Effects of Teen Marijuana Use Essay

According to a 2012 Monitoring the Future study, marijuana is the illicit drug most likely to be used by teens (Maine Integrated Youth Health Survey). Marijuana comes from the plant Cannabis Sativa and appears as a green/brown mix of flowers, stems, and leaves (Teens Health 1). Marijuana is also known as pot, weed, MJ, Mary Jane, reefer, dope, ganja, herb, and grass. Marijuana is most often smoked in cigarettes, hollowed-out cigars, pipes, or water pipes, but is sometimes mixed into food or tea (1). Why are there concerns about teen use of marijuana? During adolescence, many developmental changes are occurring and poor choices could affect a teen’s future (University of Washington ADAI). As a result of teen marijuana use, teens engage in problematic behavior, neglect their education, and risk their health. Problematic behavior remains an effect of teen marijuana use. â€Å"A 2008 longitudinal study of heavy cannabis users from ages 14 to 25 in a New Zealand birth cohort found that increasing cannabis use in late adolescence and early adulthood is associated with a range of adverse outcomes in later life† (University of Washington ADAI). Ashbridge found that there is an increased risk of driving, a doubled risk of being in an accident, under the influence of marijuana (qtd. In U of W ADAI). Driving while under the influence of marijuana risks not only the user’s life, but also the lives of others. An accident caused by a driver under the influence of marijuana could potentially ruin many lives, and could easily be prevented with smart behavior. Marijuana affects ones concentration, perception, coordination, and reaction time; all skills needed for safe driving (courtinfo.ca.gov). Data has shown people who drive under the influence of marijuana show the same lack of coordination as those who drive under the influence of alcohol (courtinfo.ca.gov). Driving under the influence of marijuana is a problematic behavior because it affects many of the skills necessary for safe driving. Criminal behavior is also seen in association with teen marijuana use. In order to pay for drug use, teens engage in criminal  behavior, motor vehicle theft, and breaking-and-entering offenses (University of Washington ADAI). Teen Marijuana users need money to pay for drug use, and in order to obtain money, teens engage in problematic behaviors. There are also legal aspects when selling, using, or possessing marijuana, involving fines, jail time, and possibly a criminal record (Teens Health 2). Teen marijuana users’ problematic behaviors involving the law can lead to consequences, sometimes with the potential to damage the teen’s future. Laws against growing, possessing, and selling marijuana exist in all states but Washington and Colorado (2). Over 7.2 million Americans have been arrested on marijuana charges since 1990, many of which were teenagers (NORML). Marijuana association damages the lives of many teens who get caught engaging in marijuana associated problematic behaviors. The problematic behaviors associated with teen marijuana use can potentially damage not only a teen’s future, but also society. In addition to the problematic behaviors that arise from teen marijuana use, problems with neglected education also arise from teen marijuana use. Marijuana causes a lack of motivation in teens, causing them to look at school as unimportant, to not care about what happens in their lives, and to lack concern about their futures (Town of Barrington). Teen marijuana use causes teens to disengage from reality; teens live in their own fairy tale land where they don’t need anything but marijuana, and the future does not exist. This fairy tale has nothing to do with school, causing teens to neglect important years of education, potentially damaging their futures. Teen marijuana use is directly associated with poorer school performance, increased absences from school, and increased risk of dropping out without graduating (University of Washington ADAI). The disengagement from school teen marijuana users experience, causes problems for teens because they neglect their educational privileges. A study on success in school related to marijuana use showed that students who used marijuana had poorer school success than those who did not use marijuana (Finn 3). Teens who use marijuana neglect their education, causing poorer results in school. Students who used marijuana had lower grades, lower classroom participation, worse attendance, more academic dishonesty, and were disciplined more often than students who did not use marijuana (Finn 3). Teens who use marijuana,  and neglect their education, can face many educational hardships as a result. Teens who use marijuana are often alienated or disgraced by their peers, causing them to disengage from school and other activities (OJJDP). Disengagement in, or quitting of, school or school activities, deprives peers, schools, teams, and communities of positive contributions a teen may have made if they did not use marijuana. Neglected education associated with teen marijuana use can potentially damage a teen’s future and can potentially deprive peers and activities of positive contributions a teen marijuana user may have otherwise made. Although teen marijuana use can cause neglect of education, teen marijuana use can, more importantly, risk a teen’s health. Teens who smoke marijuana can experience minor health problems and major health problems. Respiratory problems caused by smoking marijuana such as phlegm, chronic cough, and bronchitis can be viewed as minor problems (Teens Health 2). Another minor problem caused by smoking marijuana is decreased blood pressure, which can cause dizziness (2). Smoking marijuana has minor effects on the body that risk a teen’s health because they can turn into larger problems or can just simply damage a teen’s growing body. One major problem caused by smoking marijuana is the impairment of the body’s ability to defend against infections and diseases (2). Another major problem caused by smoking marijuana is abnormal functioning of lung tissue, ultimately injuring or destroying the lung tissue (Town of Barrington). Smoking marijuana can cause permanent damage to the body; this damage becomes a bigger risk for a teen’s health because a teen’s body is still developing. Some of the major problems can even risk a teen’s life, shortening the life they could have had if they did not smoke marijuana. The last major problem caused by smoking marijuana is the cancer causing chemicals that come from smoking it (SAMHA). Teen marijuana smokers’ risk of developing lung cancer is increased because, in order to maximize their high, they inhale deeply and hold the marijuana smoke in their lungs. (SAMAHA). Teen marijuana smoking can risk a teen’s health because marijuana smoke contains cancer causing chemicals, which could potentially lead to a teen acquiring cancer early, or later in life. Teen marijuana use can risk a teen’s health, potentially damaging their bodies forever. As a result of teen marijuana use, teens engage in problematic behavior, neglect their education, and risk their health. Teens who are associated with marijuana, and participate in illegal activities, could potentially damage their future with criminal records. Teens who drive while under the influence of marijuana risk not only their own lives, but also the lives of others, potentially damaging their futures with criminal records. Teens who neglect their education because of association to marijuana could lose opportunities they would have otherwise had, potentially damaging their future. Teens who smoke marijuana risk their health, both in minor ways and major ways, potentially damaging their bodies forever. Is teen marijuana use really worth risking the bright futures of these teens? Works Cited â€Å"Adolescents and Marijuana.† University of Washington ADAI. University of Washington, June. 2013. Web. 16 April 2014. â€Å"Consequences of youth substance abuse.† OJJDP. USA.gov, May. 1998. Web. 16 April 2014. Finn, Kristin V. â€Å"Marijuana Use at School and Achievement-Linked Behavior.† The High School Journal 95.3 (2012): 3-13. Project Muse. Web. 16 April 2014. Maine Integrated Youth Health Survey. â€Å"Your Teen & Marijuana.† SAMHA. Maine.gov. 2011. Web. 16 April 2014. â€Å"Marijuana.† TeensHealth. The Nemours Foundation, April. 2009. Web. 16 April 2014. â€Å"Scary Stats.† courtinfo.ca.gov. Administrative Office of the Courts, n.d. Web. 16 April 2014. â€Å"Teen Marijuana Use.† Town of Barrington. Rhode Island, n.d. Web. 16 April 2014. â€Å"Your Government Is Lying To You (Again) About Marijuana.† NORML. NORML Foundation, n.d. Web. 16 April 2014.

Anthropologie Culturelle Essays - Jewish Culture, Hebrew Calendar

Anthropologie Culturelle Essays - Jewish Culture, Hebrew Calendar Anthropologie Culturelle Les Amish : une communaut? hors du temps I) LES ORIGINES DES AMISH On trouve les racines des Amish dans la communaut? des Mennonites. Les deux appartiennent au mouvement des Anabaptistes qui remonte ? lpoque de la R?forme. Les Anabaptistes croyaient que seuls les adultes devaient ?tre baptis?s car ils avaient conscience de leur acte et qu?ils devaient rester en marge de la soci?t?. Beaucoup d?Anabaptistes furent extermin?s, consid?r?s comme h?r?tiques par les Catholiques comme les Protestants et beaucoup all?rent se r?fugier dans les montagnes suisses et au sud de l?Allemagne. C?est dans ce contexte qu?appara?t le mouvement Amish : les pers?cutions continu?rent jusqu?au XVIII? si?cle et entre 1693 et 1697 une partie de lglise Mennonite suisse (les Fr?res Suisses) se s?para du reste de la Communaut? pour former le mouvement Amish. Cette communaut? souhaitait pr?server la discipline biblique au sein de la communaut?. A partir de 1663, une partie ?migra aux Etats-Unis pour ?chapper au militarisme europ?en et pr?server la foi des anc?tres! dans un pays neuf aux perspectives ?conomiques attrayantes : ils stablirent au nord des Etats-Unis, en Pennsylvanie, et se lanc?rent dans l?agriculture avec succ?s. 1. Quelle est la valeur symbolique du schisme Amish ? En 1693 un ?v?que suisse du nom de Jacob Amman se s?pare des Fr?res Suisses Mennonites : ses successeurs ont ?t? baptis?s les Amish. Bien que les deux communaut?s se soient s?par?es, elles partagent de nombreux points communs : elles ont les m?mes croyances en ce qui concerne le bapt?me, la non violence et les doctrines bibliques fondamentales. Cependant elles diff?rent en mati?re de v?tements, de technologie, de langue, de fa?on de travailler et d?interpr?tation de la Bible. D?apr?s l?historien Eli Gingerich, dans ses ?crits de 1978, il y a sept domaines au centre de la controverse entre les Mennonites Suisses et les Amish qui ont pouss? au schisme entre 1693 et 1697 : ? la communion deux fois par an ? l?habitude de laver les pieds d?autrui comme rite religieux ? le fait d?isoler et dviter un membre de la communaut? excommuni? ou puni ? s?en tenir ? une discipline communautaire tr?s stricte ? die Treuherzigen : le probl?me de savoir si oui ou non les ? justes ? ?taient prot?g?s ? les codes vestimentaires ? les codes concernant la coiffure Gingerich explique plus loin que ? ni l?un ni l?autre des deux parties ne voulait c?der. Chacune ?tait d?termin?e. Aucune ne voulait admettre la possibilit? de se tromper ou dchouer. Il s?est av?r? qu?il ?tait impossible de communiquer pour mieux comprendre l?autre partie. Les deux Eglises ne se sont jamais retrouv?es. ? En fait ces sept domaines ou points de dispute ne suffisent pas d?apr?s d?autres auteurs ? expliquer le schisme : il y avait d?j? au sein de l?Eglise Mennonite Suisse une litt?rature ? proto-Amish ? identifi?e comme telle par Nikolaus W?thrich en 1807 et par Christian Plank qui faisait partie du cercle d?intimes de Jacob Ammann mais avait quitt? le groupe Amish. En fait ces auteurs d?montrent qu?il faut remonter ? Simon Menno, le fondateur du mouvement Mennonite pour expliquer la controverse sur deux points fondamentaux pr?c?demment cit?s : l?isolement d?un excommuni? ou d?un puni et les Treuherzigen. ? L?isolement physique : d?apr?s W?thrich , il est impossible de consid?rer l?isolement physique que pratiquent les Amish et que contestaient les Mennonites comme ?tant fond? du point de vue biblique par l?ap?tre Paul. Tout remonte donc ? Menno lui-m?me. Gingerich explique ainsi que cet isolement physique date en fait de 1555 : Leenaert Bouwens a ?tabli cet isolement pour punir les personnes nocives au reste de la communaut?. Cet isolement se fait entre toutes les cat?gories de personnes : les enfants sont s?par?s de leurs parents, les ?pouses de leur mari ... Cependant cette mesure fut contest?e par une femme qui refusait dtre s?par?e de son mari : en cons?quence, Menno lui-m?me lutta contre cette s?v?rit?. En 1693 lorsque Jakob Ammann essaya de r?introduire l?isolement physique dans la communaut? suisse Mennonite, il re?ut l?appui des plus traditionalistes et conservateurs qui favoris?rent le schisme. ? Les Treuherzigen : c?est le deuxi?me point important de la controverse Mennonites/Amish. Litt?ralement les Treuherzigen sont ceux dont le coeur est fiable, fid?le ou loyal. Ils sont parfois appel?s les Anabaptistes partiels. En fait ce sont ceux qui

Whenever vs. When Ever

Whenever vs. When Ever Whenever vs. When Ever Whenever vs. When Ever By Maeve Maddox It’s interesting that two-word phrases like â€Å"any place,† â€Å"a lot,† and â€Å"all right† are often squeezed into nonstandard one-word forms like anyplace, alot, and alright, but one-word wherever is often written incorrectly as â€Å"when ever.† As a relative conjunction introducing a conditional clause, whenever means â€Å"at whatever time, no matter when.† Here are some examples in which whenever is used correctly: Whenever you find yourself on the side of the majority, it is time to pause and reflect.- Mark Twain Some cause happiness wherever they go; others whenever they go.- Oscar Wilde. Whenever I turn on my computer, the screen says â€Å"Monitor going to sleep.† Here are examples of whenever incorrectly written as two words: Incorrect: Journalists are like dogs, when ever anything moves they begin to bark. Correct : Journalists are like dogs, whenever anything moves they begin to bark. Incorrect: She smiles at me when ever I see her. Correct : She smiles at me whenever I see her. Incorrect: The computer crashes when ever I try to game. Correct : The computer crashes whenever I try to game. The words when and ever are written separately when the sense is â€Å"when, if ever?† Here are some examples of when ever used correctly: When ever will you  get over your fear of cats? When ever will you  have this chance again?   When ever will they learn  to not put stuff up there? When  ever  did these feelings start?   When ever are you going to clean the house? When, Ever, Is a Murderer Anything but a Murderer? If your intended meaning is â€Å"every time that,† write whenever. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Misused Words category, check our popular posts, or choose a related post below:Regarding Re:8 Types of Parenthetical Phrases10 Tips for Clean, Clear Writing

About marketing Essay Example | Topics and Well Written Essays - 750 words

About marketing - Essay Example These strategies were part of â€Å"The way forward† an initiative that the CEO adopted to make the company profitable. Ford Company recognized that each of its market segments has unique needs. In this regard, the company introduced new and stronger brands such new Fusion auto. In order to make the new brand attain stronger customer awareness, the company emulated Fusion studio, a promotional campaign that was focused at female customers who highly valued the brand. During the promotion, women were offered free beauty services, music as well as fitness training (Magee and Ford 47). Another strong brand that Ford introduced in the market was the Ford Fiesta. Even though the company brands are focused at meeting the needs of various market segments, Ford Fiesta is a unique model that is accepted in all the market segments. The shift from luxury market in Europe to an emerging market in Asia is another tactic that Ford has adopted to excel in the global market. This has resulted to high demand for Ford models in China and Asia leading to expansion of operations in the two countries. In addition to the introduction of electric vehicles, Ford has continued to emulate effective pricing techniques for its products making it to offer stiff competition to its main rival, Toyota Motor Corporation. Trek Bicycle adopts various market segmentation variables to retain the loyalty of its customers. One of the major variables is lifestyle and behavior. The company realizes that consumers who like to ride in city streets behave differently from those who value mountain riding. In the same way, while some of its customers like a smooth ride, others prefer to experience rough terrains while riding. In this regard, the company focuses at retaining its city riders by selling to them electric motors and pedal-power bikes. Similarly, Trek offers full-suspension model to consumers who value comfort while those who like to feel the terrain are offered with hard-tails. Gender

The Need to Establish a Film Industry in Sierra Leone Term Paper

The Need to Establish a Film Industry in Sierra Leone - Term Paper Example Further, schools and colleges were encouraged to join the industry through events such as National Art Festivals. However, all these were dropped at some point. The film has been dragging along without proper regulation and no empowerment at all. Consequently, local Sierra Leoneans can now only produce poor quality films which cannot make it to the international platforms. No wonder, only foreign films shot in Sierra Leone make it to the international level. However, it is worth noting that the spirit to revive the industry is alive. What needs to be done is to set up necessary mechanism such as film schools to empower the industry into producing quality products. Rationale For many in the West, Sierra Leone remains the land of blood diamonds and drugged-up child soldiers, even though the country has been at peace for almost a decade. The film â€Å"Blood Diamond† was the one that installed the image for many overseas. At a time when Sierra Leone was desperately looking to reb rand itself, the film scared off tourists and drove away investors. Now, we will aim to erase that image with the establishment of the new film school. The President of Sierra Leone stressed that the film industry will tell a new story of peace, democracy, humanity, and determined to progress in many areas of human endeavors. Sierra Leone’s first ever film and acting school, IDF Film School, will be established by the Director of Institut de Francais, Ahmed K. Mansaray who also doubles as a movie executive producer and director.

Black world study reflection paper, based on reading and viewing Essay - 1

Black world study reflection paper, based on reading and viewing materials - Essay Example In the early 60s, stereotyping was rife in United States whereby people from certain races were subjected to discrimination. In a bid to oppose the treatment, many resorted to art using music and other forms. With time, the Americans recognized very race courtesy of art demonstrated by many artists. For this reason, it is appropriate to agree that â€Å"dance, poetry, music can bring difference in this country and in this world† (Brown, p.2). To cement this point, various movies have been released where the oppression in many Islamic countries happen. As a result, some countries like Qatar have lately been viewed as civilized due to its approach to various issues. Additional, singer Elton John, a renowned gay activist has transformed the way same-sex marriages are viewed through music. As a result, same-sex marriages have been legalized and the couples are treated the same as heterosexuals. From the case materials, the story of Primus proves beyond reasonable doubt the power of art. Even though stereotypes still exists in today’s society, it is appropriate to state that much of the change that has been witness is due to art. For instance, in the case of Primus, the owner at the Cafà © society judged her as per her appearance. However, upon insisting for a chance, Primus, â€Å"danced with such skill and enthusiasm at her audition that she earned a coveted slot as a Cafà © Society entertainer† (p.13). From the above explanation, it is clear that afterwards, the perception towards Primus change thanks to art. It is for this reasons that emphasis is made on the power of art. Indeed, it has the capability to change the society but only when given a chance. Racism issues in United States were rampant but one of the people who actively participated in its end was primus. Interestingly, to do this, ‘she waged her artistic and political fight for

Relevance of Psychology in Primary Health Care Delivery

Relevance of Psychology in Primary Health Care Delivery Critically discuss how an understanding of psychology can enhance the delivery of primary health care. (District Nursing) Essay The concept of psychology as relevant to district nursing and the primary healthcare team can be examined on a number of different levels. An understanding of psychology is clearly important to the nurse when she interprets a patient’s reaction to events in their personal illness trajectory. (Yura H et al. 1998). It is equally important as she considers her professional approach to the patient and the understanding of how a patient will react to the delivery and impact of healthcare, particularly in her considerations of how to achieve maximum patient compliance in any given therapeutic regimen. (Dean A. 2002).There are other, arguably less immediately obvious, ramifications of the impact of psychological implications in the delivery of primary health care when one considers the interactions and dynamics of the primary healthcare team and the interplay between various members of the team. In this essay we shall consider all of these implications. We start with the general plan that the topic of psychology in this context is potentially vast and for this reason we shall consider individual illustrative episodes in some detail in order to demonstrate an overall understanding of the area. The perception of any given situation and indeed, the evaluation of the probabilities that arise from it, are generally dependent on its presentation. This in turn gives rise to differences and variations in the number and scope of the possible outcomes from that situation. This is the so called Theory of Rational Choice (De Martino B et al. 2006). The perception of a situation is dependent on its â€Å"framing†. It therefore follows that the outcome is also dependent on the same concept of framing of the presentation. This has great relevance to our question, as the District Nurse can make decisions that are influenced by the â€Å"framing† of the presentation by the patient, but more significantly, she can seek to modify the decisions that a patient ultimately makes by framing her presentation of the situation in a number of different ways. There is a substantial evidence base in the literature which cites examples of how decisions can be changed or even reversed if t hey are presented with different emphasis on different factors in the presentation (van Osch S M C et al. 2006). A full consideration of the implications of this statement will suggest that these psychological concepts will have a direct bearing on other professional considerations such as autonomy and other ethical issues. (Hendrick, J. 2000). How can a patient be considered to be making a truly autonomous decision if that decision is being influenced by the abilities of a nurse to â€Å"frame† the presentation of the relevant factors in order to suggest that one outcome is better than another? (Green J et al. 1998). How can a patient be considered to be â€Å"empowered and educated† about a course of treatment if the nurse has been selective in the way that treatment has been explained to the patient? (Sugarman J Sulmasy 2001). We do not presume to suggest that such concepts are necessarily wrong. It may be entirely reasonable for a nurse to use her professional skill and judgement to suggest to a patient that one particular course of action is preferable to another by framing the presentation in such a way that the patient is guided towards a certain decision. In a commonly experienced clinical situation such as a frightened patient with an extensive skin wound to the leg which clearly requires suturing and who is saying that they don‘t want anything to be done, we could probably all agree that it would be quite appropriate for a nurse to suggest that the procedure of suturing is not very painful and will give a good cosmetic result whereas to leave the wound open will give rise to infection and other difficulties. From an analytical viewpoint, this approach could be viewed as detracting from the patient’s autonomy and ability to make their own valid consent. (Gillon. R. 1997). A pragmatist mi ght equally suggest that the nurse is employing valid psychological principles in her professional desire to achieve what is probably the best outcome for the patient (Coulter A. 2002) One of the major areas that we shall consider in this appreciation of the significance of psychology in the delivery of healthcare, is that of attitude of those delivering the particular intervention to the patients concerned. This area is examined in commendable detail by the paper by Johansson (K et al. 2002) which specifically considered the effectiveness of the delivery of alcohol awareness programmes in a group of problem drinkers. The reason that we have selected this paper for an initial consideration is that, unusually for a research paper, it does not simply consider the efficacy of a particular healthcare package, but it reviews and critically analyses the attitudes of the healthcare professionals on the overall outcomes with specific focus on their readiness to participate in such a venture. This is seminal to the major thrust of this essay and therefore merits a detailed examination. In essence, the entry cohort to this study was a collection of about 150 primary healthcare team workers who could potentially be involved in the delivery of an alcohol awareness programme. Each was asked to fill in a questionnaire which was designed to evaluate a personal profile of the respondent and covered areas such as: experiences with patients with alcohol-related health problems, knowledge and perceived capacity concerning early identification and intervention, attitudes towards the role of primary care staff in early identification and intervention and current intervention methods in use at the health centre. The results are interesting insofar as there was general agreement that the likelihood of a patient generating or triggering an enquiry into their alcohol usage was most likely to be when issues relating to the alcohol-related health-risks were perceived by the healthcare professionals. The relevance of the psychological aspects of such an enquiry became clear when it was found that nurses were more likely to enquire than the doctors in the sample and that on average, nurses tended to drink less alcohol than doctors. (Dihn-Zarr, T et al. 1999) Those who drank the least were more likely to be concerned about the health risks than those who drank more. Clearly the effects of alcohol in any individual patient are specific, but the willingness of a healthcare professional to instigate healthcare measures to minimise the health-related effects of alcohol appears to be dependent on their own attitudes towards alcohol and this may be reflected in their own levels of consumption. There is an old adage that the definition of an alcoholic is a patient who drinks more than their doctor. (Fleming, M et al. 1999). In the light of this study, this comment may not be as flippant as it initially appears. In alcohol-related problems, there is frequently an element of denial, both in terms of alcohol intake and its effects. (Herbert, C et al. 1997). If the healthcare professional involved has a degree of denial of their own intake, clearly this will have repercussions on their presentation of the problem to the patient and their subsequent evaluation and willingness to invoke therapeutic or interventional measures for that patient. (Kaner, E. F. S et al. 1999) Other significant factors that contributed to the likelihood of a healthcare professional instigating therapeutic measures were found to be their individual perception of their own degree of knowledge on the subject, both in terms of the effects of alcohol on the body and also in terms of the interventions that were available. (Aalto, M. et al. 2001) Many nurses expressed the fact that they were concerned that patients might react negatively to such enquiries and that this would affect the degree of patient empathy. Doctors appeared to be generally more confident about handling the possibility of a negative reaction. The same study pointed to the fact that it appears that such fears were unfounded in reality, as the same proportion of patients reacted in a negative way in both groups. >From this brief overview, it can be seen that psychology plays a role at many different levels in what is basically a fairly straightforward healthcare professional / patient interchange, and the attitudes of both patient and healthcare professional can have a profound impact on the eventual outcome of the care package for the individual patient. The paper itself makes the comment that: Nurses appear to be an unexploited resource, in need of training and support. Nurses may need to be convinced that an active role does not interfere with the nurse–patient relationship. Building teams of GPs and nurses in primary care might enhance the dissemination of alcohol prevention into regular practice. A further psychological input that is relevant in this area is the perception of the healthcare professional of just how effective the intervention that is proposed is likely to be. A previous paper on the same subject (Andrà ©asson S et al. 2000), concluded that healthcare professionals were much more likely to recommend a healthcare intervention that they had personally experienced or witnessed as successful, with greater frequency than one which had been shown to have a secure evidence base in published literature. The paper concludes with the suggestion that specific training in the subject needs to be implemented and this training not only needs to address the knowledge gap that has been identified, but also the belief systems and attitudes of the healthcare professionals in the primary healthcare team in order that it can reach its maximum potential. Although this paper was targeted and written in relation to a specific alcohol related intervention, it is reasonable to assume that the selected comments cited in this essay are sufficiently general to apply to most specific health related interventions and we will consider and explore other psychological rationales in specific relation to Health Promotion initiatives together with the inferences that can be drawn in relation to team building issues at greater length later in this essay. One of the major areas where psychology is relevant to the success (or otherwise) of a particular treatment is encapsulated in the concept of empowerment and education. (Howe and Anderson 2003). The patient who is both empowered and educated by the nurse will approach their illness trajectory in a completely different psychological frame of mind than one who is not. Time spent in explanation to a patient of the parameters and reasons for their treatment is rarely wasted. (Holzemer W et al. 1994). Marinker’s concept of the differentiation of compliance and concordance. (Marinker M.1997) is particularly useful in this respect. Although his original paper was written with specific regard to the taking of medication, the principles that it expounds are sufficiently general that they are now commonly extrapolated to cover most aspects of the interaction between the healthcare professionals and the patient. The patient who understands why he is being asked to undergo a particular th erapeutic regimen is far more likely to complete is successfully than one who is simply told what to do. This can be encapsulated in the professional advice on the subject from the RCN Patients are as fully involved as practicable in the formulation and delivery of their care (e.g. through the use of self-care plans) Where appropriate, patients are offered treatments other than medication Treatment plans are individually tailored for each patient Patients are involved, unless impracticable, in any decisions about referral Where practicable, patients are informed of the reasons for referral to specialists or other professionals (cited in CSAG 1999) This element of compliance is frequently cited in many of the tools of quality indication that are used in formal studies in this area. The degree to which a patient complies (or concords) with instructions can be viewed as a measure of success of the presentation of that treatment directly to the patient. (Campbell S M et al. 2000) As we have intimated in the introduction, the title of this essay can be interpreted at several different levels. In this segment we shall consider the impact of formal psychology services in primary health care. The rationale for our consideration of this topic specifically lies in the fact that an understanding of basic psychological principles is fundamental in allowing the nurse to appreciate the elements of treatment commonly undertaken in a psychology clinic. The excellent and informative article by Sobel (A B et al. 2001) provides a good starting point for this consideration. In practical terms, the average attendance at a psychology clinic is about five outpatient attendances. (Arndorfer, R. E et al. 1999). This means that the contact of a patient with the primary healthcare team is likely to outnumber the attendances at the clinic over a period of time. To give a specific example, it is clearly important for the nurse, who may come into contact with (for example) an anorexic adolescent, to understand the issues revolving around body dysmorphia, self-image enhancement and self-esteem (Lavigne, J. V. et al. 1999) if they have been undergoing treatment, if the nurse is to consider giving any degree of holistic consideration to whatever problems are being presented to her at the time. It is clearly of little value, if requested to give advice on the subject of weight loss (which is a common enquiry at nurse-run clinics), (Hogston, R et al. 2002) . to attempt to give such advice without a background knowledge of the psychological principles that have been employed in trying to restore the patient’s eating habits to a more normal pattern. (La Greca, A. M. 1997). Equally the parents of a child who is undergoing treatment for enuresis may have questions that they have not felt able to ask at a busy clinic and these may be presented to the practice nurse. A background knowledge of current treatment (both interventional and behavioural) is clearly vital t o being able to answer the questions with a degree of professional confidence. Another area where the nurse’s knowledge of psychological issues may be important is that, given the fact that a comparatively high number of patients default from follow up before being formally discharged, the nurse should know that psychological treatment is rarely successful if the â€Å"less than optimum† course of treatment is completed. (Sobel, A. B et al. 2001). Encouragement to return to complete the full course may be a useful remit for the nurse confronted by a patient in this situation. It follows that a sensitive exploration of the reasons for default my also be helpful and a knowledge of the subject is clearly helpful here as well. The patient who has defaulted from follow up through apathy needs completely different handling from the patient who has defaulted because of a resurgence of painful or difficult memories during a course of cognitive behavioural therapy. (Street, L. L.et al. 2000). In the latter case, empathetic handling is of great importance a s the issues involved may have a deep significance for the patient and completion of the course may be fundamental to a complete resolution of the issues involved. (Mitchell M C et al. 2004). When dealing with the patient who has specific emotional or psychological issues, the professional nurse would commonly have to employ a degree of psychological understanding which may be deeper than in many other cases for both of the reasons set out above. Let us now consider a different aspect of psychology and its relevance to nursing practice in primary care. A large proportion of the work of the district nurses can be taken up with the care of the dying patient. The dying, or terminally ill patient typically has a psychological profile that is quite different to the â€Å"average† patient. This was explored in the fascinating and very well written paper by The (The et al. 2000) who considered the elements of denial and cognitive distortion exhibited by a patient when being given news that they do not want to hear. The diversity of psychology shown by these patients is virtually unique to this group and a firm grasp of the essential elements is vital if the district nurse is going to handle the situation both professionally and well. The concept of â€Å"a good death† (Seale C et al. 2003) is one that is frequently cited in the modern literature and a fundamental prerequisite to a good death is that the patient is surr ounded and treated by healthcare professionals who have broad understanding of the psychological issues that are relevant to this spectrum of patient. (Wilkerson, S. A et al. 1996) There are many patients who confront the inevitability of death with a stoical inevitability that makes their management a relatively straightforward matter (Wadensten et al. 2003). The patients that we shall specifically consider in this segment however, are those who have a positive diagnosis of a life threatening condition but employ a number of coping mechanisms so that they do not have to directly confront the possibility of imminent death. These mechanisms can range from false optimism right through to frank and abject denial (Weeks et al 1998). We have already considered some of the ethical implications of autonomy and consent earlier in this essay, but they also are of great relevance in this section. It follows that if a patient is to have any degree of meaningful input into their treatment plans and consideration of the various options that are open to them, they must be both fully aware of, and quite prepared to confront, the implications of the situation that they find themselves in. If they chose to distort some or any of the relevant facts of the case, it equally follows that they cannot make a reasoned and rational decision about the options and choices that they have in front of them. Once again we return to the issue and concept of framing the presentation, the only difference here is that it is generally the patient who deliberately distorts the frame rather than it being distorted or manipulated by the healthcare professionals. This specifically is the issue that The and his colleagues considered in their paper (The et al. 2000). We should start a consideration of this issue however, with a reference to an earlier paper by Jennings (1997) who described the â€Å"emotional roller coaster† experienced by patients who deal with a malignant diagnosis and that this â€Å"evolution of emotional landscapes† can be predicted with a degree of certainty. This can be best examined with a verbatim extract from the The paper which refers to patients with small cell carcinoma of the lung: â€Å"False optimism about recovery is usually developed during the (first) course of chemotherapy and was most prevalent when the cancer could no longer be seen in the x ray pictures. This optimism tended to vanish when the tumour recurred, but it could develop again, though to a lesser extent, during further courses of chemotherapy. Patients gradually found out the facts about their poor prognosis, partly because of physical deterioration and partly through contact with fellow patients who were in a more advanced stage of the illness and were dying. False optimism about recovery was the result an association between doctors activism and patients adherence to the treatment calendar and to the recovery plot, which allowed them not to acknowledge explicitly what they should and could know. The doctor did and did not want to pronounce a death sentence and the patient did and did not want to hear it. Clearly an understanding of the psychology of what colours the patient’s reactions is vital to the district nurse if she is to handle this type of situation both professionally and empathetically. If we take a completely detached and dispassionate consideration of this situation the healthcare professional can say with almost complete certainty, that the patient with a positive diagnosis of small cell carcinoma of the lung is going to die. Statistically we know that over 90% of patients are dead within two years of diagnosis and the overall five year survival figures are nil. (Seale C et al. 2003) The practicality of the situation is therefore that it clearly makes sense to discuss options in terms of treatment, palliation and support as soon as a positive diagnosis is made. In real terms, this is rarely done because healthcare professionals frequently find it difficult to effectively pronounce a â€Å"death sentence† on patients. In this respect the psychology of the situation is as much a reflection of the attitudes and feelings of the healthcare professionals as it is of the patient. On a fictional level one can cite the classic literary example of A J Cronin’s Dr Findlay (Cronin A J 1934) who disagreed with his partner Dr Cameron. Dr Findlay felt strongly that the eponymous Mrs McIver should be told of her hopeless prognosis on the grounds of being completely truthful with the patient and this was against the advice of the older, more experienced partner, Dr Cameron who had been hitherto managing the situation by keeping the lady’s spirits high by telling her how well she was looking at each occasion he had contact with her. Dr Findlay confronts the situation by telling Mrs McIver the truth and within a few days she has died. The relevance of the story is seen at the end where Dr Findlay is depicted talking to the dead lady’s husband and Dr Findlay expresses his shock at the speed at which the old lady died and the husband concludes the episode by observing that: â€Å"She was doing really well until you took away from her the one thing that she had left – and that was hope†. In short, this episode highlights some of the difficulties and dilemmas that are frequently faced by healthcare professionals in general and district nurses in particular. The practicality of the situation could have been handled better with a more thorough understanding of the thought processes and psychological mechanisms employed by Mrs McIver in her last few weeks. One can see the point of view of Dr Findlay who took the view that the lady would not have been in any realistic position to make appropriate arrangements to confront her own death if she had never faced the possibility in the management plan that Dr Cameron had adopted. Dr Findlay’s approach could be argued to have allowed her to consider a number of timely treatment options if the truth was confronted. The fact of the matter was that she chose to actively collude with the optimistic approach of Dr Cameron and she derived strength and the ability to cope from the transparent belief (a cognitive distortion) that her prognosis was not hopeless. Dr Cameron was clearly of the opinion that this was of greater benefit to her than confronting her imminent death. What the story does not tell us (and we can only surmise) is that Dr Cameron, in common with many other real healthcare professionals, also has psychological difficulties in dealing with the subject himself. A number of different mechanisms may be active in this situation. It is possible that, by telling a patient that they are soon to die, it may challenge the notion that medical science can cure everything and that healthcare professionals are infallible (sadly, a still all to common belief). Equally it could be that the healthcare professionals involved do not like to be vicariously reminded of their own mortality and therefore collude willingly with the patient’s false optimism. Others again may take a rational view that â€Å"if the patient wants to know the truth then they will ask, if they don’t want to know then they won’t ask† and thereby actively avoid confronting the situation (Curtis J R. 2000) The The paper examines this issue in considerable depth with a commendable degree of scientific scrutiny. In the words of the paper, the authors suggest that: The problem of patient / doctor collusion does actually require an â€Å"active, patient orientated approach from the doctor†. A practical and novel solution to this problem is suggested in the form of the use of a â€Å"treatment broker† who is defined as: â€Å"a person who is trusted by both patient and doctor and who can help both parties to clarify and communicate their (otherwise implicit) assumptions and expectations†. The’s analysis suggested that the majority of patients in the study did actively want to know if the illness that they had was terminal with over 85% stating that they would wish to be told the truth rather than be given false optimism in an unrealistic fashion. This is contrasted with the finding that, in the study, when a patient was given a terminal diagnosis, the next question was almost invariably a variation of â€Å"what are the chances of a cure?† (Meredith et al 1996). It is also the case that other studies on the psychology of this type of situation have shown that when patients ask about their condition (and this applies not specifically to terminal conditions) they do not want to hear anything other than good news (Costain et al 1999). This argument is extrapolated even further in a study by Leydon and his co-workers (Leydon et al 2000) who provide an excellent qualitative study into patient’s reactions and they cite examples of patients who were interviewed directly after a recorded conversation with a healthcare professional and who overtly denied that they had been given a terminal diagnosis even though this was demonstrably not true. An interesting twist in these discussions of the psychology of the situation is provided by Dean (Dean 2002), who offers a specific insight into the way patients perceive the differences between nurses and other healthcare professionals. He takes the arguments of false optimism and overt denial and examines them further. Again, this paper is specifically concerned with the patient with a terminal diagnosis, and it looked at the differences in the content and tone of the conversations that patients had with both doctors and nurses. A significant finding from this paper was that a patient may choose to overtly collude with the doctor during discussions of â€Å"a cure† but within a very short space of time may choose to talk in a much more open way with a nurse when pretences of a cure are actively dropped. Dean suggests that â€Å"such a dichotomy of approach is not unusual†. He suggests that: Patients may well feel a need for a theatrical faà §ade to bolster their own psychological states as well as to collude with the doctor and indicate that they are remaining positive and confident in the doctor’s ability to try to achieve a cure. And this suggestion is echoed and expanded in the Curtis paper (Curtis 2000) with the observation that, in their more candid moments patients may well wish to get a more â€Å"down to earthâ€Å" response, which they perceive that they will get from the nurse, who they think may not require a faà §ade or even indulge in the sophisticated game play of the doctor. Lynn (Lynn 2001) adds a counter-intuitive note of caution for the nurse with the thought that this situation requires a great deal of careful handling by the nurse, as the psychological mechanism that underlies the nursing approach is that the patient may actually be looking for reassurance and (possibly unexpected) reinforcement of their own false optimism. This is an exemplification of the constant calls in the literature for a holistic and patient centred approach to patient care rather than a blanket approach to this type of clinical problem. The rest of The’s paper is concerned with the psychological theory behind the explanations of just why it is that patients do adopt these defensive positions and just why it is that healthcare professionals frequently collude with them on this issue. It is not particularly relevant to explore this in any further detail as the point is clearly made that a basic understanding of the mechanisms by which patients cope with their adversity and the psychological constructs that are frequently presented in these circumstances is of great importance to the nurse who has to deal with, interpret and empathise with the patient’s particular needs at any given time in their illness trajectory. Nurses are often involved, both overtly and in their everyday work, in the business of Health Promotion. Psychology plays a very important part in the overall success and implementation of health promotion strategies on a both a population and an individual level. The theoretical basis of much recent work in the field of Health Promotion is in the concept of the Attitude-Behaviour theory (A-B theory) (Rise J 2000). This theory suggests that the optimum change in behaviour patterns (at least in the field of health and self-interest) is achieved with the optimum change in attitude (or â€Å"realignment† in the jargon). We opened this essay with a reference to the Theory of Rational Choice. An offshoot of this theory (the Theory of Reasoned Action) modifies the A-B Theory to the extent that it provides a model framework by which one can assess the many divergent processes by which attitudes guide behaviour. The hypothesis states that if people can become highly motivated to make a correct decision and are in a position (because they have been given relevant information), then they are likely to spontaneously engage in a â€Å"deliberate and thoughtful process in deciding how to behave† (Rise J 2000). In the context of Health Education (which was the field that the theories were originally developed in) the theory suggests that if people are given sufficient and persuasive information in relation to their health, then a significant proportion will spontaneously indulge in lifestyle changing activity which can be consistent with healthier living. The significance of these theories is that, if t he nurse has a remit to promote a healthier lifestyle (which is arguably part of a professional remit), she is most likely to have the greatest success in providing significant amounts of information to patients rather than simply dictating to them how they should alter their lifestyle without any significant explanation. This comment effectively brings us full circle to the concept of compliance and conformance as postulated by Marinker. Another issue that has deep seated psychological implications, is the current trend towards teambuilding in primary health care. The ramifications of this concept are huge, and therefore we intend to only discuss the issue by considering a number of the most relevant points. To a large extent, team building overlaps with the concept of multidisciplinary team working. This move has required a redistribution of both power and authority (and thereby a redistribution of responsibility) within the team. (Shortell S M et al. 1998).The psychological implications of this are that if one considers the NHS of more than about twenty years ago its structure was more isolationist and based on individual practice (DHSS 1988). Individual speciality teams and individuals worked in a degree of comparative isolation and this also implied a greater degree of individual responsibility than they have at present. This change has brought about a number of major changes in areas such as ethics and work prac tices which are not particularly relevant to our topic in this essay (and therefore will not be discussed further), and also the psychology of working, which clearly is. The first consideration is the psychology behind the concept of leadership. Leadership is clearly important if one is to have an effective team. In psychological terms styles of leadership can be divided into several categories. The two most prominent being congruent leadership and transformational leadership. A full discus