Studies Related To Dementia And Caregivers Burden Nursing Essay

Studies Related To Dementia And Caregivers Burden Nursing Essay The literature review was based on extensive survey of books, journals and international nursing studies. A review of literature relevant to the study was undertaken which helped the investigator to develop insight into the problem and gain information on what has been done in the past. An extensive review of literature was done by the investigator to lay a broad foundation for the study and a conceptual framework based on Wiedenbachs Helping Art Clinical Nursing Theory to proceed with the study under the following headings. For the purpose of logical sequence the chapter was divided into the following sections: 2.1 Section A: Studies related to dementia and caregivers burden of clients with dementia. 2.2 Section B: Studies related to psychological interventions on level of burden among caregivers of clients with dementia. SECTION A: STUDIES RELATED TO DEMENTIA AND CAREGIVERS BURDEN Harrison BE (2012) conducted a study to identify the evidence of factors influencing dementia related caregivers burden. 565 caregivers participated who were selected by purposive sampling technique. Caregivers Interview Schedule were given to the caregivers of clients with dementia. The findings of the study revealed that, many factors influence the impact of the caregiving experience such as gender, relationship to the patient, culture and personal characteristics. Hepworth JT (2012) conducted a cross -sectional study on burden experienced by caregivers of clients with dementia in Taiwan. 150 caregivers were participated from outpatient clinics of three hospitals by convenience sampling technique. The Caregiver Burden Inventory and Cost of Care Index Scale were used to assess the caregiver burden. The findings of the study revealed that 62% of caregivers had high level of burden. Rosenheck R (2012) conducted a cross sectional study on caregiver burden in dementia. 421 ambulatory outpatients with a diagnosis of dementia, those caregivers were participated as sample who were selected by convenient sampling technique. Burden Interview, caregiver distress scale, The Beck Depression Inventory Scales were administered. The findings of the study revealed that 80% of caregivers had severe behavioural disturbances, and psychiatric symptoms. Scheltens P (2012) conducted a epidemiological study on identifying a target group depression among caregivers of clients with dementia in Netherland. 725 caregivers participated who were selected by convenient sampling technique. Depression scale was administered to the caregivers. The findings of the study revealed that 72% caregivers had increased risk for depression and psychological distress. Steven H. Zarit (2012) conducted a longitudinal study to assess the subjective burden of husbands and wives in the care of clients with dementia. 1585 caregivers participated and selected by convenient sampling technique. Zarit Burden Assessment Scale was administered to caregivers of clients with dementia. The findings of the study revealed that among spouses, 65% of wives are having more burden than husbands. Christofoletti G (2011) conducted a cross sectional study to assess the neuropsychiatric disturbance of caregivers of clients with dementia and mental burden of their caregivers. 59 caregivers participated .Semi structured Burdren Interview Scale was used to assess the data. The result of the study revealed that 40% of caregivers had neuropsychiatric disturbance and mental burden. Papastavrou E (2011) conducted a descriptive study to investigate the burden experienced by families providing care to a relative with dementia in Cyprus. 172 caregivers are participated in the study. Convenient sampling technique was used. Data collected by using Burden Interview Scale, Behaviour Memory Problem Checklist, Depression Scale and Ways of Coping Questionnaire. The results showed that 68.02% of caregivers were highly burdened and 65% of caregivers exhibited depressive symptoms. Aizcorbeurrozc (2010) conducted a cross sectional study to evaluate the association between caregivers burden and psychological distress and to estimate the prevalence of mental disorder among the caregivers. 40 caregivers participated and assessed by Zarit Burden Scale and GHQ 28 to evaluate psychological distress. Convenient sampling technique was used. The result of the study showed that 80.7% of caregivers had high level of psychological distress. Ebenezer E, Prince MJ (2010) conducted a cross sectional study to examine selected factors of dementia patients and their caregivers that were associated with the burden of family caregivers. 225 caregivers participated in the study. Participants were selected by convenient sampling. Zarit Burden Interview Schedule was used to measure the caregivers burden. The result of the study showed that 78% of caregivers had high level of burdened because of informal support and ethnicity. Rinaldi P (2010) conducted a cross sectional study to investigate the burden perceived by caregivers of clients with dementia in different aspects of caregivers life and caregivers characteristics on its difference dimension in Italy. 419 caregivers participated. Caregivers burden inventory scale was used to quantify burden. The findings revealed that 80% of caregivers experienced that high level of anxiety and depression. Rothkopf M (2010) conducted a descriptive study to assess the distress and burden associated with sleep disturbance in dementia caregiver. 60 female caregivers participated through convenient sampling technique. Actigraphic Sleep Parameter and Burden Interview Schedule was used to measure the sleep and level of burden. The result of the study revealed that 98% of caregivers had depressive symptoms associated with poorer sleep efficiency. Williams C (2010) conducted a descriptive correlational study to identify the factors within marital relationships that increase risk of burden and depression in USA. 5 men and 11 women caregivers of clients with dementia participated. Zarit Burden Interview Schedule was used to measure the caregivers burden. The results showed that 74 % of spouses caregivers were overburdened and had depression. Anderson S (2009) conducted a cross-sectional study to examine association between caregivers burden and perceived health among caregivers of clients with dementia living at home in Netherland. 2238 samples participated. Caregivers Burden Scale was used to collect the data. The findings of the study revealed that the 84% of caregivers experienced moderate burden associated with isolation, disappointment and emotional involvement with perceived health. Elmstnhl S (2008) conducted a cross-sectional study to assess the financial burden and psychological distress among caregivers of clients with dementia in Sweden. 50 caregivers were participated. Burden Interview Schedule was used to assess the economic and social conditions. The study revealed that caregivers experienced total burden, strain and disappointment because of low income that leads to higher degree of burden. SECTION B: STUDIES RELATED TO PSYCHOLOGICAL INTERVENTIONS ON LEVEL OF BURDEN AMONG CAREGIVERS OF CLIENTS WITH DEMENTIA. Hauck WW (2011) conducted a prospective study to assess the Tailored Activity Program to reduce caregivers burden of clients with dementia. 60 caregivers were participated. Tailored Activity Program was given as an intervention for 4 months to reduce the caregivers burden. Zarit Burden Interview Schedule was used to assess the burden level. The findings of the study revealed that Tailored Activity program reduce the depression and anxiety among caregivers of dementia clients. Guetin S (2011) conducted a cross sectional study to assess the impact of music therapy on depression for caregivers of clients with dementia. 286 caregivers were participated. Hamilton Depression and Anxiety Scale, Zarit Burden Scale was used to assess the depression and burden level of caregivers of clients with dementia. 44 session music therapy was given to the caregivers. The findings of the study revealed that music therapy was reduced 80% of caregivers anxiety and depression. Jerimia Heinik (2011) conducted a cross sectional study to assess the effectiveness of recreational activities on level of burden among caregivers of relatives with dementia. 286 caregivers were participated. Zarit Burden Scale, Hamilton Depression and Anxiety Scale was used to assess the level of burden. Recreational activities were given for 5 months. The findings of the study revealed that recreational activities reduced 75% of level of burden among caregivers of clients with dementia. Sinder T (2010) conducted a cross sectional study to identify the effects on deep breathing exercise to reduce the level of burden among caregivers of clients with dementia in Taiwan. 465 caregivers participated. Convenient Sampling Technique was used. Deep breathing exercise was given to the caregivers of clients with dementia for 3 months. The findings of the study revealed that deep breathing exercise reduced the anxiety, anger among caregivers of clients with dementia. Philip D (2009) conducted a cross sectional study to assess the effectiveness of recreational activities on level of burden experienced by caregivers of clients with dementia in Europe. 238 samples participated in this study. Zarit Burden Interview, Burden Assessment Scale was used to identify burden. Painting, drawing was given as recreational activities for 12 weeks. The findings of the study revealed that 84 % of burden level was reduced for caregivers of clients with dementia with the help of recreational activities. Chandragupta and Bhola (2008) conducted a meta analysis studies to find the effectiveness of support groups for caregivers of dementic patients to reduce the burden and psychological well being. 521 caregivers participated. Burden Assessment Scale was used. Purposive sampling technique was used.The result indicated that support group helps to reduce the depression, anxiety and it improves the psychological well being. Graff ST (2008) conducted a longitudinal study to assess the effectiveness of community based occupational therapy on level of burden among caregivers of clients with dementia in France. 10 sessions of occupation therapy was given for 5 weeks. Caregiver burden was assessed with Zarit Burden Interview Schedule. 400 samples participated in this study. The findings of the study revealed that occupational therapy reduced 60 % of level of burden among caregivers of client with dementia. Naresh R, et al., (2007) conducted a longitudinal study on self efficacy for managing dementia and reduce the level of burden and depression among dementia caregivers. 84 caregivers participated. Zarit Burden Interview Schedule was used. Convenient sampling technique was used. The result revealed that self efficacy is used to alleviate the symptoms of burden and depression among caregivers of clients with dementia. Mittelman M (2007) conducted a longitudinal study to assess the effectiveness of family meetings to prevent of anxiety and depressive symptoms among caregivers of clients with dementia. 420 caregivers participated. Caregivers Burden Assessment Scale, Hamilton Anxiety Depression Scale were used to collect the data. The findings of the study showed that family meetings help to reduce the anxiety and depressive symptoms among 75% of caregivers of clients with dementia. Stella et al., (2007) conducted a cross sectional study to assess the effectiveness of physical activity on the level of mental burden among caregivers of clients with dementia. Convenience sampling technique was used. 245 caregivers participated. Burden Assessment Scale was used. The results revealed that the regular practice of physical activity reduce the burden of the caregivers of dementia patients. Gerentol GZ (2006) conducted a longitudinal study to assess the effectiveness of structured teaching program on activities of daily living on care of clients with dementia. 425 caregivers participated. Burden Assessment Scale was used to collect the data. Convenient sampling technique was used. The findings of the study showed that planned activities of daily living for dementia clients reduces the level of burden, depression and anxiety among caregivers of clients with dementia. Cantent C (2005) conducted a cross sectional study to assess the effectiveness of self group on level of burden among caregivers of clients with dementia. 425 caregivers participated. Zarit Burden Assessment Schedule was used to collect the data. Convenient Sampling Techinique was used.The findings of the study revealed tha self group reduces the level of burden among 65% of caregivers of clients with dementia. Pahlavandeh S (2005) conducted a study on effectiveness of family education program on caregiver burden of dementia clients. 560 caregivers participated. Zarit Burden Assessment Scale was used in this study. The findings of the study revealed that family education program reduces the level of burden among 60% of caregivers of clients with dementia. Kuskowski MA and Kirk LN (2005) conducted a exploratory study to examine the personal and relational impact on caregiving wives. Supportive group therapy was applied as a intervention. 115 female spouse caregivers participated. Convenient sampling technique was used. Burden Assessment Scale was used in this study. The findings of the study was revealed that supportive group therapy enhance the caregivers sense of personal mastery and it help to reduce the negative effects of caregivers of dementia clients. Tuokko H (2005) conducted a cross sectional study to assess the effectiveness of educational training program on reducing the level of burden among caregivers of clients with dementia in Lucknow. 526 caregivers participated. Burden Assessment Scale was used in this study. The findings of the study revealed that educational training programme brought awareness among caregivers and it helped to reduce the overburden and depression among 60% of caregivers of clients with dementia.

Belonging Is More Than a Connection to a Place; It Also Means Being at Home Within Yourself and Knowing Who You Are

Belonging is an essential part of human life that is not always just a connection to a place; it is a feeling of being at home within yourself and having the patience to discover who you are. Being at home within yourself is a process that is not instantaneous and this is evident in the film Ten Canoes and the poem ‘Digging’. Through characters and text specific techniques, the film and poem portray processes of how developing an understanding of group dynamics and relationships allows one to gain a sense of personal belonging, deeper than merely a connection to a place. Understanding the group dynamics and laws relating to specific cultures allows one to avoid alienation and feel comfortable as an individual. The narrative voice of David Gulpilil in Ten Canoes invites the audience into his story of the covetous youth, Dayindi and his older brother who has three wives, Minygululu. Minygululu also has a story to tell, diachronically through time to that of the ancestors, Yeeralparil and Rijimiraril, not to the audience but to Dayindi, â€Å"to help him live the proper way†, however the audience is still involved through the narration of David Gulpilil, â€Å"it is Minygululu’s story for Dayindi back then, and it is my story for you now† so the audience can learn this ‘proper way’ too. Dayindi is introduced through the voice over as a young and somewhat naive boy who lusts for his brother’s youngest wife and resents living in the single mans camp. It is obvious Dayindi does not quite belong to this clan, despite his connection to the tribe and the land through birth, â€Å"they make fun of Dayindi, they know he is liking the younger wife of his brother Minygululu†. Dayindi steps outside what is socially accepted as the proper way, the law and this alienates him. Dayindi is impatient and throughout the story states, â€Å"the only thing he learned is that Minygululu take long time to tell a story†, but through this drawn out story Dayindi learns that understanding the right way is not an instantaneous process but it requires patience. By learning the laws, the ‘proper way’, Dayindi overcomes his wrongful desires of the young wife and achieves a sense of belonging to the tribe that comes from his own personal realisation of who is he is and what is right. The poem ‘Digging’ also depicts how an understanding of what is morally accepted within a culture enhances how an individual belongs within themselves. The Irish poem arrests the attention of the reader with a smile, â€Å"the squat pen rests; as snug as a gun†, hinting at the fraught context of poem, written during a time of war. The persona then seems to escape the brutal reality of life at this time by going back diachronically in time, a technique similar to that of the ancestral story within a story, depicted in Ten Canoes. He goes back to a memory of watching his father digging, through the proud memory of the hard working men of his family, â€Å"could cut more turf in a day than any other man on Toner’s bog† inspires within him a new determination. â€Å"I’ve no spade to follow men like them†, however, â€Å"the squat pen rests. I’ll dig with it†. The pen is no longer associated with a snug gun and its unlawful violence, but the concept that ideas win wars and he will dig for ideas. He can still belong to this family of hardworking diggers now he has an understanding of how he can work hard with the other tool available to him, the lawful one, and through this understanding a new determination and sense of home within oneself is gained. Through relationships of kinship and ancestors one can achieve a sense of belonging within themselves from knowing where they come from and what this means. In Ten Canoes, Dayindi’s kinship with his brother and link to his ancestor Yeeralparil allow him to overcome his lust for Minygululu’s young wife and feel at home within himself. Minygululu, does not chastise Dayindi in the film for having feelings for his younger wife, but casually tells him a story to help him. This strengthens the somewhat disrupted relationship between the two brothers and Dayindi learns, â€Å"one important thing in his life. He is learning to be patient†. With the patience that his brother teaches him, Dayindi accepts his position in the tribe and knows one day he will have a wife, but he must wait and do things the right way. Through the story being told of Yeeralparil, Dayindi relates to this ancestor and in the film, the two characters are played by the same actor, Jamie Gulpilil which enhances this relationship between the two young men. Dayindi learns that for Yeeralparil, the fantasy of the youngest wife never become a reality, even when his brother Rijimiraril dies, and so he too knows within himself the same fate is for him. Through the two relationships Dayindi learns to accept that he will never be with the young wife and this realisation allows him to lose his resentment and do what is right in the tribe in order to belong. In the poem ‘Digging’ the persona maintains a sense of belonging through the relationship he has with his family. â€Å"The old man could handle a spade, just like his old man. † The proud recognition of his family history is obvious through the finely observed memory with strong details that engage all of the senses, allowing the audience to be a part of this diachronic experience, â€Å"the cold smell†, the â€Å"soggy peat†, and â€Å"straining rump†. Through this detailed description and admiration of his hardworking family the audience can see that he feels a strong sense of belonging with these people. But he is not immediately apart of that group as the audience is informed at the beginning of the poem, he is an office man, an educated man with not a shovel but a â€Å"squat pen† rested in his hand. It is only through a feeling of being at home within himself, and the feelings of home that he has held onto from his past that he can still belong to his ancestors. Although Dayindi belongs to his tribe and the land through his birth rights he needs more than a connection to a place in order to belong. It is only when he learns the process of understanding the laws and accepting his place through a strengthening relationship with his brother that he feels he belongs within himself and ultimately his tribe. The poem ‘Digging’ enforces similar processes of family kinship and understanding how to overcome breaking the law in order to belong within oneself. Through knowing group dynamics and having strong relationships, a deeper sense of belonging is created, a feeling of being at home within yourself.

Sample Appeal Letter for College Dismissal for Alcohol

Alcohol and drugs play a significant role in many college dismissals. Students who spend much of the week impaired arent going to do well in college, and the consequences can be the end of their college careers. Not surprisingly, however, students are extremely reluctant to admit that alcohol or drug abuse was the cause of their academic failures. While students are quick to identify family problems, mental health issues, roommate situations, relationship problems, assaults, concussions, and other factors as the reasons for poor academic performance, almost never does a student admit that excessive college drinking  was the issue. The reasons for this denial are many. Students may fear that admitting to the use of illegal drugs will hurt, not help, their appeals. The same can be said for under-age drinking. Also, many people with alcohol and drug problems deny the problem to themselves as well as others. Honesty Is Best For an Alcohol-Related Academic Dismissal If youve been dismissed from college for poor academic performance that is the result of alcohol or drug abuse, your appeal is a time to take a careful look in the mirror and be honest. The best appeals are always honest, no matter how embarrassing the circumstances. For one, the appeals committee knows when students are withholding information or being misleading in their appeals. The committee will have lots of information from your professors, administrators, and student affairs personnel. All those missed Monday classes are a pretty clear sign of hangovers. If youve been coming to class stoned, dont assume your professors dont notice. If youre always at the center of the college party scene, your RAs and RDs know this. Will being honest about your substance abuse result in a successful appeal? Not always, but youre more likely to succeed than if you try to hide the problem. The college may still decide that you need time off to mature and address your problems. However, if you are honest in your appeal, acknowledge your mistakes, and show that you are taking steps to change your behavior, your college may give you a second chance. Sample Appeal Letter for Alcohol-Related Academic Dismissal The sample appeal letter below is from Jason who was dismissed after a terrible semester in which he passed just one of his four classes and earned a .25 GPA. After reading Jasons letter, be sure to read the discussion of the letter so that you understand what Jason does well in his appeal and what could use a little more work. Also be sure check out these 6 tips for appealing an academic dismissal and tips for an in-person appeal. Heres Jasons letter: Dear Members of the Scholastic Standards Committee: Thank you for taking the time to consider this appeal. My grades at Ivy College have never been great, but as you know, this past semester they were horrible. When I received news that I was dismissed from Ivy, I cant say that I was surprised. My failing grades are an accurate reflection of my effort this past semester. And I wish I had a good excuse for my failure, but I dont. From my very first semester at Ivy College, Ive had a great time. Ive made lots of friends, and Ive never turned down an opportunity to party. In my first two semesters of college, I rationalized my C grades as the result of the greater demands of college compared to high school. After this semester of failing grades, however, Ive been forced to recognize that my behavior and irresponsibility are the issues, not the academic demands of college. I was an A student in high school because I am capable of good work when I set my priorities correctly. Unfortunately, I have not handled the freedom of college well. In college, especially this past semester, I let my social life spin out of control, and I lost sight of why I am in college. I slept through a lot of classes because I was up until daybreak partying with friends, and I missed other classes because I was in bed with a hangover. When given the choice between going to a party or studying for an exam, I chose the party. I even missed quizzes and exams this semester because I didnt make it to class. I am obviously not proud of this behavior, nor is it easy for me to admit, but I realize I cant hide from reality. Ive had many difficult conversations with my parents about the reasons for my failing semester, and I am grateful that they have pressured me into seeking help so that I can succeed in the future. In truth, I dont think Id be owning up to my behavior now if my parents hadnt forced me to be honest with them (lying has never worked with them). With their encouragement, I have had two meetings with a behavioral therapist here in my hometown. We have begun discussing the reasons why I drink and how my behavior has changed between high school and college. My therapist is helping me identify ways to change my behavior so that I dont depend on alcohol to enjoy college.   Attached to this letter, you will find a letter from my therapist outlining our plans for the coming semester should I be readmitted. We also had a conference call with John at the counseling center at Ivy College, and if I am readmitted, I will be meeting with him regularly during the semester. I have given John permission to confirm these plans with the members of the committee. My dismissal has been a big wake-up call for me, and I am very aware that if my behavior doesnt change, I dont deserve to attend Ivy. My dream has always been to study business at Ivy, and I am disappointed in myself for letting my behavior get in the way of that dream. I am confident, however, that with the support and awareness that I now have, I can be successful at Ivy if given a second chance. I hope you will give me the opportunity to prove to you that I am capable of being a strong student. Thank you again for taking the time to consider my appeal. Please dont hesitate to contact me if any members of the committee have questions that I havent answered in my letter. Sincerely, Jason Analysis and Critique of the Appeal Letter First of all, a written appeal is fine, but  in-person is better. Some colleges will require a letter along with an in-person appeal, but Jason should definitely strengthen his letter with an in-person appeal if given the opportunity. If he does appeal in person, he should follow  these guidelines. Like  Emma  (whose poor performance was due to a family illness), Jason has an uphill battle to fight to get readmitted to his college. In fact, Jasons case is probably more difficult than Emmas because his circumstances are less sympathetic. Jasons failure is the result of his own behavior and decisions more than any forces that were outside of his control. His letter needs to prove to the appeals committee that he has owned up to his problematic behavior and has taken steps to address the issues that led to his failing grades. As with any appeal, Jasons letter must accomplish several things: Show that he understands what went wrongShow that he has taken responsibility for the academic failuresShow that he has a plan for future academic successShow that he is being honest with himself and the appeals committee Jason could have tried to blame others for his problems. He could have made up an illness or blamed an out-of-control roommate. To his credit, he does not do this. From the beginning of his letter, Jason owns up to his bad decisions and acknowledges that his academic failure is a problem that he created himself. This is a wise approach. College is a time of new freedoms, and it is a time to experiment and make mistakes. The members of the appeals committee understand this, and they will be pleased to see that Jason acknowledges that he didnt handle the freedom of college well. This honesty shows far more maturity and self-awareness than an appeal that tries to deflect responsibility onto someone else. In the four points above, Jasons appeal does a pretty good job. He clearly understands why he failed his classes, he has owned up to his mistakes, and his appeal certainly seems, to be honest. A student who confesses to missing exams because of excessive drinking is not someone who is trying to lie to the committee. Plans for Future Academic Success Jason could do a bit more with #3, his plans for future academic success. Meeting with the behavioral therapist and school counselor are certainly important pieces to Jasons future success, but they are not a complete map to success. Jason could strengthen his letter with a bit more detail on this front. How will he involve his academic advisor in his efforts to turn around his grades? How does he plan to make up the failed classes? What class schedule is he planning for the upcoming semester? How will he navigate the social scene that he has been immersed in over the past three semesters?   Jasons problems are ones that the appeals committee will have seen before, but most students are not so honest in their failures. The honesty will certainly work in Jasons favor. That said, different schools have different policies when it comes to underage drinking, and it is always possible that his appeal will not be granted because of an inflexible college policy. At the same time, it is also possible that Jasons punishment will be lessened. For example, instead of dismissal, he may be suspended for a semester or two. On the whole, Jason comes across as an honest student who has potential but made some all-too-common college mistakes. He has taken meaningful steps to address his failures. His letter is clear and respectful. Also, because this is Jasons first time that he has found himself in academic trouble, he will be a more sympathetic case than a repeat offender. His readmission is certainly not a given, but I do think the appeals committee will be impressed by his letter and give his readmission serious consideration. A Final ​Note Students who find themselves in academic trouble because of alcohol or drug abuse should consult with professionals for guidance and support.

Personal Experience On Leadership Styles in the Military

Intro There have been a number of people that I would consider as having had a strong influence on my life, especially throughout my working years. I encountered several effective leaders during my years in the military. Looking back on these leaders, the one constant that was present was the variety of different leadership styles they exhibited. No two leaders were exactly the same in how they approached their duties. They were all effective, but had different strengths and weaknesses, and unique takes on how they felt was the most effective way to lead their subordinates, many of whom would rotate in and out of their command in a short period of time. This created a need to choose or develop a leadership style flexible enough to work with a variety of individuals, some from vastly different upbringings, cultures, and values. 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