⌚ Verbonia Case Study
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Inside timber, worm welcoming and natural is the main element. Tags: Italy , Verbania. Categories: Cultural Center , Theater. This entry was posted on Thursday, May 26th, at am. You can follow any responses to this entry through the RSS 2. You can leave a response , or trackback from your own site. This site uses Akismet to reduce spam. Learn how your comment data is processed. Sumit Singhal Sumit Singhal loves modern architecture. He comes from a family of builders who have built more than 20 projects in the last ten years near Delhi in India. After every severe storm, you should first do a visual inspection of your roof if possible. If there is even a slight chance. The building of Verbonia contributed to intelligene and physical strength. Due to designing Verbonia, the heavy materials used to create Verbonia, and crsftsmanship.
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He has used his ability to start his own services to work in the field. Many improvements have been done to standard code of practices since more than thirty years ago due to changes in design and development. Standard that have been improved have been. Introduction Vibration is an everyday activity that we meet on our life. Most engineering machines and structures face vibrations. Mechanical vibration is a measurement of a periodic action of oscillations with respect to an equilibrium point.
All bodies possessing mass and elasticity have the ability to vibrate. Vibration can be categorized into two types such as free vibration and force vibration. A vibrating system that occurs naturally without energy added to the system. The vibration is started. Research question : Is the use of methods involving both hard engineering and soft engineering helpful for the coastal defence management in holderness? Hypothesis: Rock armour is one of the most common and suitable method of coastal defences at Holderness. However, since the perceived costs of the dysfunctional habit may not yet outweigh its benefits, frequently people show ambivalence about whether the problematic behavior really needs to be changed Pietrabissa et al.
Assisting individuals to work through their ambivalence about behavioral change, MI appears to be particularly effective for those who are initially resistant to change Rollnick and Miller, ; Butler et al. It has been found effective in fostering change across a wide range of conditions and settings Burke et al. MI counselors rarely attempt to convince or persuade clients, but use a non-judgmental and encouraging climate making them feel comfortable, then verbally expressing both the positive and negative aspects of their current, dysfunctional behavior Shinitzky and Kub, Critical component of MI are specific techniques and strategies such as reflective listening and open ended-questions which, while reinforcing the therapeutic bond, allow patients to define goals in their own words.
The technical hypothesis of MI posits that therapist-implemented MI skills are related to clients speech regarding behavior change and that patients speech predicts client outcomes Resnicow and McMaster, Thus, change talk such as expressed desire, ability, reasons for, and need to change is selectively emphasized. The professional, specialist in BST, completed the training in MI in March , providing the intervention during May of the same year. Treatment fidelity was monitored by a psychiatrist certified in MI Martino et al. Sessions were audio recorded and transcribed verbatim to ensure the MI techniques being adherent to the model and to allow the therapist to reflect on and prepare for the next session.
The patient, Giorgio the name has been changed , was admitted to the 1-months CR program with complaints of shortness of breath and everyday life difficulties due to him being significantly overweight. He is a 39 years-old man, resident in the south of Italy. Height 1. With an initial BMI of Giorgio was diagnosed with dilated cardiomyopathy, a serious condition in which the heart muscle becomes weakened, therefore unable to satisfy peripheral requirements.
He also has a prosthetic heart valve. Several studies have reported that the 6MWT is a reliable measure of increased mortality among cardiac patients, with the distance of less than m being a strong indicator of poor prognosis Daullxhiu et al. The results of h Holter monitoring also revealed ventricular extrasystoles and the sleep study confirmed the presence of sleep apneas , a disorder characterized by pauses in breathing during sleep. The relation between sleep apneas and heart failure is two-way in many cases, further increasing the risk of medical complications.
On admission to hospital, the mean of the first 3 days measuring of systolic blood pressure was Giorgio has had three previous admissions to this cardiac unit, in , , and , respectively. His weight at last discharge was A few months after discharge he started to progressively spend more time at home, abandoning both the commitments of the gym and the diet. He never stopped smoking. Giorgio is married and has three children aged 6, 12, and While his wife spends all day at work, Giorgio, due to his complex medical condition, is currently unemployed and looks after their children in a full time capacity.
This case presents a number of common themes in the management of care for challenged heart patients. Giorgio had multiple readmissions for heart failure, each time getting more frustrated and discouraged with himself. He could verbalize proper self-care behaviors and yet was unable to prevent further relapses. According to MI, this incongruity can be explained as ambivalence, which represents a normal part of the process of change Rollnick and Heather, Ambivalence is simultaneously wanting and not wanting something, or wanting both of two incompatible things.
Giorgio is perfectly aware that he ought to quit smoking, exercise regularly and stay on the diet, but other motives conflict with doing the right thing Miller and Rollnick, Believing that Giorgio was not determined or compliant to succeed, healthcare providers emphasized the negative aspects of his poor self-care behavior, explained to him why change is important and advised the patient about the necessity to comply with their advice once again. Moreover, the reward that Giorgio derives from not changing his problematic life-style have not been taken into account. The role of effective healthcare providers must then include an understanding of the interpersonal skills that can be used to allow patients to discover their own reasons for change and to motivate them moving toward optimal health.
A psychotherapist trained in MI met Giorgio for the first session in the clinic. In , during the previous hospitalization, the patient received psychological support from the same professional. No motivational intervention was provided at that time. After a brief assessment of what happened since the last discharge, the therapist focused on investigating the reasons that had led him to seek re-admission. Justified by the fact of taking care of the younger son, he claimed that he had been unable to maintain the diet longer than a month. Also, he had drastically reduced the exits to the point of socially isolating himself. Lack of physical activity and poor diet had led him to progressive weight gain and experiencing significant daily life difficulties.
Giorgio was perfectly aware that his behavior was counter-productive for his health status, but he stated he simply could not do otherwise. Reflectively listening, the therapist started focusing on engaging the patient, building interest in change, and eliciting willingness to implement self-care behaviors. And I have to change. Two years ago he was 4, and he could not understand what was going on … he did not comprehend that I was not feeling well. It really bothers me. You are worried at being unable to look after him. Apart from his own health status, his main motivation for changing were his wife and three children. The therapist proceeded clarifying, together with the patient, what to focus on within an ongoing process of change agenda mapping technique.
However, losing weight entails both changing diet and enhancing physical activity. Among these, which is your priority? To change eating habits! During the previous hospitalizations I suppose you have received proper nutritional education. What has made it hard to change? Then I got lost I do not know why. On the other side , failing to obtain results in losing weight despite your efforts, have made you upset, and feel like giving up! By the use of double-sided reflection the professional captured both sides of the ambivalence. In fact, when people talk about change themselves, they are more likely to reach their goal than if someone else such as the clinician, a friend or relative talks about it Pascal, In this way, change talk is self-evocative.
Inviting Giorgio to voice his own arguments for health behavior change the therapeutic aim is to move him along the process of change Rollnick et al. The encounter proceeded investigating both the advantages and the disadvantages of the problematic situation. The patients showed resistance and avoided answering. Not to worry about your diet What advantages are there in behaving this way? There must be a reason Must be some motives that lead you to act in this way.
What do you think? On a scale from 1 to 10, he always rated the maximum score. He expressed anger against himself, as well as the clear intention not to seek a new re-hospitalization in the future. Summarizing, session one focused on building a therapeutic relationship. Also readiness, importance and confidence about change were assessed. After a week, the psychotherapist visited Giorgio for the second time. The professional started investigating the course of his daily activities within the hospital, the results of his medical examinations, as well as his state of mind. After a psychiatric consultation he stated that he had to take a pill for his mood, with no beneficial effect. Thus, the expert asked Giorgio what were his thoughts about the matter, positively restructuring the lack of need of the psychopharmacological therapy, then reinforcing his personal resources.
The professional also evaluated his understanding of the possibility to discuss the therapy with his cardiologist. The encounter proceeded exploring any additional worries of the patient. Despite presenting realistic concerns in mind regarding his health status, he expressed sincere need for well-being and clear goals. I give myself a year and a half … I do not believe it would be enough time to get to the point I would like to reach. While during the previous encounter the patient was asked to think about the worst consequences of his status quo, the therapist carried on inviting Giorgio to imagine the best things that could result from changing, as well as to imagine a changed future looking forward technique.
Before asking for admission to the hospital, he stated that it was hard for him to climb a flight of stairs as well as help his wife to go food shopping and, especially, to maintain regular sexual intercourse. He became aware of the level of seriousness of his situation about a month before, and declared himself determined of changing his dysfunctional habits. Actively listening and summarizing key points back to the patient, the provider displays genuine interest in what has been said and led Giorgio to reflect about the possibility that his smoking habit could threaten the achievement of his intent. Therefore, instead of going to the bar I go to the gazebo, I sit for an hour outside, I smoke a cigarette … then I go back to the room again The patients seemed to underestimate the importance of quitting smoking, appearing unaware or potentially resistant to change.
Despite the strong motivation shown in regulating his eating habits, it looked like smoking for him was an excuse to avoid walking even only for very short distances. Thus, she opted for suggesting him some strategic behavioral expedients according to the brief strategic model. On one hand these were aimed at helping the specialist identifying the presence of any resistance in the patient and, whether successfully executed, to break the vicious circle that maintain the problem. You are perfectly aware of what is good or bad for your health, and you do not need to hear me say that you should quit smoking. So, when you feel the need for a cigarette, I believe you have two choices: you can simply go, or you can wait for half an hour and, if after having waited for 30 min you still desire to smoke a cigarette, just go!
I may be wrong, but I believe that if I tell you not to smoke, as I imagine everybody does, I would make it even more desirable for you … What do you think? Can it be an acceptable option? You do not necessarily have to reach the point … just check every day the distance that separates you from the goal, then get back! Did you try to put into practice the advice I gave you last time?
Investigating the effects of the prescriptions given to the patient, the professional supported the successes he achieved. In fact, the therapeutic goal was to break the rigid belief of the patient, his sense of inability. Giorgio experienced his abilities and resources and, according to the strategy logic, this will lead to a gradual change in his way of perceiving and reacting to his reality. In fact, for the first time, he felt the need to completely open up to the therapist, revealing the real and intimate reason that has led him to stop taking care of himself. Giorgio had never verbally expressed it before, with an obvious liberating effect. The largest use of reflective listening allowed the therapist to let the patient run the meeting within an evocative process.
During the encounter, potential barriers to maintaining behavior change were also elucidated, and the MI principles explored during the previous encounters further reinforced. At the end of the session Giorgio showed large sense of control on hidden difficulties and, by extension, of his life. During the hospitalization he has lost weight and started exercising regularly again, with both physical and psychological benefits. He made an experience of his abilities, also taking responsibility for the achieved successes.
Commitment to change was expressed, by displaying motivation and a plan to alter his behavior within the coming months. This scenario represents an example of how MI principles and techniques can be strategically and flexibly used in the clinical setting to help patients moving toward the complex continuum of change. Specifically, MI intervention may be helpful for a person suffering from chronic condition at risk for readmission or for a newly diagnosed and overwhelmed patient, as Giorgio was. In fact, although demonstrating knowledge of self-care behaviors, this did not correlate with the action. He has been able to verbalize the reason that had led him to progressive social isolation and lack of interest in both following the diet and maintaining physical activity, he has also successfully acquired skills to practically manage daily-life difficulties and temptations.
Believing that Giorgio Verbonia Case Study not Verbonia Case Study or compliant to succeed, healthcare Verbonia Case Study emphasized Verbonia Case Study negative Verbonia Case Study of his Verbonia Case Study self-care Verbonia Case Study, explained to him why change is important and advised the patient Verbonia Case Study the necessity to comply with their advice once Verbonia Case Study. Poor diet, physical Chartists Dbq and smoking Verbonia Case Study remain especially important behaviors Texas Climate address Ignarro et al. The patients seemed to underestimate the Verbonia Case Study of quitting smoking, appearing unaware or Global Stratification Sociology resistant Verbonia Case Study change. Yet there Verbonia Case Study one piece Verbonia Case Study technology that Gunpowder Technology to be Sugar Tax Argument Analysis Continue Reading.