Dunia tanpa sempadan, pengetahuan dan mentality memberikan kesinambungan kepada pengalaman yang menakjubkan dalam dunia pemikiran
World without borders, knowledge and mentality provide continuity to the amazing experience in the world of thought
Author : Muhammad Afiq Shahiri
Bin Sapie (MC210915114) Date: 18/10/2023 Volume : (3) 1-4 Subject : A journal of subject
theory of counselling : Applying
individual psychology theory to My daily life, University of UNITAR
Ipoh, Perak
Mengaplikasikan teori psikologi individu dalam kehidupan seharian saya
Adler dikaitkan dengan perkembangan teori psikologi individu, yang memberikan pandangan baru tentang psikologi manusia di samping menyediakan alat berguna untuk pembangunan dan kemajuan peribadi. Teori ini menggalakkan individu untuk menyiasat idea, perasaan, dan tingkah laku mereka sendiri dan memberi penekanan kepada kepentingan memahami orang itu dalam konteks persekitaran sosial mereka. Dengan memasukkan konsep-konsep ini ke dalam aktiviti harian kita, kita boleh membangunkan pemahaman yang lebih mendalam tentang siapa kita dan membuat pelarasan membina yang akan menyumbang kepada peningkatan kesihatan kita. Adalah menjadi harapan saya bahawa dengan mendekati proses penemuan diri dalam rangka teori psikologi individu alfred adler, saya akan dapat memperoleh pemahaman yang lebih mendalam tentang interaksi antara idea, emosi dan tingkah laku saya. Penyiasatan saya dibuat berdasarkan latar belakang tumpuan adler pada pencarian kepentingan dan kepentingan peristiwa awal pada pembentukan personaliti. Matlamat saya menyimpan diari ini adalah untuk menyimpan rekod pengalaman harian saya, menggabungkan konsep dari psikologi individu untuk mendapatkan pengetahuan yang lebih baik tentang siapa saya dan untuk menggalakkan perkembangan peribadi saya sendiri.rujukan.
Memahami maksud menjadi lebih rendah sambil berusaha untuk menjadi penting:
Saya telah menggabungkan konsep teori ini ke dalam idea peribadi saya sendiri tentang teori psikologi individu untuk membantu saya menavigasi melalui tinggi dan rendah yang merupakan sebahagian daripada kehidupan seharian saya. Saya mempraktikkan idea ini dengan menjalankan analisis mendalam tentang pemikiran saya sendiri. Menurut adler, cara kita secara peribadi mentafsir peristiwa mempunyai kesan yang besar terhadap perasaan dan tingkah laku yang kita alami. Saya dapat menghadapi pemikiran negatif saya dan menyusun semula mentaliti saya supaya saya boleh mengembangkan idea yang lebih positif dan membina dengan menyedari corak pemikiran kebiasaan saya dan mencabarnya.
Sebagai contoh, jika saya merasakan bahawa saya sentiasa bimbang tentang keadaan yang berada di luar kawalan saya, saya akan mengingatkan diri saya tentang penekanan adler untuk menumpukan perhatian pada aspek kehidupan yang saya kuasai dan akan cuba mengalihkan perhatian saya ke sana. Ini membantu saya memfokuskan semula perhatian saya untuk mencari penyelesaian kepada masalah dan mengambil usaha proaktif ke arah mencapai objektif saya. Oleh kerana saya sedar tentang kaitan yang wujud antara idea dan perasaan saya, saya dapat mewujudkan sikap yang lebih positif dan lebih berjaya menguruskan tekanan saya. Hari ini, saya memikirkan beberapa contoh dari sejarah saya yang mungkin menjadi faktor dalam pembangunan kompleks rendah diri. Menurut teori psikologi individu, peristiwa formatif mempunyai kesan yang mendalam terhadap persepsi individu tentang siapa mereka. Saya melihat kembali ingatan awal saya dan melihat corak yang mungkin mempunyai peranan dalam membentuk idea saya sekarang. Menyedari asal usul ini adalah langkah pertama dalam memfokus semula usaha saya untuk mencari kepentingan dengan cara yang lebih bermanfaat dan membantu untuk diri saya dan orang lain.
Penilaian cara hidup anda dan perasaan anda:
Saya meneliti rutin dan tingkah laku harian saya berdasarkan tanggapan adler bahawa gaya hidup seseorang adalah cerminan keperibadian mereka, dan saya membuat kesimpulan bahawa saya harus menjalankan penilaian gaya hidup. Adakah keputusan yang saya buat adalah selaras dengan kepentingan yang ingin saya capai? Saya menentukan bidang yang saya perlukan untuk membuat perubahan untuk membentuk cara hidup yang bukan sahaja membantu untuk mencapai objektif utama rekaan saya tetapi juga menggalakkan kesejahteraan keseluruhan saya. Memahami kesan yang dimainkan oleh emosi kita dalam mempengaruhi pilihan yang kita buat adalah satu lagi komponen teori psikologi individu yang saya praktikkan dalam kehidupan seharian saya. Emosi adalah petunjuk penting tentang kehendak dan aspirasi kita, oleh itu adalah penting untuk memberi perhatian kepada mereka. Apabila saya memberi perhatian kepada reaksi emosi saya, saya menjadi lebih berhubung dengan sentimen terdalam saya, dan sebagai hasilnya, saya dapat membuat pertimbangan yang berpendidikan yang berdasarkan keinginan tulen saya dan bukannya bertindak terburu-buru dalam bertindak balas terhadap situasi. Amalan muhasabah diri yang kerap telah mengajar saya untuk menerima malah menghargai perasaan saya serta melihatnya sebagai sumber maklumat yang penting. Saya membuat satu titik untuk tidak mengabaikan atau menekan perasaan saya; sebaliknya, saya memberi kebenaran kepada diri saya untuk merasakannya sepenuhnya dan mengatasinya dengan cara yang seimbang. Oleh kerana itu, saya dapat bertindak balas terhadap kesukaran dan kesenangan hidup seharian dengan cara yang lebih tulen dan membantu.
Gangguan personaliti merupakan satu keadaan mental yang dicirikan oleh corak pemikiran, perasaan, dan tingkah laku yang berbeza daripada norma masyarakat dan kekal dalam jangka masa panjang. Ia boleh menjejaskan fungsi harian dan hubungan interpersonal seseorang individu. Di Malaysia, kesedaran tentang gangguan ini semakin meningkat, namun masih terdapat banyak stigma dan salah faham mengenainya.
Jenis-jenis Gangguan Personaliti
Menurut Manual Diagnostik dan Statistik Gangguan Mental (DSM-5), gangguan personaliti boleh diklasifikasikan kepada beberapa kategori utama:
Gangguan Personaliti Klasifikasi A (Eksentrik atau Aneh):
Paranoid: Mempunyai kepercayaan bahawa orang lain berniat jahat atau tidak boleh dipercayai.
Schizoid: Mengelakkan hubungan sosial dan tidak menunjukkan banyak emosi.
Schizotypal: Memiliki pemikiran atau kelakuan aneh dan percaya pada perkara yang luar biasa.
Gangguan Personaliti Klasifikasi B (Dramatik, Emosional atau Tidak Stabil):
Antisosial: Tidak mengambil kira hak atau perasaan orang lain.
Borderline: Emosi yang tidak stabil, imej diri yang kabur, dan hubungan yang tidak tetap.
Histrionik: Sentiasa mencari perhatian dan cenderung dramatik.
Narsistik: Mempunyai perasaan kepentingan diri yang berlebihan dan memerlukan penghargaan berterusan.
Gangguan Personaliti Klasifikasi C (Cemas atau Takut):
Avoidant: Mengelak daripada situasi sosial kerana rasa takut terhadap kritikan atau penolakan.
Dependent: Bergantung secara berlebihan kepada orang lain untuk membuat keputusan dan memenuhi keperluan diri.
Obsessive-Compulsive: Terlalu fokus kepada kesempurnaan, peraturan, dan kawalan.
Faktor Penyumbang di Malaysia
Terdapat pelbagai faktor yang boleh menyumbang kepada perkembangan gangguan personaliti di kalangan rakyat Malaysia:
Budaya dan Sosial:
Tekanan sosial dan harapan budaya yang tinggi, seperti kepentingan keluarga dan kejayaan akademik, boleh mencetuskan atau memperburuk gangguan personaliti.
Stigma sosial terhadap gangguan mental menyebabkan ramai individu tidak mendapatkan bantuan yang diperlukan.
Ekonomi:
Kesempitan hidup dan tekanan ekonomi boleh mempengaruhi kesejahteraan mental seseorang.
Perubahan pantas dalam ekonomi negara turut memberi kesan kepada kestabilan emosi dan psikologi rakyat.
Keluarga dan Persekitaran:
Pengalaman zaman kanak-kanak yang negatif, seperti penderaan atau pengabaian, boleh menyumbang kepada perkembangan gangguan personaliti.
Dinamika keluarga yang disfungsional juga boleh menjadi faktor risiko.
Genetik dan Biologi:
Faktor genetik mungkin memainkan peranan dalam perkembangan gangguan personaliti, di mana sejarah keluarga dengan gangguan mental boleh meningkatkan risiko.
Prevalensi dan Cabaran dalam Penjagaan
Kajian menunjukkan bahawa gangguan personaliti agak umum di kalangan rakyat Malaysia, namun prevalensinya sering diabaikan atau disalah tafsir sebagai masalah sosial atau moral. National Health and Morbidity Survey (NHMS) pada tahun 2015 mencatatkan bahawa sekitar 29.2% rakyat Malaysia mengalami masalah kesihatan mental, yang termasuk pelbagai jenis gangguan personaliti.
Cabaran utama dalam menangani gangguan personaliti di Malaysia termasuk:
Kekurangan Kesedaran dan Pendidikan:
Masih terdapat banyak salah faham dan kurang pengetahuan tentang gangguan ini.
Usaha pendidikan awam masih kurang, menyebabkan kesedaran masyarakat terhadap isu ini berada pada tahap yang rendah.
Akses kepada Rawatan:
Kekurangan sumber dan kemudahan perubatan untuk rawatan kesihatan mental di kawasan luar bandar.
Kurangnya pakar psikologi dan psikiatri yang terlatih dalam menangani gangguan personaliti.
Stigma dan Diskriminasi:
Individu dengan gangguan personaliti sering berhadapan dengan stigma dan diskriminasi, yang menyukarkan mereka untuk mendapatkan bantuan atau rawatan.
Tanggapan negatif masyarakat terhadap gangguan mental menghalang mereka daripada mendapatkan sokongan yang diperlukan.
Intervensi dan Sokongan
Untuk mengatasi masalah gangguan personaliti di kalangan rakyat Malaysia, beberapa langkah boleh diambil:
Meningkatkan Kesedaran dan Pendidikan:
Melalui kempen kesedaran awam dan program pendidikan di sekolah untuk mengurangkan stigma dan meningkatkan pemahaman mengenai gangguan personaliti.
Penglibatan media dalam menyebarkan maklumat yang betul dan mengurangkan stereotaip negatif tentang gangguan ini.
Memperbaiki Akses kepada Rawatan:
Meningkatkan bilangan pakar kesihatan mental dan kemudahan di seluruh negara, terutamanya di kawasan luar bandar.
Menyediakan latihan untuk profesional kesihatan agar mereka lebih bersedia untuk menangani kes gangguan personaliti.
Menyokong Keluarga dan Komuniti:
Menyediakan sokongan dan sumber untuk keluarga dan individu yang terjejas, seperti kumpulan sokongan dan perkhidmatan kaunseling.
Menggalakkan persekitaran yang inklusif dan penyayang dalam komuniti untuk membantu individu yang menghadapi gangguan personaliti.
Mengembangkan Polisi dan Sokongan Kerajaan:
Kerajaan perlu menggubal dasar yang menyokong penjagaan kesihatan mental yang komprehensif dan mudah diakses.
Meningkatkan pembiayaan dan sumber untuk program kesihatan mental di seluruh negara.
Gangguan personaliti adalah isu yang signifikan dan memerlukan perhatian serius di Malaysia. Dengan meningkatkan kesedaran, memperbaiki akses kepada rawatan, mengurangkan stigma, dan menyediakan sokongan yang berkesan, kita boleh membantu mereka yang terjejas oleh gangguan ini untuk menjalani kehidupan yang lebih baik dan lebih bermakna.
Rujukan
American Psychiatric Association. (2013).Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association.
Institute for Public Health. (2015).National Health and Morbidity Survey (NHMS) 2015. Ministry of Health Malaysia.
Teoh, H. J., & Rose, P. (2001).Child mental health: An integrated approach to the planning and delivery of services with respect to culturally diverse communities. Asia Pacific Journal of Social Work and Development, 11(2), 80-91.
This study relies on the notion of persuasion
to anticipate reactions to marketers' attempts to convince customers with
varying levels of persuasion expertise. The report includes a meta-analysis of
the findings from 148 studies and 171 separate data sets. Persuasion knowledge
effects are significant when compared to persuasion attempts, but it cannot
suppress or eliminate persuasion effects in the marketplace since it only
reaches roughly 50% of the explanatory power of persuasion. The impacts of
persuasion knowledge on assessments and coping are dependent on the parameters
of the persuasive process. All persuasion factors assist customers in
identifying and better understanding benefits not just for themselves, but also
for marketers and how marketers realize those benefits.
Discussion
According to Campbell &
Kirmani in their 2008 research in terms of the substance and structure of
persuasion knowledge effects, research shows that persuasion knowledge enhances
consumers' coping reactions and leads to fewer positive ratings. Additionally,
other studies indicate that the persuasive impact is not as positive. However,
other studies claim that they have discovered a wide range in the impact of
persuasive information and that in some circumstances, it may even result in a favourable
assessment of the persuasive agent.
Other than that,
we go to another side of researchers said consumers' understanding and opinions
about marketers' attempts at persuasion, as well as their motivations and
strategies behind those efforts, are referred to as their level of persuasion
knowledge. It is the notion of persuasion is at the heart of persuasion
knowledge, thus knowing what persuasion comprises is necessary to define
persuasion knowledge. The prevalent understanding of persuasion is that it is a
deliberate attempt through communication to influence a recipient who has some
degree of freedom of choice, despite the fact that there are several
definitions, conceptualizations, and persuasion models. In conclusion,
persuasiveness in business is advantageous to all parties involved, including
the sender and the influencer This, together with persuasive expertise, is a
typical assumption in persuasion models.
After that, we also
want to take you to another angle to think about the definition of the concept
of persuasion, knowledge of persuasion can apply to and have an impact on
results that the influencer either intends or does not intend. This means the
judgments, intentions, behaviour, and recollections of customers that are
connected to a brand, a channel, or a company are referred to as the
influencers' desired results in a marketing setting. If customers learn
persuasive strategies that are advantageous to both them and the marketer, and
if they notice that marketers employ potentially manipulative tactics and may
even be trying to limit consumers' options. Finally, they found out that This
overwhelming response is the result that the marketer did not intend. they
develop resilience and response to persuasion results.
Jakarta 2022
Article critique
From the Journal sentence
criticism 1: In this study, we refer to the concept of persuasion to
systematize consumer responses triggered by persuasion knowledge and to
identify relevant moderators of persuasion knowledge effects.
In my point of view,
this journal should provide a comprehensive study, in terms of the response of
persuasion in marketing. This is because it can happen in many forms and
persuasive advertising can be quite impersonal, unlike direct sales, when the
salesperson often talks one-on-one with the consumer. Advertisers can only
customize advertising so much without compromising their mass appeal because
they want their ads to reach as many potential customers as possible.
From the Journal sentence
criticism 2: Insights about persuasion knowledge effects are of interest to
researchers, marketers, consumers, and public policymakers because they carry
major implications for marketing actions’ effectiveness and consumers’
susceptibility to these actions.
This is because in my perception this kind of action is not
professional and It will attempt to influence the most fundamental human
emotions and utilize that manipulation to take advantage of unsuspecting
clients. An illustration of an unethical commercial is one that exploits
people's fears. It can appear that if customers do not buy the offered goods,
their health would be in jeopardy.
In conclusion, the persuasive strategy plays on the buyer's
fears and emphasizes what they would lose if they didn't buy the good or
service. In my opinion, I would like to suggest some things for improvement in
this strategy without jeopardizing their investments to buy goods from
marketers. To provide a basis for future research ideas on persuasion knowledge
is very necessary to ensure the quality of goods and public knowledge. Limitations
in giving persuasion can reduce pressure on buyers and anxiety about the
situation.
Ethical quandaries develop when individuals or
communities are forced to make difficult judgements involving moral principles
or values that are in contradiction with one another. These quandaries
frequently give rise to challenges and disputes. Because they require
individuals to make decisions between opposing interests, ethical dilemmas can
offer substantial problems. However, there is not always a straightforward
answer to these conundrums. Its include decision-making conflicts, stakeholder
conflicts, legal and regulatory conflicts, public perception and reputation and
emotional distress.
It is essential to confront ethical conundrums in a
methodical and reflective manner, taking into account a variety of viewpoints,
ethical frameworks, and the potential outcomes of one's actions. Participating
in open discourse, looking for ethical counsel, and fostering a culture of
ethical awareness are all things that may help reduce the likelihood of
disputes and make it easier to deal with these issues. The decision to put an
end to one's life presents complicated obstacles and tensions since it requires
one to make challenging choices regarding medical treatment, care, and the
preservation of human life in the face of severe circumstances or terminal
sickness. This moral conundrum emerges when individuals, families, and
healthcare professionals are put in a position where they must make decisions
that will have an effect on the persons' quality of life, autonomy, and dignity
as they draw closer to the end of their lives.
Communication that is both open and empathic is necessary
to address the problems and tensions that are inherent in end-of-life choice
dilemmas. This communication must involve patients, their families, healthcare
providers, and other stakeholders. Access to palliative care, advance care
planning, and ethical frameworks, such as shared decision making models can all
be helpful in navigating these issues and promoting compassionate
decision-making in end of life circumstances.
1.Case Study 1
Adam was a 2-year-old child
with congenital acute myeloid leukemia. He was admitted to the pediatric
intensive care unit (PICU) after receiving an allogeneic bone marrow
transplant. One week after the transplant, a severe pulmonary infection
developed, resulting in irreversible lung injury; he was ventilator dependent.
Adam was a patient in the PICU for 2 months and he had good and bad days. On his bad days, the PICU
staff struggled to manage his hypoxemia, hypercapnia, and hemodynamic
instability. He had several close calls to death, including being resuscitated
twice after having cardiac arrests. Neurologically at times, he opened his eyes;
he had limited motor ability. When he became restless, he was given sedative
drugs.
Several family meetings
occurred over his 2-month PICU stay. The palliative care team was consulted 5
weeks into his stay. At the most recent meeting, the palliative care APRN
reviewed Adam’s illness trajectory, discussed his current condition and told Adam’s
parents that the team would like to consider a change in the focus of Adam’s
care.
The pediatric intensivist
discussed Adam’s poor prognosis and his parents were given time to ask
questions. The palliative care APRN discussed the possibility of focusing
Adam’s care on comfort and suggested that it was time to consider decisions
such as withholding cardiopulmonary resuscitation (CPR) if Adam’s heart were to
stop again. She asked Adam’s parents whether they would support this decision.
Adam’s mother said that she agreed that CPR should not be started if her son’s
heart stopped. Adam’s father became angry and stated that the staff was giving
up on his son. He absolutely wanted all treatment continued, including CPR. He
got up and stormed out of the conference room.
Adam’s PICU nurse was not
sure whether to stay in the meeting or leave. She decided to leave and look for
Adam’s father. She found him sitting at his son’s bedside crying. He told her
that he needed a little time alone, so the nurse left and gave him time with
his son. When she returned, she acknowledged how difficult it must be to
participate in these types of decisions. Adam’s father told her that he did not
want to give up on his son. The nurse reinforced what good parents both he and
his wife were. Adam’s father said that he needed time to think about
everything. He had hoped that his son would recover and he was just starting to
realize that he might not. The PICU nurse emphasized that Adam would continue
to receive the best care possible, regardless of what decision was made, and
that the team was there to help not only Adam but also his family. (Wiegand, 2015, pg. 145)
This case study presents a
conflicting decision between both parents of a terminally ill 2-year-old boy
with acute myeloid leukemia. Despite a poor prognosis as well as multiple
resuscitations from cardiac arrests, the father refused to discontinue resuscitation
attempts with the perception that the medical team is giving up on his son. The
mother, however, was accepting of the decision due to the condition of her son.
The medical team, however, was adhering to the ethical principle of autonomy,
by allowing both of the parents, the autonomous legal guardian of their son, to
give their final decision on this end-of-life matter. Despite wanting to
provide the best treatment that may benefit the patient (beneficence), the
medical team also would like to reduce and minimize any harm that may be
inflicted on the 2-year-old boy (non-maleficence).
One of the dilemmas that
may be seen here is the contradiction between the father’s decision from the
medical team’s advice. Other than the literal physical definition of ‘alive’
towards the patient, the decision-maker, in this case, the parents, must also
consider the weight of their son’s quality of life should the treatment and
resuscitation be continued, apart from the consideration of their cultural and
religious norm. The process of end-of-life decision-making should consider the
well-being of the patient from all aspects; physical, emotional, religious, and
even personal beliefs (Puteri, 2015). Though admittedly, a 2-year-old may have
less consideration for religion and personal beliefs, the consideration of
end-of-life decisions should also include the immediate family and guardian.
The counsel team did a
praiseworthy job in assuring the parents that they will strive in providing the
best care possible for whichever path the parents choose to decide. Should the
parents choose the continue treatment, the medical team will work hard in
providing the best treatment that benefits the patient, and if the parents
choose to discontinue treatment and resuscitation, the medicals team will also
give as much effort in maximizing comfort and care if the provision of the best
palliative care for their son, Adam.
Ethically, this end-of-life
decision may only be made by the parents and should not be interfered with by
any other party. However, the medical team and the psychological support team,
if any, should be ready to be transparent and honest (veracity) in providing a
full, detailed explanation of Adam’s condition to both parents. The parents
should be able to make a fully informed decision and psychological and
emotional support services should be made available to the parents should they
need them. End-of-life care is an all-hands-on-deck situation where every party
serves a huge role in ensuring the best outcome for the patient, the parents as
well as the medical team. Despite everyone’s involvement, both decisions of
continuing or discontinuing treatment are not ethical violations as long as all
information is given and received by all parties involved
2.Case
Study 2
The case of Ms. Rahimah is
a hypothetical case study of a 65-year-old woman with end-stage chronic
obstructive pulmonary disease (COPD), a condition characterized by the
progressive deterioration of the airways in the lungs. Despite undergoing
various treatments for her condition over the years, her COPD has continued to
worsen, and she has now reached a point where her doctors have determined that
there are no more viable treatment options available. They have explained that
her condition will ultimately lead to her death, and they have suggested that
she and her family begin to think about her end-of-life care.
Rahimah has expressed to
her doctors and family that she does not want to prolong her suffering any
further, and she has decided to elect hospice care. Hospice care is a form of
palliative care that provides comfort and pain relief to patients who are dying,
and it often involves the withdrawal of life-preservation interventions such as
intubation or resuscitation. Ms. Rahimah's decision to elect hospice care
reflects her desire to prioritize comfort and quality of life overextending her
life at all costs.
While Ms. Rahimah's
decision may be a difficult one for some family members to understand, it is
ultimately her right to self-determination, as she is entitled to make
decisions about her healthcare based on her values and preferences. Her
decision is an example of the importance of open and honest discussions about
end-of-life care and the role that patients, families, and healthcare
professionals play in these discussions. By taking an approach to end-of-life
care, we can help patients and families make informed decisions that prioritize
comfort, dignity, and quality of life.
End-of-life decisions are
complex and require careful consideration of the patient's preferences and
values. The case of Ms. Rahimah illustrates the importance of respecting a
patient's autonomy in making these decisions, and providing care that
prioritizes comfort, relief from suffering, and an increase in quality of life.
Autonomy is a fundamental
principle in ethics and is especially important in end-of-life care. It
involves allowing a patient to make their own healthcare decisions, including
decisions about their end-of-life care. By treating a patient as autonomous person,
we respect their dignity and agency, and we help to ensure that their values
and preferences are considered in care planning.
In the case of Ms. Rahimah,
it was important to respect her autonomy in making her decision to elect
hospice care. She had the right to make this decision, and it was not
appropriate for others to impose their own beliefs or values on her. Healthcare
professionals should provide information, support, and guidance to help
patients make informed decisions, but they should not pressure patients to
choose a particular course of care.
Aside from respecting
autonomy, it is also important to provide care that is non-maleficent or that
does not cause harm. Hospice care is designed to provide comfort and relief
from suffering, rather than to prolong life at all costs. Healthcare professionals
should ensure that they are not providing treatments or interventions that
could cause harm or prolong suffering and should instead focus on providing
palliative care that addresses the patient's needs and aims to improve their
quality of life.
In addition to
non-maleficence, it is also important to provide care that is beneficial or
that brings about good. End-of-life care should not only be about avoiding harm
but should also be about providing benefits to the patient, such as relief from
pain and distress, and an increase in their quality of life. Palliative care is
designed to do just that, and healthcare professionals should take a holistic
approach to care that addresses the patient's physical, emotional, and
spiritual needs.
Finally, justice is a
principle that requires individuals to be treated fairly and equitably and not
be subjected to discrimination or bias. In the case of Ms. Jones, it is
important that healthcare professionals do not discriminate against her based
on her age, or gender.
3.Case
Study 3
John Anderson, a
68-year-old man, has been living with end-stage heart failure for the past two years. Current Condition severe shortness of breath, fluid retention, declining
organ function. Despite various medical interventions, his condition has progressively
worsened. John's heart function has significantly declined, leading to severe
shortness of breath and fluid retention. He is frequently hospitalized for
complications related to his heart failure. The medical team believes that John
is approaching the end stages of his illness.
Ethical Dilemma:
John's family and
healthcare providers are facing an ethical dilemma regarding end-of-life
decisions. John's condition is unlikely to improve, and his quality of life is
greatly compromised. The medical team and family members have different
opinions on the best course of action. Some family members advocate for
continuing
aggressive interventions, while others believe that
focusing on comfort care and ensuring a peaceful end is more appropriate.
Options Considered:
Continuation of Aggressive Interventions:
Continue with advanced
medical treatments, such as cardiac interventions, mechanical circulatory
support, or transplantation, with the goal of extending John's life. Engage in
ongoing discussions with the medical team to assess the potential benefits, risks,
and burdens of these interventions. Understanding these factors will help John
and his loved ones make informed decisions regarding the continuation of
aggressive treatments. Ensure that John's goals and preferences are considered
in the decision-making process.
Transition to Palliative Care and Symptom
Management:
Transitioning to palliative
care signifies a shift in the treatment approach, placing emphasis on improving
John's quality of life. Instead of pursuing aggressive interventions, the focus
now shifts to providing holistic care that addresses his physical, emotional,
and spiritual well-being. Palliative care aims to alleviate symptoms, manage
pain, and enhance overall comfort, allowing John to make the most of his
remaining time. Symptom management is a vital aspect of palliative care.
Medications are commonly used to alleviate symptoms such as pain, nausea,
anxiety, and shortness of breath. The palliative care team, in collaboration
with John, will develop an individualized plan tailored to his specific needs.
This approach ensures that medication regimens are optimized, providing
effective relief while minimizing potential side effects. Shortness of breath
is a distressing symptom often experienced by individuals with advanced medical
conditions. In palliative care, oxygen therapy and non-invasive ventilation can
significantly improve John's breathing and enhance his comfort. These
interventions aim to alleviate breathlessness, allowing him to engage in
activities that bring joy and maintain a sense of independence.
Shared Decision-Making and Advance Care Planning:
Shared decision-making is
crucial in the continuation of aggressive interventions. It involves
collaboration between John, his family, and the medical team. By providing
comprehensive information about the available treatment options, their
potential outcomes, and associated risks, the medical team can empower John and
his family to actively participate in the decision-making process. This
collaborative approach ensures that the final decision aligns with John's
values, preferences, and long-term goals.
4.Conclusion
From the case study
presented, there are 3 prong conflicts that can be observed regarding
decision-making for end-of-life care; the patient’s advocate vs healthcare
worker, the patient vs her family member, and the patient’s family member vs
the healthcare worker.
In this dire situation,
everyone involved does have their best intention at heart, aiming for the best
outcome for the patient, but when it concerning the end of life care, the
willingness to participate in the conversation is varied, both for the patient’s
themself and their relatives as it is emotionally challenging (Gjerberg, E. et
al, 2015) and it poses communication challenge even with the healthcare
provider (Naomi, R. et al. 2016). Adding the weight of the situation is when
the patient can’t exercise their autonomy, the responsibility to make the
decision will fall onto their legal next-of-kin, as this has always been part
of hospital policies.
However, many of the
patient’s relatives did not really know what the patient’s needs were, despite
the patient’s belief in them (Georg Bollig et al. 2016).
Since all the case studies
happen in hospital settings and involve palliative care, referring to
Palliative Care Services Operational Policy 2010 by the Ministry of Health
(MOH) is essential as it provides ethical guidelines for handling the
situation. As palliative care is generally a new medical specialty recognized
by MOH in 2005, another guideline that can be helpful to assist in the
decision-making for the professional parties is Handbook in Palliative Medicine
in Malaysia, developed in 2015. The reasons this was emphasized was that this
policy and handbook can assist in making better solutions for the case studies,
as it is coherence with Principal A: Beneficence and Non-Maleficence, of APA
General Principle (2010) when the psychologists' scientific and professional
judgments and actions may affect the lives of others, they need to be alert and
guarded against personal, financial, social, organizational, or political
factors that might lead to misuse of their influence.
According to the policy,
effective communication skills are essential tools in palliative care and
healthcare providers must develop these skills, including effective listening,
providing information, facilitating decision making and coordinating care among
the patient, family, and other healthcare providers, as this has proven to
better prepare the patient for their final outcome and reduce moral distress
for their relatives (Georg Bollig et al. 2016). This provision is aligned with
Principle E: Respect for People's Rights and Dignity, of APA General Principle
(2010), where individual differences are respected and taking these differences
into consideration when working with others.
Managing end-of-life care
decision’s making can also be guided by the Resolution on Palliative Care and
End-of-life Issues, adopted by the APA Council of Representatives, which
“endorses the principles that care for individuals with advanced serious illness
should be comprehensive, high quality, integrated, interdisciplinary,
patient-centered and family oriented, coordinated across all providers and
settings; accessible, and available through governmental and private health
insurers and care delivery programs. Individuals should have the opportunity to
engage in conversations about their health care, the results of which should be
incorporated into ongoing care plans.” (2017, para 74).
eorg Bollig, Eva
Gjengedal and Jan Henrik Rosland (2016) They know! —Do they? A qualitative
study of residents and relatives’ views on advance care planning, end-of-life
care, and decision-making in nursing homes. Palliative Medicine Vol. 30(5)
456–470 DOI: 10.1177/0269216315605753
Gjerberg, E.,
Lillemoen, L., Førde, R. et al. (2015) End-of-life care communications and
shared decision-making in Norwegian nursing homes - experiences and
perspectives of patients and relatives. BMC Geriatric 15 https://doi.org/10.1186/s12877-015-0096-y
Naomi R. George,
Jennifer Kryworuchko, Katherine M. et al. (2016) Shared Decision Making to
Support the Provision of Palliative and End-of-Life Care in the Emergency
Department: A Consensus Statement and Research Agenda. Academic Emergency
Medicine https://doi.org/10.1111/acem.13083
Jahn
Kassim, P. N., & Alias, F. (2015). End-of-life decisions in Malaysia:
Adequacies of Ethical Codes and Developing Legal Standards. Journal of Law and
Medicine.
Wiegand,
D. L., MacMillan, J., dos Santos, M. R., & Bousso, R. S. (2015). Palliative
and end-of-life ethical dilemmas in the Intensive Care Unit. AACN Advanced
Critical Care, 26(2), 145–146. https://doi.org/10.4037/nci.0000000000000085
American
Heart Association. (2017). Shared Decision-Making in Advanced Heart Failure: A
Scientific Statement from the American Heart Association. Circulation: Heart
Failure, 10(9), e000025.
National
Consensus Project for Quality Palliative Care. (2021). Clinical Practice
Guidelines for Quality Palliative Care, 4th edition. Retrieved from https://www.nationalcoalitionhpc.org/ncp/.
Meier,
D. E. (2011). Increased access to palliative care and hospice services:
Opportunities to improve value in health care. The Milbank Quarterly, 89(3),
343-380.
Upadhyay,
A., & Mello, M. M. (2014). The ethics of chronic pain management. In J. C.
Ballantyne & D. J. Sullivan (Eds.), The Oxford Textbook of Palliative
Medicine (5th ed., pp. 126-134). Oxford University Press.
Akdeniz,
M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations in
end-of-life care. SAGE Open Medicine, 9, 20503121211000918.
Cavallaro,
V. (2014). Advance Directive Accessibility: Unlocking the toolbox containing
our end-of-life decisions. Touro L. Rev., 31, 555.
Parks,
S. M., Winter, L., Santana, A. J., Parker, B., Diamond, J. J., Rose, M., &
Myers, R. E. (2011). Family factors in end-of-life decision-making: Family
conflict and proxy relationship. Journal of palliative medicine, 14(2),
179-184.
Disunting oleh: Muhammad Afiq Shahiri Bin Sapie 4 September 2020 1 (2)
Ramai orang yang telah didiagnosis dengan penyakit mental mendapat kekuatan dan penyembuhan melalui penyertaan dalam terapi individu atau kumpulan yang diprogramkan. Pilihan terapi adalah banyak dan berbeza dari seorang ke seorang. Walaupun tiada satu terapi berkesan untuk semua orang, orang ramai boleh memilih rawatan, atau gabungan terapi, yang mereka percaya paling berkesan untuk mereka.
Apabila kita pergi ke gangguan kecemasan. Terdapat beberapa cara yang boleh dilakukan untuk menguruskan psikoterapi gangguan kecemasan ini. Psikoterapi sering dikenali sebagai terapi bercakap atau kaunseling psikologi, adalah usaha kolaboratif antara anda dan ahli terapi untuk mengurangkan gejala kebimbangan anda. Ia berpotensi untuk menjadi terapi kebimbangan yang berkesan.
Pakar psikologi telah memberikan petua dan peranan untuk mencegah atau mengawal jika seseorang itu mengalami kebimbangan seperti mengekalkan tahap aktiviti fizikal yang sihat setiap hari. Elakkan mengambil minuman beralkohol dan menggunakan dadah rekreasi untuk memastikan badan anda kekal sihat dan juga merokok harus dielakkan, dan minuman berkafein harus dikurangkan atau dielakkan sama sekali. Selain itu, pengurusan tekanan dan strategi relaksasi harus digunakan untuk melaksanakan setiap hari.
Bandung 2020
Diagnosis Awal dan Tepat:
Lakukan penilaian klinikal yang menyeluruh.
Menggunakan alat penilaian dan diagnostik standard.
Mengambil kira sejarah perubatan dan psikososial pesakit.
Rawatan perubatan:
Penggunaan ubat psikotropik seperti antidepresan, antipsikotik, dan penstabil mood.
Pemantauan kesan sampingan dan pelarasan dos ubat jika perlu.
Rundingan tetap dengan pakar psikiatri.
Terapi Psikologi:
Terapi kognitif-tingkah laku (CBT).
Terapi keluarga atau kumpulan sokongan.
Terapi berasaskan kesedaran seperti meditasi dan yoga.
Pendidikan dan Sokongan Pesakit:
Memberi pendidikan tentang gangguan mental yang dialami.
Membantu pesakit memahami dan menguruskan simptom.
Membangunkan kemahiran mengatasi dan teknik relaksasi.
Sokongan Sosial:
Galakkan hubungan sosial yang positif dan sokongan daripada keluarga dan rakan-rakan.
Menyediakan akses kepada kumpulan sokongan komuniti.
Mengurangkan stigma terhadap gangguan mental dalam masyarakat.
Pelarasan Gaya Hidup:
Menggalakkan amalan gaya hidup sihat seperti diet seimbang dan senaman yang kerap.
Kurangkan atau elakkan penggunaan bahan seperti alkohol dan dadah.
Uruskan tekanan melalui aktiviti relaksasi dan tidur yang cukup.
Pemantauan dan Penilaian Berkala:
Penilaian berterusan keberkesanan rawatan.
Menyesuaikan pelan rawatan berdasarkan kemajuan atau perubahan dalam keadaan pesakit.
Dapatkan maklum balas daripada pesakit dan keluarga berkenaan rawatan.
Campur Tangan Krisis:
Penyediaan pelan tindakan untuk situasi kecemasan atau krisis.
Hubungi perkhidmatan kecemasan atau hospital jika perlu.
Berikan intervensi segera untuk mengurangkan risiko kepada diri sendiri atau orang lain.
Akhir sekali, terdapat begitu banyak yang disyorkan oleh ahli psikologi untuk menguruskan gangguan mental. Apa yang dikongsikan di sini adalah sebahagian daripada perkara penting untuk anda tahu bagaimana untuk menguruskan sekiranya berlaku gangguan mental yang akan berlaku. Antara yang penting lain ialah psikoterapi sokongan ialah sejenis psikoterapi yang membantu orang berasa lebih baik tentang diri mereka sendiri. Jenis yang paling kerap digunakan, adalah berdasarkan perkembangan hubungan simpatik dan sokongan antara pesakit dan ahli terapi.
