Critical Reflection On Personal Experience With Anxiety Patient Nursing Essay

Critical Reflection On Personal Experience With Anxiety Patient Nursing Essay Boyd and Fales (1983) suggest that critical reflection is the difference between whether an individual repeats the same experience several times therefore developing proficiency in one behaviour or if the person can learn from an experience in such a way that the individual becomes more open to change and development. By using reflection as a tool, many advantages can be gained in the development of nursing care. It is suggested that by encouraging nurses to reflect upon nursing situations, in order to promote the nurses professional development there will be by a process of growth better nursing care for the patients (Gustafson and Fagerberg , 2004). This essay presents a reflective overview of an experience that took place during my clinical placement with the Accident and Emergency Psychiatric Liaison Team and will focus specifically on my experience with a patient who attended the department with an anxiety disorder. I will use the Levitt-Jones (2007) narrative framework to underpin this essay and also aim to demonstrate and implement the Specific Capabilities in Practice (SCiPs) during this reflective process. It is important at this point to review the principles of confidentiality, as detailed by the Nursing and Midwifery Council (2008), when providing information about a patients care it is important to maintain confidentiality. Therefore the patient will be referred to as Jane (not her real name) for the purpose of this essay. Jane attended the Accident and Emergency department complaining of tightness in her chest, nausea, feelings of dizziness and a dry mouth. She was examined by the medical team who found no underlying physical cause for these symptoms. During the medical assessment process it was disclosed by Jane that she had been prescribed medication for an anxiety disorder by her GP. It was with this knowledge that Jane was referred to the Psychiatric Liaison Team for a mental health assessment. My mentor had suggested that I go and introduce myself to Jane and let her know we would be coming to complete a mental health assessment once her blood results had come through and she had been classified as medically fit. I approached the bed area where Jane was and noted the curtains were partially pulled round the bed, as I approached the bed area round the curtain I started to introduce myself and explain about the mental health assessment, however I was unable to finish my introduction and explanation as Jane shouted go away, get out, I want you out. At this time I am aware I froze, uncertain as how to proceed as this was not what I expected, Jane again stated that she wanted me to go away so I turned and walked away from the bed area and returned to my mentor to report what had just occurred. My mentor advised me that we would wait for Jane to be cleared medically and then she would go and speak to Jane about what had just occurred; my mentor suggested this would give Jane time to calm down and give us an opportunity to request any past psychiatric records. Whilst I was waiting for a fax from Janes GP, I was pre-occupied with what had happened and wondered if Janes reaction was because she had some kind of issue with me, my appearance or what I was wearing. I also questioned if Jane did not want student nurses involved in her care or if she had issues about having a mental health assessment. I also ran through, over and over, what I had said and how I had said it; was I too loud? Did I startle her by coming round the curtain unannounced? My mentor returned to the office after having spoken discreetly with Jane and disclosed to me that as I approached Jane she was in fact experiencing a panic attack and she had become agitated and shouted for me to leave as she was worried I would think she was mental and couldnt bear the thought of a stranger watching her have a panic attack. I had felt relieved and some of my own anxiety was reduced when this information was handed over to me as I had become convinced I had done something wrong to provoke this reaction from Jane; however my mentor suggested that Jane was now willing for me to complete the mental health assessment. During the course of the assessment I was able to identify some key points that required some further exploration with Jane and my mentor encouraged me to sit with Jane and talk through our suggested treatment plan and plan of care. Jane disclosed that her anxiety symptoms had started several months ago following the death of her cousin in a road traffic accident, initially they had been mild but as time had gone on things had got a lot worse. In addition to the symptoms of anxiety Jane had described she also during the course of our assessment identified experiences that could also be defined as symptoms of depression; these included; loss of appetite, early morning waking and low mood. The GP records that had been faxed over indicated that an anti depressant had been prescribed for Jane (Citilopram) months ago but she disclosed she had not taken this on a daily basis as she thought it was just to help when she was really bad. It is reported that despite an increase in the prescribing of anti depressants compliance with antidepressants by patients has been described as a major problem (Pampallona et al, 2002). This can be attributed to many reasons including; fear of dependence, concern of social stigma and also the prescriber giving unclear instructions about how and why the medication should be taken (McMullen and Herman, 2009). Jane had stated that she did not know why she had been given and anti depressant for anxiety and that she was not aware that she should take it every day. Jane also expressed concern that she was going to become addicted to the anti depressants and that she would not want to stay on them for any longer than a couple of weeks. I aimed to reassure and educate Jane by telling her that Citilopram; although a medication from the anti depressant family also, had properties that would treat her symptoms of anxiety and panic. The benefits would only be felt if the medication was taken every day and only after at least a period of 3 to 4 weeks should any benefit be highlighted (NICE, 2009). I was also able to inform Jane that it is recommended that treatment with anti depressants should continue for at least six months, even if she was to feel better, to ensure the chance of relapse and re emergence of symptoms is reduced (NICE, 2009). Jane stated her GP had told her the medication was to make her feel better but not much more information about how often and for how long she should take it, Jane indicated she would now take it every day and see if it helped her. At the end of the assessment Jane thanked me for my help and again apologised for snapping at me. I felt it was important to end the assessment with both myself and Jane feeling the issue was resolved so that our relationship could move so I empathised with her that she was having a very difficult time and her response was understandable in the context of what was happening to her at that time. Berg and Hallberg (2000) suggest that caring for people with mental illness demands an intensified presence, not allowing one to glide away, close the door or just disappear. On reflection I felt that although initially anxious and self critical of my initial interaction with Jane, I was tempted not to return to complete the assessment with my mentor, however I was glad that I did so that a relationship could be established and the outcome became more positive for myself and most importantly for Jane. I was able to spend some time a week later with my mentor and we discussed the outcomes from Janes assessment. Initially I had felt unwilling to proceed with the assessment and admitted to my mentor that I had felt very anxious about Janes initial reaction to me. My mentor identified she was aware that I had personalised Janes response and that I had questioned myself at length about what I had done wrong. My mentor was able to advise me that although it is essential for nurses to reflect on their interactions with patients, it is also important to attempt to obtain balance in the reflective process; which on this instance I had initially failed to do. I had become so focused on what I could have done wrong this was not balanced with what other factors may have influenced the patients reaction. Hem and Heggen (2003) suggest that an important element for mental health nurses was to recognize personal vulnerability in order to survive and develop professionally. The interaction with Jane did make me feel vulnerable; however by spending time with my mentor and by resolving the issues with Jane by understanding the reasons behind her behaviour, I feel that have further developed my skills and self awareness when delivering patient care.

Barclay’s Bank

Barclays is the third largest bank in the United Kingdom. The bank can trace its roots back to 1690 in London. The name â€Å"Barclay† first arose in 1736. Today the bank is a global financial service provider operating in the UK, Europe, United States, and Africa. The bank's headquarters are at One Churchill Place in Canary Wharf, in London's Docklands, having moved there in May 2005 from Lombard Street in the City of London. Barclay's US headquarters are in Wilmington, Delaware where it acquired the former Juniper Bank (Answers Barclays Bank 2006).Barclays is a UK-based financial services group, with a very large international presence in Europe, the USA, Africa and Asia. It is engaged primarily in banking, investment banking and investment management. In terms of market capitalisation, Barclays is one of the largest financial services companies in the world (Barclays Newsroom 2006). Barclays has been involved in banking for over 300 years and operates in over 60 countries w ith more than 113,000 permanent employees (including 33,500 at Absa). For the year ended 31st December 2005, the group achieved a pre-tax profit of ?5,280 million, up fifteen per cent on 2004. In 2005 Barclays paid approximately ? 3 billion in taxes (Barclays Newsroom 2006). Customers are served through a variety of channels comprising: the branch network, cash machines, telephone banking, online banking and relationship managers. It is managed through two business areas, UK Retail Banking and UK Business Banking. In UK Retail Banking there are 14 million retail customers, including current accounts, savings, mortgages, and general insurance (Barclays Newsroom 2006).Local Business provides banking services to 592,000 customers; UK Premier provides banking, investment products and advice to 286,000 affluent customers (Barclays Newsroom 2006). UK Business Banking provides relationship banking to larger and medium-sized businesses. 183, 000 customers are served by a network of relation ship and industry sector specialist managers (Barclays Newsroom 2006). Barclay’s strategic objective is to â€Å"To deliver top quartile total shareholder return relative to our peers, consistently over time† (Barclays p 2 2004). The company focuses directly on increasing shareholder value rather than employee retention and morale.Barclay’s does not have a directly available mission and values statement that is visible to the external environment. The internal environment at Barclay’s is one of traditional top-down management. The corporate culture at Barclay’s maintains a hierarchy of experience and education, where the management team places a large amount of focus on meeting the shareholder strategy. According to Barclay’s â€Å"In recent months, we have taken a number of steps to enhance further our corporate governance practices. We have expanded the remit of the Remuneration Committee to cover strategic human resource issues† (B arclay’s 2004 p 3).These strategic changes included: â€Å"continued and upgraded our investment in established; programs for the community, equality and diversity, and the environment; built on our reputation as a pioneer and leader in the field of financial inclusion; excellent terms and conditions for colleagues impacted by offshore outsourcing; developed a clear statement on human rights, and continued our participation in the Business Leaders Initiative on Human Rights; and made good progress in adapting our branches and offices to be fully accessible to customers with disabilities (Barclays p 12 2004).Barclay’s did not, however, remunerate a corporate strategy or mission to address its near 20% turnover rate which has been continuous and barely changing for the past three years, an indication that Barclay’s focus is on stakeholder value and not developing or addressing employee morale. However, Barclays does have a large focus on community service, receiv ing the â€Å"2004 National Business Award for Corporate Social Responsibility† (Barclays p 12 2004). Roadmap-Thesis The thesis statement is that the lack of direct employee relationships may have a strong impact on the seemingly high turnover rate.Personal interviews were conducted over the telephone with two Barclay’s employees, neither of which are relatives. Saunders et al (2003) define an interview as â€Å"a purposeful discussion between two or more people,† and can collect data which is both reliable and valid. Saunders et al (2003) describe a structured interview as using questionnaires based on predetermined and standard or identical sets of questions; a semi-structured interview as having a list of themes and questions to be covered; and an unstructured interview as informal but used to explore in depth a general area of interest.The interviews conducted were unstructured, which is decidedly the best format for discussing the interesting concepts of Ba rclays organizational strategy and how it relates to the employees . Interview Results The organizational strategy at Barclay’s seems almost non-existent to the participants, who each note that while dedication to customer satisfaction is important, manager and leadership concerns are impacting the employee morale. One interviewee even equated working at Barclay’s to a prison system, which is a reflection of the top-down managerial strategy.This managerial strategy has not been forthcoming to create or enhance employee morale, in fact it almost seems as though the employees are afraid of, or diminished by, the current leadership strategy. Customer service metrics are well known, however it is the organization strategy to continue team training that focuses on the same customer service strategy and not on new information, such as training opportunities or important technological concerns of the employees.This creates an atmosphere where the employees may feel constricte d, rather than encouraged, by internal training and education. The organizational strategy may be clear to stakeholders, investors, and corporate government, but there seems to be a distinct lack of information dissemination to the ground floor employees, which makes it hard for employees to follow a strategic vision and understand their basic role in the organization.The organizational culture at Barclay’s seems another sore point with the participants, who explained that there is a concern with office politics. Both employees examined that within the organizational culture, there is a strong adherence to management rule where favoritism is accepted. The other disheartening view of the organizational culture is that one participant was made to feel frequently inadequate for asking questions.Another concern about the organizational culture is the manner in which management responds to employee’s needs, which seems seriously lacking in its execution. Both employees made statements regarding lack of quality leadership motivation and that management’s engagement with employees and their customer service does not fit into the employee’s need for motivation. Both interviewees understood the importance of customer service and were able to relate customer service quality to their functional roles.They did not state that leadership has offered a beneficial measurement of customer service or employee motivation, because neither participant made any positive statements regarding motivation as an organizational strategy. Based on these interviews, the concern with organizational strategy is not simply turnover rate as noted before, but that employees are not offered constant educational information about the organization, its values, mission, goals and opportunities. Academic Research Recommendations for ImprovementIn human capital management, organizational changes should be administered by a general framework according to Dreher and Doherty (p 16-17 2001): motivating change requires that the people within the organization understand and commit to the change; creating vision in employees is a continuation of commitment where employees know where they fit into that change; developing political support means that stakeholders-from employees to HR professionals-have been assessed according to their place and function in the change; managing the transition must be set by parameters and adequate available technology as well as an understanding employee wide of how the parameters and technology work towards the goals; the momentum is sustained by â€Å"(1) providing resources for change, (2) building a support system for the agents of change (3) developing related competencies and skills among those charged with administering and using the modified process and (4) reinforcing new behaviors called for by the changed environment.† To this effect, Barclays must alter their strategy towards change and not the change itself by adequate communication and technology as well as transition training and reinforcement of change strategies amongst employees to foster a positive environment and develop open lines of input and communication. Incentive programs involve a system of rewards and recognition. There is a distinction between recognition programs and reward programs. Recognition is acknowledgment, appreciation and approval, and targets the psychological need of the individual. Reward, by definition, is usually something given in return for good or evil done or received, especially that is offered or given for a service. Rewards focus on the physical benefit, usually financial, however â€Å"self-esteem, respect, intrinsic motivation and dignity are not guaranteed by a competitive salary† (Glasscock and Gram 1995).Both recognition and rewards are important in reinforcing intrinsic and extrinsic motivators, and provide positive reinforcement for desired behavior performance. Employees will differ on which has the greater personal impact, but ultimately both reward and recognition programs affect an individual’s self esteem. The value an employee has on an incentive program is therefore highly correlated to the employee's engagement in customer service. According to Dr. Mohammed S. Chowdhury of Monroe College, Bronx, New York and Mohammed Nurul Amin of the West Virginia University of Technology: Employee values, attitudes, and leadership behavior play a very important role in enhancing employee work motivation and performance.Employee work values, attitudes and leadership behavior can carefully be adjusted to produce a strong impact on employee work motivation (www. sba. muohio. edu). A customer-focused culture is enhanced when employees understand that the organization will reward them for exceptional performance and customer service. Research shows that employee motivation and engagement is greatly enhanced when employees clearly understand the link between organiza tionally desired behaviors and rewards. It is important to recognize that an employee focus and a customer focus are complementary. It is noted that the importance of employee engagement in a sales environment to diminish the amount of money spent on employees.Accordingly, research has shown that improving the employee engagement will increase employee retention. Kenexa. com states that: Research has shown that fully engaged employees tend to be more productive, conscientious and have higher levels of organizational commitment. In addition, research has shown that an engaged work force tends to stay employed longer, miss work less often, have higher levels of customer satisfaction and service quality, attain and surpass organizational goals more regularly, are more productive and have comparatively lower worker's compensation and accident claims (2005). To measure constructs of employee engagement, benchmarks would be an above average response of high values.A successful research wo uld develop an increase in value rating per employee per category. In essence, the purpose is to develop employee engagement in conjunction with the benchmarks and defined constructs according to the majority values of tenured employees. Benchmarks for evaluation of success can be defined by an organizational increase in retention of employees compared to past trends in the facility, with increase in employee engagement of facility compared to past trends. The recommendation is to focus on team and individual development to ensure that employees become fully engaged within their function and as team members. According to David Beswick of the University of Melbourne:Mangers generally, and anyone formally or informally responsible for oversight of others who are engaged in work or learning tasks, will be aware that some people are participating more out of interest in the task than others are. Others gain their satisfaction principally out the way in which their performance on the tas k leads to rewards like pay or status or good grades in a course. But typically there is a mixture of motives for which a range of different incentives is relevant. (www. beswick. info 2004) Any recognition program will reflect an organization’s culture and values. Increasingly, recognition programs are part of company’s total quality program.Recognition programs may take several forms, from highly formalized programs induced and implemented by management to informal, spontaneous â€Å"ceremonies† arising from fellow co-workers. Recognition and celebrations are a ways of reaffirming to people that they are an important part of something that matters. Conclusion Engaged employees receive training for necessary skills and are â€Å"on board† with the organization's goals. Employees will be unable to perform if they lack the skills needed for their roles, so organizations need to identify employees with gaps in their training. Formal performance appraisal pr esents a good opportunity to do so.Research shows that organizations with good performance appraisal systems have significantly higher levels of employee engagement that those with a poor performance appraisal system. However, for performance appraisal to identify employees with specific needs, managers first need to have a good understanding of the performance appraisal system. Therefore, the training needs of managers should not be overlooked. Managers should be trained to identify performance weaknesses as well as how to effectively tie performance to recognition and rewards. Engaged employees receive training for necessary skills and are â€Å"on board† with the organization's goals.Employees will be unable to perform if they lack the skills needed for their roles, so organizations need to identify employees with gaps in their training. Formal performance appraisal presents a good opportunity to do so. Research shows that organizations with good performance appraisal syst ems have significantly higher levels of employee engagement that those with a poor performance appraisal system. However, for performance appraisal to identify employees with specific needs, managers first need to have a good understanding of the performance appraisal system. Therefore, the training needs of managers should not be overlooked. Managers should be trained to identify performance weaknesses as well as how to effectively tie performance to recognition and rewards. ReferencesAnswers Barclays Bank 2006 Barclays Bank Barclays plc Type Public Founded 1896 Location London , United Kingdom Key 2006 Answers Corporation . Retrieved September 15, 2007 from www. answers. com Barclays Bank PLC (2006) Barclays Newsroom. Registered in England. Registered No: 1026167. Registered Office: 1 Churchill Place, London, E14 5HP. . Retrieved September 15, 2007 from www. barclays. com Barclays (2004) Annual Report 2004. Registered Office: 1 Churchill Place, London, E14 5HP. Retrieved September 15, 2007 from www. investor. barclays. co. uk Beswick, David (2004) of the University of Melbourne. Copyright:  © David Beswick 1997-2004. Retrieved September 15, 2007 www. beswick. info Chowdhury, Mohammed S. (n. d.) Relative Importance of Employee Values, Attitudes and Leadership Behaviors in Employee Motivation. Monroe College, Bronx, New York Retrieved September 15, 2007 from www. sba. muohio. edu Dreher & Dougherty. (2001). Human resource strategy: A behavioral perspective for the general manager. New York: McGraw-Hill Glasscock and Gram (1995) Secrets of a Successful Employee Recognition System. BT Bastford. LTD. 2000 Kenexa. com (2005) 650 East Swedesford Road 2nd Floor Wayne, PA 19087 Retrieved September 15, 2007 from www. kenexa. com Saunders, M. , Lewis, P. and Thornhill, D. (2003), Research Methods for Business Students, 3rd Edition, London: FT Prentice Hall.

Annotated Bibliography On Database Encryption - 2297 Words

1. INTRODUCTION Database Encryption is one of the technique used for securing the data in database. This method transforms information on a computer in such a way that it becomes unreadable. So, even if someone is able to gain access to a computer with personal data on it, they likely won’t be able to do anything with the data unless they have original data key, complicated or expensive software. The main function of encryption is essentially to translate normal text into cipher text. Encryption makes sure that data doesn’t get read by the wrong people, but can also ensure that data isn’t altered in transit, and verify the identity of the sender. Data Encryption method typically uses a specified parameter or key to perform the data transformation. Some encryption algorithms require the key to be the same length as the message to be encoded, yet other encryption algorithms can operate on much smaller keys relative to the message. Encryption is most used among transactions over insecure channels of communication, such as the internet. Encryption is also used to protect data being transferred between devices such as mobile telephones, automatic teller machines (ATMs), and many more. Encryption can be used to create digital signatures, which allow a message to be authenticated. When properly implemented, a digital signature gives the recipient of a message reason to believe the message was sent by the claimed sender. 2. THREATS TO DATABASE 2.1 Database Databases are theShow MoreRelatedManaging Information Security Risks: The Octave Approach1635 Words   |  6 Pagesand Bonatti discusses security policies as well as the corresponding mechanisms of enforcement. Biskup, J.; Flegel, U.; Karabulut, Y. Secure Mediations: Requirements and Design, 127-140. Database Security XII: Status and Prospects. Edited by S. Jajodia. Twelfth International Working Conference on Database Security, Chalkidiki, Greece, July 15-17, 1998. Norwell, MA: Kluwer Academic Publishers, 1999 (ISBN 0792384881). In this paper, Biskup et al discuses the the secure mediation to it risks throughRead More Networking Report Essay6037 Words   |  25 Pagesnbsp;nbsp;nbsp;nbsp;nbsp;DIGITAL SUBSCRIBER LINE (DSL) 25.nbsp;nbsp;nbsp;nbsp;nbsp;ACCOUNT SECURITY 26.nbsp;nbsp;nbsp;nbsp;nbsp;CONCLUSION 27.nbsp;nbsp;nbsp;nbsp;nbsp;RECOMMENDATION 28.nbsp;nbsp;nbsp;nbsp;nbsp;BIBLIOGRAPHY 29.nbsp;nbsp;nbsp;nbsp;nbsp;ANNOTATED BIBLIOGRAPHY 30.nbsp;nbsp;nbsp;nbsp;nbsp;APPENDICES APPENDIX 1.1: THE SERVER APPENDIX 1.2: THE NETWORK CARD APPENDIX 1.3: THE ROUTER INTRODUCTION I have decided to research into Networking as myRead MoreEssay Elemica7043 Words   |  29 Pagesethical issues 17 List of references 18 Annotated Bibliography 20 1. ENVIRONMENTAL ANALYSIS * Company analysis Elemica is the leading provider of supply chain integration and optimization services to the world’s tire amp; rubber, chemical, energy, and related industries. The company maintains a B2B industry trading hub, a neutral platform that enables companies to link their ERP systems so that information is moved into each company’s database while maintaining confidentiality and securityRead MoreDatabase Security28570 Words   |  115 Pages- 1 - Database Security *) GÃÅ"NTHER PERNUL Institut fà ¼r Angewandte Informatik und Informationssysteme Abteilung fà ¼r Information Engineering Università ¤t Wien Vienna, Austria 1. Introduction 1.1 The Relational Data Model Revisited 1.2 The Vocabulary of Security and Major DB Security Threats 2. Database Security Models 2.1 Discretionary Security Models 2.2 Mandatory Security Models 2.3 Adapted Mandatory Access Control Model 2.4 Personal Knowledge Approach 2.5 Clark and Wilson Model 2

Pob Sba - Free Essay Example

Sample details Pages: 1 Words: 294 Downloads: 7 Date added: 2017/09/12 Category Advertising Essay Did you like this example? Description of the Business The name of the business is Darrien Vision Inc. It is a partnership business which produces various video-games for entertainment purposes from just ideas brought to us by video-game fans who really have a great input into what a video-game contains. Darrien Vision Inc. Don’t waste time! Our writers will create an original "Pob Sba" essay for you Create order is a nationwide business that exports its products internationally for entertainment purposes. The company is run by a board of directors, in which each member is a share holder in the business, and also the CEO/Owner of the Company, Darrien N. Jones. The business is located at P. O. ox 97017 Los Angeles. Justification of Location The business is located at P. O. box 97017 Los Angeles in the city close to other businesses and around where the most of the population always is. The land was purchased to hold a big company within the city to lessen the cost of advertisement a bit and for it to be accessible for the public to find out what the business is all about. On the property its self is a gaming arcade to help promote our products and the video-games we develop and by our company being in the city is a major part and a great advantage of advertisement over other companies. The business is in a suitable location because the public is what makes our business successful. Selection of Appropriate Labour Darrien Vision Inc. is a video-game developing company. To operate this business it requires; graphic artists, animation specialists, graphical engineers, graphical architects, video-game programmers, video-game designers, video-game testers, voice actors and accountants. It is a business that requires distinctions in the subjects; Technical Drawing, Information Technology, Art, Physics, Math, English and English Literature. But only certain distinctions are required for different aspects within the business.