Reflection On Appearance And Behaviour

31 y/o AA male patient seen today for psychiatric-mental health assessment. He is awake, alert and oriented x4. He is calm, cooperative and follows commands during assessment. The patient reports he is depressed, difficulty sleeping and nightmares at night. The patient explained his depression is as a result of deep thinking from a news he received two days ago from his elder brother that his mother is ill. Stressors identified by the patient include losing his job a week ago before the news about his mother; his wife is 6-months pregnant with their first child, who currently works part-time at her present job; patient relates difficulty paying monthly bills and inability to provide adequately for his family as a man. The patient denies mood swings, suicidal/homicidal thoughts and ideation. Patient reports his spouse is at work at the moment and he does not want to put stress on his wife due to her current condition. Patient denies been hospitalized for depression or psychiatric illness; and denies family history of mental illness. Patient reports he is seeking help because he does not like feeling this way using terms of “helpless and loss of worth from his spouse”. Patient reports he needs help with his depression and nightmares before his current condition get out of hands and ruined his marriage.

Dr. Ramachandran wrote in his book that to diagnose a movement disorder, one needs to hear the patient instead of seeing them. I listen keenly.

Patient is a 50-year-old-year-old left-handed white male who presents with his wife for evaluation of multiple symptoms that have been present since an MVA in 02/2013. At that time, he was T. boned and his car was totaled. He has amnesia for the event and is unaware whether or not he hit his head. The airbag did deploy. Afterwards, he was confused and noted significant pain in his neck and upper back. Since then, he has had multiple symptoms. He does have involuntary twitching on the right, more than left, both hands, legs, and sometimes feet. He demonstrates one of these twitches and it looks like a focal myoclonic jerk of a limb. These occur on a daily basis. He also has problems with his left thumb and index finger locking up. When he is fatigued, especially when his neck gets tight, he has some problems with word finding, paraphasic errors, and syntax errors. He did see Anthony P. Knox,

A bed mobility assessment was completed upon arrival of a new patient. She was asked to turn over on each of her sides as far as she could and lift her hips off the bed while lying down and pushing off with her feet. A graphesthesia assessment was given to a patient with a CVA who showed decreased sensation as evidenced by not differentiating the letter, number, or shape drawn on her hand. Range of motion assessments were also completed for many of the

Patients will report to physical therapists with a multitude of impairments throughout the progression of the disease. The most prominent impairments will present during cerebellar testing. Patients will show signs of dysmetria, dysphasia, dysdiadochokinesia, and ataxia primarily as a result of the atrophy and damage to the cerebellum. Instability and lack of postural control will be demonstrated during the Romberg's test. Additionally, cranial nerve testing will have positive results for many cranial nerve palsies such as CN III, V, VII, IX, and XII. Patients show weakness in their trunk and extremities during the manual muscle testing. Vestibular testing will result in abnormal VOR, saccades, smooth pursuits and nystagmus. As a result of these impairments, patients experience functional limitations. Primarily, these patients are considered to be “high fall risks,” which ultimately decreases their independence due to weakness, instability and decreased postural control. These patients will feel uncomfortable in many situations and be unable to function independently in the community. This creates an increased risk for further injury. Due to the dysmetria and weakness, patients will also experience difficulty with their daily living skills, such as maintaining proper hygiene; They will have trouble bathing themselves and brushing their teeth without assistive equipment. PT interventions can help minimize and control these limitations. The implementation of balance training and assistive devices will be imperative interventions for an individual to modify and adapt to their gait

His thoughts were logical and coherent. He appeared somewhat measured in relating emotionally laden information. He was goal directed, however. He identified auditory hallucinations of people “yelling and screaming” and gunshots/explosions were identified. His basic level of intellectual development revealed probable upper low average to low end of average intelligence. Dr. DeRoeck diagnosed the claimant with Post Traumatic Stress Disorder (Chronic), Unspecified Depressive Disorder, Alcohol/Cannabis Use Disorder (in early remission). Dr. DeRoeck opined the claimant’s impairment would interfere with activities of daily living associated with increased social isolation. He shops minimally particularly if the store is crowded. He also interact with his children. He can dress, groom, and bathe without prompting or supervision. His capacity to communicate and interact in a socially adequate manner is limited by the impairment. He avoids eye contact and has limited tolerance for interaction with others. In addition, his capacity to cope with the typical mental demands of basic work-like tasks is limited by his impairment. He also has difficulty coping with stress in job-related activities. His capacity to sustain persistence is

making Practice-Based Learning work Reflection on PRACTICE A resource commissioned by the Making Practice Based Learning Work project, an educational development project funded through FDTL Phase 4 Project Number 174/02 and produced by staff from the University of Ulster. www.practicebasedlearning.org Author Patricia McClure School of Health Sciences, University of Ulster www.practicebasedlearning.org contents Reflection on Practice 02

In the emergency room on 4/17 the claimant walked with a normal gait. However, at the IMCE he had an antalgic gait. There is no explanation for this drastic change . Additionally there is no medical imaging in file to substanciate a severe impairment.

O: Slow but normal gait, sitting upright on the examination table without any support, able to get up and down without any assistance on the exam table; no grimace on his face, limited lumbar spine range of motion (per TM); no muscle spasm; no impairment of NVS; no muscle atrophy noted; intact reflexes, + 5 strength to lower and upper extremities, peripheral pulses +3, sensation intact; Straight leg test was negative.

All cranial nerves tested within normal limits. Pt passed visual fields exam and no problems with gag reflex. Pt moved muscles evenly and bilaterally and was able to shrug shoulders and move head from side to side.

Malfunctioning Motor Skills – Incapable of body movement. Mutism. Body clenched in a stiff position. No awareness of environment.

Fine Motor: During consultation he demonstrated cylindrical grasp for puzzle placement. He appears to have increased bilateral upper extremity tone when an attempt was made to redirect extremity for completion of task. He was able to scribble with prompts. He required hand over hand to complete this task. He demonstrated palmar grasp for picking up

Reflection is considered as a vital element of professional practice as it precedes to insight and then subsequent change in practice. The hypothesis of reflection is not new as it can be tracked as far back in the 5th century by the influential Greek philosopher, Socrates and to the 1930s primarily focusing on John Dewey’s work. Dewey is one of the founders of learning from experience. He theorised reflection as ‘active, persistent and careful consideration’ (Dewey, 1933) initiated by a specific situation which was opposing, perplexing or uncertain. One of its most common use today is coming up with a thought, an idea, or opinion made or an observation made as a result of concentration, suggesting in essence a way of thinking in which one looks back and meditate upon (Agnes, 2004).

Social psychology, the study of how we think about, influence, and relate to another, can be used to explain many situations and phenomena that happen in the world. For instance, it can be used to explain why and how people react the way they do when they perform poorly in an act that they’re usually good at, also known as self-serving bias. It is blaming external factors when bad things happen, but contributing internal factors to the reason why good things happen.

This paper is my personal reflection on teaching and learning that is based on a model developed by Schӧn; reflection-in-action and reflection-on-action. An action based on reflection is beneficial for the progression of my career as a nursing educator and for the quality of my teaching. When I reflect in and on action, I engage in a reflection which is targeted not only at appreciating myself as a nurse educator, but also at refining my teaching skill (Serdenciuc, 2015). Schön (as cited in Molloy & Delany, 2009) described reflection-in-action as challenging my own inherent critical thinking, analysis and evaluation of an activity while maintaining a sense of inquisitiveness. Schön (1983, p. 280) also mentioned that reflection-in-action is a process where my thinking and action should harmonize. On the other hand, reflection-on-action is a process where I revisit the action with my retrospective thinking so as to acquire insights for the future (Wieringa, 2011). When reflecting-on-action, I should keep a reflective diary to record details of the action immediately after the action (Mulholland & Turnock, 2012, p. 74).