Improving Concordance to Smoking Cessation Treatment

Improving Concordance to Smoking Cessation Treatment National Institute of Clinical Excellence (2009) identified that medicine taking is a complex human behaviour that lies ultimately, in the hands of the patient. NICE (2009) estimates that between a third and a half of all medicines prescribed are not taken as recommended and Dunbar-Jacob et al (1995) evaluates that up to 80 per cent of patients can be expected not to comply with their treatment at some time. Shuttleworth (2006) noticed that health professionals use two terms to describe the medicine taking behaviour of patients: compliance and respectively adherence. Compliance represents the extent to which a persons behaviour coincides with the medical advice, for example patients to do as they are told (Haynes et al, 1979) while adherence is the capacity of the patient to self-regulate his or her treatment, for example his or her ability to re-fill prescriptions (Brock, 2000). Medicines Partnership (2003) argue that in both compliance and adherence patients have a passive role, with no implication in their care and therefore concordance is needed to correct issues of non-compliance and non-adherence. Concordance advocates the idea of shared decision-making between health professionals and patients and it requires health professionals to engage with patients as partners, taking into account their beliefs and concerns (Medicines Partnership, 2003). NICE (2009) insists that the biggest challenge of the research of concordance is how to influence and change behaviour and this is where health psychology comes in. According to Marks and Evans (2005) health psychology attempts to move away from a linear model of health that treats only the physical, to a model that treats the whole person including his or her behaviour. In this essay the author will critically discuss how knowledge of health psychology can help nurses improve concordance with treatment in smoking cessation treatment. The idea promoted is that smoking is a behaviour influenced by the patients beliefs; the nurse will explore the patients beliefs on smoking and will help the patient to make an informed decision regarding her treatment. Patient X will be used as an example to observe behaviour change. The Stages of Change Model and other theories from health psychology will also be discussed. Discussion: Health Development Agency (2004) estimates that smoking is the greatest single cause of preventable illness and premature death in the UK, being responsible for more than 106,500 deaths each year. Approximately 4000 chemical compounds have been identified in the cigarette smoke, of which 40 are known to cause cancer (McEwen et al, 2006). Among these compounds tar was linked to cancer, lung disease and heart disease; carbon monoxide (CO) was also identified as an inevitable consequence of the combustion that takes place while smoking (Tyler, 1995); furthermore, nicotine was found in cigarettes, however nicotine is not connected to cancer but with the addiction process. According to the RCPÂ  [1]Â  (2000) nicotine meets all criteria used to define a drug of dependence and Wilkinson et al (2004) reasons that this makes smoking not a habit but an addiction. In the light of these, nurses face a real challenge when trying to improve patients concordance with smoking cessation treatment. However, NIHÂ  [2]Â  (2008) urges that most patients are ready to hear and receive help from nurses as the patients willpower alone has been shown to succeed in only 3 per cent cases of smoking cessation (McNeill et al, 2001). The following scenario will be used to exemplify a nurses action and use of health psychology knowledge in helping improve a patients concordance with smoking cessation treatment: Patient X is a bank manager. She has been a smoker for ten years. She is married and has one child age 5. She doesnt want to stop smoking because smoking calms her nerves, because it is not a good time and because she is afraid of withdrawal symptoms and gaining weight. The nurse will use the Transtheoretical Stages of Change Model to assess patients X motivation. The model was developed by Prochaska and DiClemente in 1982 to examine the five stages of change in addictive behaviours. According to Odgen (2009) the model is dynamic, not linear, with individuals moving backwards and forwards across the stages. The first stage of the model is Pre-contemplation. Patient X was identified as being in this stage because she is not interested in quitting. McGough (2004) points out that sometimes beliefs are used to sustain unhealthy behaviours, for example cigarettes calm my nerves, as patient X claims. To address such health beliefs and her resistance to change, the nurse will use a consciousness raising exercise, respectively she will address patient X reasons for not quitting and give counterpoints to refute these reasons (Perkins, Conklin and Levine, 2007; Kaufman and Birks, 2009). For example, patient X states that it is not the right time; the nurse can address this by saying, Im concerned about your health and I would like you to consider quitting. I know its going to be difficult because it will interfere with life responsibilities however, the perfect time to quit may never come therefore this moment is as good to quit as any (Perkins, Conklin and Levine, 2007; Hollis et al, 2003; Rana and Upton, 2009). TMAÂ  [3]Â  (2008) suggests that such message can prove more effective than a lecture about the lung cancer however the nurse can have a stop smoking handout to give to the patient as well. This interaction with the patient must be kept as patient-centred as possible to improve concordance with treatment (Walker, J et al, 2007). Balint et al (1970) as cited in Rena and Upton (2009) suggest that being patient-centred should involve the asking and receiving of questions and information which result in patients understanding of the health information and the treatment proposed. An accurate assessment of patient X within this stage will generate a strong treatment plan, therefore improved concordance (Straub, 2006; Brock, 2000). Furthermore, the nurse will convey warmth, understanding, acceptance and respect for the patient; this will help develop a fundamental nurse-patient relationship that is seen as a contributing factor to the patients concordance with the treatment regimen (Rana and Upton, 2006; Donohue and Levensky, 2006). By learning that smoking is not good for her health patient X will move to the second stage of the Stages of Change Model called Contemplation. The patient is now aware of the health risks that smoking entails and contemplates the idea of quitting (Perkins, Conklin and Levine, 2007). At this stage motivational interviewing can be used by the nurse to allow the patient to discover her own internal motivating factors in the favour of quitting; examples of factors can be: my five year old child will grow in a smoke free environment or I will have less changes of getting cancer (Ogden, 2009; NIHÂ  [4]Â  , 2009). Furthermore, the nurse can suggest that patient X writes down as a reminder I lose these benefits every day that I do not quit smoking (Connors, Donovan and DiClemente, 2004). Moreover, the nurse can help patient X identify the pros and cons of smoking cessation treatment (Hollis et al, 2003). According to the Health Belief Model (HBM) (Rosentock, 1974 as cited in Rana and Upton, 2009) by weighing the pros and cons of treatment, people arrive at a decision of whether the perceived benefits (e.g. NRTÂ  [5]Â  ) outweighs the perceived barriers (e.g. being afraid of the side effects of NRT). Moreover, patient X is concerned that she may gain weight upon quitting. By still using the HBM the nurse can help the patient decide whether the perceived benefits of quitting (e.g. improved health) outweighs the perceived barriers (e.g. gaining weight) (Perkins, Conklin and Levine 2007). The HBM is a social cognition model that has been applied to understand adherence behaviour in patients. This model suggests that the likelihood that someone will engage in a given health behaviour (e.g. adherence) is a result of four functions: perceived susceptibility, perceived severity, perceived benefits and cues to action (Rena and Upton, 2009). In an argument against HBMs application to smoking cessation, Robinson and Beridge (2003) state that weighing pros and cons of smoking cessation treatment is not a reliable approach because the smoking behaviour is underlined by addiction, so that it operates outside conscious awareness and it does not follow decision-making rules. Perkins, Conklin and Levine (2007) agree that the motivational intervention used in the contemplation stage may push the person into the third stage of the Stages of Change model, called Preparation. The patient is now determined to make a change. Both the nurse and patient X will share a decision making over preparation strategies; the outcome of this partnership will be a patient-centred, tailored plan that will improve adherence. For example, a nicotine patch may indeed help patient X to quit smoking, but a patient Z who not only has nicotine patches but also told his family and colleagues (especially those who smoke) about his quit attempt and ask for their support, is likely to be more successful than someone who relies on nicotine patches and willpower alone because social support enhances the likelihood of adherence (TMA, 2009; McEwen et al, 2006; Medicines Partnership, 2003). Furthermore, patient X will be encouraged to set a quit date. The chosen date should be of significance for the patient so she can feel motivated to adhere to the treatment (Gross and Kinnision, 2007). Moreover, the nurse may suggest behavioural changes such as clearing the house of all cigarettes and lighters (Marinker and Shaw, 2003). Patient X will also be educated to recognize withdrawal symptoms and will be given tips on how to resist cravings (e.g. keep busy, eat fruits, sip water, call a helping friend); patient X will be re-assured that withdrawal symptoms last 2-4 weeks and reduce gradually; also, the nurse must introduce patient X to medication that can help reduce the severity of the withdrawal discomfort, such as NRT and Bupropion (McEwen et al, 2000). According to NICE (2009) the information about medication should be written to serve as a reminder at any stage of the treatment. Moreover, the patient will be shown how to use nicotine patches and gums because in this stage specific skills rather than motivation alone are needed to facilitate concordance with treatment (Gross and Kinnison, 2007; Thomason, Parahoo and Blair, 2007). Furthermore, the nurse will answer any questions that the patient may have regarding medication. The Royal Pharmaceutical Society (1997) as cited in Rana and Upton (2009) suggests that how individuals perceive and think about medication (medication belief) is important when considering treatment adherence, therefore the nurse should be aware of patients X medication beliefs if she wants to break the barrier of non-adherence to treatment. Patient X is now considered ready to move into the penultimate stage of the Stages of Change Model called Action. At this stage, the nurse must provide on-going support to prevent the patients relapse. The nurse is encouraged to be honest with patient X about the likelihood of reverting to the old behaviour once the change process has started, not because the nurse expects patient X to fail, but because it normalizes the experience and takes away some of sense of failure and shame (Singer, 2009). The nurse will also monitor patient Xs CO and saliva cotinine to confirm abstinence and boost motivation (Haskard-Zolnierek and DiMatteo, 2010). According to the Foundation for Blood research (2010) many patients may not be truthful when answering questions about their smoking behaviour, therefore tests such as measuring the amount of nicotine in saliva and the amount of carbon monoxide levels in the patients expired air can be useful to compare self-reported smoking behaviour against real measurements. In an argument against this, Riemsma et al (2003) state that there is no evidence that moving an individual closer to the action stage actually results in a sustained change of behaviour at a later date. After approximately six months in the action stage patient X will move to the last stage of the Stages of change model, the maintenance stage. The nurse will praise the patient for the efforts made to change the unhealthy behaviour into a healthy one. This will make the patient feel self-efficient and have confidence to maintain the behavioural changes done in the quitting process (Odgen, 2009; NIH 2009). Self-efficacy is a term introduced by Bandura (1997) as a cognitive mechanism underlying behavioural change. According to this theory, efficacy determines whether coping behaviour is initiated and maintained when faced with obstacles (e.g. nicotine cravings) (DiClemente, 1981). Furthermore, the nurse can also write down essential tips to help patient X maintain concordance with treatment, such as do something else instead of smoking, keep yourself busy, avoid tempting situations and stick with your effort to quit, you can do it (Johnson et al, 1999; NIH, 2009). Conclusion: To review, within this essay the author highlighted the ideas that knowledge of health psychology can be used to understand the patients smoking related health beliefs and also, improved concordance with smoking cessation treatment can be achieved by involving the patient as partner in care.

Drug Addiction :: Social Issues, Drug and Alcohol Abuse

According to Webster's New Worldâ„ ¢ Medical Dictionary, 3rd Edition, Addiction is a chronic relapsing condition characterized by compulsive drug-seeking and abuse and by long-lasting chemical changes in the brain. Addiction is the same irrespective of whether the drug is alcohol, amphetamines, cocaine, heroin, marijuana, or nicotine. Every addictive substance induces pleasant states or relieves distress. Continue use of addictive substances induces adaptive changes in the brain that lead to tolerance, physical dependence, uncontrollable craving and, all too often, relapse. Dependence is at such a point that stopping is very difficult and causes severe physical and mental damage from withdrawal (WILLIAM C. SHIEL JR., 2008). Over the past two decades, many researchers have identified subgroups of alcohol and drug user based in similarities like drinking style (Kevin M. King, 2009), behavior problems, etiology, outcome, and other clinically significant phenomena; making the most predominant the antisocial, primarily neurotic, mixed neurotic and antisocial, and psychotic (Malow, 1989). But the antisocial features have been the most prominent between all the subtypes; especially on drug user. This literature will review these thru the following questions: 1. How addiction impact family and social relationships? 2. Do alcohol and drug addictions have relationship with crime? 3. What is the economic cost related to alcohol and drug addiction? How addiction impact family and social relationships? Drug and alcohol abuse is a large problem for adults in our world today. It is destructive, not just in terms of its effect on the addict but for the suffering it inflicts on the loved ones and family (Sadava, 1987). Though the addict may have no conscious intention of harming his companions and relatives, his self-destructive actions are a source of anguish for anyone with genuine affection for him/her. One of the most common situations is when the partner tries to hide the addict’s behavior from family member, co-workers, employer or general public. This type of behavior is known as Codependence (Malow, 1989). A codependent partner will make up excuses for the addict’s work absences or a car accident; even will tries to clean up any legal messes resulting from the addict’s behavior; allowing the addict to continue his destructive path without dealing with its consequences. Consequences that can go from continuous fights to elevated levels of dome stic violence. Most the time related to financial hardships, causes by the addict’s need to buy drugs, as well as from his inability to find consistent employment.

Human memory Essay

The investigation into whether images aid memory recall has been fairly successful. The experimental hypothesis: participants in condition 1(words with images) would perform better than those in condition 2 (words without images), has been rejected therefore the null hypothesis: there will be no difference in condition 1 (involving grid of random words supported by images) and condition 2 (only consisting of random words) has been accepted. Only to some extent from the line graph (Condition 1 vs. Condition 2), can we say condition 1 (words with images) recalled more words than those in condition 2 (words without images) because the line for condition 1 is generally above the line for condition 2 and this fairly supports the experimental hypothesis. The results measured using central tendency and measures of dispersion moderately support the experimental hypothesis. The mean and median for condition 1 (14. 1 & 14. 5) was greater than of condition 2 (12. 6 & 13. 5) indicating that there is a better recall when words are companied by visual aid and this supports the experimental hypothesis. The range (11) illustrated that data for both conditions were equally spread out, which does not necessary support the experimental hypothesis. Standard deviation, a more reliable measure of the dispersion than range has shown data in condition 2 (3. 977715704) is slightly more spread out than in condition 1 (3. 604010112). Descriptive statistics (numerical & graphical) have illustrated that condition 1 (words with images) performed better and this supports the experimental hypothesis. Not only do the numerical statistics support the hypothesis but the results are fairly pronounced, simply by looking at the line graph (graphical statistics); there is definitely a difference between both conditions although the Mann-Whitney U-test shows this to be below the level of significance. Inferential statistics, which enable us to draw clear conclusions about the likelihood of the hypothesis being true, is evidence for accepting the null hypothesis. The implication of the results measured using a non-parametric method, The Mann-Whitney U-test clearly shows that at the significance level of 0. 05, the results were very likely to have happened by chance. Though the observed value, 35 is greater than the critical value of 23 but only by 10. Comparatively, the findings of this study support previous theory and research but also are contrary to them. Bower, 1972 imagery recall experiment found that participants, who used imagery, recalled 80% of the words compared to only 45% by the non-imagers. In this investigation, participants in condition 1 (words with images) recalled 70. 5% of the words compared to 63% by the non-imagers. My investigation does support Bower’s findings, since there is a difference however the differences between the two conditions is not significant. Previous research does suggest that data in STM is stored in an acoustic manner this was demonstrated by Conrad (1964). Illustrating people may not always use visual codes to remember data and this supports the null hypothesis; in addition Baddeley’s (1966) study suggests that data is also stored semantically and this again illustrates that people may not always use visual codes. A possible problem with this experiment is the experimental design which lacks ecological validity and also does not account for individual differences. The study used independent groups, which meant it lacked control of participant variable and needed more participants. A matched participant design could have been used instead to deal with participant variables as participants are matched on key variables such as age and memory ability. Another problem of the study was the sample size. The study only used 20 participants, a small sample; therefore findings cannot be generalised to the rest of the population. So, a larger sample size of 50+ would be more representative and can be generalised. In addition, the investigation used opportunity sampling, which is very biased, and again it cannot be generalised. Random sampling would be the best method to select participants since it is potentially unbiased. An additional problem was the images used; some of the images were cartoon images (i. e. bible & pizza) and others were actual photographs (real life images, i. e. greenhouse). This may have been a problem since real life images may possibly be easier to remember than cartoon images or vice versa. To resolve such problem, would be by using only cartoon images alone or only real life images. The recall between genders may have wider implications: on the whole men have performed better than women, when studies have shown women should perform better than men. For example; women perform better than men in tasks such as verbal learning remembering tasks, name face association, and first last name associations learning (Larrabee and Crook, 1993). Ideas for a follow up research study is the effects of gender recall and discover if there is a significant effect for the sex of a participant on the types of gender associated images recalled and to compare the effects of visual and semantic codes in depth. There is evidence to illustrate that people do remember more with the aid of visual representation and evidence to illustrate people remember more without any visual representation. This itself suggests people do remember data and information differently (individual differences), i. e. acoustically, semantically. Therefore it is important to recognize these findings as they have strong insinuations for its involvement in everyday life, for example with teaching, revision and marketing. References & Bibliography Atkinson, R. C. & Shiffrin, R. M. (1968) Human memory: A proposed system and its control processes. In K. W. Spence and J. T. Spence (Eds. ), The psychology of learning and motivation, vol. 8. London: Academic Press Baddeley, A. D. (1966) Encoding in LTM: The influence of acoustic and semantic similarity on long-term memory for word sequences. Quart. J. exp. Psychol. , 18, 302-9 Bahrick, H. P. (1975) The nature of LTM: ‘Fifty years of memory for names and faces: A cross-sectional approach’, Journal of Experimental Psychology: General, vol. 104, pp. 54-75

Sociological Analysis of Brothers Keeper - 656 Words

Brothers Keeper Sociology is an important part of science in that it tends to create a distinction between the different values and norms that people hold in the society. Theories in sociology have been depicted in books and movies. Brother’s Keeper is a 1992 movie by Joe Berlinger and Bruce Sinofsky. The movie tends to reveal the characters of different members of the society. It creates a distinction between the different forms of social orders that exist in the society. The movie revolves around the lifestyle of The Ward brothers who live in Munnsville; New York. The movie’s main theme tends to contrast two groups of people in the society. One group consists of people who come from the rural areas while the other group is that of people from the urban setting. The social norm of the people in the rural areas is based on simplicity and illiteracy. The story revolves around the murder of one of The Ward Brothers. The death of William occurs and his brother Delbert is accused of killing him. Delbert denies the allegations but before he is set free he is taken into custody and made to sign some forms. According the social norms of the people of Munnsville, The Ward Brothers are illiterate and they live a life of simplicity. After the death of William, law enforcers make Delbert to sign some forms that he does not understand because of his illiteracy. This can be seen as a contrast in the social order between the rural setting and the modern urban setting. This notion is