Organisational Behaviour Essay Example for Free

Organisational Behaviour Essay I. Introduction An organisation is commonly defined as a group of people who work together in a consciously coordinated social unit for a shared purpose. Management refers to the activity of controlling and organizing people to accomplish its goals. In today’s increasingly global and competitive environment the effective management of people is even more important to the successful performance of the work organisations. Therefore, the managers need to understand the main influences on how people behave in an organisation setting. Mullins (2008, p.4) defined organisation behaviour (OB) as ‘the study and understanding of individual and group behaviour, and patterns of structure in order to help improve organisational performance and effectiveness’. It comprises a synthesis of a variety of different theories and approaches. Therefore, this essay opens by briefly explore a number of interrelated disciplined to the study of organisational behaviour, before examining the relevance of four main approach to the subject in today’s workplace. Finally, it discusses the purpose of organisations. II. Interrelated discipline to the study of organisational behaviour The study of behaviour can be viewed in terms of three main disciplines – psychology, sociology and anthropology. The contribution of all three disciplines has played an important role to studying organisational behaviour. Psychology is the science and art of explaining mental processes and behaviour. The main focus of attention is on the individuals and explores such concepts as perception, motivation, perception and attitudes. It is arguable that McKenna considers psychology as the key discipline in studying organisational behaviour. There are five key areas in Psychology that can impact on organisations; these are: psychological psychology, cognitive psychology, development psychology, social psychology and personality psychology. Psychological aspects are useful to the practical applications such as job analysis, interviewing models or selection, but it provide too narrow view for understanding of organisational behaviour which ‘is not concern with the complex detail of individual differences but with the behaviour and management people of people’ (Mullins, 2008, p. 7). Watson (2008) defined sociology is more concern with the study of social behaviour, relationships among social groups and societies. It focuses on group dynamics, conflict, work teams, power, communication and intergroup behaviour. It is possible that Watson considered sociology to be the key discipline in studying organisations though he also places emphasis on economics. The structuration reflects the dual effect that individuals make society and society makes individuals. Watson (2008, p. 30) presents six strands of thought applied to his framework for analysis. He further presents six substantive areas applied to the six strands of though in a matrix which are work, society and change; work organisations; the changing organisation and the management of work, occupations and society; work experiences, opportunities of meanings; and conflict challenge and resistance in work. This discipline is valuable to the organisation. It helps managers recognise the relationships between large-scale social forces and the actions of individual. However, Mullins (2008, p. 7) argues that the study of organisational behaviour cannot be studied entirely in single discipline. Although each discipline has an important contribution, it just underpins the study of subject. Indeed, Mullins synthesises interrelated disciplines which are psychology with sociology, anthropology that explore culture and behavioural factors; economics that attempts to provide a rational explanatory framework for individual and organisational activity; and political science that is study of power and control between individual and groups; in his framework for analysis of organisational behaviour. III. Four main approaches In Mullins’ framework, the study of organisational behaviour is concerned with not only the behaviour in isolation, but with interaction among the structure and operation of organisations, the process of management and behaviour of people that are affected by external environment. He applies a number of approaches to organisation: 1. Classical  2. Human Relations 3. Systems 4. Contingency 1. Classical Approach The classical writers considered organisation in terms of purpose and formal structure with attention to hierarchy of management and technical requirements of organisation. Frederick Taylor with the Scientific Management had a major contribution to the Classical Approach. Taylor’s theory was based on the psychological discipline that is concerned with the study of individuals’ behavior. He believed that individuals behave rationally toward financial incentive. Worker would be motivated by highest possible wages by doing highest grade of work. Furthermore, his main objective is to find more efficient methods and procedures for the task design and control of work. Combined with training workers, it was always possible to find the one best way to perform each task. It was criticized that since workers passively do repeated task and paid by result, the less human approach can cause a decline in worker morale as well as in skill requirements, reducing flexibility.Nevertheless,massive productioncompanies stilladopt partially Taylor’s theory in order to maintain or increase productivity. For example, Mc Donald uses the payment method of Taylor’s theory to motivate and encourage the workers. The human who work in fast food restaurant are trained to do a limited number of tasks in precisely. 2. Human Relations Approach Human Relations is a managerial approach based on the consideration of and the attention to the social factors at work and the behavior of employees. Attention is paid to the informal organization and the satisfaction of individual’s needs through groups at work. Elton Mayo (1880-1949) conducted Hawthorne tests on organizations to access productivity. He moved away from scientific beliefs on money and discipline towards importance of group belonging (social study). The tests examined effect of group piecework pay system on productivity. The result is that workers did not necessarily seek to maximize production in order to receive enhanced bonuses but social pressure caused them to produce at group norm level. On the other hand, the research was originally intended to examine effects of lighting on productivity. As a consequence, productivity increased regardless of lighting level was due to workers’ receiving attention. The Hawthorne effect adopted in Human relation approach suggested that good supervision and environment increase satisfaction and other variables affect this, such as structure, leadership, and culture. Unlike the classical thought with consideration of improving productivity, human relation approach ‘strove for a greater understanding of people’s psychological and social needs at work as well as improving the process of management. However, Mullins (2008, p. 29) criticized human relations as a ‘unitary frame of reference’ and oversimplified theories. Even today the Hawthorne experiment is still useful for describing the changes in behavior of individuals and groups, and opened the door to more experiments by other sub-division of approach known as neo human relation. 3. Systems Approach The system approach to the study of organizations combines the contrasting position of the classical approach, which emphasized the technical requirements of organization and its needs ‘organization without people’, and human relations approach, which emphasized the human fulfillments and social aspects – ‘people without organization’. This approach inspires managers to regard organization as an open system interacting with environment and to view total work but not the sum of separate parts. In Figure 2.5 (Boddy, 2008, p.60), the system consists of a number of interrelated subsystems, such as people, power, technology or business processes system; which add complexity and interact with each other and external environment. It is stated that any part of an organization’s activity affects all other parts because there are areas overlap between various subsystems. Therefore, it is the task of management to integrate these interrelated subsystems and direct efforts of members towards the achievement of organizational goals. The system approach, which is components of interrelated subsystems, provides analysis of organizational performance and effectiveness while the socio-technical approach takesorganization as viewed by the individual members and their interpretation of the work situation. In time of increasing globalization, technological change has influenced on the behavior of people and other parts, thus the whole system. It is valuable for manager to manage the total work and coordinate the technical change and the needs of individuals. 4. Contingency Approach According to Mullins (2008, p. 31), the contingency approach rejects the idea of ‘one best form or structure’ or ‘optimum state’ for organizations. The organizations needs to be flexible to cope with change and managers need to change structure and processes required. This approach influenced many management practices such as market research, PR or strategic planning, which stress response to external conditions. Furthermore, it emphasized that the practice depends on people interpreting events and managers be able to have subjective judgments as much as rational analysis. The contingency approach is relevant to management and organizational behavior. It provides a setting in which to view large number of variables factors that influence on the organizational performance. Hence, it enables process of management to change the structure of organization at the expense of the need for stability and efficiency. IV. The purpose of organizations As defined earlier in this essay, organization is a group of people who work together in a structured way for a shared purpose. It is a task for management to clarify strategy, which tell people how to work, where to go, and what to achieve. Therefore, it is necessary to understand the nature of strategy for the formal organization in order to study organizational behavior. Johnson et al. (cited in Mullins, 2008, p. 350) define the strategy is ‘the direction and scope of an organization over the long term, which achieves advantage in a changing environment through its configuration of resources and competences with aim of fulfilling stake holder expectation’. People dimension of strategy is concerned with people as a resource; people and behavior and organizing people, therefore, influencing behavior of people to achieve success and motivation of individuals are central part of organization’s strategy. Mullins (2008, p. 352) stated that ‘the goals of an organization are the reason for its existence’. It is the desired state for organization to pursue in the future. Therefore, an organization gains its effectiveness and performance through achieving its goal. To be effective, the goals need to be clearly stated and understandable, thus making impossible for people in organization to perceive. It is clearly evident that goal setting promote immediately behavior of people at work and it can be considered as successful tools of increasing work motivation and effectiveness. An organizational goal are likely to achieve when informal goal, which are defined by individual and based on both perception and personal motivation, are compatible with organizational goals. Therefore, it is crucial role for management to integrate the needs of individuals with the overall objective of the organization. Organizational goals are generally translated into objectives that set out more specifically the goals of organization. Drucker (cited in Mullins, 2008) indicated eight key areas for setting objectives, which ‘are needed in every area where performance and results directly and vitally affect the survival and prosperity of the business’. SWOT analysis, which focuses on Strengths, Weaknesses, Opportunities and Threats facing the organization, draw out strategic implication.First, Strengths are internal aspects of organization that give it competitive advantage over others in the industry such as size, structure, technology, reputation or staffing. Second, Weaknesses are those negative aspects that place organization at a disadvantage regarding to other. Examples of weaknesses could be operating within narrow market, limited resource, and lack of information. Third, Opportunities are favorable chances arise from external environment which provides potential for the organization to offer new, or to develop existing goods or services. Finally, Threats are external elements in the environment that cause trouble for the organization. For example, change in law, increasing tax or competition from other organizations. SWOT analysis may be used in evaluating any decision-making situation when a desired end results (objectives) has been defined. V. Conclusion In conclusion, this essay has been identified the main approaches to the study of organization. In the first section, it provides a discussion on the interrelated disciplines of Organizational behavior, which is Psychology and Sociology. McKenna stated his idea that psychology has the biggest contribution to the study of subject; whereas Watson placed emphasis on sociology. However, the subject is rooted in multidisciplinary and cannot be undertaken in any single discipline. In Mullins’ framework, he examines a broader view, and then presents four main approaches to the study of organizational behavior. In the final section, this essay has defined the strategy that directs to the goal and objective of organization, and commented on the usefulness and relevance of SWOT analysis in evaluating the strategy.

Personality Disorder Carer and Family Support Impact

Personality Disorder Carer and Family Support Impact ARE PSYCHO-EDUCATIONAL AND SUPPORT PROGRAMMES FOR FAMILY AND CARERS EFFECTIVE IN REDUCING RELAPSES AND FACILITATING RECOVERY OF PEOPLE SUFFERING FROM PERSONALITY DISORDERS? ABSTRACT Background Carers and families of people suffering from personality disorder are in desperate need of support and services. Providing these services can reduce relapses and facilitate recovery in sufferers of personality disorder. The Research Question How can psycho-educational and support programmes for carers and families of those with personality disorder improve their recovery? Methodology The results of this study were obtained through a systematic literature review. Results Diagnosis and treatment of personality disorder are still complex and often confusing issues, even for professionals. Still, treatment can produce recovery and this recovery can be expedited if carers and families are provided with programmes to equip them to effectively face the challenges that personality disorder presents. Conclusions Providing psycho-educational and support programmes makes carers more effective and can help treat personality disorder. Social Workers can help to bridge a gap in the services that is adversely affecting the treatment outcomes of sufferers and hence placing greater strain on the Health System than is necessary. Contextualisation The carers and families of individuals suffering from personality disorders are an underserved population. Considerable strain is placed upon them and their loved ones and they are often at a loss as to how to effectively perform their duties and assist the recovery of those they care for. If more psycho-educational and support programmes for carers and families were provided, it is possible that treatment for personality disorder could be improved. Personality disorders can be defined as: â€Å". . . psychiatric conditions relating to functional impairment, or psychological distress resulting from inflexible and maladaptive personality traits.†1 Personality disorders are explained in the two most prominent classification schemes, the DSM-IV, where personality disorders can be found in Axis II, and the ICD-10. The definitions in these diagnostic classification systems are much the same. Defining ‘severe personality disorder has proved problematic for experts, who have yet to establish a generally accepted definition. The suggestion of the Royal College of Psychiatrists (1999) that severe personality disorder is marked by extreme societal disturbance and at least one extreme personality disorder has provided some guidance.2 Alternatively, having two severe disorders could mean that the sufferer has one disorder that expresses itself in more than one extreme way, or could simply indicate one deeply disturbing disorder. One study graded the severity of personality disorder on 163 subjects and found that the patients whose personality disorder was described as ‘complex demonstrated the greatest number of symptoms and recovered the least. Personality disorder carers are people who support a person who suffers from any form of personality disorder, whether they are relatives, friends or partners. Often, carers give sufferers emotional and financial support and may even act as informal social workers. Previous studies have shown that carers of people with personality disorder benefit from psycho-educational and support programmes. Psycho-educational programmes are educational programmes that contain an element of counselling or therapeutic activity for the family. The main aim of these programmes is to minimise the strain experienced by families and carers of people with mental illnesses, here personality disorder. Psycho-educational and counselling programmes exist ultimately to facilitate recovery and reduce relapses; indeed, the success of programmes is usually measured by examining relapse rates. Programmes attempt to provide adequate support, information, signposting to appropriate resources, advocacy and respite for carers. They also coach carers to increase their problem solving abilities, improve their communication and help them construct their own support networks. Support programmes for carers of people with a mental illness attempt to support the contribution that carers make to the lives of those they care for. They work toward advances in policy that will augment the services that satisfy carer requirements. Support programmes prompt dialogue between members of the government and carers, as well as encouraging carer involvement in the creation and delivery of carer and patient services. Further, support services connect carers with agencies to assist them in their role and facilitate modes of best practice in aiding carers. The Research Question This literature review examines a number of studies on personality disorder, its effect on carers and issues connected with diagnosis and treatment in an attempt to determine whether psycho-educational and support programmes for family and carers are effective in reducing relapses and facilitating recovery of people suffering from personality disorders. If social workers are to work effectively with this client base, they must put aside antiquated beliefs that personality disorder cases are hopeless and that those who suffer from personality disorder never get better. This study reveals that one of the greatest challenges to carers and families is obtaining the support they need and the services they are entitled to, and Social Workers can be instrumental in bridging gaps in the Mental Health system. Methodology This dissertation undertakes a systematic literature review of health care and psychological literature to address key issues in the support of carers of people suffering from personality disorders. Several different studies and a range of approaches were examined. Although the number and breadth of studies was a strength of the review, the variety of approaches made it challenging to compare the overall merits of one study against another. The literature was obtained through a variety of means. Google searches, journal articles, working group reports, service provider reports and academic papers were used. The research methods that appear in the utilised material included telephone interviews, questionnaires and surveys, face-to-face interviews and meta-analysis. Some were literature reviews themselves and some simply reported on the outcomes when a group of treated individuals was observed. Of the studies that involved observation of a group, very few included a control group in the study so methodological rigour was not as great as it could have been. Neither is it certain that studies where self-reporting was used are as empirically reliable as one would like, as sufferers of personality disorder tend to over- or under-report their symptoms . Some of the studies that were conducted recently showed positive outcomes, but the long-term follow-up for the same groups may make the figures less significant. Even where there has been longterm follow-up, some of those who took part in the initial study may not be included because of death, inability or unwillingness to participate, or inability to be located. The methodological rigour of the studies is further complicated by the fact that the process of diagnosis and treatment of personality disorder is fraught with complexities. The categories for personality disorder are somewhat defined by behaviours and are not theoretically based or grounded in common mechanisms of the disorder. The actions and symptoms of patients are so extremely varied that both diagnosis and treatment are difficult to present, much less to assess. Yet just because a comprehensive catalogue of truths about personality disorder cannot be presented does not mean that no reliable statements can be made. The evidence that is presented here is solid enough to make general assertions regarding the affects of carer support on patients based upon the evidence, and that is what it intends to do. Assessing the impact of support and education for carers upon the sufferers of personality disorder themselves proved more challenging than, for example, assessing the impact of treatment on sufferers, for which there is abundant literature. Still, the impact of psycho-educational and support programmes on consumers has been assessed and outcomes observed. Additionally, the evidence for the improvement of the lives of carers and the quality of care they give their charges is strong, and this fact bolsters the hypothesis that improved care for carers improves the mental health of those for whom they care. These conclusions are definitely linked, especially given the statistics that show that improvement for personality disorder takes place over a long period of time and is facilitated by positive interpersonal relationships with people who are equipped to deal with the symptoms that people with personality disorder exhibit. The presence of positive relationships with carers who are tr ained, educated and supported will assuredly improve the ‘treatment conditions for those with personality disorder. In narrowing the scope of the literature to be included in the study, several factors had to be noted. Some of the literature was so grounded in certain programmes for certain countries that many sections were not transferable to this review. For example, the results of the Network for Carers (2004) report were based upon specific programmes offered in Australia, so some information had to be excluded. However, this document was very helpful in establishing general facts about the needs of carers and the impact of programmes upon their ability to care for sufferers. It was also a thorough exposition of the opinions of carers,through which their voice was clearly heard. There were also other limitations regarding the particular demographic studied. The NHS National Programme on Forensic Mental Health Research and Development Expert Paper on Personality Disorders primarily assessed offenders with personality disorder and not merely members of the wider public suffering from the disorde r. Because of this, significant sections of the material had to be ignored. Still, this paper was useful in understanding the complexities of treatment and diagnosis of personality disorder, and provided definitions for contextualisation. In evaluating the quality of the data, the analytical tool Critical Appraisal Skills Programme (CASP) was used to assist in making sense of the evidence. This tool is advantageous to those who are strangers to qualitative research, assessing the merits of a source with regard to rigour, credibility and relevance.CASP initially asks two screening questions, the first addressing research aims and significance. The second screening question considers whether the research interprets subjective experiences of participants.Answering these two questions with a ‘yes then leads to eight more questions covering issues such as recruitment strategies, collection of data and ethical issues. In a literature review there are several ethical issues that must be considered, especially when dealing with a vulnerable population such as sufferers of mental illness. For each study used in the review it was necessary to consider whether ethical standards were maintained throughout the study, includi ng the manner in which consent was obtained and the way that confidentiality was upheld. Another ethical consideration is the handling of the outcomes of the study with the participants after the study.9 In the data observed here, it is not always explicit that consent was obtained but is often implied. Eliciting feedback from carers carries implied consent even if consent was not explicit, for obviously no individual would be forced to comment against his or her will. Confidentiality is maintained through omitting names and keeping the results impersonal. Yet the information given for studies is in its final and often abbreviated form, and the background work is not always documented comprehensively enough to ascertain whether all ethical considerations have been taken into account. One ethical consideration that is not always considered is the treatment of ethnic minorities in research projects, especially those for whom English is not their first language. The wording of questions and the criteria by which outcomes are judged is often tainted by cultural bias for those being assessed outside their native surroundings. It is practically impossible to remedy this, because part of the methodological rigour of the study depends upon all participants being treated and assessed in the same way. Differentiation on the basis of cultural differences would compromise the consistency of the study, but the impact of cultural factors is most certainly felt by those of foreign origin. Discussion of Findings Traits The traits exhibited by sufferers of personality disorder differ immensely because of the wide scope of the disorder. Examples of traits range from anxiety, narcissism and compulsivity to defiance, abnormal attachments and avoidance of social situations. Sufferers may demonstrate an arrogant interpersonal style, or may show extreme submissiveness. Personality disorders are linked with negative results in the wider population such as marital breakdown, criminal actions and professional difficulties.The anomalies of personality disorder are apparent in the thought patters, expressions and levels of self-control of sufferers. The patient will display abnormalities in the way that he or she interacts with others which will appear in a range of circumstances. There are various types of personality disorders, and each has its own banners of dysfunction. It has been recognised that the kinds of personality disorders covered in DSM and ICD are a small cluster when contrasted with the array o f personality impairments that can be identified in large configurations of people.11 Personality disorders can be divided into three clusters, A-C. In the first cluster disorders relating to paranoia and schizophrenia are found. Cluster B includes antisocial and narcissistic disorders, and Cluster C focuses on avoidant, dependent and obsessive-compulsive disorders. Prevalence It is estimated that between 6% and 15% of the population have one or more personality disorders of some kind—different studies produce different results.13 The goal of one study was to estimate the prevalence of personality disorders in a local sample and discern the most common demographic groups therein. The frequency of the DSM and ICD personality disorders and the interactions between disorder clusters and demographic qualities was assessed in a local sample of 742 participants between the ages of 34 and 94 over two years.14 The results showed that the overall prevalence of DSM-IV personality disorders was approximately 9%. Among the disorders, antisocial personality disorder was the most common and appeared in almost 5% of those assessed. Dependent personality disorder and narcissistic personality disorders were rare. The prevalence of many of the individual disorders was only 1% to 2%. For ICD-10 disorders, the overall presence in the surveyed group was 7%. Again, the prevalence for individual disorders was 1% to 2%. The most common disorder in for the ICD disorders was dissocial personality disorder at 3%. Dependent personality disorder was, again, very rare. Who is affected? Studies dedicated to uncovering the risk factors for personality disorder produced a variety of results. Prominent factors that may lead to a personality disorder include having a parent who is involved in or has been convicted of a crime, having a parent with deficient parenting abilities and being part of a large family. Factors such as low intelligence also feature in the list of risk factors. However, this study and studies that are similar raise certain issues about the nature of judging which factors should be included as risk factors for personality disorder. These sorts of factors could be criticised for having prejudicial antecedent assumptions regarding what it means to be a functioning human being. It is likely that people from lower socio-economic classes will have a tendency to fit these categories more than their middle- or upper class counterparts.Care should be taken in describing risk factors to ensure the language used is not biased by class. In the study mentioned above, several demographic characteristics were assessed with regard to prevalence of personality disorder. The outcomes demonstrated that Cluster A disorders were more common in males than in females. Cluster A disorders were also more prevalent in participants who were divorced or separated than those who were married or widowed. Subjects who had never been married were the most susceptible sub-group of all. In the Cluster B category, men were again more prone to having a personality disorder than women. Cluster B disorders were most common in the youngest age range surveyed and least common in the oldest range. Further, this cluster was most prevalent in participants who lacked a high school diploma and was least prevalent in participants who graduated from high school and continued their education afterwards. The odds of having one of these disorders decreased approximately 6% for each year an individual aged. One possible explanation for the increase of prevalence of disorder with age could be that people of more mature generations are less likely to have, know about or report symptoms of personality disorder. The prevalence of Cluster C disorders was most closely related to marital status, again showing that participants who had never been married were most likely to have one of these disorders. The likelihood of having a Cluster C disorder was almost 7 times greater in those never married when contrasted with those who were married or widowed. The results of this study broadly match a number of previous studies whose results showed the prevalence of personality disorders in the general population to be 9-13%. However, there were some differences between previous studies on prevalence and this study. The present study found a notably higher prevalence of antisocial personality disorder and a much lower prevalence of histrionic and dependent personality disorders than previous studies. These differences could have been caused by methodological variants and the diagnostic criteria used such as which version of the DSM was utilised. The differences could also be a result of participant source, form of assessment, assessors experience and data collection methods. Notable strengths of the study were that the participants were obtained through a community sample and personally interviewed by psychologists who have a significant amount of experience in cross-examination. The limitations included the fact that not all subjects coul d be interviewed and that the sample size was not really large enough to pick up on very rare disorders. The results of other studies have been less conclusive. An American study examined the theory that personality traits stop transforming by the time an individual reaches the age of 30. One of the major strengths of this study was the sample size of 132,515. The subjects, aged 21-60, participated in a web-based Big Five personality measurement. The results of this study showed that qualities such as being agreeable and conscientious increased during adulthood up through middle age. The quality of being neurotic diminished for women but remained static for men.20 Both men and women decreased in openness after the age of 30, and while men increased in extraversion from 31 to 60, the same quality diminished in women in the same age range.21 While the sample size of this study was certainly impressive, one concern was that conducting the study over the internet might bias it toward younger subjects. Another concern was the cohort effect, since people of earlier generations might not engag e with psychological instruments with the same ease as those who are younger. Overall, the multiplicity in paradigms of change did not affirm either that personality does not change after 30 or that it does. The study concludes that the traits examined are complex in nature and subject to an array of developmental influences. Historical View The onset of the de-institutionalisation of mental health establishments has produced a number of benefits. There is now less public stigma placed upon sufferers of mental illness and their traits and presence in wider society has come a long way toward normalisation. Suffers of mental illness have become less isolated and enjoy greater freedoms, including the freedom to choose from a selection of services. From a governmental point of view, deinstitutionalisation has saved them an enormous amount of money. However, the responsibility for managing and caring for mental illness sufferers has been transferred from the institution to the local community, and specifically to carers. Carers are involved in every possible aspect of the lives of their charges, even to the extent that their role could be characterised as an informal social worker. But the burden of the role combined with the lack of training, education and support often results in the damage of the psychological health of th e carer, as well as strict limitations on their life outside the caring role. The striking impact of caring on the lives of carers and other factors led to the undertaking of research on the involvement of families in managing and treating mental illness. From this came solid evidence of the benefits of such involvement, and the needs of carers began to be recognised. In recent years services have been put in place to assure that the needs of carers are met, and education for carers has been pinpointed as the most beneficial service for carers and consumers. Carers need to be educated in order to feel equipped to perform their tasks effectively. Specifically, carers named a need for â€Å"education about mental disorders† and information about treatment options† as their most salient needs. These statements are reinforced by studies from various countries where carers named the same things as most important for their success. Historically, studies examining the impact of educational programmes for carers have come from two different hypotheses. The first is that the chances of a consumer recovering from a mental illness are augmented if an educated and informed family surrounds him or her. Such a family will have deeper knowledge and sympathy for the condition of the sufferer and will be equipped to manage challenging behaviours. The second hypothesis is that because of the implications of their role, carers have an inherent right to access to adequate services. They have a right to services that will enhance their individual welfare and their effectiveness as carers. Assigning a course of treatment to personality disorder has always been an inexact science. Personality disorder is particularly complex to treat because the prime method of treatment is not always apparent after a diagnosis has been arrived at. The type of treatment which will prove most effective for the patient differs from individual to individual. Case conceptualisations can be helpful in assessing the individuals issues, identifying areas of risk and determining proper treatment goals.24 There is an abundance of research about treating personality disorder, but the studies cannot always be relied upon due to their lack of sound methodology. While some forms of treatment for personality disorder can reduce relapses and facilitate recovery, there is no simple panacea for this ailment. Cognitive treatments including cognitive-behavioural approaches have produced some pleasing results with personality disorder patients, as have psychodynamic treatments. Diagnosis Individuals who suffer from personality disorder encounter several issues with their diagnoses. They may be diagnosed through the means of an interview, a self assessment questionnaire or other means. Clinical psychiatrists often diagnose patients through interviewing them with regard to the DSM or ICD categories. This method is slightly better for detecting the existence or not of a personality disorder, but shows low accuracy for particular types of disorder. Self-report questionnaires like the Personality Diagnostic Questionnaire (PDQ-IV) and the Millon Clinical Multi-axial Inventory (MCMI) are also used to diagnose personality disorder. These questionnaires are considered imprecise because individuals tend to over-emphasise or under-emphasise the issues they are having. In addition to these methods of diagnosis, there are several semi-structured interview schedules to assist professionals. These schedules feature lists of questions that correlate to the DSM or ICD and the clinici an may then mark the patient and determine whether he or she has a disorder according to the criteria. Interview schedules have shown that they are slightly more reliable than other forms of diagnosis, but this success is only relative and the results are still much less valid than is needed. Really none of the diagnostic tools should be considered better than any of the others, for they are all faulty to the extent that they cannot be relied upon. There is a problematic absence of consensus regarding the reliability of diagnosing in general and the consistency of different diagnostic schemes. Part of the problem is that the explanations of personality disorders in the DSM and ICD feature a concoction of psychological traits and displayed behaviours, so that it becomes uncertain whether the diagnoses are attempting merely to pinpoint deviant actions or to identify traits whose presence is significant for determining personality disorder. The solidity of diagnoses for personality disorder is frequently questioned, and there are only a few disorders whose diagnoses are considered reliable. The diagnosis that can be made with the most certainty is antisocial personality disorder, because this problem can be identified by external actions that can be easily observed. Those who diagnose individuals with personality disorder are not always able to be precise in identifying which personality disorder they are dealing with, therefore m ultiple personality disorder diagnoses are common. Clinicians often find themselves confronting comorbidity, and prudent professionals test for the full scope of disorders. Comorbidity is quite common, with male legal psychopaths having an average of three disorders each. Women may have four.28 There is a great amount of interaction between the descriptors of the various types of personality disorder and so it is difficult to tell them apart. When dealing with multiple diagnoses, it is advisable to keep all disorders in mind when constructing a treatment regime, even if many of the features of the respective disorders overlap. The classification of disorders is also problematic, because the categories lack the quality of homogeneity present in reliable psychological categories of other types. Categories of psychological dysfunction work best when each class is different from others and common elements are contained within one class. This is not the case with personality disorders. For example, there are literally hundreds of ways to satisfy the criteria for borderline personality disorder, and so individuals with the same diagnosis may have utterly distinct behaviours, symptoms and needs. Axis I disorders feature frequently in those who suffer from personality disorder, particularly where there is substance abuse or depression. The classifications for personality disorder tend neither to be theoretically based, nor to stem from statistical research, which is presumably part of the reason that precise diagnoses are so elusive. The categories are so unreliable that abandoning the categories altogether and composing a new classification system is often proposed. While this may be the ideal way to correct the flaws, the time and effort already invested in the use of the present system is likely to ensure its continued existence. One approach to dealing with personality disorder is the trait approach. This approach states that a minimal amount of theories can illumine the majority of human behaviour. Observing the personality traits exhibited by an individual and placing them on a continuum from truly normal to extremely dysfunctional is more faithful to the structure of t he human psyche and tells clinicians more about the true nature of the dysfunction suffered by the patient. Currently, the most extensively developed trait theory relating to personality disorder is the theory of psychopathology. Treatment Cognitive-behavioural treatments (CBT) aimed at treating personality disorders have a tendency to take a broad approach. CBTs engage an array of behaviours, thoughts, preconceptions and internal emotional mechanisms. Many treatments are residential and are conducted with a group. They frequently include tenets of other methods such as psychodynamic therapy. Therefore it is an arduous task to pick out what, if any, elements are effective in a multi-dimensional approach so that they can be improved and repeated. Dialectical behaviour therapy (DBT) is a method of CBT focusing on female patients with borderline personality disorder. The goal of the therapy is to reduce or eliminate incidents of self-harm through group skills training. Group sessions address destructive thought patterns and social skills. Individual therapy can also be used. The outcomes for one study showed that women who were treated experienced reduced anger and self-destructive or suicidal thoughts. Their social skills improved and they required less psychiatric treatment. Arnold Lodge Regional Secure Unit has produced a treatment method aimed specifically at offenders with a personality disorder. The treatment programme centres on teaching patients socially acceptable mechanisms for problem solving. The patients work individually and with others and receive regular counselling. This regime is supplemented with services that are individually tailored to the needs of the individual, such as anger management sessions or substance abuse education. This form of treatment has been shown to reduce deficiencies in social functioning and self-control.32 While the initial studies are promising, long-term analysis will confirm or refute the true effectiveness of this type of treatment. Therapeutic communities, cognitive therapies and dynamic therapies may also be used to treat personality disorder. Therapeutic communities are tailored primarily for offenders and have produced promising results in terms of reduced recidivism and improved social integration. A study into the effectiveness of therapeutic community treatment of personality disorder explored whether this type of treatment improved the health of patients to the extent that the burden on Health Services eased. Several previous studies reported reductions in the use of psychiatric services after therapeutic community treatment. The previous studies were limited by the fact that they observed participants for one year only and lacked thorough follow-up. This study sought to fill the methodological gaps of the previous studies by tracking patients for years after treatment. They assessed the impact of treatment on Health Services by counting the number of admissions to hospital before and after treatment. Th e study found that therapeutic community treatment resulted in a statistically significant drop in in-patient admissions over the 3-year period. Those who were admitted to hospital tended to be the subjects who had the briefest experience of therapeutic community treatment. Another study involving therapeutic community treatment focused on individuals with severe personality disorder. The effect of p Personality Disorder Carer and Family Support Impact Personality Disorder Carer and Family Support Impact ARE PSYCHO-EDUCATIONAL AND SUPPORT PROGRAMMES FOR FAMILY AND CARERS EFFECTIVE IN REDUCING RELAPSES AND FACILITATING RECOVERY OF PEOPLE SUFFERING FROM PERSONALITY DISORDERS? ABSTRACT Background Carers and families of people suffering from personality disorder are in desperate need of support and services. Providing these services can reduce relapses and facilitate recovery in sufferers of personality disorder. The Research Question How can psycho-educational and support programmes for carers and families of those with personality disorder improve their recovery? Methodology The results of this study were obtained through a systematic literature review. Results Diagnosis and treatment of personality disorder are still complex and often confusing issues, even for professionals. Still, treatment can produce recovery and this recovery can be expedited if carers and families are provided with programmes to equip them to effectively face the challenges that personality disorder presents. Conclusions Providing psycho-educational and support programmes makes carers more effective and can help treat personality disorder. Social Workers can help to bridge a gap in the services that is adversely affecting the treatment outcomes of sufferers and hence placing greater strain on the Health System than is necessary. Contextualisation The carers and families of individuals suffering from personality disorders are an underserved population. Considerable strain is placed upon them and their loved ones and they are often at a loss as to how to effectively perform their duties and assist the recovery of those they care for. If more psycho-educational and support programmes for carers and families were provided, it is possible that treatment for personality disorder could be improved. Personality disorders can be defined as: â€Å". . . psychiatric conditions relating to functional impairment, or psychological distress resulting from inflexible and maladaptive personality traits.†1 Personality disorders are explained in the two most prominent classification schemes, the DSM-IV, where personality disorders can be found in Axis II, and the ICD-10. The definitions in these diagnostic classification systems are much the same. Defining ‘severe personality disorder has proved problematic for experts, who have yet to establish a generally accepted definition. The suggestion of the Royal College of Psychiatrists (1999) that severe personality disorder is marked by extreme societal disturbance and at least one extreme personality disorder has provided some guidance.2 Alternatively, having two severe disorders could mean that the sufferer has one disorder that expresses itself in more than one extreme way, or could simply indicate one deeply disturbing disorder. One study graded the severity of personality disorder on 163 subjects and found that the patients whose personality disorder was described as ‘complex demonstrated the greatest number of symptoms and recovered the least. Personality disorder carers are people who support a person who suffers from any form of personality disorder, whether they are relatives, friends or partners. Often, carers give sufferers emotional and financial support and may even act as informal social workers. Previous studies have shown that carers of people with personality disorder benefit from psycho-educational and support programmes. Psycho-educational programmes are educational programmes that contain an element of counselling or therapeutic activity for the family. The main aim of these programmes is to minimise the strain experienced by families and carers of people with mental illnesses, here personality disorder. Psycho-educational and counselling programmes exist ultimately to facilitate recovery and reduce relapses; indeed, the success of programmes is usually measured by examining relapse rates. Programmes attempt to provide adequate support, information, signposting to appropriate resources, advocacy and respite for carers. They also coach carers to increase their problem solving abilities, improve their communication and help them construct their own support networks. Support programmes for carers of people with a mental illness attempt to support the contribution that carers make to the lives of those they care for. They work toward advances in policy that will augment the services that satisfy carer requirements. Support programmes prompt dialogue between members of the government and carers, as well as encouraging carer involvement in the creation and delivery of carer and patient services. Further, support services connect carers with agencies to assist them in their role and facilitate modes of best practice in aiding carers. The Research Question This literature review examines a number of studies on personality disorder, its effect on carers and issues connected with diagnosis and treatment in an attempt to determine whether psycho-educational and support programmes for family and carers are effective in reducing relapses and facilitating recovery of people suffering from personality disorders. If social workers are to work effectively with this client base, they must put aside antiquated beliefs that personality disorder cases are hopeless and that those who suffer from personality disorder never get better. This study reveals that one of the greatest challenges to carers and families is obtaining the support they need and the services they are entitled to, and Social Workers can be instrumental in bridging gaps in the Mental Health system. Methodology This dissertation undertakes a systematic literature review of health care and psychological literature to address key issues in the support of carers of people suffering from personality disorders. Several different studies and a range of approaches were examined. Although the number and breadth of studies was a strength of the review, the variety of approaches made it challenging to compare the overall merits of one study against another. The literature was obtained through a variety of means. Google searches, journal articles, working group reports, service provider reports and academic papers were used. The research methods that appear in the utilised material included telephone interviews, questionnaires and surveys, face-to-face interviews and meta-analysis. Some were literature reviews themselves and some simply reported on the outcomes when a group of treated individuals was observed. Of the studies that involved observation of a group, very few included a control group in the study so methodological rigour was not as great as it could have been. Neither is it certain that studies where self-reporting was used are as empirically reliable as one would like, as sufferers of personality disorder tend to over- or under-report their symptoms . Some of the studies that were conducted recently showed positive outcomes, but the long-term follow-up for the same groups may make the figures less significant. Even where there has been longterm follow-up, some of those who took part in the initial study may not be included because of death, inability or unwillingness to participate, or inability to be located. The methodological rigour of the studies is further complicated by the fact that the process of diagnosis and treatment of personality disorder is fraught with complexities. The categories for personality disorder are somewhat defined by behaviours and are not theoretically based or grounded in common mechanisms of the disorder. The actions and symptoms of patients are so extremely varied that both diagnosis and treatment are difficult to present, much less to assess. Yet just because a comprehensive catalogue of truths about personality disorder cannot be presented does not mean that no reliable statements can be made. The evidence that is presented here is solid enough to make general assertions regarding the affects of carer support on patients based upon the evidence, and that is what it intends to do. Assessing the impact of support and education for carers upon the sufferers of personality disorder themselves proved more challenging than, for example, assessing the impact of treatment on sufferers, for which there is abundant literature. Still, the impact of psycho-educational and support programmes on consumers has been assessed and outcomes observed. Additionally, the evidence for the improvement of the lives of carers and the quality of care they give their charges is strong, and this fact bolsters the hypothesis that improved care for carers improves the mental health of those for whom they care. These conclusions are definitely linked, especially given the statistics that show that improvement for personality disorder takes place over a long period of time and is facilitated by positive interpersonal relationships with people who are equipped to deal with the symptoms that people with personality disorder exhibit. The presence of positive relationships with carers who are tr ained, educated and supported will assuredly improve the ‘treatment conditions for those with personality disorder. In narrowing the scope of the literature to be included in the study, several factors had to be noted. Some of the literature was so grounded in certain programmes for certain countries that many sections were not transferable to this review. For example, the results of the Network for Carers (2004) report were based upon specific programmes offered in Australia, so some information had to be excluded. However, this document was very helpful in establishing general facts about the needs of carers and the impact of programmes upon their ability to care for sufferers. It was also a thorough exposition of the opinions of carers,through which their voice was clearly heard. There were also other limitations regarding the particular demographic studied. The NHS National Programme on Forensic Mental Health Research and Development Expert Paper on Personality Disorders primarily assessed offenders with personality disorder and not merely members of the wider public suffering from the disorde r. Because of this, significant sections of the material had to be ignored. Still, this paper was useful in understanding the complexities of treatment and diagnosis of personality disorder, and provided definitions for contextualisation. In evaluating the quality of the data, the analytical tool Critical Appraisal Skills Programme (CASP) was used to assist in making sense of the evidence. This tool is advantageous to those who are strangers to qualitative research, assessing the merits of a source with regard to rigour, credibility and relevance.CASP initially asks two screening questions, the first addressing research aims and significance. The second screening question considers whether the research interprets subjective experiences of participants.Answering these two questions with a ‘yes then leads to eight more questions covering issues such as recruitment strategies, collection of data and ethical issues. In a literature review there are several ethical issues that must be considered, especially when dealing with a vulnerable population such as sufferers of mental illness. For each study used in the review it was necessary to consider whether ethical standards were maintained throughout the study, includi ng the manner in which consent was obtained and the way that confidentiality was upheld. Another ethical consideration is the handling of the outcomes of the study with the participants after the study.9 In the data observed here, it is not always explicit that consent was obtained but is often implied. Eliciting feedback from carers carries implied consent even if consent was not explicit, for obviously no individual would be forced to comment against his or her will. Confidentiality is maintained through omitting names and keeping the results impersonal. Yet the information given for studies is in its final and often abbreviated form, and the background work is not always documented comprehensively enough to ascertain whether all ethical considerations have been taken into account. One ethical consideration that is not always considered is the treatment of ethnic minorities in research projects, especially those for whom English is not their first language. The wording of questions and the criteria by which outcomes are judged is often tainted by cultural bias for those being assessed outside their native surroundings. It is practically impossible to remedy this, because part of the methodological rigour of the study depends upon all participants being treated and assessed in the same way. Differentiation on the basis of cultural differences would compromise the consistency of the study, but the impact of cultural factors is most certainly felt by those of foreign origin. Discussion of Findings Traits The traits exhibited by sufferers of personality disorder differ immensely because of the wide scope of the disorder. Examples of traits range from anxiety, narcissism and compulsivity to defiance, abnormal attachments and avoidance of social situations. Sufferers may demonstrate an arrogant interpersonal style, or may show extreme submissiveness. Personality disorders are linked with negative results in the wider population such as marital breakdown, criminal actions and professional difficulties.The anomalies of personality disorder are apparent in the thought patters, expressions and levels of self-control of sufferers. The patient will display abnormalities in the way that he or she interacts with others which will appear in a range of circumstances. There are various types of personality disorders, and each has its own banners of dysfunction. It has been recognised that the kinds of personality disorders covered in DSM and ICD are a small cluster when contrasted with the array o f personality impairments that can be identified in large configurations of people.11 Personality disorders can be divided into three clusters, A-C. In the first cluster disorders relating to paranoia and schizophrenia are found. Cluster B includes antisocial and narcissistic disorders, and Cluster C focuses on avoidant, dependent and obsessive-compulsive disorders. Prevalence It is estimated that between 6% and 15% of the population have one or more personality disorders of some kind—different studies produce different results.13 The goal of one study was to estimate the prevalence of personality disorders in a local sample and discern the most common demographic groups therein. The frequency of the DSM and ICD personality disorders and the interactions between disorder clusters and demographic qualities was assessed in a local sample of 742 participants between the ages of 34 and 94 over two years.14 The results showed that the overall prevalence of DSM-IV personality disorders was approximately 9%. Among the disorders, antisocial personality disorder was the most common and appeared in almost 5% of those assessed. Dependent personality disorder and narcissistic personality disorders were rare. The prevalence of many of the individual disorders was only 1% to 2%. For ICD-10 disorders, the overall presence in the surveyed group was 7%. Again, the prevalence for individual disorders was 1% to 2%. The most common disorder in for the ICD disorders was dissocial personality disorder at 3%. Dependent personality disorder was, again, very rare. Who is affected? Studies dedicated to uncovering the risk factors for personality disorder produced a variety of results. Prominent factors that may lead to a personality disorder include having a parent who is involved in or has been convicted of a crime, having a parent with deficient parenting abilities and being part of a large family. Factors such as low intelligence also feature in the list of risk factors. However, this study and studies that are similar raise certain issues about the nature of judging which factors should be included as risk factors for personality disorder. These sorts of factors could be criticised for having prejudicial antecedent assumptions regarding what it means to be a functioning human being. It is likely that people from lower socio-economic classes will have a tendency to fit these categories more than their middle- or upper class counterparts.Care should be taken in describing risk factors to ensure the language used is not biased by class. In the study mentioned above, several demographic characteristics were assessed with regard to prevalence of personality disorder. The outcomes demonstrated that Cluster A disorders were more common in males than in females. Cluster A disorders were also more prevalent in participants who were divorced or separated than those who were married or widowed. Subjects who had never been married were the most susceptible sub-group of all. In the Cluster B category, men were again more prone to having a personality disorder than women. Cluster B disorders were most common in the youngest age range surveyed and least common in the oldest range. Further, this cluster was most prevalent in participants who lacked a high school diploma and was least prevalent in participants who graduated from high school and continued their education afterwards. The odds of having one of these disorders decreased approximately 6% for each year an individual aged. One possible explanation for the increase of prevalence of disorder with age could be that people of more mature generations are less likely to have, know about or report symptoms of personality disorder. The prevalence of Cluster C disorders was most closely related to marital status, again showing that participants who had never been married were most likely to have one of these disorders. The likelihood of having a Cluster C disorder was almost 7 times greater in those never married when contrasted with those who were married or widowed. The results of this study broadly match a number of previous studies whose results showed the prevalence of personality disorders in the general population to be 9-13%. However, there were some differences between previous studies on prevalence and this study. The present study found a notably higher prevalence of antisocial personality disorder and a much lower prevalence of histrionic and dependent personality disorders than previous studies. These differences could have been caused by methodological variants and the diagnostic criteria used such as which version of the DSM was utilised. The differences could also be a result of participant source, form of assessment, assessors experience and data collection methods. Notable strengths of the study were that the participants were obtained through a community sample and personally interviewed by psychologists who have a significant amount of experience in cross-examination. The limitations included the fact that not all subjects coul d be interviewed and that the sample size was not really large enough to pick up on very rare disorders. The results of other studies have been less conclusive. An American study examined the theory that personality traits stop transforming by the time an individual reaches the age of 30. One of the major strengths of this study was the sample size of 132,515. The subjects, aged 21-60, participated in a web-based Big Five personality measurement. The results of this study showed that qualities such as being agreeable and conscientious increased during adulthood up through middle age. The quality of being neurotic diminished for women but remained static for men.20 Both men and women decreased in openness after the age of 30, and while men increased in extraversion from 31 to 60, the same quality diminished in women in the same age range.21 While the sample size of this study was certainly impressive, one concern was that conducting the study over the internet might bias it toward younger subjects. Another concern was the cohort effect, since people of earlier generations might not engag e with psychological instruments with the same ease as those who are younger. Overall, the multiplicity in paradigms of change did not affirm either that personality does not change after 30 or that it does. The study concludes that the traits examined are complex in nature and subject to an array of developmental influences. Historical View The onset of the de-institutionalisation of mental health establishments has produced a number of benefits. There is now less public stigma placed upon sufferers of mental illness and their traits and presence in wider society has come a long way toward normalisation. Suffers of mental illness have become less isolated and enjoy greater freedoms, including the freedom to choose from a selection of services. From a governmental point of view, deinstitutionalisation has saved them an enormous amount of money. However, the responsibility for managing and caring for mental illness sufferers has been transferred from the institution to the local community, and specifically to carers. Carers are involved in every possible aspect of the lives of their charges, even to the extent that their role could be characterised as an informal social worker. But the burden of the role combined with the lack of training, education and support often results in the damage of the psychological health of th e carer, as well as strict limitations on their life outside the caring role. The striking impact of caring on the lives of carers and other factors led to the undertaking of research on the involvement of families in managing and treating mental illness. From this came solid evidence of the benefits of such involvement, and the needs of carers began to be recognised. In recent years services have been put in place to assure that the needs of carers are met, and education for carers has been pinpointed as the most beneficial service for carers and consumers. Carers need to be educated in order to feel equipped to perform their tasks effectively. Specifically, carers named a need for â€Å"education about mental disorders† and information about treatment options† as their most salient needs. These statements are reinforced by studies from various countries where carers named the same things as most important for their success. Historically, studies examining the impact of educational programmes for carers have come from two different hypotheses. The first is that the chances of a consumer recovering from a mental illness are augmented if an educated and informed family surrounds him or her. Such a family will have deeper knowledge and sympathy for the condition of the sufferer and will be equipped to manage challenging behaviours. The second hypothesis is that because of the implications of their role, carers have an inherent right to access to adequate services. They have a right to services that will enhance their individual welfare and their effectiveness as carers. Assigning a course of treatment to personality disorder has always been an inexact science. Personality disorder is particularly complex to treat because the prime method of treatment is not always apparent after a diagnosis has been arrived at. The type of treatment which will prove most effective for the patient differs from individual to individual. Case conceptualisations can be helpful in assessing the individuals issues, identifying areas of risk and determining proper treatment goals.24 There is an abundance of research about treating personality disorder, but the studies cannot always be relied upon due to their lack of sound methodology. While some forms of treatment for personality disorder can reduce relapses and facilitate recovery, there is no simple panacea for this ailment. Cognitive treatments including cognitive-behavioural approaches have produced some pleasing results with personality disorder patients, as have psychodynamic treatments. Diagnosis Individuals who suffer from personality disorder encounter several issues with their diagnoses. They may be diagnosed through the means of an interview, a self assessment questionnaire or other means. Clinical psychiatrists often diagnose patients through interviewing them with regard to the DSM or ICD categories. This method is slightly better for detecting the existence or not of a personality disorder, but shows low accuracy for particular types of disorder. Self-report questionnaires like the Personality Diagnostic Questionnaire (PDQ-IV) and the Millon Clinical Multi-axial Inventory (MCMI) are also used to diagnose personality disorder. These questionnaires are considered imprecise because individuals tend to over-emphasise or under-emphasise the issues they are having. In addition to these methods of diagnosis, there are several semi-structured interview schedules to assist professionals. These schedules feature lists of questions that correlate to the DSM or ICD and the clinici an may then mark the patient and determine whether he or she has a disorder according to the criteria. Interview schedules have shown that they are slightly more reliable than other forms of diagnosis, but this success is only relative and the results are still much less valid than is needed. Really none of the diagnostic tools should be considered better than any of the others, for they are all faulty to the extent that they cannot be relied upon. There is a problematic absence of consensus regarding the reliability of diagnosing in general and the consistency of different diagnostic schemes. Part of the problem is that the explanations of personality disorders in the DSM and ICD feature a concoction of psychological traits and displayed behaviours, so that it becomes uncertain whether the diagnoses are attempting merely to pinpoint deviant actions or to identify traits whose presence is significant for determining personality disorder. The solidity of diagnoses for personality disorder is frequently questioned, and there are only a few disorders whose diagnoses are considered reliable. The diagnosis that can be made with the most certainty is antisocial personality disorder, because this problem can be identified by external actions that can be easily observed. Those who diagnose individuals with personality disorder are not always able to be precise in identifying which personality disorder they are dealing with, therefore m ultiple personality disorder diagnoses are common. Clinicians often find themselves confronting comorbidity, and prudent professionals test for the full scope of disorders. Comorbidity is quite common, with male legal psychopaths having an average of three disorders each. Women may have four.28 There is a great amount of interaction between the descriptors of the various types of personality disorder and so it is difficult to tell them apart. When dealing with multiple diagnoses, it is advisable to keep all disorders in mind when constructing a treatment regime, even if many of the features of the respective disorders overlap. The classification of disorders is also problematic, because the categories lack the quality of homogeneity present in reliable psychological categories of other types. Categories of psychological dysfunction work best when each class is different from others and common elements are contained within one class. This is not the case with personality disorders. For example, there are literally hundreds of ways to satisfy the criteria for borderline personality disorder, and so individuals with the same diagnosis may have utterly distinct behaviours, symptoms and needs. Axis I disorders feature frequently in those who suffer from personality disorder, particularly where there is substance abuse or depression. The classifications for personality disorder tend neither to be theoretically based, nor to stem from statistical research, which is presumably part of the reason that precise diagnoses are so elusive. The categories are so unreliable that abandoning the categories altogether and composing a new classification system is often proposed. While this may be the ideal way to correct the flaws, the time and effort already invested in the use of the present system is likely to ensure its continued existence. One approach to dealing with personality disorder is the trait approach. This approach states that a minimal amount of theories can illumine the majority of human behaviour. Observing the personality traits exhibited by an individual and placing them on a continuum from truly normal to extremely dysfunctional is more faithful to the structure of t he human psyche and tells clinicians more about the true nature of the dysfunction suffered by the patient. Currently, the most extensively developed trait theory relating to personality disorder is the theory of psychopathology. Treatment Cognitive-behavioural treatments (CBT) aimed at treating personality disorders have a tendency to take a broad approach. CBTs engage an array of behaviours, thoughts, preconceptions and internal emotional mechanisms. Many treatments are residential and are conducted with a group. They frequently include tenets of other methods such as psychodynamic therapy. Therefore it is an arduous task to pick out what, if any, elements are effective in a multi-dimensional approach so that they can be improved and repeated. Dialectical behaviour therapy (DBT) is a method of CBT focusing on female patients with borderline personality disorder. The goal of the therapy is to reduce or eliminate incidents of self-harm through group skills training. Group sessions address destructive thought patterns and social skills. Individual therapy can also be used. The outcomes for one study showed that women who were treated experienced reduced anger and self-destructive or suicidal thoughts. Their social skills improved and they required less psychiatric treatment. Arnold Lodge Regional Secure Unit has produced a treatment method aimed specifically at offenders with a personality disorder. The treatment programme centres on teaching patients socially acceptable mechanisms for problem solving. The patients work individually and with others and receive regular counselling. This regime is supplemented with services that are individually tailored to the needs of the individual, such as anger management sessions or substance abuse education. This form of treatment has been shown to reduce deficiencies in social functioning and self-control.32 While the initial studies are promising, long-term analysis will confirm or refute the true effectiveness of this type of treatment. Therapeutic communities, cognitive therapies and dynamic therapies may also be used to treat personality disorder. Therapeutic communities are tailored primarily for offenders and have produced promising results in terms of reduced recidivism and improved social integration. A study into the effectiveness of therapeutic community treatment of personality disorder explored whether this type of treatment improved the health of patients to the extent that the burden on Health Services eased. Several previous studies reported reductions in the use of psychiatric services after therapeutic community treatment. The previous studies were limited by the fact that they observed participants for one year only and lacked thorough follow-up. This study sought to fill the methodological gaps of the previous studies by tracking patients for years after treatment. They assessed the impact of treatment on Health Services by counting the number of admissions to hospital before and after treatment. Th e study found that therapeutic community treatment resulted in a statistically significant drop in in-patient admissions over the 3-year period. Those who were admitted to hospital tended to be the subjects who had the briefest experience of therapeutic community treatment. Another study involving therapeutic community treatment focused on individuals with severe personality disorder. The effect of p

Literary Analysis Essay -- Essays Papers

Literary Analysis In James Joyce’s Dubliners, Joyce writes about difficulties and hardships of the Irish people during the 19th century. In the stories â€Å"The Sisters† and â€Å"The Dead,† the separation of an individual from the rest of society is portrayed through many occurrences of eyes and visions. There are many examples that run though out these stories that can be interpreted. Some of these examples can range from being on a symbolic level to an emotional level within the characters. In â€Å"The Sisters,† there are many emotional changes that are a result of visions through certain objects. After the little boy in â€Å"The Sisters† sees the flowers in the store, he goes through a rollercoaster of emotions (3-4). He begins to realize how his feelings are different from all of the other people about the death of the priest. The boy feels a sense of liberation due to the death of the priest (4). He is upset and annoyed by this and does not know what to do with this emotion. Being put through the death of his best friend the priest, he would change his view on life. He started out in the beginning of the book as just a normal boy, but towards the end he took a new perspective on everything. During the story â€Å"The Dead,† the vision Gabriel has at the end of the story makes him go through an emotional change. In the story, after the main character Gabriel learns about his wife’s past love (221-222), he looks out the window and stares at the snow for a little bit and then starts to cry. His emotions have taken over him as he is now thinking differently about everything he had every thought of. The previous feeling of how lovely his wife is and how he was looking forward to being with her... ...ead,† Gabriel questions many things including himself. After hearing his wife explain her sadness about her past, Gabriel looks out the window to see the dark snowy night. He questions his own role as a husband to his wife. He questions his role in society also. He does not have any answers for these questions. So he then goes to bed as his soul fades away. All of these examples show the separation of an individual from the rest of society. Joyce words stories so well that the separation can be shown through simple visions throughout the stories in â€Å"Dubliners.† To recognize these themes in the stories gives the reader a better understanding of what is going on. They can actually connect with what the main character is feeling or at least have an idea of what is unfolding. These themes bring the sad truth to us in a beautiful well written manner.

Whistle or Scream While You Work :: Essays Papers

Whistle or Scream While You Work Life is full of encounters with annoying, horrendous, wretched, irritating, pathetic wastes of human life, and I am in constant contact with them wherever I go. Although I have a choice whether or not I want to deal with these people, I do not have a choice at my place of employment. While working at 9 Ball Joe, a coffee/billiards hall, I am forced to interact with mainly four groups of people; from rowdy, revolting children and useless, pitiable teens, to scheming schoolgirls and bothersome regulars, a line of work seeming so simple is anything but. First and foremost, I am a 19 year-old college student who places value in any chance I get for peace and quiet, thus, babysitting is not my profession of choice. However, on most weekend nights 9 Ball Joe is infested with children between the ages 12-16. They are loud, obnoxious, and in some situations, disrespectful. Unfortunately for me, they have strength in numbers. Because most of them are too young to drive, they often come piled in a van driven by one of their parents. Before entering the building, they feel it is necessary to â€Å"hang out,† or loiter in the parking lot for at least ten minutes, leaving a trail of litter behind. Once in the building, they huddle in a large mass near the entrance door causing messy customer traffic-jams. Because young children are commonly indecisive, fifteen minutes can pass before any decision is made on whether to shoot pool, or to purchase drinks. If they do decide to get drinks, they spend as little as possible (a one drink minimum is policy). Jones Sodas seem to be the beverage of choice since they are cheap, colorful, and sweet. Having to deal with their loud voices and sugar-high theatrics all night is only the beginning of my torture. I am continually left with scads of dishes to clean up after they leave even though our signs clearly read: PLEASE TAKE CARE OF YOUR OWN DISHES. The next breed of 9 Ball-goers consists of 20 year-old high school dropouts who still live with their parents and have excessive drinking problems. Unfortunately, age is not an indicator of maturity. These individuals are worse than youngsters half their age. I often wonder how they make enough money to feed their alcohol and cigarette addiction as well as pay for their pool and drinks.

Importance of Emotional Intelligence in Nursing :: Nursing Reflective Practice

Nurses are the caregivers in hospitals that tend to stand out in comparison with other healthcare professionals. They are constantly on the front lines of the battle to maintain an optimal environment for the wellbeing of their patients. For instance, more than a year ago, I was visiting a friend and her young daughter, who had a heart transplant before the age of two, at the Stollery Children’s hospital. I clearly saw how a nurse and her nurturing characteristics, she had shown with her young patient, distinguished her from the other health care professionals. The nurse’s exemplifying and loving interactions with her client show clear links between emotional intelligent, the child’s environment and personal knowing, one of Carper’s four patterns of knowing in nursing. During a patient’s stay in the hospital the way they interact with their environment is an important factor in their health. Burger and Goddard (2009) acknowledged that a good environment for patients meets their physical needs, and keeps them emotionally comfortable and safe (p.249). Furthermore factors such as noise, distractions and lack of privacy or space cause confusion, tension and discomfort (p.249). Although, identifying that health is influenced by environment strays away from the medical model of health which conceptualized â€Å"the body†¦ being disconnected from the mind, soul, and social and environmental contexts or settings† (Young, & Wharf-Higgins, 2009, p. 51). Health involves more than just the body, but also the mind. It has been proven there is â€Å"a relationship between the experience of chronic stress and increased susceptibility to the common cold (Williams, & Iruita, 2004, p.807). These finding strengthen the fact that the mind and bod y are connected. Generally speaking, it is significant for healthcare professional, especially nurses to monitor the environment and be aware of issues that many affect the patient physically, emotionally and mentally. In particularly with my friend’s child who had the heart transplant providing the most favorable environment is important because along with the heart transplant the child is now immune depressant. Regardless of the child being immune depressant the link between her body and her mind is noteworthy. Williams, and Iruita (2005) noted the body is influenced by psychosocial influences and that the body can produce certain type of hormone that is cause elicited by emotional status (p. 807). Moreover they wrote that stress has been related to some autoimmune disorders, and positive emotions have been discovered to boost average immunoglobulin levels (p.

Inventory and Alliance Supermarkets

Alliance Supermarkets has been using a point-of-sale (POS) system for some time to track its inventory. The system uses a laser scanner to read the universal product code (UPC) on each item at the checkout container. The UPC is a number that uniquely identifies the product on which it appears. Currently, Alliance is using the UPC information to update inventory records for each item. Although the system has greatly improved the company’s ability to replenish inventory promptly, the company still has some problems.For example, sudden changes in demand for a particular item can catch the company by surprise as it bases inventory replenishment on historical demand patterns. Further, demand patterns and preferences may vary from one store to another depending on the customers served by each, but the inventory system groups all demand information together and treats each store equally. Finally, the manufacturers that make the products stocked by Alliance Supermarkets are always pre ssuring Alliance to help them target appropriate customers for special promotions and sales.The chief information officer (CIO) of Alliance realizes that much more could probably be done with the data collected from its POS system. For example, the company could analyze the relationship between each product’s sales and weather patterns. It is even possible to analyze an individual customer’s buying habits and identify instances when a customer may be persuaded to try a different brand of a certain product. Suppose you have been asked to study this situation and suggest possible new and innovative uses for the information generated by the POS system.Ideally, these ideas should help Alliance better serve its customers by ensuring that adequate quantities of each item are available, that costs are kept low, and that customers are made aware of new products that may interest them. 1. What information may help Alliance reduce costs while providing better service? 2. If purc hase information can be obtained on individual customers, what new approach could be used by Alliance?Your paper should be in paragraph form (avoid the use of bullet points), and supported with the concepts outlined in your text. Do not include the original questions of the assignment in the paper. Carefully review the Grading Rubric for the criteria that will be used to evaluate your assignment. Alliance Analysis The CIO for Alliance Supermarkets desires to make better use of the volume of data retrieved with each sale via the Point of Sale (POS) software that documents the sale of each product as it is bar coded.There are three key issues which the CIO wishes to address: 1) be able to respond to sudden, unanticipated inventory demand; 2) identify demand patterns that vary from store to store; 3) assist the manufacturers to better target customers for special promotions and sales. With the use of POS, Alliance Supermarkets have the ability to track sales of products and reorder the m automatically. With this type of information, the manufacturers have ready access to what products have been sold as they are scanned.Scanning the bar code for each product sends a signal to the manufacturers documenting the sale of each item in inventory as the sale occurs. When predetermined levels are reached, an order is placed with the manufacturer to replenish the inventory. The POS information can also help manufacturers â€Å"analyze an individual customer's buying habits and identify instances when a customer may be persuaded to try a different brand of a certain product† (Vonderembse & White, 2013).Alliance Supermarkets can better serve its customers by having adequate supplies of inventory based upon the ways that the store tracks its inventory. Not only will regular order replenishment of inventory improve customer satisfaction, but it will have the added effect of improving efficiencies and making the best use of capital resources. A perpetual inventory system of some merchandise such as perishable foods like meat, dairy products, and vegetables can help lower costs through greater efficiencies in processes.By avoiding Stock Outs, customers will have the ability to purchase their desired products without inventory costs. Adding Safety Stock to the inventory control plan can also aid Alliance in flexing up for sudden surge demand. Taking advantage of volume discounts is another way that costs can be controlled more efficiently. There is not always a cost savings in buying in volume. Therefore, using the formula of OP = dL can be used to determine an optimum point to reorder. OP = order point. d= daily use, and L = lead time.This helps determine how much advance notice is needed in order for the store not to run out of inventory. (Vonderembse & White, 2013 p. 10. 4) Alliance can also make use of demographic and purchasing decisions based upon POS transactions. Sorting the data individually by each store will help Alliance identify purchasin g trends. Orders can be placed specific to each stores demographic. A periodic inventory control system of non perishable items such as dairy products, meat and vegetables could be used to help assess the grocery stores replenishment goals without running out of goods.

Amma Unavagam

Growth through CARS Initiatives Pfizer is the world's largest and one of the most admired pharmacy companies with an income of about US $52 Ban in 2013. In 2001 when Dry Hank McKinley took over as Chairman and CEO of the company, Pfizer was very stable and financially sound. It was poised to become the world's largest pharmaceutical company with revenues doubling In the next five years. But the CEO had other serious challenges to contend with.In response to these challenges, Dry McConnell formulated a new mission of Pfizer to become the world's most valued company not Just to Investors, patients and customers but also, to employees, partners and communities where we live and work. † In line with this mission, Pfizer became the first pharmacy company and one the first corporate in the world to sign up for support for the LINE Global Compact (UNC). UNC among other things envisages that businesses should: 1. Support and respect the protection of internationally proclaimed human ri ghts and 2.Uphold the elimination of discrimination in respect of employment and occupation. To deliver on his commitments to these principles of UNC, Dry McKinley created and launched Its The Global Health Fellows Program (GAFF) In 2003 under his personal oversight. Under this program, Pfizer would send their skilled employees to developing countries on short term assignments (2 – 3 months) to help Noose there build health and social infrastructure in communities ravaged by various dreaded diseases.These employees would transfer their professional, medical and business expertise to the Noose in such a way that the Noose would learn to promote more efficient access to quality health services for the needy. Starting with mere 18 people in 2004, today over 300 Pfizer employees participate in assignments in 45 countries in partnerships with 40 international development organizations. Experience shows that through GAFF initiative, the MONGO partners gained expertise in capacity-b uilding analysis, planning and training that they couldn't otherwise afford.This helped them to Identify health trends and plan Interventions, enhanced their drug-trial competence helping them attract more western resources, and manage their programs better. International social cause as good corporate citizen. The Program became a personnel development tool. Returning volunteers came home with new operational and business insights as well as better understanding of the company's stakeholder including patients, communities, medical professionals and MONGO etc around the world especially in emerging markets.This in turn contributed to better policy making and program planning including bringing better AIDS therapies to the market. This program also served as a valuable recruitment and retention tool. It also helped build better relationships with legislative and regulatory authorities. Interestingly, the success of the GHB Program enthused Pfizer to include reports of philanthropic a ccess programs in their financial reports to the investors.