Implenting Dorothy Orem's nursing theory on a psychiatric practice Essay

Implenting Dorothy Orem's nursing theory on a psychiatric practice unit - Essay Example The contribution of the patients toward their care is apparent. This proceeds to the evaluation of the role of nurses in the sustainability of effective nursing techniques. Evaluation However, prior to the evaluation of the contribution of the Orem's theory to the generation of effective nursing techniques, it is vital to evaluate the description that is painted from the embrace of the theory. Orem's theory is established from a connection of actively interrelated assertions that steer towards the development of a common idea. The theory places its aim at configuring out different avenues upon which the central aim can be attained (Z?eleznik, 2010). This aim is narrowed along the improvement of the service, as the desires and interests of the patient are prioritized. The developments of these assertions are built along a logic approach. This implicates that the development of the theory is founded on an interweave of logical assertions and principles. This perception assists in the d evelopment of an effective theory in terms of acceptance (Barbosa & Severinsson, 2010). Pointing on the nature of the theory, a general conclusion can be ascertained on its simplicity in terms of ease of understanding. It is eminent that the utilization or the adoption of this theory is highly pegged on the ease upon which its effective implementation can be achieved. The developments of complications along the deciphering of its content are highly reduced since the perception or the development of a reliable conclusion is easily attained. The development of successful scientific theories is strengthened by the ability to allow for the integration of increased abilities to evaluate each hypothesis proposed by the theory. It is eminent that the integration of successful evaluation methodologies is essential in the development of ultimate faith in scientific theories. This can be reflected in the Orem's theory, which allows for the utilization of simplified methodologies towards the e valuation of its relevance. Such backgrounds contribute grossly to the development of convenient nursing options for the medical world. It is apparent that the development of the Orem's theory focused on achieving these assertions. This is with regard to the structure upon which it is developed. The simplicity in deduction plays a contributory role in the development of effective adoption models for the theory. Upon evaluating the streaking points that seek to define the perception upon which the theory is developed, it is essential to identify the details that jolt the theory. Apparently, Orem's theory is founded on three principle assertions that can be defined as the sub theories to the main idea. Amongst these is the theory of self-care, a theory that seeks to improve the standards upon which health care can be improved. This aspect of the general Orem's theory seeks to identify health care as an international religion subscribed by each individual. The central aim rests at ensu ring that the perceptions of safety (with regard to health) are not solely based on the shoulders of the nurses but to the patients, as well (Barbosa & Severinsson, 2010). The theory seeks to re-cluster the whole ideology of effective health by distributing it to the individuals that stand to reap the utmost benefits of effective health care practices. This refers to the patients who can be defined as

Communication Plan Final Proposal Essay Example | Topics and Well Written Essays - 250 words

Communication Plan Final Proposal - Essay Example In either way, the customer will be disappointed if the bug is removed and if it will be ignored (Best Game Productions, 2015). From the motto of the CEO â€Å"An ethical company is a thriving business†. To maintain the ethics of the company and to retain the consumer loyalty, the video game has to be released containing the bug. Eventually, the company will implant some measures to employ a technician who will work on complete removal of the threat. The stakeholders are requested to comply with the decision made by the management. Once they release the game in the planned period, the future games will be developed in a more advanced manner that bug will have no room. According to the ground rules of the company’s ethical code, it states explicitly on how to deal with the consumer and also upholding the business’s name (Best Game Productions, 2015). To instill honesty and integrity, the consumer has to know the truth about the effect that will result if they buy a product containing a

How sports affect children in a positive way Research Paper - 1

How sports affect children in a positive way - Research Paper Example It could be defiant, stubborn, hyperactive, short tempered, rude, disrespectful, liar, demanding, violent, lazy, or coward. It is not necessary that a child has all these negative attributes, but what ever he has, it is his inheritance. This inheritance depends on many factors. The parent from whom he is born, the environment in which he is brought up, the education he receives, the family, economic, social and religious conditions in which he grows. All these are the factors that are built into a child’s psyche and character. Every child therefore is an individual of its kind. U.N. Convention on the Rights of the Child in Article 29 states â€Å"the education of the child shall be directed to (a) the development of the childs personality, talents and mental and physical abilities to their fullest potential. (d) The preparation of the child for responsible life in a free society, in the spirit of understanding, peace, tolerance, equality of sexes, and friendship among all peoples, ethnic, national and religious groups and persons of indigenous origin;†[3] These clauses indirectly put responsibility on a State to promote sports for children because it is only through Sport that a child can have access and opportunity to understand, practice and build all these qualities. Any activity by a human being which requires physical exertion or skill and competition is usually identified as â€Å"sport†. It generates interest and enthusiasm in the person who does such activities. Even children with disabilities are encouraged to play sports. Sport is one thing that is not influenced by the character and individuality of a child. In fact, it is the children which are affected and influenced most by the sport. It is one of the most important things in recent times as Sports have changed in the children, their negative psyche in to the positive individuality. Many researches and studies have been conducted on the child

Drinks that Influenced History and Civilization Essay Example for Free

Drinks that Influenced History and Civilization Essay The author describes the origin of six drinks that greatly influenced history and civilization around the world: beer, wine, spirits, coffee, tea, and cola. He explains how each drink was the defining drink during a historical period from antiquity to present day. The fluids are vital because each had a role of shaping the modern world. They have been used as currencies, in religious rites, as a political symbol, sources of philosophical and artistic inspiration. Some have served to highlight the power of the elite, and appease the downtrodden. They connected world cultures by impacting trade, economy, religion, and politics. Beer was discovered through different methods of cooking and storing cereal grains. When the ice age ended, lands such as the Fertile Crescent provided abundant cereal grains. Such grains provided a reliable source of food, and the ability to store cereal grains began to encourage people to stay in one place. This resulted in permanent settlements as societies transitioned from hunting and gathering to farming. Although the residents of such villages continued to hunt, skeletal evidence suggests that they subsisted mostly on plant-based diets. Beer was shared, and it was symbol of hospitality and friendship. To Neolithic drinkers, beer’s ability to intoxicate and ferment seemed magical, and it was concluded that it was a gift from the gods. Beer-drinking cultures tell stories and myths of how it was discovered. Mesopotamians and Egyptians saw beer as an ancient, god-given drink that supported their existence, formed part of their cultural and religious identity, and had great social importance. It was consumed by anyone regardless of status, age, or gender. Beer impacted the growth and diffusion of the earliest civilizations greatly. The emergence of complex societies, the need to keep written records, and the popularity of beer all followed from the surplus of grain. It was also used as a form of currency and payment. Beer also had a direct link to health. Mesopotamians and Egyptians used it medicinally. The Egyptians used bread and beer in funerals. Without the discovery of beer, the earliest civilizations of Southwest Asia and Egypt would not have been as prosperous.

Moral and Ethical Values in Engineering Industry

Moral and Ethical Values in Engineering Industry MORAL ETHICAL VALUES IN AN INDUSTRY AS AN ENGINEER There are three main Moral Ethical values in an industry, which an engineer is always obliged to obey, these values not only helps the industry but also benefits equally an Engineers personal gain. These three main points are: Professional Duties Ethical Values Human Values An Engineers good conduct (as captured in professional codes of conduct) toward other engineers, toward employers, toward clients, and toward the public is an essential part of the life of a professional engineer while remaining in the industry. As professionals, engineers need to internalize their codes and to realize that they have a personal stake in the application of codes as well as the process of developing the codes As professionals, engineers should try their best to solve every problem. i.e. If a problem situation is related to other engineer field, an engineer should know at least the know-how to solve that problem. Engineers should always respect their field rules as per their fields literature. In industry, an Engineer is responsible to think about the interaction of technology and society, because engineers are the ones who create all of technology. In industry, the central focus of an engineers profession must be on the application of scientific knowledge and creative thinking to meet societal needs. Engineers must bring both the industry name and his profession to the equal level so that there will not be any defaming situation created in any of both cases. In an industry, the purpose of the scientist is to know things, while that of the engineer is to perform on things and invent. The scientist enhances to the stock of confirmed, organized information of the corporal realm while an engineer fetches this information to stand on real-world problems. In an industry, an engineer is not allowed to choose the problem that comforts him; he must resolve problems as they arise. A solution to the given problem by an engineer in an industry must be reliable, cheap and most importantly safe. An engineer should keep paramount the safety, health and welfare of the public. An engineer should always avoid any type deceiving acts. An engineer should do amenities only in the zones of their capability. Engineers should shoulder projects lonely when qualified by schooling or knowledge in the precise technical fields involved. As a professional engineer, he must turn for each employer or customer as faithful agents or representatives. Engineers must conduct themselves morally, dutifully, morally, and legally so as to improve the integrity, standing, and practicality of the occupation. Engineers should support only those engineering forms that are in conformism with appropriate standards. Engineers may show openly practical thoughts that are established upon facts and competency in the topic matter. Engineers should not assist or support the illegal exercise of engineering by an individual or firm. Time is money-that well-known proverb must be every engineers priority working in an industry. An engineer should have human moral awareness (skills in knowing moral glitches in engineering) Forceful moral perceptive (understanding, measuring dissimilar views) An engineer should always keep in the view about the effects on the human health caused due to the industries. An engineer should pay his complete attention to his work especially when working on forums related to human moral values. An engineer must use moral message, to show and upkeep ones technical opinions to others. Moral sensibleness i.e., eager and talented to be ethically technically responsible for human lives. An engineer must respect for people, which shows apprehension for the well-being of humankind. While proposing an idea to an industry, an engineer must keep in mind that his/her project is eco-friendly, that in turn is ultimately beneficial for the mankind. An engineer must keep moral confidence i.e., trust in using lucid discussion for undertaking ethical engagements. Honesty, which incomes moral truthfulness, and assimilating ones proficient life and individual beliefs.

The Fifth Discipline Essay -- Essays Papers

The Fifth Discipline Chapter 11 of Peter Senge's book, The Fifth Discipline, talks about the idea of Shared Vision, and how this concept has transformed organizations, and individuals working for them, into a cohesive unit of long-term innovative achievement. Having and transmitting a successful "shared vision" requires true "buy-in" on the part of the employees and the organization as a whole, and must foster genuine commitment and active enrollment in order to bring that organizational vision to a personal level. For shared vision to become a product of personal vision, each individual must "feel it", and be able to see how this vision can be articulated to promote the long-term interests of the company's success, and position in the larger scheme of things. This road to the end result is usually not mapped out or even guaranteed, and the creative tension this inspires, through personal commitment and dedication, is the fire it produces form it's visionary fuel. The most current example of this that I have witnessed is the remarkable performance of the '98 World Championship Denver Broncos. So far they are undefeated this season and give no indication of letting up as the make their way into the history record books of the NFL. They were 11 and 0, Eleven wins and no losses, going into last night's game against the San Diego Chargers here at home and although nobody here wanted to see it happen, they defeated the Chargers 31-16, extending their perfe...

Crisis Counseling: an Overview

Psychology in the Schools, Vol. 46(3), 2009 Published online in Wiley InterScience (www. interscience. wiley. com) C 2009 Wiley Periodicals, Inc. DOI: 10. 1002/pits. 20370 CRISIS COUNSELING: AN OVERVIEW JONATHAN SANDOVAL, AMY NICOLE SCOTT, AND IRENE PADILLA University of the Paci? c Psychologists working in schools are often the ? rst contacts for children experiencing a potentially traumatizing event or change in status. This article reviews basic concepts in crisis counseling and describes the components of psychological ? rst aid.This form of counseling must be developmentally and culturally appropriate as well as individualized. Effective intervention can prevent post-traumatic stress syndrome and facilitate normal mourning processes associated with any losses experienced. These prevention activities are also discussed. Some children may need resources beyond those that the school can provide, and appropriate referrals can link children and adults to a variety of treatments such as psychotherapy and medication, also brie? y outlined. C 2009 Wiley Periodicals, Inc.Most children and adults are resilient and have ways of coping with stressful events. In fact, according to the National Institute of Mental Health (NIMH; 2001), recovery from crisis exposure is the norm. Children usually need minimal assistance from family members, teachers, clergy, or other caring adults. Others, particularly those with few social supports, enter into a crisis state (Barenbaum, Ruchkin, & Schwab-Stone, 2004; Caffo & Belaise, 2003; Litz, Gray, Bryant, & Adler, 2002; Ozer, Best, Lipsey, & Weiss, 2003). People in crisis are in what Caplan (1964) terms a state of psychological disequilibrium.This disequilibrium occurs when a hazardous event challenges normal psychological adaptation and coping. Individuals often behave irrationally and withdraw from normal social contacts. They cannot be helped using usual counseling or teaching techniques. Nevertheless, children in crisis are usuall y also in school. School psychologists and other guidance personnel must be able to support teachers, parents, and the children themselves during periods of crisis. The primary goal in helping an individual who is undergoing a crisis is to intervene in such a way as to restore the individual to a previous level of functioning.For children, this means returning to the status of learner. Although it may be possible to use the situation to enhance personal growth, the immediate goal is not to reorganize completely the individual’s major dimensions of personality, but to restore the individual to creative problem solving and adaptive coping. Of course, by successfully resolving a crisis an individual will most likely acquire new coping skills that will lead to improved functioning in new situations, but that is only a desired, possible outcome, not the sole objective of the process (Caplan, 1964).Because failure to cope is at the heart of a crisis, the promotion of coping is an o verall objective of crisis intervention. P SYCHOLOGICAL F IRST A ID School psychologists and other mental health personnel working in schools are in a position to offer psychological ? rst aid (Parker, Everly, Barnett, & Links, 2006). Analogous to medical ? rst aid, the idea is to intervene early when a hazardous event occurs for an individual, and offer compassionate support to facilitate adaptive coping. At the same time, the need for further intervention may be assessed and planned.According to The National Child Traumatic Stress Network and National Center for Post Traumatic Stress Disorder (PTSD) (2006) there are eight core psychological ? rst aid actions. Of course, the exact actions taken need to be tailored to the particular circumstances of crisis victims. Correspondence to: Jonathan Sandoval, Department of Educational and School Psychology, Benerd School of Education, 3601 Paci? c Avenue, Stockton, CA 95211. E-mail: [email  protected]? c. edu 246 Crisis Counseling Overvi ew 247 Making Contact The ? st action is to establish a relationship through verbal and nonverbal means with the child. Generally speaking, the sooner contact is made the better. By simply being physically present with the child and supporting nonverbal behavior alone, anxiety can be lessened. Providing Safety It is important to protect children from further harm by moving them to a secure location and attending to their basic needs for food, drink, sleep, shelter, or freedom from further danger. To relieve tension, it is also helpful to provide a place for play and relaxation.Children need to be protected from the eyes of strangers and the curious, and they need to be spared watching scenes of a traumatic event in the media (Young, Ford, Ruzek, Friedman, & Gusman, 1999). Stabilizing Affect Counselors must demonstrate nonverbally that they are able to be calm and composed. Adults modeling calmness and competence can communicate that problems may be solved and emotions can be control led in time. A counseling relationship will be important to help the child manage fear, anxiety, panic, and grief. Nondirective listening skills are most effective.However, it is also important not to offer unrealistic reassurance or to encourage denial as a defense or coping mechanism (Sandoval, 2002a). Addressing Needs and Concerns Once the crisis worker has been able to formulate an accurate, comprehensive statement about the student’s perception of the situation by identifying all of the sources of concern, it will be possible to begin the process of exploring potential strategies to improve or resolve the emotionally hazardous situation. Jointly, the crisis worker and pupil review the strategies explored and select one for trial. The outcome should be an action plan.This is much like the problem solving that occurs in conventional counseling, but must be preceded by the steps previously mentioned. Moving too quickly to problem solving is a common mistake of novices. Howe ver effective the problem solution is, the very process of turning attention to the future and away from the past is bene? cial in and of itself. Provide Practical Assistance Helpers need to be direct with children and take an active role in managing their environment. Because parents may be disabled by the disaster, it is comforting to see some adult taking control and making decisions.Some solutions may involve actions by others, such as teachers or school administrators. To the extent necessary, the crisis worker may act as an intermediary communicating with authorities on the child’s behalf. When working in schools, a task will be to reunite children with their parents or loved ones. Plans need to be in place to communicate with parents and track children should a disaster occur at a school site (Brock, Sandoval, & Lewis, 2001). Facilitate Connections with Social Supports Finding social supports may be particularly dif? cult during times of crisis.In a disaster, for examp le, whole communities are affected. There is a disruption of both schools and social services. There is often an absence of adults with whom children can process feelings of loss, dread, and vulnerability. Psychology in the Schools DOI: 10. 1002/pits 248 Sandoval, Scott, and Padilla Nevertheless, it is usually possible to ? nd either a group of peers or family members who can provide emotional support and temporary physical assistance during the crisis. In this way the pupil’s energies may be devoted to coping with the crisis.Being with and sharing crisis experiences with positive social support systems facilitates recovery. Conversely, lower levels of social support often predicts traumatic stress reactions (Barenbaum et al. , 2004; Caffo & Belaise, 2003; Litz et al. , 2002; Ozer et al. , 2003). If family is not available, there are often community resources that may substitute and the crisis worker should be knowledgeable about them. Facilitating Coping During the process o f crisis intervention, the student will have temporarily become dependent on the crisis counselor for direct advice, for stimulating action, and for supplying hope.This situation is temporary and before the crisis intervention interviews are over, the crisis counselor must spend some time planning ways to restore the student to selfreliance and self-con? dence. This restoration may be accomplished by consciously moving into a position of equality with the student, sharing the responsibility and authority. Although earlier the crisis counselor may have been very directive, eventually he or she strives to return to a more democratic stance.Techniques such as one-downsmanship [where the counselor acknowledges the pupil’s contribution to problem solving, while minimizing the counselor’s own contribution (Caplan, 1970)] permit the counselee to leave the crisis intervention with a sense of accomplishment. Helping individuals to ? nd alternative rewards and sources of satisfa ction using problemfocused coping (Lazarus & Folkman, 1984) is most helpful. Providing anticipatory guidance involves connecting children to knowledge and resources, and involves providing information about stress reactions and future challenges that the client will face.It acts to reduce distress and promote adaptive functioning. Any action strategies must be implemented in the context of what the student thinks is possible to accomplish. Crisis ? rst aid providers can emphasize what positive there is in the situation, even if it seems relatively minor. For example, even the victim of a sexual assault can be congratulated for at least surviving physically. The crisis situation often leads to a diminution in self-esteem and the acceptance of blame for the crisis.With an emphasis on how the child coped well given the situation so far, and how the person has arrived at a strategy for moving forward, there can be a restoration of the damaged view of the self. Drawing from the self-conc ept literature, it may also be important to emphasize positive views of the self in speci? c areas, as self-concept has been theorized to be a hierarchical and multidimensional construct (Marsh & Shavelson, 1985; Shavelson, Hubner, & Stanton, 1976). According to the compensatory model (Marsh, Byrne, & Shavelson, 1988), which holds that selfconcept in different domains may be additive, it may be bene? ial for students to increase their self-concept in one area if it has been diminished in another area as a result of a traumatic event. Helping children recognize competence in other areas besides the ones affected by the trauma will protect feelings of self-worth. This notion of building up other branches of self concept, such as academic self-concept, is also supported by Shavelson’s hierarchical model (Shavelson et al. , 1976). Create Linkages with Needed Collaborative Services Prime candidates for resources in many cultures are clergy, but these resources may also be an in? e ntial neighborhood leader or politician. In non-western (and western) cultures the family is an important system of support during times of crisis. Keep in mind that de? nitions of â€Å"family† do differ considerably. Psychology in the Schools DOI: 10. 1002/pits Crisis Counseling Overview 249 In many non-western cultures when individuals enter a crisis state, they turn to individuals (shaman) who are acknowledged within their communities as possessing special insight and helping skills. Their helping skills often emphasize non-ordinary reality and the psychospiritual realm of personality (Lee and Armstrong, 1995).Referral Although this is not one of the core psychological ? rst aid actions, as the ? rst and perhaps only person on the scene, the school psychologist should be helpful. Attend to physical needs, offer appropriate reassurance and anticipatory guidance, and help those in a crisis state to take positive action to facilitate coping (Sandoval, 2002a). As soon as poss ible, however, facilitate an appropriate referral to a culturally appropriate helper and/or to community-based services, and follow-up to determine that a connection has been made.D EVELOPMENTAL I SSUES I N C RISIS C OUNSELING A child of 5 and an adolescent of 16 have radically different faculties for dealing with information and reacting to events. Differences in cognitive, social, and emotional development mean that they will respond differently to hazards and will need to be counseled differently should they develop a crisis reaction (Marans & Adelman, 1997). The same event (e. g. , the death of a parent) may be a crisis for a preschooler as well as a high-school senior, but each will react and cope with the event differently.Counseling with younger children often involves the use of nonverbal materials, many more directive leads to elicit and re? ect feelings, and a focus on concrete concerns as well as fantasy. The use of drawing, for example, has proved very effective in getti ng children to express what has happened to them (Hansen, 2006; Morgan & White, 2003). In terms of increasing self-concept with children after a crisis, one must consider the dimensionality of self-concept as it relates to cognitive, language, and social factors (Byrne, 1996; Harter, 1999). Self-concept dimensions tend to increase with age.That is, young children are able to make judgments about themselves in terms of concrete and observable behaviors and tend to display all-or-none thinking. Thus, self-concept at this age tends to have few dimensions. Children at this age describe themselves in relation to certain categories, such as â€Å"I am 5† or â€Å"I have blond hair,† and are able to make simple comparisons such as â€Å"I am crying and he is not crying† (Harter, 1999). Although young children tend to have very positive descriptions of the self, negative life experiences, such as a traumatic event, may cause them to view themselves negatively.During mid dle childhood, self-concept dimensionality increases and children are able to make more global statements about their self-concept. However, they will often overestimate their abilities. Their descriptions change from being concrete to traitlike. Children during this stage also begin to use social comparison as they judge themselves and they can make social comparison statements, such as â€Å"I am more shy than most kids† or â€Å"I’m good at (one subject) and not (other subjects). † All-or-none thinking may continue at this stage, which may cause children to view themselves negatively (Harter, 1999).Traditional talk therapies such as nondirective counseling capitalize on a client’s capacity for rational thought and high level of moral development and are more likely to be effective with adolescents. With adolescents, the school psychologist can also acknowledge and use the ageappropriate crisis of establishing an identity. During adolescence, more diffe rentiation of the self occurs and peers may be used for social comparisons. Abstract concepts are used to describe the self, and there is an awareness of â€Å"multiple selves,† where they may behave or act differently in different contexts.Adolescents begin to make statements with interpersonal implications, such as, Psychology in the Schools DOI: 10. 1002/pits 250 Sandoval, Scott, and Padilla â€Å"Because I am shy I do not have many friends† or â€Å"People trust me because I am an honest person† (Harter, 1999). In reviewing the crisis intervention principles and procedures just outlined, it seems reasonable to expect that younger children would have a greater dif? culty acknowledging a crisis, and would be more prone to use immature defenses such as denial and projection to avoid coping with a crisis (Allen, Dlugokinski, Cohen, & Walker, 1999).In contrast, an adolescent might use more advanced defenses such as rationalization and intellectualization. In coun seling children, more time might be spent on exploring reactions and feelings to the crisis situation and establishing support systems that engage in lengthy problem solving. With older adolescents, then, it may be possible to focus much more on establishing reasonable expectations and avoiding false reassurance, as well as spending more time on focused problem-solving activities. ATTENDING TO C ULTURAL D IFFERENCESMany events that frequently stimulate a crisis reaction in the dominant culture, such as a death, a suicide, or a natural disaster, may or may not have a similar effect on members of other cultures (Sandoval, 2002b). Sometimes a reaction to a traumatic event will be culturally appropriate but will seem to western eyes to be a breakdown of ordinary coping. Extreme outward expression of grief by wailing and crying followed by self-mutilation and threats of suicide following the death of a loved one may be normal coping behavior expected of a survivor in a particular culture (Klingman, 1986).A cultural informant will be useful in indicating what normal reactions to various traumatic events are for a particular culture. One of the most important manifestations of culture is language. Many important cultural concepts cannot be satisfactorily translated from one language to another, because the meaning is so bound up in cultural values and worldview. If possible, crisis interveners should speak the same language as their client and be familiar with their cultural perspective.In an emergency, this kind of match of counselor and client may not be possible, so school psychologists need to be prepared to work with interpreters and cultural informants. Attention to nonverbal communication is also important during a time of crisis. A number of behaviors including form of eye contact, physical contact, and proximity can be different between members of different cultures (Hall, 1959). Because these behaviors are subtle, counselors may easily miss them without hel p. Training in cross-cultural work may be delivered through workshops or by consultation with an experienced psychologist.A ? rst step in working with children from different cultures will be to learn the extent to which the client has become acculturated to the dominant culture. One cannot assume that a child is fully a member of either the culture of the family’s origin or of the American mainstream. Working with the child and family will be individualized on the basis of culturally appropriate intervention. P REVENTING PTSD The common goal of responding to children experiencing situational crises is to prevent the formation of PTSD. This syndrome, ? st identi? ed among military combat veterans, also manifests itself in children. Their reaction is similar to that in adults, although their reactions may be somewhat different and the symptoms will vary with age (American Psychiatric Association, 2000). To be diagnosed with PTSD, a person who has been exposed to trauma must ha ve symptoms in three different areas: persistent reexperiencing of the traumatic stressor, persistent avoidance of reminders of the traumatic event, and persistent symptoms of increased arousal.These symptoms must be present for at least one month, and cause clinically signi? cant distress or impairment in social, occupational, or other important areas of functioning (American Psychiatric Association, 2000). Children are more likely than adults to have symptomatology related to aggression, anxiety, depression, and regression (Mazza & Overstreet, 2000). As noted earlier, traumatic stress reactions Psychology in the Schools DOI: 10. 1002/pits Crisis Counseling Overview 251 are to a signi? ant extent dependent on the child’s level of development (Joshi & Lewin, 2004). Especially among younger children, traumatic stress reactions are less connected to the stressor and more likely to take the form of generalized fear and anxiety. It is certainly not true that all children, if untr eated, will develop PTSD. In fact, recovery is the norm (NIMH, 2001). Recent studies regarding the prevalence of PTSD in children and adolescents estimates that about 15% –43% of children have experienced at least one traumatic event in their lifetime.Although estimates vary by extent and type of trauma, a conservative estimate is that 12% –15% of children may develop PTSD six or more months following a disaster (La Greca, Silverman, Vernberg, & Prinstein, 1996; McDermott & Palmer, 1999). In a review of the literature, Saigh, Yasik, Sack, & Koplewicz (1999) report that rates of psychological trauma among children and adolescents (as indicated by the presence of PTSD) vary considerably both within and between types of crisis events (with rates of PTSD ranging from 0% to 95%).Some may even develop longterm characterological patterns of behavior following a disaster, such as fearfulness (Honig, Grace, Lindy, Newman, & Titchener, 1999). These character traits, exhibited la ter in life, may originate as negative coping responses to the trauma. Severity of symptoms is related to the magnitude of exposure to the event itself, and the degree of psychological distress experienced by children in response to trauma is measured by several factors. The closer a child is to the location of the event (physical proximity), or the longer the exposure, the greater likelihood of severe distress.Having a relationship with the victim of trauma also increases the risk (emotional proximity). A third factor is the child’s initial reaction; those who display more severe reactions, such as becoming hysterical or panicking, are at greater risk for needing mental health assistance later on. The child’s subjective understanding of the traumatic event can sometimes be more important than the event itself. That is, the more the child perceives an event as threatening or frightening, the greater the chance of increased psychological distress.Additionally, children who experience the following family factors are at an increased risk: those who do not live with a nuclear family member, have been exposed to family violence, have a family history of mental illness, or have caregivers who are severely distressed themselves (Fletcher, 2003). Children who face a disaster without the support of a nurturing friend or relative appear to suffer more than those who do have that support available to them. Symptoms in children may be more severe if there is parental discord or distress and if there are subsequent stressors, such as lack of housing following a disaster (La Greca et al. 1996). The traumatic death of a family member also increases the risk of stress reactions (Applied Research and Consulting, Columbia University Mailman School of Public Health, & New York Psychiatric Institute, 2002; Bradach & Jordan, 1995). Finally, children who have preexisting mental health problems or previous exposure to threatening or frightening events are more likely to experience more severe reactions to trauma than are others. Symptoms may also be heightened among ethnic minorities (La Greca et al. , 1996). La Greca and her colleagues (1996) discuss ? e factors related to the development of severe symptomatology: 1) exposure to disaster-related experiences, including perceived life threats; 2) preexisting child characteristics such as poverty and illness; 3) the recovery environment including social support; 4) the child’s coping skills; and 5) intervening stressful life event during recovery. These factors may interact with biological factors that make the child particularly vulnerable, such as genetically based premorbid psychopathology and temperament (Cook-Cottone, 2004).Clearly intervention must supply an appropriate recovery environment that is suited to a child’s characteristics and facilitates coping. Determination of what intervention is appropriate for a given student should be based on assessment of risk for psychologi cal traumatization. Nevertheless, school is an important environment where prevention and healing can take place. Cook-Cottone (2004), drawing from the literature on children with cancer, has outlined a protocol for reintegrating children into school following a traumatic experience that has led to their absence from school.Psychology in the Schools DOI: 10. 1002/pits 252 Sandoval, Scott, and Padilla FACILITATING THE G RIEVING P ROCESS Grieving, and mourning the losses common to most potentially traumatic events, will be among the counseling objectives. Losses may include those of signi? cant others as well as loss of status. However, emotional numbing and avoidance of trauma reminders that accompany trauma can greatly interfere with the process of grieving. Trauma work often takes precedence over grief work; nevertheless, ultimately appropriate mourning must be facilitated (Hawkins, 2002). Worden (2002) has identi? d four tasks of mourning. The ? rst task is to accept the reality o f the loss and neither deny it has occurred nor minimize the impact on the child’s life. It is common for children to fantasize about a reunion or that there has been a mistake about the loss, or that divorced parents will reunite. Before a child can progress to the second task, there must be a reduction in spiritual, magical, or distorted thinking (Hawkins, 2002). Worden’s second task is to experience the pain of grief. There are many pressures, both cultural and familial, to not express or feel sadness at a loss.Children are told not to be a â€Å"crybaby† and to â€Å"act like an adult. † However, if the emotional pain is not experienced, there may be a manifestation in psychosomatic symptoms or maladaptive thinking or behaving (Hawkins, 2002). The third task of coping with a loss is to adjust to a new environment that does not include the lost status or relationship. The child must learn to create a new set of behaviors and relationships to replace th ose lost. The goal is to build a meaningful and authentic new lifestyle and identity.A failure to accomplish this task leaves a child feeling immobilized and helpless, clinging to an idealized past. The ? nal task of mourning is to withdraw emotional energy from the lost status and reinvest it in other relationships and endeavors. By holding on to the past, lost attachments rather than forming new ones, a child may become stuck. Instead, the trauma victim must eventually embrace a new status. Worden (2002) believes that, when the tasks of mourning are accomplished, the individual will be able to think of the loss without powerful pain, although perhaps with a sense of nostalgia and perhaps some sadness.In addition, the child or adolescent will be able to reinvest emotions in new relationships without guilt or remorse (Hawkins, 2002). T REATMENT School-based Counseling Galante and Foa (1986) worked in groups with children in one school throughout the school year following a major Ita lian earthquake. The children were encouraged to explore fears, mistaken understandings, and feelings connected to death and injury from the disaster using discussion, drawing, and role playing. Most participants, except those who experienced a death in the family, showed a reduction in symptoms.Another feature of disasters and terrorist acts is a lowered sense of control over one’s destiny and heightened fear of the unknown. Thus, a focus on returning a sense of empowerment to children will be important. If children can be directed to participate in restorative activities and take some actions to mitigate the results of the disaster, no matter how small, they can begin to rebuild an important sense of ef? cacy. Finally, there may be issues of survivor guilt, if there is widespread loss of life or property. Survivor guilt is a strong feeling of culpability often nduced among individuals who survive a situation that results in the death of valued others. Those individuals spar ed, but witnessing the devastation of others, may have extreme feelings of guilt that will need to be dealt with. Children, particularly, ascribe fantastical causes to the effects they see. Consequently, some may Psychology in the Schools DOI: 10. 1002/pits Crisis Counseling Overview 253 need to explore their magical thinking in counseling or play therapy about why they escaped injury or loss. School community–based support groups can provide one vehicle for feeling connected to others and working through these feelings.Ceballo (2000) describes a short-term supportive intervention group based in the school for children exposed to urban violence. Her groups are designed to 1) validate and normalize children’s emotional reactions to violence, 2) help children restore a sense of control over certain aspects of their environment, 3) develop safety skills for dealing with the environment in the future, 4) understand the process of grief and mourning, and 5) minimize the in? uence of PTSD symptoms on educational tasks and other daily life events. Such structured support groups can promote resiliency and promote constructive coping with problems.Depending on training and supervision, the school psychologist might also engage in therapies validated for the treatment of PTSD. These therapies are reviewed in the section on community-based therapy. Time and other constraints often make outside referral necessary. Bibliotherapy Bibliotherapy may also be useful following a disaster. A particularly useful resource for children is a book entitled I’ll Know What to Do: A Kid’s Guide to Natural Disasters by Mark, Layton, and Chesworth (1997). The authors focus on four concepts they view as fundamental to recovery: information, communication, reassurance, and the reestablishment of routine.They explore children’s feelings that often emerge in the aftermath of a disaster, and offer useful techniques to help young people cope with them. Another technique in which the child is an active participant in the creation of a book about personal experiences is called the resolution scrapbook (Lowenstein, 1995). Here the child is guided through a set of experiences and activities designed to help the child reprocess traumatic experiences and place completed work in a scrapbook. Evidence for the effectiveness of this technique is largely anecdotal to date. Other Adults in CrisisAn important feature of a traumatic event is the fact that the adults in the school as well as the children are affected. The teachers, administrators, and guidance staff would be as traumatized as children by an earthquake, terrorism, or an airplane crashing into the school. They will need assistance in coping with the aftermath of the crisis as much as the children will (Daniels, Bradley, & Hays, 2007). It is likely that outside crisis response assistance will be needed to help an entire community deal with disaster and mayhem associated with violence. Comm unity-based PsychotherapyCognitive behavior therapy. There are many treatments being studied for their effectiveness in the area of PTSD. Currently, much of the research suggests that cognitive behavior therapy (CBT) may be the most promising treatment for PTSD (Jones & Stewart, 2007). CBT is a structured, symptom-focused therapy that includes a wide variety of skill-building techniques. All are based on the premise that thoughts and behaviors can cause negative emotions and patterns of interactions with others. Making maladaptive thoughts and behaviors more functional is the goal of CBT (Jaycox, 2004).CBT uses techniques that integrate elements of cognitive information processing associated with anxiety with behavioral techniques—such as relaxation, imaginal or in vivo exposure, and role playing—that are known to be useful in the reduction of anxiety (Cook-Cottone, 2004). Psychology in the Schools DOI: 10. 1002/pits 254 Sandoval, Scott, and Padilla Another protocol fo r dealing with treating PTSD is eye movement desensitization and reprocessing (EMDR). It includes many of the same elements as CBT, with the exception of in vivo exposure, and includes rhythmic eye and other tracking exercises (Greenwald, 1998).It has been successfully used with school-age populations (Chemtob, Nakashima, & Carlson, 2002). Play and art therapy. Play and art therapy are also being studied to determine their effectiveness on PTSD symptoms, especially in young children because of issues in language development (Cole & Piercy, 2007). Because play is a child’s natural method of developing mastery over the environment and because many symptoms of PTSD are seen in children’s play, this is a natural course of treatment (Kaduson, 2006). The use of art therapy has also shown to be effective in group work (Hansen, 2006). Medication.As a measure of last resort, medication may be used to treat severe PTSD. Often the symptoms of anxiety or depression that have resul ted from exposure to a traumatic experience are treated. Selective serotonin reuptake inhibitors (SSRIs) in particular are often prescribed to treat the symptoms of anxiety and depression, including sertraline, paroxetine, and ? uoxetine (Foa, Davidson, & Frances, 1999). In the adult population, antipsychotic, antiepileptic, and other psychotropic medications have been explored and may be effective depending on the symptoms of the individual (Davis, Frazier, Williford, & and Newell, 2006).If medications are prescribed to a student, it is important that there be a liaison between the school and the treating physician or psychiatrist to monitor effectiveness and deleterious side effects. C ONCLUSIONS School psychologists are often the contacts in schools when there is a traumatizing event. School psychologists should be ready to administer psychological ? rst aid that is individualized and developmentally and culturally appropriate. By intervening and facilitating coping processes and the grieving process, it may be possible to prevent or minimize the development of PTSD.School-based protocols have been developed to respond to children in crisis. 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