Read Me a Story

The way I that define reading is as the process of receiving and interpreting data being communicated through symbols.  It is also much more than that.  Stories transmute experiential knowledge that can define for us the meaning of life.  Two main components of developmental influence that inspires creative consciousness are context clues and content.  Reading can allow us to create, destroy, and re-create our reality.  According to a 1978 report by Mitchell & Green in which they examined the processes by which fluent readers comprehend prose, concluding that “reading rate is largely determined by the speed with which a reader can access the meanings of words and construct a representation of the text rather than by the speed with which they can formulate and test successive predictions about it.”  It could be thought of as pronouncing an additional sense.  

When I was in grade school, after reading fables and tall tales, the class repeated comprehension check worksheets twice a week.  It was at that age too at a vacation bible school teaching the story of the Hebrews Exodus from Egypt that a passion for literary meaning and something that I later heard of Jesus calling parables of the Kingdom.  As I listened for an entire seven days to the stories of emancipation from the chains of slavery by God through Moses, all the until the climax in chapter 14 at the parting of the Reed Sea, I contemplated the relevance and potential applications to understand for myself and for my family.  I instinctively and literally wanted to become Moses for my image in nation and of course, a resolve to a choice competitive elimination.  It was like hearing the voice of God.  Confirmations are abundant from within the text itself, “[And] God looked upon the children of Israel, and God had respect unto them” (Exod. 2:25, 1611 KJV, Holy Bible).  One of the most amazing pieces of information that kept my attention even more so today was to learn the meaning of God’s name, YHVH, “I am that I am.”

I had always been reading years beyond most other children my age.  The first such of long, stories outside of the Bible that I can distinctively remember reading fully on my own without my being assigned was Heidi, an 1881 work of fiction for children by Swiss author, Johanna Spyri.  “We must never forget to pray, and to ask God to remember us when He is arranging things, so that we too may feel safe and have no anxiety about what is going to happen.”  The moral reasoning that I most appreciated from the text was learning the value of friendship, humility, and simplicity.  I have noticed just today, my daughter too, seeing it for the first time, is captivated by the characters and this story.  The apple does not fall far from the tree.

According to Steinberg, Bornstein Vandell & Rook (2011) by the study of children’s computation time, we come to have some etymologically significant terms for intelligence like in microgenetic analysis, [which is] determining children’s progression using the computation strategy to an unconscious use of the shortcut strategy to conscious use of the shortcut strategy over a series of sessions, also called assimilation (pg. 277).  In cohesion with this is a contemporary developmental theory of intelligence from one Robert Steinbern called “triarchic theory of successful intelligence, composed of analytical abilities to critique, judge, and evaluate; creative abilities to invent, discover, and imagine; and practical abilities to utilize and implement ideas in the real world. Research suggests that these components are relatively independent statistically, and that children apply them to different kinds of problems” (Steinberg, et al, 2011, pg. 279).  Socially, it is a natural occurrence in learning and in growth that similar problems will connect similar people together to co-create prospective new solutions, and that is called the never ending story.

References

Mitchell, D. C., & Green, D. W. (1978). The effects of context and content on immediate processing in reading. The quarterly journal of experimental psychology, 30(4), 609-636.

Steinberg, L. Bornstein., Vandel , D., Rook, K. (2001) Lifespan Development Infancy throught Adulthood. Belmont, CA: Cenage Learning.

Comparisons & Contrasts of Bhagavad Gita and Tao te Ching

Wisdom is formless, it has no shape.  It is, though, a very dense substance, like water, and like water, wisdom can fill a vessel—the vessels, for the purpose of the subject here, being the mind or the body.  When wisdom enters vessels is when it becomes attainment.  Attainment is equal to understanding.  Understanding allows merciful relations by giving way to right judgement.  All of these manifestations are perceived to be knowledge.  Knowledge is beautiful.  To know the intricacies of the creative process has been the search of mankind since the invention of language. 

A few ancient texts describe wisdom.  Two that will be discussed here are Bhagavad Gita and Tao te Ching.  Bhagavad Gita is the cornerstone of the Hindu faith, was written in India, and is thought to have been penned sometime between the 5th and 2nd century BCE.  Mahatma Gandhi thought of Bhagavad Gita as his spiritual dictionary.  It is comprised of exactly 700 verses.  Tao te Ching was written around the same time but wasn’t transliterated into English until the 19th century AD.  This is most likely because it was written in Classical Chinese, which can be altogether difficult to understand.  According to Holmes Welch, "It is a famous puzzle which everyone would like to feel he had solved” (Welch, 1965).  Even the word Tao is more precisely pronounced as it is more accurately spelled, Dao.  It became the foundation of a widely known, Oriental religion called Taoism, or Daoism.  Both texts are considered very sacred and should be read with an open heart and mind.
          The kinds of wisdom discussed in the Gita are of the government of creation by the three modes of material nature or Gunas, transcendentalism, awareness of impermanence, and also the identity of the Self in respects to the all that is.  The attainment revealed in the Tao te Ching is a sort of awareness of the Way that is called Tao, which is parallel to the truth revealed in the Gita but also is easier for an outsider of the culture to accept, being that it does not evoke a deity.  As is stated, “Just realize where you come from; this is the essence of wisdom” (14).

            The awakening described in both contribute to savvy individual and communal structure and peace.  Bhagavad Gita and Tao te Ching differ however in their revelation about the source of structure and peace.  In Bhagavad Gita, the Supreme Personality of Godhead, called Krishna, teaches that He is the creator of the entire system that governs creation, the giver of sustenance, and the destroyer of what is no longer necessary.  In Tao te Ching, Lao Tzu, the author, suggests that the governing system itself, has always existed, and does not require a name to be exalted or identified.  In fact, the Tao teaches that “The Tao (Way) that can be named is not the eternal Tao (Way)” (1).  Denouncing any dogma and perhaps implying, in the practical sense, that His instructions are all allegorical, Krishna states in chapter 18 of the Gita, “Abandon all varieties of religion, and surrender unto Me.  I will deliver you from all sinful reactions” (18:66).  Practicing surrender to an idea is more proactive that surrendering to an image or character outside of the Self.

            Both the devotion to God implored in the Gita and the embrace of the way explained by the Tao are meant to make a person closer to perfection.  The Tao te Ching says that in striving for perfection, perfection becomes less achievable.  The Gita says that a person should always strive to control the senses for the purpose of attaining the eternal.  Controlling one’s relationship to sense objects and resting in absolution are not so very different really.  In the Gita, Krishna describes it as what the Hindus call Dharma, “By following his qualities of work, every man can become perfect” (18:45).  The following illustration can relay the link that makes them similar: if a person is constantly attached to the concept of being incomplete, they are more likely to chase after sense pleasure in order to fill the void they assume that they have.  If, however, a person refutes the thought that they are not whole, then they can rest in amazement and live with simplicity.

            Krishna, in the Gita, refers to other scriptures He supposedly inspired and the purposes of other parts of the Hindu culture by talking about chants and rituals that He claims are beneficial for whatever reason, truly known only by one learned in Sanskrit, the language with which the Gita was written.  Tao te Ching is not so ritualistic to prescribe particular actions for cleansing but instead inspires deeper contemplation for the attainment of wise stature. 

The way in the Gita is called, as mentioned earlier, transcendentalism, which is defined as an existence beyond the material world.  Materialism is also shunned by the Tao, and the purpose of Taoism is to be at one with the Tao, which the texts says “has no desire for itself,” (7) and having desire for the self is one way to identify the materialistic in nature.  Tao te Ching says “Fill your bowl to the brim, and it will spill” (9).  In the Gita, Krishna says to Arjuna who is lamenting over seeing his friends and relatives on the opposite side of a battlefield, “While speaking learned words, you are mourning for what is not worthy of grief. Those who are wise lament neither for the living nor the dead” (2:11).  Indifference to duality is a piece of wisdom that can be learned by both those who study the Gita and followers of the Tao.

            Another revelation in both texts are that the physical world and everything in it is an illusion.  Both texts use the word “dispel” as the action to apply to those appearances.  In the Gita, Arjuna says to Krishna, “This is my doubt, O Krsna, and I ask You to dispel it completely. But for Yourself, no one is to be found who can destroy this doubt” (6:39).  In Tao te Ching, Lao Tzu writes, “He has no will of his own.  He dwells in reality and lets all illusion go” (38).  The illusions in the Gita is that there is some other way, besides what is being explained by Krishna.  The illusions in Tao te Ching is something extra appearing outside of a person that is added by external forces.

            Both the Gita and the Tao say that to know the way in actuality, in practice, and to attain by it is altogether, hardly possible.  Krishna says in the Gita, “Out of many thousands among men, one may endeavor for perfection, and of those who have achieved perfection, hardly one knows Me in truth” (7:3).  Likewise, Tao te Ching states, “So unclear, so indistinct, Within it there is image, So indistinct, so unclear, Within it there is substance, So deep, so profound, Within it there is essence” (21).  Arjuna states in the Gita that Krishna is “both the knower of everything and the object of knowledge” (13:11).  The Tao te Ching states, “Its name never departs, To observe the source of all things, How do I know the nature of the source?, With this” (21).  So, paradoxically, both texts seem to offer wisdom that is unreachable and, at the same time, they both inspire the seeker to reach towards what is thereby imperishable.

            Krishna instructs devotees in the Gita, “Perform your prescribed duty, for action is better than inaction. A man cannot even maintain his physical body without work” (3:8).  The Tao te Ching instructs followers to be “Simple in actions and in thoughts” (66).  Simplicity may be the best quality of heart that one can attain, especially since it is required of us modern humans that we “earn a living,” and duty is life’s service.  We should take heart of that as Yeshua, or Jesus as He is well known, is quoted in the Gospel of John saying, “In this world you will have trouble, but take heart, I have overcome the world.” (16:33) 

            It has been said and taught by many sages that Jesus is an advent of Krishna.  Krishna Himself speaks of His many births into the world.  “In order to deliver the pious and to annihilate the miscreants, as well as to reestablish the principles of religion, I advent Myself millennium after millennium” (4:8).  That sounds like the whole purpose of the Messiah in a fallen world, which is who Jesus of Nazereth is said to be.  Also, Krishna states in a chapter of the Gita called ‘The Most Confidential Knowledge,’ “Fools deride Me when I descend in the human form. They do not know My transcendental nature and My supreme dominion over all that be” (9:11).  That pretty much sums up the reason Christians claim Christ was crucified.  As was stated before, there is no deity in the Tao, only what is called the Way.  The Tao in relation to the Biblical narrative, since that is the point that was raised, Jesus says also in the Gospel of John, “I am the Way, the Truth, and the Life” (14:6).  John says in chapter one of his Gospel that “His life is the light of men” (1:4).  The life of Jesus was said to be gentle, and to this, Tao te Ching states, “The softest things of the world, Override the hardest things of the world” (43).  It could be that Lao Tzu was also an incarnation of Krishna, only in a different millennium and to different people?  Think about it.

References

    

Bhaktivedanta, A.C. (1972).  Bhagavad Gita: As It Is.  Retrieved from http://www.asitis.com

Gospel of John--KJV (n.d.)  Retrieved from http://biblehub.com

Linn, D. (2006).  Accurate Translation of the Tao te Ching.  Retrieved from http://taoism.net/ttc/complete.htm

Welch, H. (1965)

Spiritual Assessment Questionnaire and Long Term Care for Elderly Residents

    This plan for an assisted living facility will incorporate designs for spiritual amenities such as assessing the unique spirituality of residents, designing a culturally diverse, therapeutic environment for them, feeding them carefully planned meals, allowing privacy, and selecting and training employees.  We also aim to provide Complementary and Alternative remedies suited to each resident’s needs.  The following is an action plan and facility design that will integrate spiritual, religious, therapeutic, and health care functions into a new, culturally diverse assisted-living/long-term care facility for elderly people.  The building is planned to house 150 people.  There will be 75 assisted-living apartments and 50 rooms for residents in long-term care; of these rooms, 25 will be single-occupancy, and the other 25 will be double occupancy.   The plan will consider spiritual needs in ways that can have universal applications.  Interfaith discussion groups would be one voluntary activity for residents, because you are never too old to learn new things.  The people ought to be able to own pets.  The music playing should be the choice of the residents.  Perhaps a lot of natural images in the settings would make the place nice and comfortable.  The family here is given full disclosure, waiving no rights, and is allowed to visit anytime, day or night or by phone.

    First will be a discussion of a spiritual assessment questionnaire that individuals applying to become residents would first need to answer.  “To provide optimal services, a spiritual assessment is often administered to understand the intersection between clients' spirituality and service provision. Traditional assessment approaches, however, may be ineffective with clients who are uncomfortable with spiritual language or who are otherwise hesitant to discuss spirituality overtly."  This facility provides a unique and specific variety of services.  Here, below is each question on the spiritual assessment questionnaire including a discussion about why the question is important, what information will be gleaned from the clients answer, and with an explanation of how the answer will apply to a spiritual intervention and/or therapy plan.  “Spirituality is posited to be a universal human impulse that may or may not be expressed in religious forums” (Derezotes, 2006).

    Question 1.  Do you believe in God? 
Prime Creator Source is in actuality an absolute, fixed, systematic observation of objective truth.  In this facility, dogma and language barriers will be put in proper, concordant contexts so to avoid conflict between residents, especially in double occupancy rooms.  “Although a bio-psychosocial assessment is typically conducted at the beginning of therapy, practitioners must remain open to revising their initial suppositions as additional information is obtained during subsequent sessions.  Similarly, one should remain open to the possibility that spirituality plays an important role in clients' lives, even though the initial preliminary assessment indicates that spirituality is not a salient life dimension” (Hodge, 2013).  The answer here would apply to intervention and/or therapy in educating the resident of needing to be aware of the unity underlining all of creation and that that very system would no less be the basis of the theology that is unanimously agreed to and encouraged at the facility.  The purpose of such information is to create friendships not “motivated by obligation” as those, according to Hodge (2013), “are distinguished from those which are perceived to emerge from voluntary responses such as caring.”
   
    Question 2.  Do you have prestige?
Self concept is a projector of the world we observe and is the fashions the ways in which we relate to others.  We would prefer residents have self-knowledge and decide for themselves to join or not join this community.  Aged individuals usually depict more of a necessity to control whatever is being arranged about their care.  Carstensen’s (1996) socioemotional selectivity theory states that older adults become more selective about their social contacts, narrowing choices to those with whom they have the strongest emotional connections.   This question would be a qualification for admitting individuals to be residents here, where application of the knowledge is to boost morale and strengthen esteem.

    Question 3.  Who are some of your oldest known ancestors, and can you relate to their plight?
“The family karma affects can be found not only as imprints in one’s personality traits, belief systems, and lifestyle but also within the mental body, the emotional body and the physical body; within one’s DNA.”  Despite the Epigenetic truth that one can freely react to stimuli as they choose, these “family karma effects can be limiting beliefs, habits, repetitive scenarios, ways of thinking and acting which do not serve the person’s greatest and highest good in this present birth or traumatic experiences with unfavorable consequences to one’s life.  These aspects often are carried forward to future generations and can manifest similar experiences, limitations to progress and even ill health” (Sadoriniou – Adhen, 2010).  An objective reason for acquiring this detailed information is for selecting a concrete, socio-familial plan for individuals therapy and for the pairing together of roommates.

    Question 4:  Do you consent to the alternative treatment methods that will be recommended by your attending physician?
This facility would be privately funded, and therefore would not require “permission” from the FDA, HMOs, or pharmaceutical manufacturers to offer treatment for the bereavements of the residents.  Given that, there would need be consent from the residents that places trust in the knowledge of the trained, care givers.  Consent is given through an informed and knowing intention that is voluntary for both parties.  The spiritual reasoning behind this specific question and its effects on intervention and/or therapy plans are as follows:  a) it supports the empowered patient, and b) it is a hallmark of the specialized care offered with abundance here.

    Question 5:  Do you have any special talents or favorite past times you would like to see developed during your stay here?
“Activity theory (of adult development) states that successful aging depends on remaining active, productive, and involved. Those who disengage after retirement are less likely to be positive and are more likely to suffer the consequences that go along with a negative outlook.  Those who have optimism, faith, hope, perseverance, and look to the future generally remain happy, content, and have positive attitudes” (Seligman & Csikszentmihalyi, 2000).   “Several researchers have found that cognitive training, specifically in abstract reasoning, can reduce cognitive losses” (Ball, Berch, & Helmers, 2002; Boron, Turiano, Willis, & Schaie, 2007).   Therefore, investment into helping the residents use the skills they have previously acquired and interactively exposing the residents to other residents’ unique abilities can be a method for keeping minds and bodies sharp.

    Question 6:  You are able, are you willing to declare sovereignty and obtain world citizenship?
This question would reveal the spiritual aptitude of residents.  Being a privately-funded facility, we are advocating that “freedom to worship God as the individuals’ conscience dictates, within the dominion where the sovereign has the power to make civil law over both religious and secular matters, can ‘be granted without prejudice to the public peace, for without such peace, piety cannot flourish, nor the public peace be secure” (Prokhovnik, 2008).  “Patriotism is defined in terms of a kind of loyalty to a particular nation which only those possessing that particular nationality can exhibit” (MacIntyre, 1984).  Since this unsubstantiated sense of pride is not universally applicable to all, it does not support a peaceful environment.  Therefore, the application of this answer would assess the individual’s measure of altruism, which is more spiritually sound than egoism.  As Sri Swami Vishnu said, “The time has come that this idea of nationalism, of patriotism must disappear, and only one unity should exist.”  The expectations of success, the thriving peace of residents, and the potential expansion of this facility has a goal of detaching this community from the structural violence that plagues the world for the sake of which we all will have remembered dying.

    Question 7:  What are some of your greatest fears?
Many elderly adults will fear things that add no self-concerns to younger populations.  “Fear of falling (FOF) is a major health problem among community-dwelling older persons both in older persons who have experienced a fall and those who have not” (Scheffer et al. 2008).  Two FOF interventions utilized at this facility would be “Tai-Chi exercise and cognitive-behavioral (CB) intervention. Tai Chi focused on improving lower extremity muscular strength and balance. The CB intervention concentrated on improving awareness of environmental hazards and medically related risk factors, changing faulty thinking tied to FOF experiences, and selecting useful management strategies and resources and improving confidence” (Tzu-Ting, Lin-Hui, & Chai-Yih, 2011).  Another fear that many aged people face is the fear of death and dying.  With this particular fear, uncertainty is prevalent among the individuals and their families.  Resulting from the awareness of their own mortality “people seek to reduce anxiety related to their mortality by attaching or investing themselves in something that will outlast their short existence (e.g., a cultural worldview)” (Benton, 2007).   For the individual, a therapeutic methodology might be exploring the inner dimensions of the sacred texts that discuss the afterlife.  For their families, the uncertainty could be resolved with appreciation, open, honest discussions with their loved ones, and preparing them to do honor to the memories of the deceased.

    Question 8:  What is your definition of belief?
The word belief is defined as the following:  a) acceptance of the truth of something: acceptance by the mind that something is true or real, often underpinned by an emotional or spiritual sense of certainty, b) trust: confidence that somebody or something is good or will be effective, and c) something that somebody believes in: a statement, principle, or doctrine that a person or group accepts as true.  Belief alone does not constitute knowledge.  It may imply knowledge, but it does not mean that we possess knowledge.  “Attribution
of first-person belief is most importantly attribution to the believer of a view of intentional reality from a vantage point that is epistemically special
in ways connected with introspection” (Martens, 2010).  The information that the answer to this question contributes to planning intervention and therapy for the resident is an important revelation for explaining and thereby improving their behavior at the roots.

    Question 9:  Have you experienced any physical or emotional trauma that left its impressions on you?
The older a person becomes, the more likely they will have experienced a debilitating, traumatic event.  “Much has been written about Post Traumatic Stress Disorder (PTSD) since it was first included in The Diagnostic and Statistical Manual of Mental Disorders in 1980.  According to the pyschiatrist Bessel van der Kolk, a leading authority in this field, it is the second most commonly diagnosed psychiatric disorder” (McBride, Armstrong, 1995).  The purpose of this question and how it relates to residents’ interventions and therapy is addressing any special care that may be required for victims of war or assault.

    Question 10:  Do you pray?
“In religion a person believes in a God, who is in control, and that there are events that happen or may happen to him or her that are felt as either good or bad. If they think that something bad is happening they start praying, and ask that god change his attitude and instead be kind and take away or prevent the bad event and make it good.  In fact, this isn’t prayer at all; it’s a kind of bribery, but to no affect” (Perceiving Reality: Prayer, n.d.).  At this facility, we want each resident to understand and be able to see the true will of the Creator in every circumstance they face.  It is said that God is unchangeable and that His actions are only for good.  By this understanding, our goal is to alter our inner nature so that we can live and perceive a very different world.  This perspective is akin to that which begets sovereignty as mentioned in Question 6; it allows for it and immediately manifests the like.

    “When culturally diverse patients are admitted to an acute care settings, their families need to feel comfortable with the access that is available to them” (Cioffi, 2006).  “Family members have a right to support their hospitalized relatives” (Johnson, 1988).  These are reasons that the facility will be accessible 24 hours a day, 7 days a week.  The family, who will most likely live in much more uncomfortable conditions, may bring various amenities at the request of their loved ones now enjoying independence.  Being jealous of the freedom might be more of an issue than cultural differences and personal preferences.
  
    “Religion and spirituality potentially can mediate quality of life by enhancing patient subjective well-being through social support and stress and coping strategies.  Theoretically, religious and spiritual beliefs may enhance subjective well-being in 4 ways: promoting a salubrious personal lifestyle that is congruent with religious or personal faith traditions, providing systems of meaning and existential coherence, establishing personal relationships with a divine other, and ensuring social support and integration within a community” (Daaleman, VandeCreek, Dmin, 2000).  This potential in an individual’s religion and/or spirituality would only be enhanced by the universality of the well educated staff at this facility.  “In the development of treatment goals and care plans, patient autonomy can be threatened when physicians' religious convictions are dissonant with those of patients and family members” (Daaleman, VandeCreek, Dmin, 2000).  Compatibility would not be an issue with the omnium-gatherums appearing disorderly being restored to order by the reckoning of collective grace.

    In conclusion, the variety of religious, spiritual, or secular backgrounds would be amalgamated into a peaceful, true, absolute unity in this revolutionary, assisted-living facility.  Special diets, rituals, or sacraments, as long as they are peaceable, will all be provided and allowed when requested.  “Spiritual concerns in later life are often driven by the paradoxes of growth/loss and weakness/strength.  In the face of these paradoxes, aging individuals can find wisdom, reflection, strength, a sense of purpose, inner peace, and transcendence in their spiritual beliefs” (Young & Koopsen, 2011).  Through a new but familiar paradigm the residents will attain tacit, holistic wellness in a welcoming community of World Citizens. 



References:

Ball, K., Berch, D., & Helmers, K. (2002).  Effects of cognitive training interventions with older adults: A randomized controlled trial.  Journal of the American Medical Association, 228, 2271–2281.

Benton, J. I. (2007).  Death Anxiety as a Function of Aging Anxiety.  Death Studies, 31(4), 337. doi:10.1080/07481180601187100.  Retrieved from EBSCOhost.

Birren, J. E. (2009). Gifts and talents of elderly people: The persimmon's promise. In F. Horowitz, R. F. Subotnik, D. J. Matthews (Eds.), The development of giftedness and talent across the life span (pp. 171-185). Washington, DC US: American Psychological Association. doi:10.1037/11867-010

Boron, J., Turiano, N., Willis, S., & Schaie, K. W. (2007).  Effects of cognitive training on change in accuracy in inductive reasoning ability.  Journal of Gerontology Series B: Psychological Sciences and Social Sciences, 62, P179–P186.

Carstensen, L. L. (1996).  Socioemotional selectivity: A life-span developmental account of social behavior.  In M. R. Merrens & G. G. Brannigan (Eds.), The developmental psychologists: Research adventures across the life span (pp. 251–272).  New York: McGraw-Hill.

Daaleman T. P., DO & VandeCreek, L., DMin (2000, Nov. 15).  Placing Religion and Spirituality in End-of-Life Care.  JAMA. 2000; 284(19):2514-2517. doi: 10.1001/jama.284.19.2514

Hodge, D. R. (2013).  Implicit Spiritual Assessment: An Alternative Approach for Assessing Client Spirituality.  Social Work, 58(3), 223-230. doi:10.1093/sw/swt019

MARTENS, D. B. (2010). FIRST-PERSON BELIEF AND EMPIRICAL CERTAINTY. Pacific Philosophical Quarterly, 91(1), 118-136. doi:10.1111/j.1468-0114.2009.01361.x.  Retrieved from EBSCOhost.

McBride, J.L. & Armstrong, G. (1995).  The Spiritual Dynamics of Chronic Post Traumatic Stress Disorder.  Journal of Religion and Health , Vol. 34, No. 1  (Spring, 1995) , pp. 5-16.  Retrieved from JSTOR.

Mullin, G. E., MD (2010).  Popular Diets Prescribed by Alternative Practitioners—Part 1.  Johns Hopkins University School of Medicine, Baltimore, Maryland.  Retrieved from http://ncp.sagepub.com.proxy-library.ashford.edu/content/25/2/212.full

MacIntyre, A. (Mar 26, 1984).  Is Patriotism a Virtue?  The Lindley Lecture:  University of Kansas.  Retrieved from  http://kuscholarworks.ku.edu/dspace/bitstream/1808/12398/1/Is%20Patriotism%20a%20Virtue-1984.pdf

Perceiving Reality:  Prayer (n.d.)  Retrieved from http://www.kabbalah.info/engkab/kabbalah-video-clips/prayer#.UwP7WM6_mt8

Prokhovnik, R. (2008).  Sovereignty : History and Theory.  Andrews UK.  Retrieved from http://site.ebrary.com/lib/ashford/docDetail.action?docID=10721237

Sadoriniou - Adhen, K. (2010).  Releasing Ancestral / Family Karma.  Retrieved from http://lightworkers.org/wisdom/konstadina-sadoriniou/97045/releasing-family-ancestral-karma

Seligman, M. E., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 5(1), 5–14.

Scheffer A.C., Schuurmans M.J., van Dijk N., van der Hooft T. & de Rooij S.E. (2008) Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons.  Age and Ageing 37 (1), 19–24.

Tzu-Ting, H., Lin-Hui, Y., & Chia-Yih, L. (2011).  Reducing the fear of falling among community-dwelling elderly adults through cognitive-behavioural strategies and intense Tai Chi exercise: a randomized controlled trial.  Journal Of Advanced Nursing, 67(5), 961-971.  doi:10.1111/j.1365-2648.2010.05553.x

Young, C. & Koopsen. C. (2011).  Spirituality, Health and Healing: An Integrative Approach (2nd ed.). Sudbury, MA: Jones and Bartlett.

The U.S Health Care System--SOC313 discussion

The U.S. Health Care System is frequently criticized as being expensive and lacking coverage of the total population.   On the other hand, the U.S. Health Care System is innovative and frequently used by foreign residents for treatment.   Managed care was a response to the cost, quality and coverage concerns.   Consider the issues of care coordination, prevention practices, formulary medication costs, delay in getting appointments or tests, denial of referrals to specialists, inadequate skill of physicians and the need for specific approval by an MCO before the most effective medication for the treatment of a condition can be obtained if the drug is not listed in the plan's formulary. Assume a position either for or against managed care.

 ~~

I oppose the managed care system for a couple of reasons.

(a)  People can’t really get the best care from abundant sources when both the doctors and providers are in cahoots to spend less monies in the least amount of time as possible per patient.
Complementary and Alternative Medicine (CAM) is the abundant source I mentioned.  Most people pay for CAM therapies out-of-pocket, because pharmaceutical companies have a monopoly on how patients are treated, and they are concerned that CAM will become the “new” low-reimbursement insurance coverage therapy (Cuellar, 2006).
Many health care consumers are advocates of the holistic abundance.  It somewhat subjugates the need for expert opinions or special access to manufactured medicines as the effects of CAM are anecdotal, meaning based on word of mouth, and herbs and berries grow freely.  Therefore, some physicians are uncomfortable with CAM and the idea of the empowered patient.  If they are planning to add CAM to medical practice, conventional providers must identify how they will prepare for a shift to CAM integration.  However, not all HMOs have fully embraced the concept of routine reimbursement for Complementary and Alternative Medicine care, and that is a key concern in the future of integrative medicine (Cuellar, 2006).

(b)  In managed care, the healthy people pay for the treatment of the ill, and it is a risk for providers if the amount the group that paid for a certain contract was maximized by the patients in treating the case of pre-existing conditions such as cancer or other illnesses that require frequent doctors visits and expensive medications.  Because individuals with chronic illness or disability may also experience medical complications and need a variety of allied services such as home care, personal assistants, or consultation with medical specialists, costs can be further increased for these individuals (Falvo, 2008).  With this aspect of managed care, the need for specific approval by an MCO before the most effective medication for the treatment of a condition can be obtained is another downside.

Two suggestions I have for enhancing managed care for chronically ill clients are (a) ending the monopoly on the food supply while educating the public more about preventative care and also (b) as Hippocrates said, “Let food be our medicine and medicine be our food.”  In the name of modernization and conveniences we have either overlooked the importance of quality of our food (Charania, 2012).  Many conditions such as cancers, depression, ADD, anxiety, addiction, and many more are the result of a poor nutrition.

Society’s values influence provision and payment for health services in (a) what parents teach their children to do in the management of the health of themselves and (b) the labeling foods that are produced with genetically modified organisms (GMOs). Promoting abundant, organic foods will improve quality of life for everyone.   

Photo credit:  No GMO South Africa & Healthy Holistic Living



According to Jeremy Gernand of True Progress, our agricultural capacity to produce food, clothing, and shelter at the standards of the western world can accommodate nearly 12 billion people.  We are only 7 billion, and the only reason some must do without is the structural violence of them not having enough monies to pay for the goods.  It’s anti-economics and makes for poorer public health.





References

Charania, B (2012).  LET FOOD BE THY MEDICINE – Hippocrates.  Retrieved from http://www.drcharania.org/2012/01/food-thy-medicine-hippocrates/

Cuellar, N. (2006). Conversations in Complementary and Alternative Medicine: Insights and Perspectives from Leading Practitioners (1st ed). Jones & Bartlett Learning.

Falvo, D. (2008). Medical & Psychosocial Aspects of Chronic Illness and Disability (4th ed). Jones & Bartlett Learning.

Gernand, J. (February 4, 2011).  The Earth Can Feed, Clothe, and House 12 Billion People.  Retrieved from http://true-progress.com/the-earth-can-feed-clothe-and-house-12-billion-people-306.htm

Instructor's comments:


Thank you for your hard work in the discussion area this week. You mentioned many great points relating to the challenges of managed care. Great connection of managed care to Complementary and Alternative Medicine and the apprehension of physicians to fully endorse this. When we view this from the physicians perspectives is it really about physicians being uncomfortable with empowered patient or should we explore other reasons? You, however, presented a great argument and helped to see managed care from a different lens. This helped us to understand the various challenges presented by the system of managed care. You mentioned a great point relating to educating the public about healthy foods and preventive care. Education and preventive care are critical in reducing many chronic diseases. Great work!

Social Implications of Medical Issues Hepatitis C Research Paper

INFECTIOUS DISEASE

    Hepatitis C is an infectious disease of the liver.  The disease is transmitted through blood to blood contact, and besides IV drug use, which is the main cause, this can happen through sex when a woman is menstruating or anal sex and by using a shaving razor previously used by an infected person.  Individuals infected by the Hepatitis C virus (HCV) have nothing to fear from sex in a monogamous, heterosexual relationship.  Transmission of HCV from an infected partner during sex is rare according to new research published in the March issue of Hepatology, a journal published by Wiley on behalf of the American Association for the Study of Liver Diseases (AASLD) (Peters, 2013).  It was discovered in 1989, and, with so many cases contracted before then, Hepatitis C sometimes goes without diagnosis.  It was originally named Post-transfusion, non-A, non-B hepatitis (Sargent, 2009).  In 2013, the CDC can only estimate 4.4 million Americans living with it.  Most chronic carriers have no symptoms of HCV for the first 10 or 20 years of the infection.  As the infection progresses, chronic carriers may experience symptoms tiredness, itchy skin, dark urine, muscle soreness, nausea, loss of appetite, stomach pain, jaundice (a yellowing of the skin and whites of the eyes), as well as fluid retention, easy bruising, and personality changes.  These usually occur about two to six months after exposure.  About 20% of chronic carriers eventually develop liver cirrhosis (scarring).  Persons with cirrhosis from HCV are at a moderate risk for developing liver cancer (Virginia Department of Health, 2013).

THE DISEASE

    Many people were infected between the years of 1949 - 1982.  Approximately 90% of infections are attributable to injecting drug use (Health Protection Agency (HPA), 2011).  Some caught the virus by receiving blood transfusions before 1992 when widespread screening of the blood supply began.  That being said, not everyone who has the virus will be offered treatment.  People who have an unstable lifestyle or other life threatening illnesses are for the most part unsuccessful with the therapy.  Unwise consumption could even cause death in a person who does accept treatment on a lark that it could work but who does not stop drug and alcohol use.  The “flu-like” symptoms and mood changes, anxiety and depression coming with the treatment are dependant upon having a healthy self-esteem, but even accomplished people suffer immensely trying to tolerate treatment.

    Hepatitis C progresses with the sign of multiplying viruses in the blood stream, and consumption of drugs and alcohol increases virus multiplication.  You cannot contract Hepatitis C through drinking alcohol, but alcoholism too is known to cause cirrhosis of the liver, and studies also show that when people infected with the hepatitis C virus (HCV) stop drinking alcohol, levels of the virus decreases.  That is to say if you have been diagnosed with Hepatitis C, drinking alcohol adds to the strain on the liver, increasing the risk of damage to cells.  Therefore, HCV patients are advised to cease alcohol consumption (Jaret, 2009).


TREATMENT

    Minimizing the impact of Hepatitis C is really about surviving the side effects of treatment, which are on par with intensive chemotherapy.  One intervention is using botany such as green tea and even marijuana to alleviate the crippling symptoms which are extreme fatigue, loss of appetite, and nausea.  The thing about cannabis is that it is not legal in over half of the United States, but the FDA has approved its extract in a mouth spray form called Sativex for those who do not like smoke.  States in which it is allowed, cannabis is an antidote not only for the side effects, but cannabinoids halt VEGF (vascular endothelial growth) production by producing Ceramide.  Ceramide controls cell death (n.d., 2013).  More research is required before the plant can be approved to be used in its fullest potential.
   
    The U.S. Food and Drug Administration (FDA) has approved two drugs in the first new class of drugs for hepatitis C since 2001.  On May 13, 2011, the FDA approved boceprevir (Victrelis).  On May 23, they approved a second drug, telaprevir (Incivek) (hepatitis.va.gov, 2013).  These new drugs have a higher cure rate than Interferon and Riberfivin, but for some, a 3 drug combination may be best.  The new drugs come with their own set of side effects.  A plus is that for many patients, treatment time can be cut in half.  Depending on the strength of their immune system and also what other medicines the patient takes, it could be a combination of only two that are prescribed.  Sofosbuvir by Gilead is brad new, and it has been shown to cure up to 90% of patients in 12 weeks.  It's currently estimated that sofosbuvir will likely generate about $5 billion in revenue for Gilead based on just the currently expected approvals, but if it clears that 12-week hurdle (of a cure) that number could easily move closer to $7 billion as it would become the preferred hepatitis C treatment for most patients (Shepard, 2013).

    Accountability for and responsibility to keep others from being infected by you comes when you receive the diagnosis of Hepatitis C.  Psycho-social challenges when you are knowingly carrying the virus are like being too self-conscious or forgetting to tell people that may need to know about your being infected.  The Hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for at least 16 hours but no longer than 4 days (CDC, 2012).  Therefore, if you carry the virus and happen to bleed, you should immediately clean up after yourself.  This is how some doctors and nurses are becoming infected--by being stuck with bio-hazardous needles.

    Also, since being treated for Hepatitis is so strenuous, and since the disease takes ten to twenty years to show symptoms, patients must decide weather or not to even attempt to cure it.  If you contract the virus after you are forty years or more in age, the medicines that treat it could be more than your body can handle, so it’s best to try and live with it and just moderate one’s diet.  As the Chinese Proverb states, “He who takes medicine and neglects to diet wastes the skill of his doctors.” 

    Complementary and Alternative Medicine (CAM) practitioners might recommend a diet of fruits and vegetables along with dandelion, licorice, milk thistle, alfalfa, burdock root, and fennel which are all known to enhance and maintain good liver function.  Some studies, reported from outside the United States, have looked at glycyrrhizin, also known as licorice root extract, administered intravenously for hepatitis C.  Preliminary evidence from these studies suggests that glycyrrhizin may have beneficial effects against hepatitis C.  However, additional research is needed before reaching any conclusions (NCCAM, 2011).

    Before any serious move towards treating Hepatitis C is made, the doctors will most likely want to do a liver biopsy where a surgeon will remove a very small piece of liver tissue that is studied in the lab to determine the liver’s condition and the extent of damage.  A liver biopsy is a simple, outpatient procedure in which a small medical biopsy needle is being inserted into the liver to obtain the tissue sample.  Understanding the whole procedure and all the needed preparations is an advancement for the patient and of course with the family.  The patient will need to stop taking aspirin, ibuprofen and arthritis medications 3 days prior to the procedure and blood thinners 5 days prior to the procedure.  As with most surgeries, food is prohibited after midnight the day of the procedure.  The patient will be instructed to lay on their right side for up to 4 hours while the wound heels, and they will need someone to drive them home. 


SUPPORT

    The American Liver Foundation’s mission is to facilitate, advocate, and promote education, support, and research for the prevention, treatment, and cure of liver disease.  Rapidly rising health care costs, unforeseen occurrences in one’s personal life, and increasing responsibilities can lead to the need for financial assistance.  Financial needs for individuals with liver disease can vary from medication assistance to transportation assistance to transplant assistance.  The American Liver Foundation connect s individuals with liver disease to the financial assistance resources they may need (American Liver Foundation, n.d.).  The ALF also offers a help line on the telephone which can be reached by dialing 1-800-GO-LIVER.

    Caring Bridge is another lifeline for patients and families.  The American Liver Foundation partners with Caring Bridge to offer free, personal and private websites that connect people experiencing a significant health challenge to their family and friends, making each health journey easier.  Saving time and energy is one positive attribute that using Caring Bridge can bring.  In a 2010 study of patients using a Caring Bridge website to share health news, 91% of patients agreed that it helped make their health journey easier and 88% of patients agreed that it positively impacted their healing process (American Liver Foundation, 2011).

CONCLUSION

    If left untreated hepatitis C can lead to serious liver disease.  What this all means is that for HCV carriers, there should be a discernment of what the disease implies.  How to change one’s ingestion and behavior and weather or not to receive treatment are both personal decisions each Hepatitis patient must come to terms with for themselves.  The modifying life away from old, bad habits and the self-awareness to determine if the heavy treatment will work are interconnected actions and attributes.  Managed care organizations would potentially, before the recent activation of the Affordable Care Act that guarantees coverage for pre-existing conditions, refuse treatment on “behalf" of their clients.  A person has free will, and no doctors in America will force the treatment on anyone but there are patient advocates in the public health system.  We should examine ourself and be wise to what is in our best interest and the best interest of our family and loved ones. 







References:

American Liver Foundation (October 4, 2011).  CaringBridge.org: A Lifeline for Patients and Families.  Retrieved from http://www.liverfoundation.org/patients/caringbridge/

CDC DVH (2012).  Hepatitis C FAQs for the Public.  Retrieved from http://www.cdc.gov/hepatitis/C/cFAQ.htm

Health Protection Agency (2011).  Shooting Up: Infections Among Injecting Drug Users in the UK 2010. An update: November 2011. Health Protection Agency, London

Jaret, P. (December 18, 2009).  Alcohol and Hepatitis C.  Consumer Health Interactive.  Retrieved from http://cvscaremarkspecialtyrx.com/node/1086

NCCAM (March, 2011).  Hepatitis C and CAM:  What the Science Says.  Retrieved from http://nccam.nih.gov/health/providers/digest/hepatitisC-science.htm

n.d. (July 17, 2013).  There’s No Mistaking the Evidence, Cannabis Cures Cancer.  Retrieved from http://www.whydontyoutrythis.com/2013/07/there-is-no-mistaking-the-evidence-cannabis-cures-cancer.html

Peters, D. (March 19, 2013).  Sex between monogamous heterosexuals rarely source of hepatitis C infection.  Retrieved from http://www.eurekalert.org/pub_releases/2013-03/w-sbm031913.php

Sargent, S. (2009).  Liver Diseases An Essential Guide for Nurses and Health Care Professionals.  Wiley-Blackwell

Shepard, B. (November 4, 2013).  Gilead’s Race for a Cure.  Retrieved from http://www.investingdaily.com/18702/gileads-race-for-a-cure/

Virginia Department of Health (June, 2013).  Hepatitis C.  Retrieved from http://www.vdh.virginia.gov/epidemiology/factsheets/pdf/Hepatitis_C.pdf