The prevention of pressure ulcers represents a marker of quality of care. Pressure ulcers are a major nurse-sensitive outcome. Hence, nursing care has a major effect on pressure ulcer development and prevention. Lyme Disease: Questionable Diagnosis and Treatment Edward McSweegan, Ph.D. Lyme disease is the most common tick-borne disease in the United States. In 2011, the Centers for Disease Control and Prevention (CDC) recorded. Can you change your phone that you're offered for another Assurance Wireless phone? Added September 19, 2004 The Role of Neurofeedback in ADHD Treatment Neurofeedback is probably the most interesting and promising treatment modality for ADHD in use today. The goal of the treatment is to teach a person to. Prevalence and Severity of Substance Use and Substance Use Disorders. How widespread is substance use by TANF recipients? What are the consequences of such use? How many substance users satisfy the screening criteria for abuse. Recent research offers compelling support for the effectiveness of Twelve Step- based treatment - - Hazelden. When academics and members of Alcoholics Anonymous meet, they tend to confirm how much they differ. People in AA see themselves as part of a fellowship, bonded by the shared disease of alcoholism and relying on a spirituality that defies measurement. In contrast, university- based researchers want numbers- -objective outcome measurements for treatment based on the Twelve Steps and results that can be replicated. AA testimonials are interesting, researchers say, but we need more reliable evidence that joining a Twelve Step fellowship changes people over the long term. Given their divergent perspectives, we might expect these two groups to keep a polite distance or even harbor some mutual suspicion. But today that expectation cannot hold. A growing number of researchers not only profess respect for AA, they see the Twelve Steps as essential to addiction treatment. Researchers call for reconciliation with AAThis reconciliation of the scientific community with AA has been hard- won. For decades, only a few studies documented the effectiveness of Twelve Step- based treatment. That's understandable. To preserve anonymity, AA keeps few statistics other than numbers of groups and members. For the 6. 5 years of its existence, AA has grown by anecdotal accounts of recovery among its members- -not by the results of research published in peer- reviewed medical journals. When approached by outside observers, some members of AA even express caution. Charlie Bishop, coauthor of To Be Continued: The Alcoholics Anonymous World Bibliography 1. AA as a form of therapy do it a disservice. According to Bishop, AA can be properly taken only on its own terms as a spiritual fellowship, not merely a treatment strategy or way to modify behavior that can be couched in modern psychology. If a scientist were to ask an AA old- timer how AA works, the answer Just fine! But the most significant studies documenting Twelve Step efficacy have come in the last five years. Project MATCH supports Twelve Step- based treatment. One of the largest and most widely quoted studies to support the . This federal effort was supported by the National Institute on Alcohol Abuse and Alcoholism. The study's title captures its aim: finding ways to match people with the kind of addiction treatment best suited to them. Doing this means looking for . Examples of those attributes are anger and readiness to change. Project MATCH examined 2. In addition, Project MATCH compared three kinds of treatment, each delivered via individual outpatient therapy: Twelve Step Facilitation Therapy, grounded in AA's concepts of alcoholism as a disease of the mind, body, and spirit and lifelong abstinence as the only sane response. This form of treatment guides clients through AA's first five steps. It also actively encourages people to attend AA meetings, keep a journal of their experiences at meetings, read AA literature, and practice AA principles . This means learning to identify cravings for alcohol and respond to those cravings in ways other than drinking. Some of those skills include challenging the thoughts used to rationalize drinking and avoiding the . Motivational Enhancement Therapy, designed to help clients discover and act on their personal reasons for staying sober. Motivational enhancement therapists help clients move through six specific stages of change: pre- contemplation (not considering a behavior change), contemplation (considering a change), preparation, action, maintaining the change, and coping with relapse. Researchers could hardly have chosen three approaches that differ so much. Cognitive Behavioral Therapy offers technique after technique for helping people change their thinking (cognition) and action (behavior). It's true that the Twelve Steps also guide people to release . However, AA members put these attempts to change in the context of surrender to a higher power. Cognitive Behavioral Therapists, ground in social learning theory, make no such assumptions about the need for . In this form of therapy, counselors make no attempt to guide clients through a step- based program of recovery. Instead, counselors offer non- judgmental feedback on clients' behavior, emphasize personal responsibility for change, and offer a menu of options for new behaviors. Sometimes Motivational Enhancement Therapists offer outright advice. Among these three approaches, Twelve Step Facilitation is the only one that specifically encourages people to reach out to other recovering alcoholics. Helping clients to actively work the Twelve Steps is the primary goal, as opposed to learning skills that the therapist teaches or responding to therapist feedback. For Project MATCH, 8. Researchers also interviewed and assessed clients to rate them on relevant attributes. The overall results were reported in 1. Almost 3. 0 percent of these clients were abstinent three years after treatment. And even those who drank during those three years abstained, on average, two- thirds of the time. Of the 2. 1 client attributes, two were the most powerful predictors of long- term drinking outcome: readiness- to- change and self- efficacy (clients' confidence in their ability to abstain). Project MATCH found few differences in outcomes among the three treatments. This means that Twelve Step Facilitation held its own, working as well as Cognitive Behavioral Therapy and Motivational Enhancement Therapy. In fact, Twelve Step Facilitation offered a statistically significant advantage when total abstinence was the desired outcome. Steps help clients who have social support for drinking. Another relevant study comes from Richard Longabaugh, Ed. D, associate director of the Center for Alcohol and Addiction Studies at Brown University, Providence, Rhode Island, and his colleagues. This study, part of Project MATCH, clearly demonstrates the advantage of Twelve Step Facilitation for clients with a particular attribute: social support for drinking. To rate clients on this attribute, researchers looked for specific information, such as the: Number of people in the client's social network. Amount of contact that the client had with key people in this network. Number of heavy drinkers in the network. Number of people who abstained from drinking and the number of recovering alcoholics in the network. In short, clients with high support for drinking had close friends and family members who drank at higher levels and offered lower levels of support for abstinence. Longabaugh and his coauthors predicted that Twelve Step Facilitation Therapy would lead to better treatment outcomes for these clients. To test this hypothesis, researchers measured the number of days that clients abstained from alcohol during a three- month period- -3. Researchers also measured client involvement in AA during and after treatment. Results confirmed the prediction: Clients with high network support for drinking who took part in Twelve Step Facilitation had 8. Motivational Enhancement Therapy had 6. What's more, even the clients who received Motivational Enhancement Therapy had more abstinent days if they attended AA after treatment. For clients with low network support for drinking, there was no significant difference between Twelve Step Facilitation and Motivational Enhancement Therapy. Researchers drew two primary conclusions from this study: Twelve Step Facilitation . And, alcoholics with such networks should consider joining AA- -regardless of the type of treatment they receive. Our study has clear clinical significance, says Longabaugh. It tells the clinician that once we know the client's support for drinking, we know how important the AA component can be to his or her recovery. For his work on this study, Longabaugh received the Dan Anderson Research Award for 1. Hazelden. This award recognizes researchers who advance scientific knowledge in the field of addiction recovery. Steps and treatment offer 'additive effect'More support for the Twelve Steps as treatment tools comes from the work of Fiorentine. For one study, he and colleague Maureen P. Hillhouse, Ph. D, followed 3. Los Angeles. 4 The researchers interviewed and assessed each client twice- -within one week of entering treatment and again about eight months later. Fiorentine was especially interested in answering these questions: Do people join Twelve Step groups (such as AA and Narcotics Anonymous) as an alternative to treatment? Why do people who are currently active in a Twelve Step group choose to enter treatment? When people are involved in a Twelve Step group before entering treatment, are they more likely to complete treatment? Are longer stays in treatment associated with higher levels of involvement in Twelve Step groups? When people take part in treatment and Twelve Step groups, do they experience an ? The data provided answers to each question: Two- thirds of the outpatient clients were attending a Twelve Step group when they entered treatment. Most clients entered treatment to support a . Clients who attended Twelve Step meetings at least once per week before treatment stayed in treatment longer- -an average of four weeks more- -and were also more likely to complete treatment. The longer clients stayed in treatment, the more likely they were to contact a sponsor at least once per week. Clients who stayed in treatment longer, completed treatment, and attended Twelve Step groups weekly had significantly higher rates of abstinence than those who did not meet these three criteria. Fiorentine concluded that people used Twelve Step groups and outpatient treatment as . When clients combine treatment and Twelve Step groups, they experience a powerful advantage over using treatment or groups alone. In summary, treatment and Twelve Step groups are best viewed as a . Fiorentine speculates that . At the 1. 2- month point, 5. Another 3. 5 percent said that they'd reduced their chemical use. Between 7. 0 and 9. More often, however, officers are reluctant to talk about the horrors they see. As one officer put it: . I shall offer the following for the reader's consideration: 1. Police officers take their roles as . Losing one's innocence through traumatizing events is bad enough without exposing one's family, those dearest to the officers, to the trauma. It is easier, in the short run, for officers to . Talking about it brings back images and pictures that arouse pain and hurt feelings about the traumatic incident. The officer may feel guilt that he was unable to save a victim. Maybe he/she is having an affair and doesn't know how to tell me. In order to remain unaffected by the suffering and pain an officer confronts on the street, it becomes necessary to keep feelings and emotions under rigid control. So often officers who enter therapy express their long- held fear that once they let their emotions flow, they will be unable to control the deluge that would follow. Even the officers themselves are unable to get past it. One release is in the use of the grotesque humor that becomes so much a part of the police mentality. You make light of the fact that people are dead. But you wouldn't last six months if you didn't do something like that. Often they may replace ? The officer cannot relate to his/her child stories of dead children pulled from car wrecks. He cannot communicate to his child how frightened he is at the thought that this could happen to his child. Police officers know that horrible things happen to good people - not just to strangers one reads about in the newspapers. Officers are more apt to command, order, and direct and less apt to discuss and request with their spouses and children. Wives complain that their husbands sometime speak to them as though they were criminals. Children relate how their police officer parent is unapproachable and distant. To separate the role of . Far too many officers succumb to this role conflict. It is little wonder that police marriages suffer as they do. Healthy human development requires balance - so do human relationships. Virginia Satir, experiential family therapist, stated that, . They are of short duration, sporadic and with faulty or poor communication. The couple grows apart leaving the spouse of the police officer feeling unimportant and rejected. How can an officer switch roles after eight hours of being a cop, especially if he/she has just watched someone die. Among the many professionals who testified was Lenore B. Johnson, Ph. D., associate professor of family studies at Arizona State University, who reported the results of her study . In the study, Johnson surveyed and interviewed 7. East Coast police departments and 4. Seventy- seven percent of the spouses were above the scale mean in reporting stress from their mates' jobs. Coping problems included alcohol abuse, divorce, family violence and suicide. Alcoholism rates for police officers exceeded the mean by 1. Forty percent of the police officers surveyed reported that within the six months before the survey, they had behaved violently toward their spouses or children. Johnson offered the following factors as contributing to family strain: ROTATING SCHEDULES: . Instead, they expected the last word in family discussions and were seen as overly critical. EMOTIONAL AVAILABILITY: Many spouses reported that the officer did not communicate his/her feelings. IMAGE ARMOR COPING STRATEGIES: The rugged individualism, being tough, was seen as a typical coping strategy that often leads to depersonalization of citizens. It's equally detrimental to marriage and family life. LACK OF SOCIAL SUPPORT: The absence of social support from all sources (squad supervisor, spouse, and friends) has an influence on police stress. Johnson's data suggested that those officers who did share work problems with their spouses or non- police friends had lower burnout. While this was true for male officers, it did not hold true for female officers who were married to non- police officers. They claimed that their husbands did not want to hear about their wives' jobs. In reporting individual and family pathology, Johnson stressed the seriousness of the problem whereby nearly 9. All available data continues to support the belief that what happens to police officers on the job very much affects their families. Johnson's study did not include interviewing the children of police officers. However, in 1. 99. Metropolitan Police Employee Assistance Program joined with the National Institute of Mental Health's Laboratory of Developmental Psychology, funded by the Mac. Arthur Foundation Research Network on Early Childhood Transitions, to study the effects of parental post- traumatic stress disorder (PTSD) on the children of police officers. The phenomenon of . Children of holocaust survivors have also fallen victim to this . Similar findings have also been reported by White in 1. In our work with police families, we are finding high rates of this secondary traumatization in children of police officers with PTSD. Many of these children are manifesting serious conduct disorders and high rates of attention deficit hyperactivity disorder (ADHD). This project investigated the possible contributions of parental PTSD to various behavioral and adjustment problems in the children of police officers. The first empirical study of its kind, the results of this project has helped us understand the effects of severe occupational stress that exists in law enforcement. Trauma is contagious and not easily forgotten no matter how hard we try to defend against the aftershocks. Let us now turn to other factors that contribute to create . They are shiftwork, midnight work, and the responsibility for people. SHIFTWORK/MIDNIGHTS . Ask it to work at night and sleep during the day and it does both rather badly. Unfortunately, officers do not always eat the right food and, more often than not, do not get proper rest and relaxation. Working the midnight shift exacts a heavy toll on police officers. Since human beings are not nocturnal, staying awake through the night requires suppressing nature's cycles. It should also be noted that daytime sleep in controlled laboratory testing has been found to be qualitatively different from nighttime sleep and less satisfying (Kroes, 1. Shiftwork, especially rotating shifts, though a necessary part of any law enforcement organization often wreaks havoc on the officer's body including adjustments in circadian rhythms. As much as shiftwork is difficult for the officer's biological and social adjustment, it also infringes in drastic ways on the lives of his/her family members. Let us turn to the complicated problem of shiftwork and the difficulty officers have adapting their physiological and psychological rhythms to a new sleep wakefulness cycle. The 2. 4- hour cyclical rhythm has been given the name . Research has shown that practically all physiological functions show circadian rhythm cycles. As one can imagine, shift work conflicts with these circadian rhythms. How negatively this will affect the individual will depend on several factors: The work environment. The individual's support system. The individual's overall health. The individual's coping style. The individual's attitude toward the shiftwork. In our society, almost all communal activities take place during the day - working, eating, shopping and socializing. When an individual deviates from this societal norm, he/she is cut off from the normal avenues of social interaction. For the young officer who works midnights, there are special problems. It's not easy to pick up his date after he gets off work at 7: 0. When the officer has a family, children are cautioned not to make too much noise; the phone must be answered on the first ring or taken off the receiver. And, of course, the spouse and children are left alone at night. When the officer works 3: 0. It takes approximately two weeks for the average individual to re- adjust his eating and sleeping patterns. For the officer on a two- week rotating shift, no sooner does he/she adjust, than he/she is forced to change gears to a new shift. Kroes, Ph. D., reported the following results of research conducted with police officers: 9. Over 3. 0 percent reported sleep problems. There are some officers who enjoy the permanent midnight shift. However, very few of officers are not adversely affected physiologically and psychologically by the midnight shift. While there are those who would argue that many people work midnights or evenings and that these individuals lead productive, healthy lives, it must be remembered that for police officers, work schedule is only one of the major stressors. In fact, these occupational stressors taken one- by- one may not be so overwhelming; but taken collectively, in addition to typical life stresses, they can be very harmful to officers and their families. RESPONSIBILITY FOR PEOPLEResponsibility for the welfare of others, for making . For an officer who is the first to arrive on the scene of a serious accident or fire, the actions he/she takes may drastically affect the lives of others. To watch human pain and suffering on a daily basis is tremendously draining - although you probably will not hear an officer say these words. More often you may hear an officer assert that it's all part of the job - no big deal. In fact, you may even hear him joke about the atrocities that he must witness on the job. There are situations for police officers that are emotionally overwhelming. One patrolman saw a three- year- old child who had been catapulted through the windshield of a car and decapitated. He went on a three- day drinking binge as a result of the experience, and when he returned, he was disciplined. He would not explain why he had been absent for three days because it would have required acknowledging that he had been deeply moved by the experience. And the department didn't know why he had behaved that way. Here is the reaction of a young officer just out of the police academy.
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