternoon, following lunch.
In our future sessions I would like to use CBT to address some issues that I have noticed in my client. My client has discussed a number of his tragic experiences with me. Most of theses tragic experiences have involved a friend, relative and even my client’s spouse lying and taking advantage of my client. After recounting such experiences, my client often remarks “don’t trust anybody”. The odd part about these conversations has been that my client doesn’t seem irritated or paranoid and doesn’t exhibit much anxiety. I was under the impression that my client has issues with trusting people. But he seems to trust me wholeheartedly, so it seems to me that my client doesn’t have trust issues that interfere in his life. I would even go so far as to suggest that the trust issues were not my client’s but rather they were problems created as a result of the fact that my client has had a long history of having a healthy trust in mankind.
Unfortunately, it seems that my client just had a lot of bad experiences with untrustworthy characters. The sad result of this is that my client doesn’t really talk to anyone other than myself. However, this phenomenon could also be the result of the fact that my client lived on a dementia unit for his first few months and now he believes that all of the resident’s at my field agency are crazy. During our therapy sessions I would like to investigate this issue more and try to find out why exactly my client doesn’t interact with the other residents
During our past sessions, I was assessing my client. I assessed him for his strengths as well as his risks. One of the obvious risks that everyone living in an institution faces is that of becoming institutionalized. Individuals living in an institution have everything done for them by the institution’s staff. This effectively takes a lot of power and control, over their lives, away from the individual. A sad eventuality for many people who are institutionalized is that they become powerless and dependant because they get used to having everything done for them. (Stephens, 1991)
Another risk that my client faces is his lack of a social support system. He has no family or friends that visit him. I have been trying to find ways of using my client’s strengths in order to empower him. One of my interventions has been to create a synthetic social support system around my client. It has been suggested that amongst the aging population there are very few protective buffers against developmental risk; however self efficacy and social support are the two exceptions because they have been shown to be quite effective buffers that are present in the aging demographic (Zimmerman…et el., 1999).
One of the things that I have done to try and create a social support network is that I have tried to engage my client in conversations with others. Every Friday, there is a fancy breakfast in the coffee lounge. The coffee lounge environment was created to look more similar to reality than having breakfast with all of the other residents in the institution’s dining room. So, I will take my client there for breakfast, in order to try and create a more realistic and less institutionalized atmosphere for my client to interact within and use as a medium for reorientation.
Hopefully, starting the day in a more realistic setting will empower my client to take control of his life and encourage him to be more outgoing. Hopefully this will lead to two things. A stronger sense of coherence and the establishment of a rapport between my client and other residents and eventually turn into meaningful relationships that compose a healthy social support system for my client.
In 1996, Rak and Patterson developed the buffering hypothesis, which detailed four conditions that provide a buffer against the risks associated with childhood development. In its primitive stages, research related to resilience theory was primarily focused on the developing child, the adolescent and the young adult. However, resilience theory has also been demonstrated to be applicable to the aging demographic.
“By acknowledging older adults’ resiliency and spiritual resources in light of past and present risk factors, care providers can focus on capabilities, assets, and positive attributes rather than problems and pathologies….a conceptual and practical framework for teaching strengths perspective counseling for older clients in which resiliency and spirituality best describe the application or operationalization of strengths” (Lewisa, 2007)
Many scholars maintain that the developing individual continues to develop throughout his or her entire lifespan. Since individuals are repeatedly faced with both normal and abnormal changes in themselves and their environment, throughout their lives, it is necessary for the developing individual to maintain his or her ability to adapt to the consistently changing circumstances, which they may find themselves in, in the most productive or beneficial way possible; and since those variables could potentially change at any point during the individual’s entire lifespan, the individual must continue to maintain his or her ability to adapt to the consistently changing circumstances for the entirety of her or his life.
In my field work at Isabella Geriatric center, I have been witness to similar demonstrations of resilience within another demographic, the aging population. In particular, one of my clients seems to be able to live contently despite the fact that he is constantly faced with overwhelming hardship. However, I am extremely impressed with many of my clients who are able to cope with difficulties of being institutionalized. Many of them exhibit the ability to accept very difficult circumstances and to adapt to those circumstances in constructive ways. Resilience theory states that there are environmental and personal factors that act as a buffer between at-risk individuals and the developmental obstacles that they are faced with, which provide the developing individual with the resilience to overcome hardship in regards to their human development.
Through my understanding of resilience theory I came to appreciate the strengths perspective. The protective buffers, as described by Rak and Patterson (1996) are good examples of the types of strengths that I have been looking for in assessing the qualities connected with my clients’ resilience. I have used the resilience theory in conjunction with a strengths based intervention model to assess my clients. In doing so, I have focused on ascertaining the qualities that have helped my clients overcome developmental obstacles in the past. I composed lists of all of the strengths of each of my clients. Then I compared each client’s strengths with the obstacles that they were facing.
I will attempt to increase my client’s awareness of his strengths and encourage him to use and develop those strengths that account for the resilience he has clearly displayed by surviving so many years and hardships. A strengths based intervention is supposed to help my client overcome developmental obstacles and adapt constructively to changing circumstances. When I first began meeting with this client, he would talk about his profession as a dance teacher quite a lot. He spoke about his experiences, with the fire and passion of a ‘true artist’; which was also how he referred to himself, a number of times.
Since my client uses a walker, I was saddened by the fact that his life used to be all about his ability to dance and now he could no longer do dance well. But, I quickly realized that my client was also a teacher of dance for many years and he still enjoyed teaching me during our conversations. I organized a group of residents who were interested in having an exercise class and proposed the idea, of teaching an exercise class, to my client. My client was very excited at the prospect of returning to teaching.
If not for resilience theory and the application of the strengths perspective, I would not have noticed the potential of the intervention that I am attempting. Thus it is clear that resilience theory has certainly proven to be helpful for informing my assessment of my client and formulating intervention strategies.
Finally, it is important to note that the Friday morning breakfast with my client also serves another purpose. By putting my client in a more realistic setting and engaging him in more lifelike rituals, hopefully he will also come to reorient himself with who he was when he lived normally in the community. Such interventions have been shown to have a positive effect on the sense of coherence felt by the individual, which, in turn, has been proven to be particularly compatible with the strengths based perspective (Langer, 1997).
Works Cited
Langer, N. (2004) Educational Gerontology, Resiliency and Spirituality: Foundations of the Strengths Perspective Counseling with the Elderly. 30: 611–617. New York.
Lewisa, Judith S. (2007) Journal of Gerentological Social Work : Sense of Coherence and the Strengths Perspective with Older Persons. P. 316-372. New Orleans, LA 70118 (http://www.informaworld.com/smpp/title~content=t792304007)
Rak, C.F. & Patterson, L.E. (1996) Promoting resilience in at-risk children. Journalof Counseling and Developmen, 74, 368-373.
Stephens, M. A. P., Ogrocki, P. K., & Kinney, J. K. (1991). Sources of stress for family caregivers of institutionalized dementia patients. Journal of Applied Gerontology, 10, 328-342.
Zimmerman, H., Gruber-Baldini, A., Fox, K., Hebel, J., Kenzora, J., (1999) Social Work Research: Short-Term Persistent Depression Following Hip Fracture: A Risk Factor and Target to Increase Resilience in Elderly People Vol. 23
Wednesday, February 23, 2011
My Client
I have many clients that I would be able to meet with regularly for the sake of this assignment. However, I am limited in choosing which clients to work with because most of them suffer from severe dementia. As a result of the dementia, most residents either exhibit either extremely repetitive or random behaviors. Very few of my residents can have a normal conversation and even less know what year it is or where they are.
However, two of my residents were only placed on my unit because there were no other open rooms at the time that they were admitted. One of my clients has chosen to stay on the floor because she is only her for a short term stay. Since she may leave in the near future, I cannot use her as the subject of this assignment. As a result, there is only one client that I could realistically work with in this assignment.
When I began working with my chosen client (who will hereafter be referred to as Mr. X), he exhibited no signs of memory loss that I noticed. However, his roommate was exhibiting very loud and disturbing behavior on a constant basis. This irritated Mr. X to the point that he had a nervous breakdown and was hospitalized for a few days until he calmed down.
A few weeks ago, Mr. X moved to another unit with higher functioning residents. Mr. X told me that he enjoys solitude because he is an artist and he can express himself creatively in a more personal way when he is free from the influence of other people. So, I thought that the best part about Mr. X’s transfer was that I was able to get him a private single resident room.
Since his hospitalization, Mr. X has been exhibiting both short term and long term memory loss. At my current field placement, we use a standardized test (Bloom, Fischer & Orme, 2009) in order to assess the mental status residents. The test is known as a mini-mental exam and consists of a few questions. The client is told three words at the beginning of the exam. The first word is a piece of furniture the second is an item of clothing and the third is a color. After answering a series of questions, which assess cognitive functioning (Bloom, Fischer & Orme, 2009), the resident is asked how many of the three words, which they were told at the beginning of the exam, they can remember.
In the few sessions that I have has with my client, I have developed quite a rapport with Mr. X. My conceptualization (Bloom, Fischer & Orme, 2009) is that my Mr. X has quickly become very fond of me. He enjoys any excuse to spend time in my company. As a result, my client was more than willing to participate with me in any study or project I undertake. For the same reasons, and also because my client has no family or friends, my field instructor is also glad that I will now have another reason to spend more time with Mr. X.
I would like to use both nominal and ordinal levels of measurement (Bloom, Fischer & Orme, 2009). This will allow me to gauge how often my client retains memories and how much of those memories he can retain.
Works Cited
Bloom, M., Fischer, J., & Orme, J., (2009). Evaluating Practice: Guidelines for the Accountable Professional. Boston, MA: Allyn & Bacon.
However, two of my residents were only placed on my unit because there were no other open rooms at the time that they were admitted. One of my clients has chosen to stay on the floor because she is only her for a short term stay. Since she may leave in the near future, I cannot use her as the subject of this assignment. As a result, there is only one client that I could realistically work with in this assignment.
When I began working with my chosen client (who will hereafter be referred to as Mr. X), he exhibited no signs of memory loss that I noticed. However, his roommate was exhibiting very loud and disturbing behavior on a constant basis. This irritated Mr. X to the point that he had a nervous breakdown and was hospitalized for a few days until he calmed down.
A few weeks ago, Mr. X moved to another unit with higher functioning residents. Mr. X told me that he enjoys solitude because he is an artist and he can express himself creatively in a more personal way when he is free from the influence of other people. So, I thought that the best part about Mr. X’s transfer was that I was able to get him a private single resident room.
Since his hospitalization, Mr. X has been exhibiting both short term and long term memory loss. At my current field placement, we use a standardized test (Bloom, Fischer & Orme, 2009) in order to assess the mental status residents. The test is known as a mini-mental exam and consists of a few questions. The client is told three words at the beginning of the exam. The first word is a piece of furniture the second is an item of clothing and the third is a color. After answering a series of questions, which assess cognitive functioning (Bloom, Fischer & Orme, 2009), the resident is asked how many of the three words, which they were told at the beginning of the exam, they can remember.
In the few sessions that I have has with my client, I have developed quite a rapport with Mr. X. My conceptualization (Bloom, Fischer & Orme, 2009) is that my Mr. X has quickly become very fond of me. He enjoys any excuse to spend time in my company. As a result, my client was more than willing to participate with me in any study or project I undertake. For the same reasons, and also because my client has no family or friends, my field instructor is also glad that I will now have another reason to spend more time with Mr. X.
I would like to use both nominal and ordinal levels of measurement (Bloom, Fischer & Orme, 2009). This will allow me to gauge how often my client retains memories and how much of those memories he can retain.
Works Cited
Bloom, M., Fischer, J., & Orme, J., (2009). Evaluating Practice: Guidelines for the Accountable Professional. Boston, MA: Allyn & Bacon.
Monday, February 7, 2011
My Agency
My agency is a geriatric center. Both conceptually and practically, a geriatric center is not to be confused with a nursing home. Conceptually, the vastly different title serves to avoid the stigma associated with nursing homes. Practiacally, the geriatric center that I work for is much greater than any mere nursing home because it also includes assisted living as well as private apartments. My agency has the ability to provide housing and care for over 700 residents. Furthermore, there are specialized units, capable of providing care for residents with intense needs such as ventricular respiration and dementia.
The unit that I work in is the Alzheimer's/Dementia unit. One of the floors that I work on is entirely popultaed by residents who are incapable of ambulating. The other floor that I work on is entirely populated by residents who can ambulate, albeit some do so rather poorly. Each floor has a supervisor who manages all of the staff and residents on the floor. The floor supervisor's title is the 'neighborhood coordinator'. The neighbor hood coordinator also serves as an advocate for their 'neighborhood' (aka floor), who can appeal to the higher ups in the bearacratic administration when necessary. There is also a head nurse on each floor, who supervises and coordinates the nursing care being administered on that floor.
My agency promotes interdisciplinary participation in the implementation of resident care. The nursing staff, social worker, dietician and neighborhood coordinator work together in order to devise, adjust and rewrite the care plans of every resident in their charge, every three months. Furthermore, all of the aforementioned employees also work with the medical doctor in charge of that resident, as well as the recreational therapist, physical therapist, speech and hearing therapists, in coordinating the care being provided for each resident.
The best aspect of my agency is the result of a policy which requires employees to maintain a positive friendly demeanor. Everyone says hello to one another in the hallways. Athough the friendliness may be mandated and in some cases superficial, it does seem to facilitate respect between employees. This respect, while it may merely be superficial, does make the work enviornment more comfortable and effective. Having such a comfortable enviorment both allows employees to do their best work and provide the best possible care for the residents.
I have the ability to choose from any resident on either of my floors and meet specifically with them for any reason. Furthermore, I have a multitude of residents who exhibit bad behaviors and the behaviors are extremely well documented. As a result, it would be really easy to choose from any resident, meet with them every week and moniter their behaviour. However, I am not sure if it is possible, meaningful or effective for me to try and change the behavior of an individual who suffers from dementia.
Every time a bad behavior is exhibited and nopticed by the staff, it is documented. At the quarterly review, each bad behavior is addressed and discussed. After looking at the behavior from the perspective of each discipline, a plan is decided on and implemented in response to the incicdent. It is often the case that a resident will change or the behavior will subside for a period of time, sometimes longer than others. However, it has never once been clear to me that the change in behavior was a result of the plan that was implemented in response to the behavior and not just random coincidence. In fact, it is often the case that the bad behavior appears to be a random occurence more than a response to the context in which it occured, or specific enviormental stimuli.
The unit that I work in is the Alzheimer's/Dementia unit. One of the floors that I work on is entirely popultaed by residents who are incapable of ambulating. The other floor that I work on is entirely populated by residents who can ambulate, albeit some do so rather poorly. Each floor has a supervisor who manages all of the staff and residents on the floor. The floor supervisor's title is the 'neighborhood coordinator'. The neighbor hood coordinator also serves as an advocate for their 'neighborhood' (aka floor), who can appeal to the higher ups in the bearacratic administration when necessary. There is also a head nurse on each floor, who supervises and coordinates the nursing care being administered on that floor.
My agency promotes interdisciplinary participation in the implementation of resident care. The nursing staff, social worker, dietician and neighborhood coordinator work together in order to devise, adjust and rewrite the care plans of every resident in their charge, every three months. Furthermore, all of the aforementioned employees also work with the medical doctor in charge of that resident, as well as the recreational therapist, physical therapist, speech and hearing therapists, in coordinating the care being provided for each resident.
The best aspect of my agency is the result of a policy which requires employees to maintain a positive friendly demeanor. Everyone says hello to one another in the hallways. Athough the friendliness may be mandated and in some cases superficial, it does seem to facilitate respect between employees. This respect, while it may merely be superficial, does make the work enviornment more comfortable and effective. Having such a comfortable enviorment both allows employees to do their best work and provide the best possible care for the residents.
I have the ability to choose from any resident on either of my floors and meet specifically with them for any reason. Furthermore, I have a multitude of residents who exhibit bad behaviors and the behaviors are extremely well documented. As a result, it would be really easy to choose from any resident, meet with them every week and moniter their behaviour. However, I am not sure if it is possible, meaningful or effective for me to try and change the behavior of an individual who suffers from dementia.
Every time a bad behavior is exhibited and nopticed by the staff, it is documented. At the quarterly review, each bad behavior is addressed and discussed. After looking at the behavior from the perspective of each discipline, a plan is decided on and implemented in response to the incicdent. It is often the case that a resident will change or the behavior will subside for a period of time, sometimes longer than others. However, it has never once been clear to me that the change in behavior was a result of the plan that was implemented in response to the behavior and not just random coincidence. In fact, it is often the case that the bad behavior appears to be a random occurence more than a response to the context in which it occured, or specific enviormental stimuli.
Subscribe to:
Posts (Atom)