This essay will present an interaction that took place in practice that captured the multi-disciplinary team discussing a service user. This interaction shows the concept of risk management, patient safety and leadership within a hospital setting. These concepts will be explored and critically reviewed to establish how important leadership and advocating for a service user is. It will also demonstrate how important a good multi-disciplinary team can work together for patient safety with least restrictive practice.

Interaction in practice

A mixed 20 bedded ward in acute mental health for adults aged 18 to 65 received an informal admission which is lease restrictive practice (Scottish Government, 2006). The service user has a diagnosis of borderline personality disorder who was known to staff on shift. As it was a weekend none of the service user’s medical team was on shift, which meant they would meet with the duty doctor, and duty consultant. The duty consultant arrived and went to one of the interview rooms to chat with the service user. On return the consultant stated that the service user would stay until they met with their own team. When asked about passes off the ward the consultant said nurse escort passes only. The coordinating nurse then stated that this would not be acting in the service user’s best interest and history has proved this to be non-beneficial. The nursing multi-disciplinary team (MDT) then proceeded to state the service user was informal and attended voluntary. This will cause distress and anxiety to service user when staff cannot facilitate the time off the ward.

The consultant stood by his recommendation but the coordinating nurse got in touch with the coordinating charge nurse (CCN) and pursued the decision. It was then talked over by the coordinating nurse, consultant and CCN as well as the staff on shift. After the MDT had discussed the matter the result ended with the service user gaining 15 minutes passes which worked out well over the weekend for the service user.

Leadership

The definition on leadership is one in a position or function as a leader to direct or guide a group or party (Waite and Soanes, 2007). Nicolson et al, (2011) states there is more ramification with being a leader such as: communication, emotions, and the relationship between followers and the leader. However if professionals in a leadership role are not performing to the high standard this can impact on the team reducing their commitment to the care and treatment of service users (Kilfedder, Power and Wells, 2001).

Researchers have not only been tasked with finding a definition for leadership but also evidencing the characteristics that make a good leader.

(Wangensteen, Johansson, & Nordstrom, 2008) state that an individual constantly producing a high level of practice above recommended standards as well as displaying a caring interest in other colleagues performance, and sharing information or guidance at the correct time has all the characteristics of a leader.

Professional socialization according to (Clearly et al. 2011) states leaders will engage in conversation to explore values, beliefs and attitudes of individuals they work with as well as initiating team building interactions and offering support towards the team members.

Alimo-Metcalfe (2003) states that individuals are most effective when they are competent and confident and aware of their own strengths and behaviours and can work well with other team members. This was displayed in the scenario as the coordinating nurse was confident and showed their strength by pursuing the matter with the backing of the MDT.

(Hogan, 1994) states leadership is persuading colleges to set aside individual concerns for a short period of time to support a mutual goal or responsibility for safety and welfare of a group.

On the other hand (Fowler, 2012) states leadership is projected through role modeling. Role modeling according to (Fowler, 2012) is an individual who is “good at their job” and competent within their role with the ability to carry out tasks with ease. However there are some clinicians that practice on the edge within ethical dilemmas that could be deemed unprofessional therefor would not make good role models.

(Bosman et al. 2012) also agrees with role modeling and its importance with leadership and states there are four aspects that experienced members of a team lead from. These are inspiration and motivation, self-efficacy reinforcing junior’s beliefs to achieve more. Learning by example of real life practice situations and a support for other members of the team.

The leadership skills displayed in the scenario above was to advocate for the service user and be their voice. This took confidence and knowledge with a compassionate and empathetic approach so the service user would not be distressed or agitated over the weekend. It also demonstrates how connected the team was to get involved in the discussion to reinforce the initial statement. By displaying communication skills and introducing an outside party to evidence reasons why this would be the best course of action for the service user the pass was granted, and there were no incidents over the weekend involving the service user.

However the service user could have went out on pass and not returned and the scenario could have been much worse even disastrous. But the staff member had evidence based knowledge about the individual and practical experience with care and treatment for the service user. Although there was a risk with this scenario all parties were following the 10 essential shared capabilities (ESCs) by working in partnership, promoting recovery, providing service user centred care, making a difference and positive risk taken (Anderson and Burgess, 2009) this guided all members to reach a decision.

Kean and Haycock-Stuart (2011) argue that policies and interactions put in place to deliver a high standard of care can suggest that the individual in the leadership role is solely responsible for its success. This singular approach fails to report the relationship between the leader and followers and the prevalence of the followers contributions (Kean and Haycock-Stuart, 2011).

The Scottish Government (2009) acknowledges that the leadership development for National Health Service (NHS) Scotland is achieving its goal. This is regarded as a priority for (NHS) Scotland and is prioritized at a local level (The Scottish Government, 2009). This has been introduced to insure healthcare professionals can practice nationally and local with leadership qualities and behaviours to deliver a high standard of care that is safe and effective. Policy within (NHS) Scotland states all employees are made clear and understand exactly what their role is. As they have a duty of care to provide the best care possible, and leaders have the responsibility to ensure this is happening to the correct standards but allow participation in the decision making process (The Scottish Government, 2009). The NHS has a model (Leading Better care, 2011) that can direct leaders to consider leadership qualities and develop positive attitudes and set out goals. How leaders behave within National Health Service (NHS) Scotland can make or break their agenda for health care.

Research suggests that an effective leader can have a positive impact on service user care. There has been many cases of bad practice in healthcare that has been publicized for the public such as; The Mid Staffordshire NHS Foundation Trust which produced the Francis Inquiry (Nolan, 2013) which explored what happened and were the trust failed. The report stated that all healthcare workers working within the health care system will be held accountable for their actions and the care they provide. The report addressed staff from all positions especially senior positions who neglected their basic leadership skills (Nolan, 2013).

(Blegen and Severinsson, 2011) state mental health nurses are always advancing their practice with change while working in environments that are challenging. By developing leadership skills that are motivating and encouraging colleagues to work responsibly and respectively with service users. This demonstrates the importance that leadership skills have when tasking or directing a colleague to have reassurance the task will be carried out correctly (Cleary et al. 2011). This can depend on the relationship of the followers and the leaders as this has an important bearing on the success of the healthcare environment. However (Kean and Haycock-Stuart, 2011) states that the followers are over looked as the framework for leadership focuses on the leaders as individuals. Kean and Haycock-Stuart (2011) state there is more to being a follower than following a leader, if judgements are made that disagree with a leader this can make or break the relationship of leader and follower. Good leadership takes opinions into consideration and work with reciprocity built on trust (Kean and Haycock-Stuart, 2011).

Along with leadership is patient safety as described in paragraphs above leadership has been the emphasis for NHS Scotland locally and nationally but these two concepts work in partnership with each other (The Scottish Government, 2010). The Nursing and Midwifery Council (NMC) acknowledge the importance for individuals to continually update skills and experience in leadership and patient safety and working in partnership with universities have implemented a new domain constructed for leadership. This domain will be part of student competencies that will be expected to be adhered to when they become registered nurses. Registered nurses must now lead and challenge in a bid to improve services to provide the best possible care (NMC, 2010).

Patient Safety

Safety is the most important part of the healthcare service, safety for service users and safety for healthcare professionals. The drive for safety within the healthcare services are one of the three ambitions by the Scottish Government which will strive to deliver and support safe and effective healthcare. All service users will receive care and treatment in a clean, safe environment free from preventable harm or injury in any NHS Scotland healthcare facility (Scottish Government, 2010). Patient safety is the foundation that nurses construct their practice around and is a professional value that the Nursing and Midwifery Council stipulate is a requirement with the code of conduct (NMC, 2015). All registered nurses must safeguard the health and well-being of all individuals for as long as there are receiving care (NMC, 2008).

Ferguson et al. (2007) states when patient safety is compromised and errors transpire the role of the clinical practitioner can be scrutinized when there are numerous factors that threaten patient safety. Some factors such as; work load pressures and staff shortages can count for miner mistakes happening within the healthcare system. However (Ferguson et al, 2007) also states good communication within a positive and motivated working team are factors that are effective in building a good safety culture.

General hospitals are subjected to the same safety risks with patient safety as in a mental health hospital such as; pressure sores and medication errors. However, additional risks to staff and patients are unique in the mental health area (Bark and Tingle, 2011).The management of violence and aggression and the use of seclusion are to support patient safety as mental health hospitals use restraining techniques which can increase the service user’s vulnerability. However mental illness can cause individuals to become suspicious, disorientated, paranoid or delusional that can cause anger or difficulty with instructions (Bark and Tingle, 2011). This can generate a more complex case for patient safety even though risk assessments are carried out daily within mental health wards. Staff predicting and planning for every preventable event that could happen, due to human behaviour is only effective with the information they possess at that time (Tate and Feeney, 2012).

Langan (2010) states that violence in a mental health facility with service users were a risk may be prevalent to themselves or to staff, argues that this can exacerbate anxiety and increase pressure that is required when assessing a service users risk. Service users can be unpredictable when first presenting and with lack of knowledge of what is happening for that service user at that time presents numerous changeable factors that can transpire (Langan, 2010). There has been many attempts to build an assessment tool for mental health services but they have failed to reach the standard required (Langan, 2010).

(NHS Lothian, 2012) state that the policy within mental health for risk assessments must be carried out for every service user that is admitted to hospital and becomes an inpatient this should be in conjunction with the service user. When filling out the risk assessment current information should be included such as; relevant history, associated behaviours, clinical diagnosis and information from the service user’s perspective as well as information from family this will ensure a robust risk assessment and support patient safety (NHS Lothian, 2012). A risk assessment is always being amended and is never complete it is an ongoing procedure that is effective at the time it is carried out (Tate and Feeney 2012). Risk assessments that are updated daily support patient safety. The mental health setting can highlight complexities with patient safety and emphasises how staff work in partnership with service users and using reciprocity keep patients safe (Tingle and Bark, 2011).

When managing patient safety within the scenario this can present challenges as the coordinating nurse was basing her evidence on previous history but had a good knowledge and rapport with the service user. By working in partnership with the service user and promoting recovery on previous admissions the nurse already had a basic plan for a risk assessment and was thinking of patient safety and what could have transpired if the passes were not granted. However ever admission is different so nothing should be assumed for example; that last admission the service user got aggressive, that does not mean this will happen this admission.

Conclusion

The scenario that was introduced was not uncommon at the week end for an inpatient in mental health services. The service user could have had a different scenario if that individual was not on shift advocating for the patient and displaying leadership qualities. By checking legislation, frameworks, local policies and training which is available to support staff to deliver a high standard of care and ensure patient safety.

By understanding what traits aid with leadership and just how important the skills to lead are and developing and nurturing them to provide a high standard of care from you and your team.

Patient safety will always be identified as an important part of healthcare and by carrying out risk assessments will insure service user receive the best care for them. For more complex situation within mental health settings staff must follow polices and legislation and support each other fully as a team and with proper planning and applying daily risk assessments can support in minimizing harmful events from transpiring.

References

Waite, M., & Soanes, C. (2007)

Oxford dictionary and thesaurus

(2nd ed.). Oxford: Oxford University Press.

Alimo-Metcalfe, B.(2003) Leadership Stamp of Greatness. Health Service Journal 113 (5861) 28-32

Kean, S., & Haycock-Stuart, E. (2011) Understanding the relationship between followers and leaders.

Nursing Management.

London 18 (8) 31-35

Scottish Government (2009)

Delivering Quality through Leadership: NHSScotland Leadership Development Strategy.

Available from:

http://www.scotland.gov.uk/Resource/Doc/289816/0088790.pdf

[accessed 9 Apr 2015]

Kilfedder, C., Power, K., & Wells, T. (2001). Burnout in psychiatric nursing.

Journal of Advanced Nursing,

34 (3) 383-396

Hogan, R. (1994) what we know about leadership.

American Psychologist,

49 (6) 493-504

Fowler, J. (2012) Professional development: From staff nurse to nurse consultant.

Part 6: Importance of role models.

British Journal of Nursing

, 21 (5) 311

Bosma, N., Hessels, J., Schutjens, V., Praag, M. V., & Verheul, I. (2012) Entrepreneurship and role models.

Journal of Economic Psychology

, 33 (2) 410–424

Wangensteen, S., Johansson, I. S., and Nordstrom, G. (2008) the first year as

a graduate nurse—an experience of growth and development. Journal of

Clinical Nursing, 17 (14) 1877–1885

Cleary, M., Deacon, M., and Hunt, E. (2011) Mental health nursing role

models. Journal of Psychosocial Nursing and Mental Health Services, 49 (8) 6–7

Cleary, M., Horsfall, J., Mannix, J., O’Hara-Aarons, M., and Jackson, D. (2011)

Valuing teamwork: Insights from newly-registered nurses working in specialist

mental health services. International Journal of Mental Health Nursing,

20 (6) 454–459

Anderson, J. and Burgess, H. (2009) Essential shared capabilities for the whole of the mental health workforce: Bringing the educators into the frame.

The Journal of Mental Health Training, Education and Practice,

4 (3) 21-29

Kean, Susanne; Haycock-Stuart, Elaine. (2011)Understanding the relationship between followers and leaders

Nursing Management.

18 (8) 31-35

Nolan, P. (2013). (2) The Francis Report.

Nursing Ethics

, 20 (7) 840-842.

Cleary, M., Horsfall, J., Deacon, M., and Jackson, D. (2011). Leadership and Mental Health Nursing.

Issues in Mental Health Nursing, 2011,

32 (10) 632-639

Scottish Government (2010).

The healthcare Quality Strategy for NHSScotland.

Available from:

http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf

[accessed 9 Apr 2015]

Ros Moore. (2011).

LEADING BETTER CARE incorporating releasing Time to Care.

Available:

http://www.evidenceintopractice.scot.nhs.uk/media/150149/lbc incorporating rtc report.pdf

. Last accessed 28th April 2015.

Nursing and Midwifery Council (2008)

The Code

: Standards of conduct, performance and ethics for nurses and midwives. Available from:

http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf

[accessed 9 Apr 2015]

Nursing and Midwifery Council. (2010)

Pre-registration nursing education in the UK.

Available from:

http://standards.nmc-uk.org/Documents/Pre-registration%20nursing%20education%20in%20UK%20FINAL%2006092010.pdf

[accessed 9 Apr 2015]

Ferguson, L., Calvert, J., Davie, M., Fallon, M., Fred, N., Gerbach, V., and Sinclair, L. (2007) Clinical leadership: Using observations of care to focus risk management and quality improvement activities in the clinical setting.

Contemporary Nurse,

24 (2) 212-224

Tate, L. and Feeney, A. (2012) the principles of risk assessment.

Medicine,

40 (11) 574-576

Bark, P. and Tingle, J. (2011) Psychological aspects of patient safety. In Patient Safety, Law Policy and Practice. (64 – 84). Routledge: London, UK.

Scottish Government (2006)

The New Mental Health Act – What’s it all about? A Short Introduction.

Available from:

http://www.gov.scot/Publications/2004/01/18753/3168

[accessed 9 Apr 2015]

Nursing and Midwifery Council (2015)

The Code

: Preserve safety. Available from:

http://www.nmc.org.uk/standards/code/read-the-code-online/

[accessed 9 Apr 2015]

Preserve safety

When conducting research into the stigma that comes with living with schizophrenia, it can be exceedingly difficult to obtain accurate information. This report will provide a variety of possible research designs that could be used in the given scenario, and by looking into multiple data collection options we are able to evaluate which methods will be the most effective when trying to obtain accurate and reliable data.

The Diary Method is well-known in psychological research and is becoming used more frequently (Bolger, et al. 2003). It involves the participant making daily written accounts of their personal thoughts and opinions, of certain experiences (Iida, et al. 2012). There are three categories of diary studies; interval-contingent protocols, signal-contingent protocols and event-contingent protocols (Wheeler and Reis, 1991). The diary method that would be best used with this scenario would be the event-contingent protocols. By using this design method, it means that the participant is required to provide a self-report each time the event in question occurs. In this case, it will be when the participant feels that they have been subject to stigma due to their schizophrenia.

One of the main advantages of using the diary method is that researchers can gather data in the participants everyday lives, meaning they are able to stop and document the event. This is exceedingly important when working with individuals with schizophrenia, as it has been shown in a study done by Alexiadou et al in 2018, that deficits were shown in episodic and semantic memories of events, facts and even regarding specifically recalled events. By decreasing the amount of time between the participant experiencing the event and documenting it, it will significantly increase the validity of events recall (Almeida, 2005).

However, one of the main issues with the diary method is that the participants may not reliably identify each relevant event. This can be due to miscommunication between the researcher and the participant or, more commonly, the individuals own perspective of what stigma towards them and their mental illness really is (Gunthert, 2012). This can lead to events not being documented, and therefore decreases the researches reliability (Iida, 2012). Although, if the event being documented is more complex than it would appear, the participant has no limit to how much they write down after the event that occurred. Giving a much deeper insight into the participants emotions and well-being.  By using this approach, it will allow phenomena and processes to be assessed in their natural settings rather than a controlled laboratory setting (Ebner-Priemer & Kubiak, 2007).

Another research method that could be used would be a self-administered online questionnaire. This questionnaire will contain both open and closed questions. The main advantage to this method, over the diary method, is that it allows for much more efficient analysis of the findings (Cantrell, et al. 2007). As well as this, this type of research allows for rapid data collection, as we can send a questionnaire to anyone who fits the criteria for it, which in this case is schizophrenia. This will give us access to a large sample of participants.

On the other hand, by using this type of questionnaire, the sample is limited. As the individuals taking part in the questionnaire must have access to a computer or some form of electronic device in which to access it, this means that all individuals who don’t have access to such devices are immediately removed from the sample. Making the results less generalisable (Le Fever, et al. 2007). But with the larger sample size that the online questionnaire would provide, some argue that the elimination of a select group would have a minimal effect of the results (Van Selm, et al. 2006).

As stated earlier, online surveys allow a researcher to reach huge amounts of people in a short amount of time, despite possibly being separated by great geographic distances (Taylor, 2000). This is not only an advantage because it allows access to a larger population but because it has also been shown to save time for researchers (Wright, 2017). However, due to the limited information that can be obtained via an online questionnaire, the biggest disadvantage is that it has lack of insight and depth into the individual and why they’ve said what they’ve said. By using the Diary method, the researcher can gain insight to each event of stigma that the participants experience. Whilst most, if not all, of this information is lost when using an online questionnaire.

Proposed Design

Design

This research shall be conducted using semi-structured interviews (SSI). The interviews will take place at the same location, each participant will have their own allotted time slot in which to arrive at the set location. Each participant will be asked the same SSI questions, provided for them by an SSI guide.

Participants

Participants will be located using the mental health service. Everyone that meets the criteria will be contacted and given the opportunity to take part in the research. 6 participants are required and the sample size was selected following previous studies such as Smith et al, (1999). All participants must provide a medical form confirming diagnosis of schizophrenia, must be between the ages of 25 – 65 with no other comorbid conditions.

Materials

A semi-structured interview guide will be provided for each researcher performing the interviews. This will contain a series of questions with prompts that the researchers can use to progress the interview. Briefing forms will also be needed for each participant along with a debriefing forms. A schedule for all the time slots for each interview will also be needed.

Procedure

A researcher will meet the participant at the agreed location, which will be somewhere quiet and private, at the selected time. The researcher will ask an opening question, to settle the participant into the conversation (Cridland, 2015). The main interview then begins, using the SSI guide provided. The interview should last at least an hour participants must be aware that all audio is recorded from these sessions (Pietkiewicz, et al. 2014). Before the interview begins the researcher must confirm that the participant fully understands the brief and their right to withdraw from the interview at any time. Once the participant has confirmed they understand the interview can begin. The researcher conducting the interview should follow the SSI guide provided, but do not be surprised if other topics are brought into the conversation by the participant. Participants should still be engaged with when they stray from the guide, as wider topic study is ideal for SSI’s (Smith, 2011). This makes it possible for the researcher and participant to engage in a dialogue, which allows further questions to be modified in retrospect of the other participants’ (Smith, 2015).  Once the interview is complete the participant can be debriefed.

Analysis

Once all interviews have been conducted, the recordings must be converted into a transcript. Each transcript is then read and annotated, identifying what you believe is to be the most interesting or significant, words or phrase, in what the participant said (Pietkiewicz, et al. 2012). Once this has been done, the researcher goes back to the annotations that have just been made and begins the process again. This is called bracketing (Husserl, 1999. In The Essential Husserl).  All summarised sections and annotations become more concise and specific, adapting a higher level of abstraction (Smith, et al. 1997). All whilst doing this, the researcher must make sure that they are going back over the original transcript to ensure that the phrases or themes that have been chosen, link back to what the participant initially said (Eatough, et al. 2008).

This transition from the initial transcript to themes, allows for over lapping to become identifiable (Smith & Osborn, 2007). These themes can now be listed together and the researcher can begin to look for connections between them. This list is usually listed chronologically. The researcher must make connections between these themes. Some themes may become subordinate, whilst other themes will cluster together. Once the clusters are identified it is vital that the researcher, once again, checks that the words used in the theme clusters came from the participants original transcript.

The final stage is to produce a table of themes and identify the ones which most strongly relate to the question at hand, which is the level of stigma people diagnosed with schizophrenia experience. The final table lists the clusters that go with certain subordinate themes, and an identifier is added to each instance. The identifier is a key word from a specific extract, from the original transcript, along with its page number (Smith & Osborn, 2007). Themes should not be selected purely based on their prevalence (Jarman, et al. 1997). In the process of creating this table, certain themes may be discarded. Once this is complete, the same thing is then done with all other 5 participants data. This type of analysis makes it ideal to incorporate all the collected data from all participants. When doing this there are two ways in which to incorporate the data; you can use themes from the first participants data to help direct any further analysis or forget about the data collected for the first participant and work off the next transcript as if it was the first. This analysis will be done with the latter.

Ethical Considerations

The participants privacy is one of the main ethical concerns, the participants will be frequently reminded of their right to withdraw at any time. As well as this, all sessions are recorded which can be construed as a breech in confidentiality, but all participants must sign a consent form acknowledging that they are aware of this.  The researcher must also try to minimize the possibility of intrusion into the autonomy of the participants, especially when a vulnerable sample is being used, such as diagnosed schizophrenics (Mahnaz , et al. 2014).

Justification

Semi-structured interviews where selected for this research scenario as they are able to provide a lot of opportunities to explore perceptions and opinions that would otherwise be complex to initiate discussion of. The open-ended style of all the questions in an SSI also allows for further probing into, what would be, sensitive topics (Barriball, 1994). This is ideal when researching schizophrenia and the stigma that comes with it ,as this research method avoids generalisations and examines participants individually on their own experiences. Another factor which contributes to the ability to examine more complex events can be attributed to the fluid frame work of an SSI. This means that it can provide in-depth and insightful data about complex phenomenon (Gale, 2013). However, this fluid frame work does require the researcher to have a less control in the semi-structured interview (SSI), to allow the participant to speak freely and comfortably. In this SSI the researcher is required to ask an opening question, that is not related to the topic that the participant is here to discuss (Cridland, 2015). This action is key for the researcher when conducting an SSI as it has been shown to relax participants more in comparison with participants who didn’t receive an off-topic opening question (Ranney, 2015). The in-depth conversation that comes hand in hand with SSI’s also allows the researcher the option to show empathy to the participant and gives them the chance to build up a rapport. By doing so it will have a positive effect on the participants relationship with the researcher, possibly allowing for greater coverage of the desired topic area (Prior, 2018). And with the topic being the stigma experienced by people diagnosed with schizophrenia, this rapport will play a vital role in getting the most relevant data.

Another advantage to using SSI is that this method can also be financially practical. By analysing the SSI’s data with interpretative phenomenological analysis (IPA). By using IPA, it will highly reduce the number of participants needed in order to produce results (Harrell, 2009). In this particular research proposal, the majority of the cost will come from data analysis, as only 6 interviews need to take place to fulfil the participant number criteria for valid results to be generated. On top of the financial benefit of a small sample size, it also means that gaining the desired amount of participants is less likely to be affected, and attrition is less likely to occur. However, the main argument when it comes to have a small sample size is that it can not be generalised to the wider population therefore the reliability of research is reduced (Boddy, 2016). On the other hand, by using SSI’s the level of in-depth data that is obtained can be seen to counteract the disadvantages of a small sample size (Anderson, et al. 2017). As well as this, since schizophrenia affects 1% of the population, it can also be argued that in a study like this, you don’t require results that are highly generalisable.

IPA has been considered the centre of idiographic commitment. Smith, in 2004, said “

I encourage researchers to be even bolder in considering studies. Doing elaborate, detailed, nuanced single case studies, where the material and topic warrants it.

” However, the interoperative frame work can make way for a pit fall that comes with the use of IPA, and that is that researchers start using the prompts provided by the SSI guide as the ‘themes’ that are reporting. If this was to occur, it would mean that no analytic work had been carried out. Meaning no themes wold have been identified across the entire data set, leaving the researcher unable to make sense of any patterned responses (Braun, et al. 2006). The interoperative frame work also makes way for the acknowledgment that there is no one way of conducting IPA, but also to remember that it is important to highlight that there is also a marked group of similarities when it comes to designing any qualitative research (Vasilachis, 2009). Smith, 2004, also argues that the quality of the final analysis is an individual’s own analytic work, and therefore is influenced by them, reducing the reliability of the research. But from a phenomenological perspective, IPA is particularly attractive because of its resilience and determination when it comes to exploring, interpreting, and allowing the participants to make sense of their own experiences (Tuffour, 2017).

It has also been stated, by Tuffour, 2017, that IPA has had some criticism due certain aspects of phenomenology not being compatible with cognition even though the role of cognition phenomenology is not fully understood. However, Smith et al (2004), threw out this criticism by arguing that the IPA’s necessity of sense-making and meaning-making which clearly resonates with cognitive psychology. Smith et al. (2009) also argued that IPA uses hermeneutic, idiographic and contextual analysis to understand the cultural position of the experiences people. Making the data gathered by this method much higher in validity.

Over all, SSI data can be applied across a range of theoretical and epistemological approaches, which can be expanded on or used to test an existing theory (Braun and Clark 2006). All the while, providing a rich amount of data to analyse. When examining individuals that deal with stigma due to their schizophrenia, by having a deeper understanding into how the participant feels during the event it can be said that the results will have a much higher validity especially when SSI is combined with IPA, it can demonstrate certain intra and inter-personal aspects of having a mental illness (Knight et al, 2003). For these participants stigma is evident in various ways, from closer sources including family, friends and mental health professionals and by using IPA it allows the researcher to gain in-sight into more detailed aspects of the individual and the stigma that they experience. By using these two detailed methods, it can be shown, through the research, what would be the best support, if any, in assisting these individuals in living with the stigma.

References

• Alexiadou, A., Bozikas, V. P., Kosmidis, M. H., Parlapani, E., Kiosseoglou, G., & Fokas, K. (2018). The effect of impaired verbal memory retrieval on autobiographical memory across different life periods in schizophrenia. Comprehensive Psychiatry, 80, 81-88.
• Almeida, D. M. (2005). Resilience and vulnerability to daily stressors assessed via diary methods. Current Directions in Psychological Science, 14(2), 64-68.
• Anderson, S. F., Kelley, K., & Maxwell, S. E. (2017). Sample-size planning for more accurate statistical power: A method adjusting sample effect sizes for publication bias and uncertainty. Psychological Science, 28(11), 1547-1562.
• Biggerstaff, D., & Thompson, A. R. (2008). Interpretative phenomenological analysis (IPA): A qualitative methodology of choice in healthcare research. Qualitative Research in Psychology, 5(3), 214-224.
• Bolger, N., Davis, A., & Rafaeli, E. (2003). Diary methods: Capturing life as it is lived. Annual Review of Psychology, 54(1), 579-616.
• Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.
• Brocki, J. M., & Wearden, A. J. (2006). A critical evaluation of the use of interpretative phenomenological analysis (IPA) in health psychology. Psychology and Health, 21(1), 87-108.
• Burnard, P. (1991). A method of analysing interview transcripts in qualitative research. Nurse Education Today, 11(6), 461-466.
• Cantrell, M. A., & Lupinacci, P. (2007). Methodological issues in online data collection. Journal of Advanced Nursing, 60(5), 544-549.
• Cridland, E. K., Jones, S. C., Caputi, P., & Magee, C. A. (2015). Qualitative research with families living with autism spectrum disorder: Recommendations for conducting semistructured interviews. Journal of Intellectual and Developmental Disability, 40(1), 78-91.
• Eatough, V., & Smith, J. A. (2008). Interpretative phenomenological analysis. The Sage Handbook of Qualitative Research in Psychology, 179, 194.
• Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC medical research methodology, 13, 117.
• Gunthert, K. C., & Wenze, S. J. (2012). Daily diary methods.
• Hamilton, S. (2015). Rationalism and the understanding of irrationality.
• Harrell, M. C., & Bradley, M. A. (2009). Data Collection Methods.Semi-Structured Interviews and Focus Groups,
• Husserl, E. (1999). The essential husserl: Basic writings in transcendental phenomenology Indiana University Press.
• Iida, M., Shrout, P. E., Laurenceau, J., & Bolger, N. (2012). Using diary methods in psychological research.
• IPA, O. (2005). Exploring lived experience. Psychologist, 18(1), 20.
• Jarman, M., Smith, J. A., & Walsh, S. (1997). The psychological battle for control: A qualitative study of health‐care professionals’ understandings of the treatment of anorexia nervosa. Journal of Community & Applied Social Psychology, 7(2), 137-152.
• Jaspal, R., & Cinnirella, M. (2012). The construction of ethnic identity: Insights from identity process theory. Ethnicities, 12(5), 503-530.
• Knight, M. T., Wykes, T., & Hayward, P. (2003). ‘People don’t understand’: An investigation of stigma in schizophrenia using interpretative phenomenological analysis (IPA). Journal of Mental Health, 12(3), 209-222.
• Lefever, S., Dal, M., & Matthiasdottir, A. (2007). Online data collection in academic research: Advantages and limitations. British Journal of Educational Technology, 38(4), 574-582.
• Louise Barriball, K., & While, A. (1994). Collecting data using a semi‐structured interview: A discussion paper. Journal of Advanced Nursing, 19(2), 328-335.
• Neupert, S. D., & Bellingtier, J. A. (2018). The ups and downs of daily diary research.
• Ohly, S., Sonnentag, S., Niessen, C., & Zapf, D. (2010). Diary studies in organizational research. Journal of Personnel Psychology,
• Pietkiewicz, I., & Smith, J. A. (2014). A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Psychological Journal, 20(1), 7-14.
• Prior, M. T. (2018). Accomplishing “rapport” in qualitative research interviews: Empathic moments in interaction. Applied Linguistics Review, 9(4), 487-511.
• Ranney, M. L., Meisel, Z. F., Choo, E. K., Garro, A. C., Sasson, C., & Morrow Guthrie, K. (2015). Interview‐based qualitative research in emergency care part II: Data collection, analysis and results reporting. Academic Emergency Medicine, 22(9), 1103-1112.
• Schmidt, C. (2004). The analysis of semi-structured interviews. A Companion to Qualitative Research, , 253-258.
• Smith, J. A. (2011). Evaluating the contribution of interpretative phenomenological analysis. Health Psychology Review, 5(1), 9-27.
• Smith, J. A. (2015). Qualitative psychology: A practical guide to research methods Sage.
• Smith, J. A., Flowers, P., & Osborn, M. (1997). Interpretative phenomenological analysis and the psychology of health and illness. Material Discourses of Health and Illness, , 68-91.

• Van Selm, M., & Jankowski, N. W. (2006). Conducting online surveys. Quality and Quantity, 40(3), 435-456.
• Vasilachis de Gialdino, I. (2009). Ontological and Epistemological Foundations of Qualitative Research. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 10(2). doi:http://dx.doi.org/10.17169/fqs-10.2.1299

Alzheimer’s disease is a progressive, irreversible brain disease that slowly causes deterioration is memory and thoughts, and eventually leads to the inability to complete simple tasks. Early onset

Alzheimer’s

disease occurs between thirty to sixty years of age and is very rare. In late onset Alzheimer’s disease, which is most commonly seen, symptoms appears when an individual is in their 60’s. Although symptoms may vary from person to person, memory changes are often the first signs of Alzheimer’s disease. Other areas of thinking such as finding the right words or impaired reasoning may also indicate the early stages of Alzheimer’s disease. Individuals with Alzheimer’s disease have difficulty completing everyday tasks such as driving a car or preparing a meal. These individuals may ask the same questions repeatedly, get lost easily, misplace things, and even find simple tasks difficult or confusing (National Institute on Aging, 2017). They may have trouble recognizing family and friends. Patients may also begin to have hallucinations, delusions, and paranoia (McNair, 2015). The purpose of this paper is to provide insight on the mental, physical, and financial burden that caregivers experience when taking care of an Alzheimer’s patient.

According to Kotradyova (2018, p. e73), “Alzheimer’s disease is the sixth most common cause of death in the US, and the fifth most common cause of death of Americans over the age of 65.” Over 5 million individuals in the United States have Alzheimer’s disease, and as the population ages, the prevalence of Alzheimer’s disease increases as well (Wennberg, Dye, Streetman-Loy, & Pham, H, 2015). With the aging population living longer, more and more individuals are diagnosed with Alzheimer’s disease. The number of people affected with Alzheimer’s disease is expected to double every twenty years. Currently in the United States one in ten people are living with this disease (Grabher, 2018). Although

treatment

can help manage symptoms in some patients with Alzheimer’s disease, currently there is no cure for this disease (National Institute on Aging, 2017).

The key words that were used when searching for articles to be included in the paper were “caregiver burden with Alzheimer’s patients”,”caregiver burden”, “caregiver stress”, “Alzheimer’s patients, and “dementia patients”. The SUNY Poly Cayan Library “CINAHL Plus with Full Text” database was used to find peer-reviewed articles. Articles were limited to current journal articles within the past five years. All articles were scholarly and in the English language. The number of articles that were provided for the search was well over a thousand although, only a total of ten articles were retained for this particular review.

Providing care for individuals with Alzheimer’s disease is demanding because more and more care is required as the disease progresses. Due to the fact that caregivers play such important roles for patients with Alzheimer’s disease, the factors that affect their burden should be rezognized (Yu, Wang, He, Liang, & Zhou, 2015). The problem addressed for the purpose of this assignment is the negative impact that caregivers experience when caring for an Alzheimer’s patient. Because of the progression of the disease, the individual with Alzheimer’s disease and the caregiver become largely affected. In many cases, patients with Alzheimer’s disease are cared for by family members such as a spouse or an adult child. At times, several family members care of the individual with Alzheimer’s disease, however, patient care is very demanding. The care of an individual suffering from Alzheimer’s disease creates emotional strain and the family may face many problems (Kotradyová, 2018). Due to the devastating effects of caring for an Alzheimer’s patient, caregivers often experience high levels of stress from the challenges of physical, psychological, emotional, social, and financial stressors related to caregiving (Wennberg, Dye, Streetman-Loy, & Pham, H, 2015).

As mentioned, Alzheimer’s disease does not only concern the patient themselves, but also those who directly take care of the individual. A study was done in Slovakia in 2016 where 10 participants who had taken care of a individual with Alzheimer’s disease for more than two years were included. A qualitative research was carried out and aimed at identifying the load factors related to taking care of individuals with Alzheimer’s disease. Research was conducted using the focus group method and informed consent was given. The results showed that the poor health condition of patient itself is what causes stress in the caregiver. The emotional stress of family members who cared for the patient was due to the loss of memory, impulsivity and irritability, and change in character or personality. The participants struggled with strong negative feelings, but also feelings of sadness because they were losing their family member to the disease. Participants described feelings of frustration that they cannot change what is going on. This frustration often leads to emotions of anger at oneself or even at the patient suffering from the disease (Kotradyová, 2018).

Caregivers of Alzheimer’s patients may suffer from mental health disorders from the constant stress of caregiving. A meta-analysis was done where 10,825 caregivers were assessed to determine the prevalence of mental health disorders perceived from giving care to an Alzheimer’s patient. The results determined the prevalence of depression was 33.9%, suggesting that at least 1 of 3 caregivers of patients with Alzheimer’s disease suffer from depression. The occurence of depression among caregivers of patients with Alzheimer’s disease was particularly higher than caregivers to patients with psychiatric diseases. When comparing the occurence of depression to the caregivers of patients with a physical illness such as a stroke, the occurence of depression was higher among the caregivers of patients with Alzheimer’s disease. The study concluded that caregivers of patients with Alzheimer’s disease have a higher occurence of mental health disorders, specifically anxiety and depression. The high occurence of caregivers with depression is commonly seen with female caregivers, caregivers with male patients, and caregivers who were married to the patient. (Sallim, Sayampanathan, Cuttilan, & Ho, 2015).

Many family members and caregivers also experience feelings of helplessness and guilt. Caregivers feel helpless in not being able to find doctors who can correctly diagnosis their family member’s impairment accurately, to going to multiple physicians to get an accurate diagnosis.  Guilt is another common feeling family members and caregivers experience. Alzheimer’s disease caregivers feel guilty for the way they behave toward the patient, for losing their temper, and for spending time with friends instead of being with the patient. Another big form of guilt is when a caregiver must do things that take away from the patient’s independence, such as taking away their car keys so they cannot drive or not allowing them to live alone or handle their own finances (Grabher, 2018).

The culture to which a person belongs to, can also affect the level of caregiver burden. A cross-sectional study included patients diagnosed with Alzheimer’s disease from two hospitals and three communities in Taiyuan, China and their caregivers.  Caregivers were assessed on their burden of caregiving, perception of caregiving, family function and social support. In the Chinese culture, caregivers view caregiving as just another part of family life. However, Chinese caregivers of patients with Alzheimer’s disease scored higher levels of depression and caregiver burden compared with caregivers in Western societies (Yu, Wang, He, Liang, & Zhou, 2015).

Caregivers continue to experience physical burdens from caring for patients with Alzheimer’s disease. They experience worsening of health and account for higher statistics of bad health and mortality, due to the fact that they’re lacking sleep, lacking time for leisure activities and lacking time to take care of their own health. Caregivers of Alzheimer’s patient have worse physical health than people who do not care for patients. Taking care of the home and chores of the Alzheimer’s disease patient such as laundry and food preparation requires energy and can be extremely exhausting, more so if the caregiver has to take care of his or her own household also. A woman, who participated in a study that cared for her father with Alzheimer’s disease for three years, said the following, “My father was a hard-working and smart person all his life. He liked taking walks and loved nature. At the beginning, I wanted him to live at least a little bit just like before the illness, so I dressed up each day and went for a walk for an hour. Today, I cannot do it. My father cannot get dressed on his own, I have to put on his shoes, clothes and then, when we get back home, repeat the whole process. It’s better during the summer, but during the winter? Also, if I want to bathe him, I get completely exhausted. Additionally, I cook, clean, try to take care of the household, but it seems like I am physically unable to continue, I’m exhausted and don’t sleep enough, since I wake up all the time wondering, if my father woke up and wanders around the house” (Kotradyová, 2018, e77). This goes to show how exactly exhausting it is for caregivers on a daily basis. In general, the workload of caregivers is overwhelming which has a negative effect on their own health.

Social isolation of caregivers who take care of an individual with Alzheimer’s disease results from the fact that the disease requires maximum supervision and care. This is often the reason why caregivers lose interactions with friends and family and close themselves off. Individuals often connect their social isolation with constant feelings of loneliness because of the continuous care for an individual with Alzheimer’s disease (Kotradyová, 2018).

Caring for an Alzheimer’s patient not only affects the caregivers mentally and physically, but financially as well. Family caregivers, especially those caring for people with Alzheimer’s disease, are likely to face some financial burden. “The Alzheimer’s Association estimated the indirect cost of dementia (including the loss of earnings as a result of reduced working hours) as $65 billion in 2005.” (Nam, 2016, p. 1093). Approximately 10% of caregivers of patients with Alzheimer’s disease missed work because of caring for the patient, approximately 30% gave up work for patient-related responsibilities, and approximately 8% turned down opportunities for promotion. A study was completed to examine the relationship between financial difficulty and depressive symptoms in 659 Alzheimer’s disease caregivers. Depressive symptoms were measured using the CESD self-report instruments for depressive symptoms in caregivers. This measure consisted of twenty statements about one’s depressive symptoms and their frequency in the past week based on a four-point Likert-type scale ranging from “rarely or none at all” (0) to “mostly or almost all the time” (3). Financial difficulty was evaluated by asking “How hard is it for you to pay for basic necessities such as food, housing, medical care, and heating?” These categories were also rated on a four-point Likert-type scale ranging from “not difficult at all” (0) to “very difficult” (3). Results conclude that financial difficulty has a significant effect on depressive symptoms. This suggests that dementia caregivers are in need of support for their financial difficulty (Nam, 2016).

There continues to be underlying financial burden related to taking care of Alzheimer’s disease patients in the hours of unpaid care and the economic value of caregiving. “In 2013, the 15.5 million family and other unpaid caregivers of people with Alzheimer’s disease and other dementias provided an estimated 17.7 billion hours of unpaid care” (Grabher, 2018, p. 10). This number shows an average of 21.9 hours of care per caregiver per week, or 1,139 hours of care per caregiver per year. These numbers have had a big impact on the caregivers, their families, and the economy (Grabher, 2018). Not only is caregiving costly currently, it can also have devastating cost for their long-term future and retirement. Caregiving can result in loss of employment, diminished savings or home equity, a loss in social security benefits, or decreased pension funding. Due to the high cost of caregiving, healthcare providers should know about the available resources and share this information with their patients and caregivers (McNair, 2015)

Coping strategies play an important role in regulating the psychologic impact caregivers experience from the disease. A study including eighty-six caregivers of corresponding patients with Alzheimer’s disease aimed to evaluate the burden and anxiety experienced, the effectiveness of coping strategies, and the relationships with burden and anxiety. The first result is that the global burden in the sample is high compared with those reported in different studies. Among other burdens, time dependence is the most important. Further, Alzheimer’s disease caregivers experience feelings of failure about their personal expectations of the phase of life they are living. Although, little impact comes from negative feelings toward the patient and their illness. Taking on the role of caregiving brings along an increasing burden, particularly in developmental and physical aspects. Relatives experience the loss of many opportunities because of the time restriction that occurs with caregiving. The coping strategies adopted by the female caregiver are often emotion-focused. This type of strategy predisposes the caregiver to a higher burden and distress. Alzheimer’s disease caregiving is often associated with negative effects. This indicates that caregivers are physically, emotionally, and financially overwhelmed by their caregiver role (Iavarone, Ziello, Pastore, Fasanaro, & Poderico, 2014).

Educating caregivers on the behaviors they can expect from patients with Alzheimer’s disease can minimize the negative impact when issues emerge. Caregivers are more likely to seek help from a healthcare provider when they are disturbed by the patients behaviors and uncertain about the best ways to interact. Early intervention by healthcare professionals could minimize the negative impact of Alzheimer’s disease on caregivers’ lives and provide caregivers with tools to manage patient’s negative behaviors (McNair, 2015

)

.

Researchers have shown that daily routines are crucial to decreasing agitation and disruptive behavior in patients with Alzheimer’s disease. By creating a predictable routine this can improve the quality of patient’s lives and the lives of their caregivers. Routines make it easier to remember what needs to be done each day, provides a sense of security, and can reduce anxiety. Routines that incorporate interests and activities the patient has enjoyed in the past are more likely to reduce negative behavioral symptoms associated with Alzheimer’s disease (McNair, 2015

)

.

Caring for a patient with Alzheimer’s disease can become very stressful. Managing work, family life, and caregiving often leads to increased emotional stress and depression. To be able to provide the best care for a patient, caregivers often neglect their own needs. Caregivers may experience feelings of sadness as they observe their patient or family member decline in function and personal identity. They may experience depression from social isolation and exhaustion from having to care for long hours. Maintaining a life outside of caregiving is important to staying emotionally and physically healthy. Healthcare providers should encourage activities that decrease social isolation such as staying in touch with family and friends and joining a social group. It is important for the caregiver of an Alzheimer’s patient to build a support system. Exercise and engaging in an enjoyable physical activity is a positive way to relieve stress and improve health outcomes in caregivers (McNair, 2015).

Many Alzheimer’s disease caregiver interventions have been developed. Strategies may include support groups, which can be used to normalize experiences and allow for more social connections and support; education classes, which provide information and give caregivers tools and skills to solve problems, and counseling interventions that develop individualized plans based on personal needs. Seeing that caregivers are at risk of developing a wide range of negative outcomes, frequent monitoring of caregiver mental and physical health is an important consideration for interventions (Wennberg, Dye, Streetman-Loy, & Pham, H, 2015).

Further research should involve the assessment and solution of caregivers and the burden that so many of these individuals face. The emotional, physical, and financial burden that caregivers experience puts them at risk of having their own health problems. Their health problems often go either avoided or unnoticed because they are busy caring for another individual. This is important for nursing practice because nurses can recognize when caregivers are emotional or physically exhausted. Nurses can be a helping hand for those that are in need. Further research that can be conducted is to assess what other factors may be contributing to the burden that caregivers face. Is it due to the fact that it is their family members suffering, because they have their own families to take care of also, or another factor? Interventions should be put into place to help and support caregivers and the important role they plan in Alzheimer’s patient lives.

References

• Grabher, B. (2018). Alzheimer’s disease and the effects it has on the patient and their family.
  
  SNM Journal,
  
  1-26.
• Iavarone, A., Ziello, A., Pastore, F., Fasanaro, A., & Poderico, C. (2014). Caregiver burden and coping strategies in caregivers of patients with Alzheimer’s disease.
  
  Neuropsychiatric Disease and Treatment,
  
  
  10
  
  , 1407-1413.
• Kotradyová, K. (2018). Determinants characterizing the life of a caregiver treating an individual with alzheimer’s disease.
  
  Social Sciences in Health,
  
  E72-E80.
• McNair, T. (2015). Early intervention for caregivers of patients with alzheimer’s disease.
  
  Home Healthcare Now,
  
  
  33
  
  (8), 425-430.
• Nam, H. (2016). Financial difficulty effects on depressive symptoms among dementia patient caregivers.
  
  Community Mental Health Journal,
  
  
  52
  
  , 1093-1097.
• National Institute on Aging. (2017). What is alzheimer’s disease? Retrieved November 10, 2018, from https://www.nia.nih.gov/health/what-alzheimers-disease
• Raggi, A., Tasca, D., Panerai, S., Neri, W., & Ferri, R. (2015). The burden of distress and related coping processes in family caregivers of patients with Alzheimer’s disease living in the community.
  
  Journal of the Neurological Sciences,
  
  77-81.
• Sallim, A., Sayampanathan, A., Cuttilan, A., & Ho, R. (2015). Prevalence of mental health disorders among caregivers of patients with alzheimer disease.
  
  Journal of the American Medical Directors Association,
  
  1034-1041.
• Wennberg, A., Dye, C., Streetman-Loy, B., & Pham, H. (2015). Alzheimer’s patient familial caregivers: A review of burden and interventions.
  
  Health & Social Work,
  
  
  40
  
  (4), E162-E169.
• Yu, H., Wang, X., He, R., Liang, R., & Zhou, L. (2015). Measuring the caregiver burden of caring for community-residing people with alzheimer’s disease.
  
  PlosOne,
  
  
  10
  
  (7).

This essay will analyse some of the main health risks posed by weight gain and obesity such as the risk of developing chronic heart disease, diabetes and cancer. It will also discuss some of the factors that can impact on wellbeing and the strategies in place nationally to promote healthy living habits.

The World Health Organisation (W.H.O), reports that weight gain is a global issue, and reports that “42 million children under the age of five were overweight or obese in 2013”. Their research found that people who are overweight have a higher risk of heart disease, high cholesterol, high blood pressure, Type 2 diabetes and other chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD), cancer and stroke.

To reduce these risks we need to help the body maintain good weight. The British Heart Foundation(BHF) advises people to seek support from a GP or even family and friends who can help to establish long term goals to achieve this. In relation to this, there are two calculations used by health professionals to predict if someone is at increased risk of serious illness: waist circumference and body mass index or BMI (Body Mass Index), calculated by dividing one’s weight (kg) by the square of their height (m).

Defining children as overweight is a difficult process since their height and weight changes at the same time, and growth patterns differ between the sexes so separate charts are used for calculations. The National Child Measurement Programme analyses these calculations in preschool children aged 4-6 in the UK and are a part of national measures to tackle obesity. A 2013 survey by Public Health England (PHE) found that obesity prevalence in 4-5 and 10-11 year old’s has been increasing. These children would need to lose weight to improve their health and lessen the risk that they will become obese adults. In 2012 The BHF estimated that more than a quarter of adults in England were obese.

In its 2012 statistical report, the BHF reported that coronary heart disease was the biggest killer in the UK in 2010. It is a common consequence of being overweight and obese and occurs when fatty material blocks arteries. The BHF advises people to eat healthily, lower alcohol consumption, exercise and avoid smoking to lower the risk.

Being overweight can affect the risk of cancer because fat tissues in the body produce hormones that can affect the way cells work. According to Cancer Research UK, obesity is linked to one in twenty cancers in the UK and is also a factor in three of the hardest to treat cancers including: pancreatic, gallbladder and oesophageal.

Smoking also increases the risk of developing at least 13 types of cancer including Lung Cancer. Chemicals in cigarettes permanently damage DNA which can cause cancer cells to grow and multiply. Smoking is also a major cause of Strokes and Chronic Obstructive Pulmonary Disease (COPD). People suffering from COPD struggle to breathe in and out due to the long term damage to the tissue around the lungs. The NHS estimates that nearly three million people in the UK are affected by COPD. People can slow the progression of the disease by stopping smoking, eating healthily and exercising.

Like Coronary Heart Disease, strokes are linked to high blood pressure, which is often linked to smoking. Strokes occur when the brain’s blood supply is restricted when the arteries become blocked causing blood clots. The NHS advises people to reduce the risk of stroke by eating a healthy diet which can lower cholesterol levels, exercising regularly and cutting down smoking and alcohol consumption.

According to Diabetes UK, diabetes affects 3.2 million people in the UK and is associated with high or low glucose and poor blood circulation since it causes arteries to become ‘’furred up’’. Diabetes occurs when there is too much glucose in the blood. Type 1 Diabetes usually appears in childhood and can be controlled by insulin injections. Type 2 Diabetes usually appears in people over 40, and is treated by a combination of eating healthy, exercising and medication. Complications can occur when diabetes is not managed properly since high glucose levels can damage the small blood vessels that supply key organs. Diabetes UK lists complications including: cardiovascular and kidney disease, feet ulcers, eye and nerve problems, and high blood pressure.

The NHS reports that High Blood Pressure (Hypertension) , often named the ‘silent killer’, affects about 30% of the English population and if untreated can increase the risk of heart disease and stroke. High Blood pressure can be reduced by altering the lifestyle by stopping smoking, lowering alcohol and caffeine consumption, and lowering weight via healthy eating and exercise. It can also be treated with some medication.

Good habits learned in childhood can ensure that key health factors such as eating varied foods as part of a healthy balanced diet and exercising become part of the daily routine. The British Nutrition Foundation recommends teaching children early about the various food groups that make up a nutritionally balanced plate, illustrated via the “Eat Well Plate”.

These food groups and their key benefits are summarised as:

-Carbohydrates: starchy foods which should form the base of what we eat and include potatoes, rice, bread, pasta. Some of these foods are available as white or wholegrain and health professionals advise to choose the wholegrain varieties such as brown rice, as they contain more minerals, vitamins and fibre.

-Protein can be found in meat, fish and beans and is essential for the body to grow and repair itself. Meat is a main source of B12, a vitamin that cannot come from vegetables. According to the National Institute of Health, B12 deficiency can lead to loss of appetite, memory loss and depression. B12 components can also reduce the risk of heart disease and stroke. Meat can be a source of vitamins, zinc and iron, but also of fat so it is advisable to buy lean meat or poultry. Oily fish such as mackerel and sardines contain essential omega 3 fatty acids that help to fight blockages in the arteries thereby reducing cholesterol and preventing heart disease.

-The dairy group comprises milk and dairy products, foods high in fat but which contain calcium, which helps to keep bones strong. Despite being high in calories fats have some beneficial roles such as helping to transport essential vitamins around the body. Fats come in two types. Saturated fat comes mainly from animal products such as meat, dairy and eggs and can increase cholesterol in the body which can lead to heart disease. Unsaturated fat products are found mainly in vegetables and plants such as nuts, olives and avocados and are beneficial to the body and help to lower cholesterol.

-Fruit and vegetables help to keep the body healthy as they are low in fat and are high in essential vitamins and minerals such as vitamin C, potassium, as well as fibre which helps to reduce bowel cancer, as well as heart disease and stroke. The Department of Health recommends eating at least five portions of fruit and vegetables a day to reduce these risks and has introduced a free piece of fruit or vegetable portion to every child in primary school aged between 4-6 years under the School Fruit and Vegetable Scheme.

Findings in 2014 by the National Diet and Nutrition Survey showed that too many people eat more than the daily recommended amount of sugar. Sugars occur naturally in foods such as fruit and milk, but they are dangerous when added to food and drink such as biscuits, fizzy drinks, sweets and contribute to obesity and tooth decay.

To help children develop good eating habits early, parents can engage children in creative activities at home such as cooking demonstrations that can help children to explore and taste new foods,explore new colours and textures which can fuel excitement and interest in food. Children can be involved in the shopping experience,at the supermarket they can select their own fruit and vegetables. Children involved in these activities,or who eat at a table with others are more likely to try different foods which can lower the risk of becoming picky eaters.

The WHO recommends that children should undertake at least one hour a day of physical activity.

It is therefore important that parents find opportunities to incorporate active play opportunities in a child’s daily routine. The NHS advises parents to minimise the amount of time young children under five spend being restrained in a car seat or pram,or watching television.

It advises that in order to maintain a healthy BMI,small children under five should be physically active for three hours spread over the day. The guidance includes energetic activities for increased movement such as swimming,using the climbing frame,chasing games involving running e.g. hide and seek. Small children can be encouraged to free play before an evening meal rather than watching television. In addition parents can involve children with physical tasks around the home,for example with cleaning or gardening. Young babies can be involved in light activity at home:such as by encouraging babies to crawl,jump or roll. Parents can let a baby kick on a changing mat before a bath or after being changed.

A 2012 Health for England Survey reported that physical activity is important for preschool children as it increases bone and muscle strength,attention,and improves behaviour and achievement. However, children’s play is becoming increasingly restricted due to factors such as parents working later hours, lack of suitable outdoor play space and parent’s fears about children’s safety on the streets.

Some charities such as Change for Life and Play for England campaign to increase awareness of the benefits that play has for children, and campaigns to increase outdoor play spaces for children. They suggest that trips to the local park and adventure playgrounds are great outdoor play opportunities, particularly valuable in a modern, urbanised society. Their Street Play Project for example,campaigns to increase residential-led street play for children particularly in disadvantaged areas.

Reducing ill health is one the Government’s visions for children and families in the UK, who following the tragic death of Victoria Climbe put together a programme-Every Child Matters to bring together all agencies looking after children in their care to prevent ill treatment. It created legislation to promote children’s mental and physical health by bring together all agencies to improve outcomes for all children in their care. Physical activity is also at the heart of the Early Years Foundation Stage (EYFS) Curriculum,one of the seven areas of achievement intended to help preschool children recognise the importance of physical activity in maintaining a healthy lifestyle by the time the reach the end of the curriculum.

Looking after the emotional aspects of life is also an important consideration of wellbeing, sitting side by side with eating healthy and staying physically fit. It is now largely accepted that what children become in their adult lives is to a great extent a product of their experiences in the early stages of their lives (Measuring National Wellbeing 2012). However research carried out by PHE in 2013 found regional differences in physical activity and wellbeing,with higher levels of obesity detected in deprived areas of low income. Issues such as poor quality of housing and material deprivation including toys and food can have a negative effect on a young person’s wellbeing.

These issues contravene some beneficial principles families should incorporate to promote a harmonious environment in the home where wellbeing can thrive. Two key principles are:

-Avoiding conflict within the home as this creates a negative atmosphere

-The consistency approach,if followed helps to develop reliability,trust and learning that actions have consequences.

In childcare settings it is essential to monitor and evaluate children’s development to ensure that they are not displaying signs of physical, social or emotional difficulties affecting their wellbeing. Equally, education practitioners can also help parents who need support with physical, emotional and economic problems impacting on their wellbeing, by offering access to parenting services such as the Triple P Program (Positive Parenting Programme) which claims that it helps lower parents stress,anger and depression. Courses include individual consultations with trained professionals and group sessions where parents can meet together in an encouraging and non judgemental environment where they can share experiences.

In conclusion, the trend in modern society is for people to become less active, in particular children who are leading increasingly sedentary lives. Parents find it challenging to help children meet the recommended minimum of one hour a day of moderate exercise, as parents work increasingly longer hours,and outdoor play spaces are reduced in urbanised environments. Lack of exercise and high carb diets mean that children are more at risk of developing serious health difficulties in the future-obesity,heart disease,weakened bone structure and cancer. It is therefore important for parents to make a change since children who develop an active lifestyle and are introduced to a variety of physical activities are much more likely to continue that healthy lifestyle into adulthood. Governments also need to continue to prevent and promote good health as identified by the Every Child Matters and School Fruit and Vegetable Scheme.

Reference List

World Health Organisation (2014) Obesity and Overweight,Factsheet No311

http://www.who.int/mediacentre/factsheets/fs311/en/

(accessed 13 November 2014)

Townsend N, Wickramasinghe K, Bhatnagar P, Smolina K, Nichols M, Leal J, Luengo-Fernandez R, Rayner M (2012). Coronary heart disease A compendium of health statistics 2012 edition. British Heart Foundation: London.

file:///C:/Users/monicasofia/Downloads/2012_CHD_Statistics_Compendium.pdf

(Accessed 11 November 2014).Pages accessed: p8,p10

British Heart Foundation,Preventing Heart Disease 2014

http://www.bhf.org.uk/heart-health/prevention.aspx

(Accessed 12 November 2014).

Public Health England, National Child Measurement Programme Operational Guidance,May 2014.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/361189/NCMP_operational_guidance_v2_Sept_14.pdf

(Accessed 14 November 2014).

Cancer Research Uk,Obesity,Body weight and Cancer,2014.

http://www.cancerresearchuk.org/cancer-info/healthyliving/obesity-bodyweight-and-cancer/obesity-body-weight-and-cancer Accessed 12th November 2014

).

Kath Roberts, Nick Cavill, Caroline Hancock and Harry Rutter Public Health England Social and Economic Inequalities in diet and physical activity 2013, p8,9,

http://www.noo.org.uk/uploads/doc/vid_19253_Social_and_economic_inequalities_in_diet_and_physical_activity_04.11.13.pdf

(Accessed 14 November 2014)

NHS ,Chronic Obstructive Pulmonary Diseaese 2014,

http://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease/Pages/Introduction.aspx#close.Smokers

(Accessed 13 November 2014).

NHS ,Stroke-Prevention,(2014),

http://www.nhs.uk/Conditions/Stroke/Pages/Prevention.aspx

(Accessed 12 November 2014).

NHS,High Blood Pressure,2014

http://www.nhs.uk/conditions/Blood-pressure-(high)/Pages/Introduction.aspx

(Accessed 12 November 2014)

Diabetes UK ,What is Diabetes, 2014,

http://www.diabetes.org.uk/Guide-to-diabetes/What-is-diabetes/

(Accessed 10 November 2014).

Diabetes UK,Nerves, Diabetes Complications 2014,

http://www.diabetes.org.uk/Guide-to-diabetes/Complications/

(Accessed 12 November 2014)

British Nutrition Foundation 2014,

www.nutrition.org.uk

(accessed 12 Novemebr 2014).

National Institute of Health,June,24,2011.Vitamin B12 F

actsheethttp://ods.od.nih.gov/factsheets/VitaminB12-Consumer/#h1

(Accessed 12 November 2014)

Department of Health,The National Archives,5 a Day

http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthimprovement/FiveADay/Index.htm

(Accessed 12 November 2014).

Department of Health,The National Archives School Fruit and Vegetable Scheme 22 march 2010

http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Healthimprovement/FiveADay/FiveADaygeneralinformation/DH_4002149

(Accessed 12 November 2014)

Public Health England Reducing Obesity and Improving Diet,Public Health and Young People 14 May 2014

https://www.gov.uk/government/news/new-national-diet-and-nutrition-survey-shows-uk-population-is-eating-too-much-sugar-saturated-fat-and-salt

(Accessed 10 November 2014)

Kath Roberts, Nick Cavill, Caroline Hancock and Harry Rutter ,Public Health England Social and Economic Inequalities in Diet and Physical Activity 2013

http://www.noo.org.uk/uploads/doc/vid_19253_Social_and_economic_inequalities_in_diet_and_physical_activity_04.11.13.pdf

(Accessed 14 November 2014)

Health Survey for England Summary of Key Findings 2012

http://www.hscic.gov.uk/catalogue/PUB13218/HSE2012-Sum-bklet.pdf

(Accesed 12 november 2014)

Every Child Matters,Department of Health -2003

https://www.education.gov.uk/consultations/downloadableDocs/EveryChildMatters.pdf

(Accessed 13 November 2014)

Play for England 2014

http://www.playengland.org.uk/

(Accessed 14 November 2014)

Change 4 Life 2014

http://www.nhs.uk/change4life/Pages/why-change-for-life.aspx

(Accessed 14 November 2014)

Theodore Joloza, Office for National Statistics,Measuring National Well-being-Children’s Well Being ,2012,

http://www.ons.gov.uk/ons/dcp171766_283988.pdf

(Accessed 14 November 2012).

Triple P Programme

http://www.triplep.net/glo-en/home/

(Accessed 13 November 2014)

In 2006, a patient named Robin became pregnant. In the 5th month of pregnancy, the patient began having trouble with diarrhoea and then developed a severe infection in her upper respiratory system. Robin’s obstetrician immediately hospitalized her and within 24 hours, Robin had a temperature of 105 degrees and was in preterm labour. Just before Christmas, Robin was diagnosed with Acute Viral Pneumonia. After getting permission from the doctor to go home for Christmas, Robin was back at the hospital 15 days later because she was in preterm labour yet again. It was then that Robin was introduced to a gastroenterologist who diagnosed her with Crohn’s Disease. Robin was immediately put on medications to try to save her and her unborn child’s lives. On 3rd February, Robin’s contractions were five minutes apart but her due date was the 17th of March. Robin came to the hospital and within one hour, I performed an ultrasound only to let her know that her unborn baby boy was no longer alive. After the funeral of her son, Robin was diagnosed with Deep Vein Thrombosis (DVT) in her inner thigh.

Reflection: Interpersonal communication skills

Listening is an active and basic process that involves not only taking the content of the person speaking by looking at their body language and listening to their words, but also being perceptive (Boyd, 2007, pp. 654-683). Good listening skills are shown by attending behaviour that is practiced by establishing eye contact, maintain a relaxed posture and sending appropriate messages to the patient through gestures (Timby, 2008, pp. 298-312). Attending behaviour works well in that it encourages the patient to verbalise their feelings and ideas freely (Hart, 2010, pp. 287-299). During listening, the nurse paraphrases the words of the patient in fewer words so as to make sure that the nurse understood what the patient wants. Paraphrasing is an important part of listening because it exposes and clarifies any mixed or double messages sent when the patient fails to make a direct statement (Huber, 2006, pp. 754-783). The third part of listening is clarifying. Clarifying goes beyond paraphrasing with an intention of bringing vague material into sharper focus (Kneedler & Dodge, 1994, pp. 258-295). Perception checking is an effective part of ensuring accuracy of a communication because it is a method of giving and receiving feedback from the patient (White, 2004, pp. 634-683). When helping Robin, I can say that I had effective listening skills. I made a point of listening to what Robin told me and I made sure that when she was talking, I made her feel comfortable and showed that I was interested in what she was saying.

Leading is a communication skill that encourages the patient to respond in an open communication so as to invite verbal expression (Chitty, 2005, pp. 512-554). The helper slightly anticipates what the patient is thinking and where those thoughts are headed. In anticipating these thoughts, the nurse leads the patient so as to stimulate the communication. Leading encourages the patient to retain primary responsibility for the direction of the communication and helps them to be active in the process (Ray & Donohew, 1990, pp. 112-148). Leading also encourages the patient to explore and elaborate on their feelings. One of the tools used in leading is using open questions that can be answered by more than just a ‘yes’ or a ‘no’ (Giger & Davidhizar, 2004, pp. 212-237). Choosing appropriate questions lead to clarification for the patient (Sully & Dallas, 2005, pp. 37-82). Another tool used in leading is by being indirect when leading the patient. Indirect leading keeps the responsibility of keeping the communication going on the patient. Indirect leading allows the patient to control the direction of the communication and protect their ideas (Knapp & Daly, 2002, 145-187). Direct leading on the other hand specifies a topic and the nurse uses suggestions to direct the patient. Direct leading is important in elaborating, clarifying and illustrating what the patient has been saying (Miller, 2008, pp. 284-325). In the case of a patient who has multiple problems or is vague, focussing is an important aspect that should be used in leading the communication (Marrelli & Hilliard, 2004, pp. 213-263). Focussing is a way that emphasizes on a certain idea or feeling and helps the patient get in touch with their feelings (Williams & Davis, 2005, pp. 27-39). I did not use leading skills when communicating with Robin and this is a skill I should in the future. I will enhance my abilities in leading skills by using open questions that will encourage the patients to share their ideas and feelings freely.

Reflecting feelings, experience and content of the patient expresses that the nurse understands and wants to perceive the world as the patient does (Chase, 2004, pp. 278-317). Reflecting the patients’ feelings brings those feelings into clear awareness from the vague expressions that they were (Sheldon, 2009, pp 87-113). Helping the patients to own their feelings is done by identifying both the obvious and subtle feelings that are hidden behind words (Rosdahl & Kowalski, 2007, pp. 1563-1612). In reflecting experience, the nurse broadly observes the patient’s verbalised feelings and their nonverbal feelings (French, 1983, pp. 116-145). Like paraphrasing, reflecting content involved repeating the essential ideas of the patient in fewer and fresher words (Hegner, Acello & Caldwell, 2003, pp 744-763). When the patient is having difficulty in expressing an idea, reflecting content helps the nurse to clarify those ideas. During communication, reflecting helps the patient to recognise and express their feelings effectively (Lipe & Beasley, 2003, pp. 267-301). In communicating with Robin, I sounded monotonous and insincere when I began my reflection with saying, ‘It seems you were very upset even after yelling for everyone to get out.’ In saying this I also said words that that Robin was unprepared for because they had too much depth of feeling. In future communication with patients, I should not read more interpretations into the statement than was intended, and I should use less monotonous words that sound sincere.

Confronting the patients is intended to help them recognize what is going on or what the nurse infers is going on (Cherry & Jacob, 2005, pp. 478-501). A patient may feel threatened and anxious at first when they are confronted. However, the patient is also grateful for the honesty albeit direct expression that shows that the nurse cares (Perry & Potter, 2002, pp 1114-1163). Confronting the patient presents feedback that is difficult to hear, and as such, the nurse should poses good timing to ensure that the patient is ready for honest feedback (Fitzpatrick & Wallace, 2005, pp. 341-367). Sometimes I find it hard to confront patients. In Robin’s case, I was finding it hard to understand and deal with her. I know that confronting the patient is one of the crucial skills that I must poses. I must recognize my feelings as the nurse and share those feelings with the patient. I must be able to involve myself in self-reflection as a form of confrontation. I believe that by practicing, training and observing others, I can develop my confronting skills.

Using interpretation helps the patient to see their problems in new ways (Barnum & Kerfoot, 1995, pp. 256-298). Unlike paraphrasing where the patient’s frame of reference is maintained, in interpreting, the nurse offers the patient a new frame of reference. The nurse adds his or her own meaning to the patient’s basic meaning (Ellis & Hartley, 2004, pp. 114-146). When the nurse adds on to the basic message from the patient, and the patient understands the new idea, then communication is accelerated. Interpreting is useful in helping the patient get a broader perception their feelings (Ferrell & Coyle, 2006, pp. 542-568). Interpretation is a communication skill that I used with Robin. While talking to Robin, she mentioned that she felt that the nurses around her were angels who lit her fire up in a time when she needed much encouragement. I told Robin that the way I saw it, she could join also become a nurse. Due to the Crohn’s disease, Robin could only live a stress-free life. However, after living the hospital, the first thing that Robin did was to go to Upper Valley Joint Vocational School where she applied for pre-requisite classes in the Licensed Practical Nurses (LPNs) program. Robin graduated in November 2009 and has been working in the nursing profession since then.

The most important thing that a nurse can do for the patient is sharing simple facts (Crisp & Taylor, 2008, pp. 1112-1196). Informing is a communication skill that is integrated with giving advice (Maurer & Smith, 2005, pp. 360-378). Under some circumstances, where advice giving does not foster dependency and is not arrogant, giving advice can be helpful to the patient. Communication through informing gives the patient a recommended course of action that the nurse has experience with. Through giving suggestions, the patient can decide the course of action that he or she will take (McConnell, 1993, pp. 96-118). Crisis situations where the patient has to adjust to a readjustment in life are an appropriate situation for giving the patient advice. In Robin’s case, after she had a stillbirth, I advised her to take her time with her son, Benjamin. I encouraged Robin to spend as much time as she wanted holding the five pound fifteen ounce baby boy. As much as Robin did not want to, I took pictures of robin and Benjamin for the memory album. I knew that that was the best albeit hardest thing robin had ever done.

Summarising skills involve paying attention to what, how, why, when and the effect of what the patient said (Antai-Otong, 2007, pp. 116-128). After communicating with a patient, the nurse should try to gather all the ideas and feeling expressed in one statement (Sines, Appleby & Frost, 2005, pp. 273-312). Summarising is important in that it gives the patient awareness of progress in exploring ides and feelings, problem solving and learning (Clark, 2009, pp. 45-96). In summarising, the communication ends in a natural note that clears a way for new ideas and clarifies scattered ideas (Quinn, 1989, pp. 324-364). Patients also gain confidence in that the nurse was attentive to them throughout the conversation. The nurse can use summarising as a means to check the accuracy of the ideas and feelings that were communicated by the patient. When communicating with Robin, I did not use summarising skills. In future communications, I should use the ideas from the patients to make a summary of the statements made. Instead of making the summary myself, I could ask the patient to summarize the themes, agreements and plans made during the communication.

Enablers and impediments to interpersonal communication

While communicating with Robin, the physical environment did not pose as an obstacle. However, my discomfort as a nurse was an obstacle when communicating with Robin. This discomfort originated from death and dying in general terms. I dealt with this discomfort by thinking that it was not my responsibility to communicate with Robin about hospice care and prognosis. My desire to maintain positive thoughts in Robin and her parents was also an obstacle. I would put off discussions about Robin’s possibility of a stillbirth until I felt that Robin and her parents could handle that conversation. In the future, I will initiate communication on prognosis and hospice care without thinking it is too much trouble. I will also control fear that emerges after telling the patient bad news. The patient can also be an obstacle to effective communication when he or she is unwilling to accept prognosis or hospice care (Mauk, 2009, pp. 374-412). This unwillingness that was evident in Robin’s case is ascribed to her non-acceptance of her son’s death and her diagnosis with Crohn’s disease. In helping with Robin’s acceptance, I encouraged her by letting her know that I would be there to help her and listened to her. Because this worked well, I will continue being an encouraging factor for future patients. Cultural and social issues did not act as an obstacle while I was communicating with Robin. During Christmas, Robin when home to celebrate the holiday with her family, and when she was admitted back a few days later, I gave Robin a Christmas present that facilitated communication.

Conclusion and recommendation

Nurses play an important role in communicating with patients because they are always in close contact. A nurse-patient relationship is improved by communication and as such, having effective communication skills is an important factor and a priority for every nurse (Daniels, 2004, pp. 1312-1325). I must develop my skills further in leading, confronting and summarising by participating in training activities. By participating in learning activities, I can develop strategies and acquire new skills as well as effectively employ those skills. Another strategy I will use is practicing key skills with actors and simulated patients because I will be able to control the nature and complexity of the task. Lastly, I must use the communication skills acquired in practice.