Demographic Profile of Diabetic Patients

Demographic Profile of Diabetic Patients INTRODUCTION Background of the Study In the last few decades, the world prevalence of diabetes among adults have increased more than twice, and expected to ascend to 380 million by 2030, according to a report from the InternationalDiabetes Institute.1 About 3.4 million, roughly 4.6 percent of the total population in the Philippines are diabetics. This figure is expected to rise to 7.8 million in the next 15 years.2 Despite such high incidence, awareness on diabetes, its complications and treatment remain major challenges, particularly in developing countries such as the Philippines. Prevention through patient education is imperative because the burden of disease on healthcare and its economic implications are of great magnitude. There is a significant amount of evidence that patient education is one of the most effective way to lessen the complications of diabetes. 3,4,5,6 When coupled with appropriate medications, it is associated with decreased morbidity and mortality.3 Patient education is more likely to be effective if we know the characteristic of the patients in terms of what they know about their disease, their attitude towards it and what they practice in their medications, diet and lifestyle. Very few studies has been made on our country to find the prevailing awareness, attitudes and practices among diabetic patients, 7,8,9 which can aid in the development of future health education interventions targeting the disease. In this study, we will determine the demographic characteristics of diabetic patients consulting at the Diabetes Clinic of a tertiary hospital in Davao City and assess their level of knowledge, attitude and practices (KAP) towards Diabetes Mellitus (DM) and the relationship of KAP and glycemic control among type 2 diabetic patients in an urban health care facility. REVIEW OF RELATED LITERATURE In the Philippines, the prevalence of diabetes according to the NNHES (National Nutrition Health Survey) study is approximately 4.6-7.2%. This figure expands to 17.8% after adding those who have pre-diabetes (impaired fasting glucose or impaired glucose tolerance or both) which has a prevalence of 10.6%. 2Therefore, one out of every 5 Filipino could potentially have diabetes mellitus or pre-diabetes. As such, the increasing trend of its incidence rate is causing alarm among medical practitioners, and among affected patients as well. In the context of an alarming increase in the magnitude of type 2 diabetes mellitus in our country, the prevailing knowledge, attitudes and practices of these diabetic patients assume immense importance in the control of the disease. Across the globe, a number of studies have been done about perception and practice of diabetic patients10-14, especially in third world countries. An Indian study made by Mukhopadhyay, et al 2010, looked into the perceptions and practices of patients with Diabetes Mellitus Type II in a tertiary hospital.11 In the Philippines, a similar study was done in the rural community of San Juan, Batangas, Philippines. A total of 156 diabetic residents were included as participants of the survey. Knowledge scores were relatively low, with an overall mean of 43%. There were also poor positive responses to attitude scale. The study emphasized the importance of evaluating knowledge, attitudes and practices as crucial means to understand observed behaviors and guide behavioral change.7 According to the American Diabetic Association, self management education is defined as the process of providing the person with diabetes the knowledge and skill that is needed to perform self care, manage immediate concerns and make life style changes. 3 To achieve such effective self care, diabetic patients and their doctors should work hand-in-hand together. Some studies have shown that self-care among individuals with type 2 diabetes had improved glycemic control and reduced complications 15, 16, 17. For people with diabetes, self-management education training is vital since diabetics and their families provide most of their care themselves. It is imperative that regular patient counseling and group education at follow-up visits by health care professionals to help in improving patients’ knowledge and ultimately modify their practices. 19 However, in our setting, adequate diabetes self-management education programs are lacking or weak in most government hospitals in tertiary care. Hence, results of this study could help us design our education programs targeting certain groups or issues that needs further strengthening. Research Question What is the level of knowledge, attitudes, and practices and its association with glycemic control among persons with type 2 diabetes in the Diabetes Clinic of Southern Phiilppines Medical Center? Significance of the Study The study will contribute to the understanding of the current status of diabetes care in our local setting, and help in the implementation of programs that would address pressing needs in our patient education and management, based on their knowledge, attitude and practices. It will also help us identify the association of KAP and glycemic control, and further assess the impact of diabetes self-management in disease control. Objectives: General Objective: 1. To determine the knowledge, attitudes, and practices of patients with type 2 diabetes in the Diabetes clinic of a tertiary hospital. Specific Objectives: To determine the demographic profile of the diabetic patients in the Diabetic clinic of a tertiary hospital in Davao City, in terms of : Age Gender Highest level of educational attainment Employment status Duration of diabetes Antidiabetic medications Co-morbidities To determine the association between patient factors such as age, sex, level of education, employment status, duration of diabetes, antidiabetic medications and co-morbidities and their level of knowledge, attitudes, and practices (KAP) regarding diabetes To establish the association between the patients’ KAP and their corresponding glycemic control based on HBA1c levels METHODOLOGY Research Design: The study will employ a clinic-based, cross-sectional analytic study design. Research Setting: This study will be conducted at the Diabetes outpatient clinic of a tertiary hospital in Davao City, from May 2014 to June 2014. Participants: All patients who are diagnosed with type 2 Diabetes Mellitus type 2 (T2 DM) who are seeking consult at the Diabetes Clinic in a tertiary hospital for the period of May to June 2014. Inclusion Criteria: Patients must be a diagnosed case of Diabetes Mellitus type 2 based on the following criteria: Plasma glucose > 126 mg/dL (7.0 mmol/L) after an overnight fast Fasting is defined as no caloric intake for at least 8 hours up to a maximum of 14 hours, or Two-hour plasma glucose > 200 mg/dl (11.1 mmol/l) during an Oral Glucose Tolerance Test The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water after an overnight fast of between 8 and 14 hours, or A random plasma glucose > 200 mg/dl (11.1 mmol/l) in a patient with classic symptoms of hyperglycemia (weight loss, polyuria, polyphagia, polydipsia) or with signs and symptoms of hyperglycaemic crisis. Patient must have informed consent. Exclusion Criteria: Patients who does not meet the criteria for T2 DM but are seeking consult at the Diabetes clinic: Impaired fasting glycemia and Impaired glucose intolerance. Patients who have intellect impairment and could not participate in the survey Sampling Procedures All the DMT2 patients visiting the diabetes centre during this period will be identified using the convenient sampling method. Assuming that the prevalence of knowledge among Filipinos is 43% 7 and estimating the proportion within 95% confidence interval with 5% error, the sample size is 168( Raosoft Sample size formula). Data Collection: The data will be collected by giving out pretested predesigned questionnaire to participants with informed consent. Pre-testing of the questionnaire will be done prior to the research proper. Relevant information from the participants will be gathered including: age, gender, highest educational attainment, employment status, duration of diabetes, antidiabetic medications and co-morbidities. Questions pertaining to their knowledge, attitudes and practices will be given in order to assess their corresponding levels. The KAP questionnaire will be adapted from a Malaysian study by Shu Hui Ng et al 15, â€Å"Reality vs Illusion: Knowledge, Attitude and Practice among Diabetic Patients†. The questionnaire has been used in previous KAP studies among diabetics and has proven to be a reliable tool. The self-administered questionnaire had a total of 25 questions (knowledge-14, attitude-5, and practice-6). Each correct answer will be given a score of ‘one’ and the wrong answ er was given a score of ‘zero’. Good knowledge attitude and/or practice will be considered if a patient attains >50% of the total score for each domain. To assess the relationship between KAP towards DM and the actual disease control, most recent(4 +/- 2 weeks) levels of HbA1c will be obtained from the patient records. HbA1C > 7% is considered to have poor control of DM. A. Independent Variables Independent Variables include: sex, age, educational attainment, current employment status, co-morbidities, latest hba1c result. B. Dependent Variables Dependent Variables include: levels of knowledge, attitude and practices Data Handling and Analysis: The principal investigator will ensure that all data collected in the study were of utmost confidential nature. Data analysis will be performed to ensure quality results using frequency, percentage, and statistical analysis. The chi-square test will be used to determine the relationship between KAP and t-test to assess the association between KAP and diabetes control. Spearman correlation test will be used to determine the association between knowledge and attitude, and between knowledge and practice. The level of statistical significance will be set at p

Haddon House

Jurists Haddam House Food Products has over 50 years of experience in the gourmet food industry. As you know our inventory selection is more than 20,000 items which consists of major brand within ethnic and gourmet categories. One of our most popular brands is Cane's Crazy Mixed-up seasonings. Haddam House is very strong when it comes to selling our products. However, Haddam House needs improvement when it comes to employee turnover.Haddam House has three major locations, two locations in New Jersey, and one in South Carolina. There are 60 people who work in our corporate office and about 700-800 sales representative. Looking back at the last five years there has only been four employees who have been promoted and a handful of employees who left the company or got terminated. It is clear that these promotions happened because the supervisor of Accounts Payable decided to leave the company because she was moving out of state.This left her position open which then the supervisor of Acc ount Receivable decided to take her position this way one of her employees could become the supervisor. This may not be considered a promotion because she was already a supervisor Just moving to a new department. Furthermore, the young lady working in customer service has only been employed with the company for two years and she has a tough time trying to get promoted In addition to the employees in the cooperate office looking at the sales representative there have been at least three employees getting terminated each week.That is a really high number and it should not be like this at all. It should be in the company's strong interest to want to keep their employees. There are many times where a sales representative will leave the company and then get hired again a month later. There are many questions that come with that. Are they leaving the company because their pay is not high enough and then Join the company later to get a better pay increase?This problem can be avoided if the sales representative can give their feedback and the company takes it into consideration to better improve the company. . There is an even amount of males and females that leave the company each year. However, by looking at the numbers more females feel the need to get remoter and have the highest Job whereas, the males feel comfortable in their position. One good aspect about Haddam House is that there are an equal number of males and females in the company.The company is also very diverse. Another variable that we looked into was if there was a correlation between education and promotion within the company. With any other company if a person gets a higher education it can give them a chance to get promoted in the company. However, with this company it rarely happens. Employees feel that when they get hired for a position it does not matter if they further their education they will be stuck that session.This comes to be a big problem because individuals do not want to keep looking for a Job because they cannot go further. Haddam house is very particular with who is in the right position and they fear that only these people are right for the Job. It would help them in the long run if they were willing to trust more people and willing to promote more people than they do now. If they can get past this threshold they may notice an increase in moral and loyalty. Which will help people stay in the company and keep it a happy and healthy environment.

The Hidden Truth About 300 Essay Topics

The Hidden Truth About 300 Essay Topics The Battle Over 300 Essay Topics and How to Win It You don't need to find super technical with legal argumentative essays, but be certain to do your homework on what the recent laws about your preferred topic actually say. Analyzing a present event appears to be a favorite topic chosen for argumentative essays. There are several interesting and challenging Shakespeare essay topics to select from. The sample topics given in the above list ought to be sufficient when you must create a winning essay. Our site is just one of the most appropriate for essay help. You can trust the ideal essay help online. If needed, do some studying to assist you in getting ideas for your short essay. Choosing fantastic essay topics for middle school needs to be a careful procedure, where a balance must be struck between topics that could be too simplistic, more fit for the key school, and choosing argumentative essay topics that can be too intricate or controversial. 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So, the choice of the topic is very important. Even if you're free to select the topic you enjoy, be ready to do a little research on it. From time to time, you're provided a particular topic to write about. Finding the most suitable arguments can help you prove your point and win. Odds are, all you have to do is relax and locate a topic you're passionate about and, naturally, one that's debatable. Picking an emotional topic is also a great idea. A good idea is going to be to look at some examples of 1000 word essay matching the overall skeleton you've prepared. Use what you read to assist you create some search terms, and to assist you choose your own position. Other times, you're able to select from a couple of different topics. It's important to select debatable argumentative essay topics since you need opposing points which you can counter to your own points. 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Informative Speech Mexico The World Below Us - 1512 Words

Informative Speech Outline Format – Template (Note, all boldface terms represent labels as they should appear in the outline you hand in – you need not bold yours but please have the label in place). Name: __Megan Bianco___ Title: Mexico: The World Below Us Specific Purpose: The specific purpose identifies information you want to communicate and a goal for the audience – â€Å"After listening to my speech, the audience will†¦Ã¢â‚¬  (Not in spoken text) After listening to my speech the audience will have a better understanding of the culture of Mexico and their traditions, as well as a look into some of their problems. Introduction: I. Attention Getter: (Spoken text starts here) Mexico is a very diverse country, and is extremely different from others. Throughout history, Mexico has faced a very bloody and violent history that has been known around the world. As a result, their society is somewhat different from anything that has been seen before and is in itself unique compared to societies such as the United States II. Thesis Statement: Mexico is an interesting country, with many different and people and customs, as well as major problems. III. Credibility Step: Needs two parts 1. What personally connects you to this topic? – I took four years of Spanish in high school in which we learned about the culture in Mexico, and I always found it very interesting. 2. What type of research have you done to add to credibility? – I have read and studied books about Mexico throughout myShow MoreRelatedSamsung Smart Fridge Business to Business Marketing Plan6903 Words   |  28 PagesCONCLUSIONÂ…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…Â…23 Executive Summary This BBM report is written to strategically plan the launch of the new ‘Smart Fridge The ‘Smart Fridge is a new fridge with multiple new aspects making it one of the most modern and advances fridges in the world. The product is made by Samsung and has a high potential of becoming the next hype on the fridge market. By reading this report it will become clear what strategies, obstacles, trends, threats and marketing/ communication tools are needed to makeRead MoreTranslation of Newspapers. Problems of British-American Press Headlines Translation15808 Words   |  64 Pagesan aid to translation. 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Functions of a Nurse in Health Care - 1843 Words

1. Pregnancy and drug abuse The drug abuse menace has been indicated to be one of the leading factors that negatively affect people at whatever stage of life right from the fetus stage to the fully grown baby and the adulthood. There were astonishing statistics from the 2008 and 2009 data that relates to the pregnant women and drug abuse. It is indicated that the drug abuse by pregnant women who are younger was higher than the elderly ones. The percentages of pregnant women between the ages of 15 to 17 and abused drugs stood at 15.8% of them, a figure that is relatively higher that that of women in the same age gap who are not pregnant at 13% (National Institute on Drug Abuse, 2011). These are grim statistics that definitely require the intervention of the entire society and all concerned agencies to ensure that the issue of drug abuse is sufficiently handled and reduced to safeguard the future generations. In order to combat this among the pregnant women, there needs to be a compreh ensive Ante Natal Care focus on the issue of pregnancy and drug abuse. The program should be one that covers the assessment, diagnosis, planning, implementation and evaluation of the ANC concerning drug abuse. Assessment; this stage will try to first find out if the pregnant mothers abuse drugs, and to what extent. This stage can be accomplished easily by the use of questionnaires with intrusive questions and those that find out the attitude of the drug abuser (Yale Medical Group, 2012).Show MoreRelatedFunction Of The Australian Nursing And Midwifery Council1382 Words   |  6 Pagesprofession, one should have the required aptitude to be able to function efficiently. 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Parts of the Hiring Process Free Essays

There are many ways a company can go about recruiting high quality and fully qualified potential employees. One of the most common ways is by going online and looking at resumes posted on such sites such as Monster, CareerBuilder, or The Ladders. But by trying to find potential employees in this way it leaves a lot of problems in the open. We will write a custom essay sample on Parts of the Hiring Process or any similar topic only for you Order Now Problems such as, what if a potential employee exaggerates on their resume or what if they add qualifications and skill that they don’t have are all problems that can easily be found after an employee is hired. Sure, a resume is a great way to discover potential employees but that process needs to be taken even further. As some companies do I think it is extremely important for a potential employee to not just have one interview with one person but multiple rounds of interviews with different people. This allows others to get a sense of the candidate and allows them to compare that person to the other people also being interviewed. Another very  ¬good way of recruiting potential employees is by having job fairs. This allows a ton of potential people to come in and meet face to face, after this a few people that are liked can be brought in for next round. Also, at these job fairs for the people that are found likeable and potential, they could be given a small test to see whether or not they know the job which they are interested in. This allows the candidate to display their skills first hand. There are 6 parts of the selection process, background information, interviews, paper and pencil tests, physical ability tests, performance tests, and references (Jones-George). Background information, meaning information gathered from job applications and resumes. This information consists of past and present job experience, colleges or other schools attended, or if they have any foreign language skills. The information is usually cross referenced with a background check to further validate accuracy. This part of the selection process is the first thing employers will use to find potential employees. Another part of process is interviews which is pretty self-explanatory. Prospects will come into work place and be interviewed and evaluated in person by being asked questions about their past employment, goals, about the company, and what they expect to get out of the job. This part of the process is good for employer to get a more personal feel for a person and see if they fit. References are also pretty self-explanatory as well. These are people that can be called, and / or emailed to learn more about the employee. They can be people that the candidate supplied to the employer or people the employer seeks out on their own. They supply the employee with an opinion of character from someone other than the candidates view to supply employer’s skills, abilities, and other personal characteristics. They are usually used at the end of the process to make a final decision. Paper and pencil tests, are usually given to candidates for ability and personality tests. For example in my company analysts are usually given these tests to check their math skills and their reading skills to make sure they are fully up to par with that portion of the job. Personality tests are given by employers to get an overall sense of a person and to make sure they are not a possible risk to both themselves and others around them. It also shows an employer their problem solving skills and how they handle s tress. Performance tests are given to candidates when they apply to a job that requires them to use specific types of programs or in other jobs maybe specific types of equipment. These tests can be anything from testing how fast a person types to how proficient a person is in excel. These tests are used to actually display a candidate’s skill rather than just listing it on a resume. This is a very important test to have a candidate perform. When interviewing a person in my field we sometimes give them a computer which we have broken and know what is wrong and ask them to see what is wrong and how to fix. Not only does this show us the skills they have, but also shows us how they think when under pressure. Physical ability tests are only given to candidates who are applying to work in a physically demanding position such as police or fire fighting jobs (Jones-George). These tests bring out who is physically and mentally ready for the job and who can properly and safely perform it without injuring themselves or others. References: Jones-George: Essentials of Contemporary Management, Fourth Edition. The McGraw-Hill Companies, 2011 How to cite Parts of the Hiring Process, Essay examples

Developmental Theories Make To Assessment †Myassignmenthelp.Com

Question: What Implications Might A Young Client's Attachment Style Have Upon Their Capacity To Engage In Counselling? Answer: Introducation The progression of the young people as well as adolescent might comply a sequence as made up of with the anticipated order for the appearance of particular behaviours and also features yet they are generally definitely variable (Ali, Farrer, Gulliver Griffiths, 2015). The personalities of the children are quite uncertain in lieu of the anticipation of the stability of the adults. As associated with this instability which is observed in them it is a clear evidence which reveal the normal development that is really often marked by numerous the behavior problems. The child along with the adolescent therapist needs to be in a position to sort out these regular issues from those which can signify the a bit more serious problems. Additionally, the consciousness to the development might also aid the therapist with regards to the clinical decision making to the numerous point with regards to the treatment process (Dowling Rickwood, 2014). There needs to be appropriate goal setting that is vital that you any one of the therapeutic venture. This offers the direction to our work, which might permit us to monitor on the progress. The children and adolescent assessment and development theory sets on the goal with regards to the development framework (Ali, Farrer, Gulliver Griffiths, 2015). Moreover, additionally they assist in these people acquiring on the problem solving cognitive abilities or maybe the moral judgment aspects. In setting of the goals above the developmental anticipation is nearly as making certain the expectations is making certain the intervention would certainly fail (Dowling Rickwood, 2014). The development theories allows the therapist in choosing on the suitable content and choose the degree of the therapeutic interaction which suit the children and the adolescents. Some of the notable developmental theories are those of work done by Freud, and Piaget (Ali, Farrer, Gulliver Griffiths, 2015). On the Piagets of the Cognitive development has provide d an excellent base when it comes to assessment of the intellectual development of the adults and the children. On this theory it provide a nature as well as the development of the human intelligence (Trower, Jones Dryden, 2015). This theory is significance in assessment and the development of the children and adolescent because it shows a progressive reorganization of their mental process which could result from the biological maturation as the experience of the environment they live in. these individuals are able to construct the understanding of the world around them, they experience on the discrepancies between what they know and what they have already discovered in their environment, then they are able to adjust on their ideas accordingly (Dowling Rickwood, 2014). This theory is at the centre of the human organism, and the language is the contingent when it comes to the knowledge and the understanding which has been acquired by the children and adolescent through their cognit ive development. The second theory is the Freudian theory of the personality (Rupani, Cooper, McArthur, Pybis, Cromarty, Hill Turner, 2014). According to Freud he claimed that the way parents treated their children basic sexual along with the hostile desires determined on their personalitys growth and also whether or not they might turn out as well adjusted adults (Joyce, P., Sills, C. (2014). The children generally undergo a several stages of the sexual development that are oral, Anal, latency, Phallic, and the Genital. Depending on view of Freud every stage focusses on the sexual activity and the pleasure which is received from a particular part of the body. With regards to the oral phase, the children are generally focussed on the pleasures that happen to be received from the sucking and the biting with their mouth (Trower, Jones Dryden, 2015). These psychosexual phases signify on the fixation of the libido on the numerous part of the body. As a child grows physically numerous areas of their body they become a significant source of the potential frustration (Joyce Sills, 2014). When assessing of the children development Freud develop the theory to describe on the way that the sexual energy accumulates as well as discharge as individual mature biologically. Moreover, he stressed that the five years of life of the children are the most important to the formation of the personality into adults. What implications might a young client's attachment style have upon their capacity to engage in counsellingOver the past the researcher has found out that the attachment theory has impact regulation and also interpersonal relationships. When people have the caregivers that are emotionally accountable, they are likely to develop secure attachment along with a positive inner working type of self and others (Dryden Mytton, 2016). The adult attachment might be pointed out when it comes to the two dimensions that are the adult attachment anxiety along with the adult attachment prevention. The young style attachment style is the conceptualized as the fear of the interpersonal rejection and the abandonment , extreme requires especially for the acceptance from others , negative view of self , along with the hyper activation of affect regulation methods that the individual over-react to the negative mindset as a method of the gains of the others support and the comfort . With regards to this attachment style the patterns tend to be more often difficult to change when this person is used for the adulthood even though it is far from impossible (Dryden Mytton, 2016). The studies which refers to the examining of the mediators of the relation that is between their attachment and their mental health results is important for the counselling since the mediators can help the individual to alleviate their distress. Furthermore, identifying of the mediator might assist individuals to decrease on the influences of the attachment patterns without requiring one changing on the patterns, which can be a much more daunting task. There are numerous ramifications which the young client attachment style bring to their specifications when engaging in counselling (Dryden Mytton, 2016). Initially the attachment style has a strong foundation with regards to the comprehending on the development of ineffective coping strategies along with the underlying dynamics of individuals emotional diff iculties. On the part of the clinicians they can help individuals with the attachment style in addition to avoidance understand on how exactly the past experiences with the caregivers or maybe other people have with regards to shaping on their patterns and precisely how these patterns work to protecting them initially but afterwards contribute to their experience of the distress . The attachment style of individual has the capacity of assisting the individual finding an alternative of fulfilling on their unmet needs (Westergaard, 2013). People who generally seek help would like to learn on how exactly to cope with their irregularities in their daily life along with modify on their dysfunctional or maybe ineffective coping strategies. When individual concentrate on the adjusting the dysfunctional coping strategies would not make certain that the people would cope well. People more regularly have acquired and continued to utilize the dysfunctional strategies simply because they have s erved an adaptive function by means of facilitating them to fulfil on their fundamental psychological needs for instance connection, autonomy as well as competence previously. Helping individuals find on their alternative ways in meeting on their unmet needs is vital when it comes to solving of their problems (Westergaard, 2013). You will need to concentrate on the modifying of the maladaptive coping strategies, but there is also a necessity to recognize on the underlying unmet needs that happen to be a lot more satisfied by utilizing these types of methods and assisting people understanding on the alternative ways to gratify on their psychological or maybe the emotional needs. Individuals with the high attachment style may gradually become less in engaging in counselling and others could lose touch with their feelings or thoughts. These individuals may not have empathy to others on their emotional experiences. They may become lonely and future depression. Additionally, they become reluctant to self-disclosure and hold negative views to others. When it comes to engaging in counselling more often these people do not engages a lot they tend to hold their thoughts and feeling (McAndrew Warne, 2014). It thus becomes difficult for the therapist to help them and the best solution to engage them would be counter complimentary interventions that improves on their ease and comfort level of self-disclosing to other people. The approach to lessen on their reluctance in the self-disclosure along with increase on their closeness is significant when it comes to decrease on the loneliness after the future depression. Conceptualisation Case Identifying information Tim is a 9 year old boy and he is in fourth grade. He has a blonde hair. Compared to the other children in class Tim seems to be of smaller height and weight for his age. Tim dresses in attire which is clean and appropriate. He lives with his mum, dad and his fifteen year old brother. He loves reading books, and watching movies. In class he is a competent boy and very attentive, but his teacher is concerned about his behavior. Chief complaint Tim was referred to the counseling at his elementary school by his teacher. The teacher stated on the referral form that Tim exhibited anger behavior. This occurred while they were having discussion with his colleagues, he became angry and shouted at them you know am not invisible. He is not good in socializing particularly on the group work (McAndrew Warne, 2014). The teacher calmed Tim down and wanted to know what the cause of the shouting was and highlighted to him he was not supposed to shoot but rather work together as a team to come with the various suggestions on the task they were assigned as a group. Presenting the problem Tim is the last born in his family and he lives with his mother, dad and his fifteen year old brother. Tim is not good in socializing with the other kinds and more often we are seeing him reading or playing alone (Geldard, Geldard Foo, 2013). Moreover, when it comes to the group work he is not good at working with the other children, he is very shy and when others do not consider on his suggestion he becomes angry and shout at them. In this situation we see Tim wants to be the leader and his suggestion to be considered and rather not the other group members. The problem of team seems to have persisted over some period and I think it could have been reflected even at home. Tim seems to be shy and likes to be alone, Relevant history Tim is the last born in their family where he lives with his mother, father and dad. Tim do not socialize with other of the children and more often you would see him playing alone. Moreover, he is not good in the group discussion particularly he became angry when others did not approve on his contributed (Geldard, Geldard Foo, 2013). The children do not usually develop their social skills as easily as others. They could earnest and seek on the peer relationships, the parents need to take long view of the social problem and be able to map out a plan to solve on this problem. The children usually go through a definitive phases of the social development (McAndrew Warne, 2014). The children usually play alone quite happily, and in the event another child wanders onto the scene, they get clonked with a block out of the circle of play. In this case we can see Tim playing alone and even reading alone. Interpersonal style: Based on the Karen Horneys conceptualization it is clear that Tim is moving against aggression and dominance. This has been exhibited when he was in the group work and each of the children was making a suggestion towards the problem they faced. Tim suggestion was not considered and he became angry and shouted to the other children. This shows some aggression behaviour and he want to be dominant to the others. He want to get on his way, and other to follow his suggestion without their decision being considered. We can also observe there is tendency towards one polarity of dominance towards another (Geldard, Geldard Foo, 2015). In this case when Tim is playing he does not want to associate himself with the other children. This can also be exhibited in the when he is reading, he does it alone, in other words he is moving away from other withdrawing and want to alone. Based on the client interpersonal stance it is clear to say that above all, he is shy, and towards the counselor and he tried to explain that the other did not even take his suggestion into consideration. He felt they saw him as invisible in that nobody was listening to his suggestion. This shows that Tim does not know how to socialize with others, he wants to be alone and do his own this particularly playing or even reading. He is not comfortable talking to the others perhaps because he is shy. Environmental factors: When it comes to the psychology, there are many scholars who have debated on the issue of the environmental factors towards the child behavior. They have observed that the environment is important when shaping the behavior of the children. The children are not spared from arguably more susceptible to the influences of environment (Geldard, Geldard Foo, 2015). This ranges from the way the family is structured to how the culture has been structured, and nearly every of the facet of the life teaches the children lessons in how they could adapt to the world. There are various environmental factors which could have contributed to the Tim behavior. One of the aspect could be toxic stress. Stress can be in small doses in the context of the supportive environment which is important to the healthy development (McLeod, 2011). Tim could be having stress back from home or even in the school. When an individual does not socialize with other he tends to feel unwanted and start developing hatred to the others. Consequently, the individual begin to get stress which could hinder on their development and the ability to learn (McLeod, 2011). This has been clearly exhibited when Tim was not able to answer a question that he was asked by the teacher. Personality dynamics When it comes to the personality dynamics I will focus on the cognitive factors, emotional and the behavioral factors. Cognitive factors are the characteristics of the children which influence on the performance as well as their learning. These aspect serve in modulating on the performance in such as it could improve or perhaps decline (McLeod, 2014). Some of the cognitive functions include attention, memory and reasoning. In this case study it is clear that Tim has good reasoning and he is also attentive to details. He clearly is a good student, but the external stimuli such as the stress has impacted on his abilities negatively. This has been shown on his performance when he was asked a question he did not even know the answer to it. Emotional factors: The emotional learning begins at the young age and the learning usually grow with their age. The emotional expression has been related to both the social and the cultural influences of both the family and the surroundings. The relationship of the children to their caretaker could give the ability to express on both the positive and the negative emotions when it comes in a socially and culturally accepted manner. Example of emotional factors would be anger which could affect on the way to which the brain processes on the information given to you. The individuals who are angry have the difficulty when it comes to the processing of the logical statements, which limit on their ability to accept explaining and the solutions offered to others (Mearns, Thorne McLeod, 2013). When it comes to this case study Tim was very angry particularly when he shouted to the other children in their group. Moreover, there would an aspect of anxiousness which could impact negative on the part of the brain that manages on the creativity and the communication skills (Mearns, Thorne McLeod, 2013). An example it can be seen when Tim constantly worries in regards to the suggestion he makes to the other group members. This hinders on his ability to concentrate on the information which he give or even receive from the others. Behavioral factors: One of the behavioral factors would be the ego aspect. This is when individuals behave in was which makes them feel good about themselves, and what to gain an approval from the others. In the case of Tim it is evident he has some ego, particularly when he want to have his way and not others. Moreover, he wanted the other group members to notice him and his suggestion to be approved (Churchill, Khaira, Gretton, Chilvers, Dewey, Duggan Antidepressants in Primary Care (CAPC) Study Group, 2000). Moreover, there are other aspect such as commitment and the reciprocity which is monitored by the other individual which has a strong bearing when it comes to our behavior. Tim is much committed in his work and particularly in his studies. He is often seen reaching and been focused on his work. Moreover, this individuals want others to reciprocate on his contribution to the group work they were doing. Counselors conceptualization of the problem: As a counselor the first thing would to learn and understand the emotions of Tim, particularly feeling upset and shouting when around other people. In the case of Tim it is evident in regards to his cognitive aspect it is evident that he has a good reasoning, and his performance is good. Looking at his behavioral aspect he has some ego issues particularly when he becomes upset and shout to the others. The problem that has been affecting Tim has been associated to socializing with others. Moreover, it has been observed he is shy and does not socialize well with others particularly in the group discussion. From these observation there are recommendation should could be employed to be able to solve on the issues affecting Tim. Based on this case it has been found that the cognitive behavioral therapy techniques could be useful when working with the children particularly who suffer from the socialization syndrome (McAndrew Warne, 2014). Moreover, the family and the teacher should comple ment on the cognitive behavioral techniques to provide a well-rounded treatment for the child as well as the support of the parent. Describe how you would engage with Tim in an initial counselling session As a counselor of Tim case the first thing I would begin in the session would to learn and understand the emotions of this child particularly on why he has been upset and angry to an extent of shouting to the other children in the group work. In order to do this, I would bring sheet with the pictures of twenty faces with the various emotions. I would then review each of these emotions with Tim and asked him to describe on each of the emotions, or perhaps provide an example of what he experience towards each of the emotions (McAndrew Warne, 2014). I would then ask him a series of question and ask him to identify an emotion to each of the question I pose. Some of the question I do you feel about the other students? How do you feel when your are at the school? How do you feel about working with the others? This exercise would be done to a couple of sessions, and on each we would refer back to the emotions sheet to check how he is feeling towards others. I believe continued doing this w ould bring some progress in the counseling to enable him to open up and become more confident. I think the main issue Tim is facing is how to socialize, and also it is evident Tim is shy. I would also make another intervention through the solution focused therapy. This is where you allow the child to identify on the aspects of his life which he need to improve. I would provide question which, he would answer then we brainstorm thing together. This would provide an empowering experience for him since he would be able to change on the way he react and act towards others. Additionally, I could purchase on a small journal for Tim to carry around to write on the issues which affect him when he is with the other people. To be able to improve on Tim interactions with the other people I would implement a role playing in the counseling. Here I would have Tim to practice asking the other kids in the class to play during recess. Role playing role during the counseling session would give Tim courage and well build on his social skills to talk and participate with the other kids. Moreover, this would provide practice for him to practice on what he was not comfortable with. By allo wing Tim to practice it would provide a positive attitude as well as courage to implement such skills at the later time while he is in class or perhaps when they are playing. Once we practice on a skill enough to the level which Tim is comfortable with we will make it a goal to enable him to practice it with the other children in the class at least once before the next session. Tim can report back the following week and process on how it would go. Challenges of working with a client the age of Tim as a counselor Some of the challenges faced by the counselor when it comes to the client who are under aged would be the issue of competency and the training. The counselor may face the challenge of not understanding the specific issues which is faced by the children. Moreover, the counselor could not have the required training or the skills when it comes to facilitating on the dialogue (Van Deurzen Adams, 2016). Another challenge could be parental involvement. In some cases the parent of the children may not be available when the child is in the session would create a barrier of the counselor to fully understand on the issue which are affecting the child. It is important for the parents and the professionals to work together in order to find the solutions. Some of the parents could be mistrusting or perhaps unwilling to work with the counselor creating barriers for progress on the case affecting the child. Moreover, there could be challenging situations as well as the unfortunate circumstances wh ere the guardians could be a single parent, other members or even entirely absent (Dowling Rickwood, 2014). There would be the challenge of emotionally draining aspect where the counselor may feel their job intrinsic involving with the other people lives and the problem could lead to the burnout. The counselor may become cynic and ineffective when delivering his assistance. This could be brought about the social environment in which the counselor work. Another challenge would be the legal issues (Dowling Rickwood, 2014). An example of this could be demonstrated in the event that the child was encountering child abuse, the counselor could be faced with the decision to report on that case on one aspect and on the other hand he need to maintain the confidentiality of information provided by the client. References Ali, K., Farrer, L., Gulliver, A., Griffiths, K. M. (2015). 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