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THE ART OF COMMUNICATION IN THE NURSING PROFESSION Nursing is a caring profession. It is also a profession that is more and more evidenced based in practice. In as much as the scientific aspects of nursing is increasing due to the complex technological advancement of medicine and the machinery that is used at the patients bedside, the fact remains that the nurse is the first person that the client usually comes in contact with in any emergency or hospital setting. Having said this, the term, "caring" is an essential emotion that all nurses, for that matter, all individuals in the health profession must possess. With caring comes the trained ability of the nurse to facilitate therapeutic communication. One might ask, what is therapeutic communication? To better answer this question, the term communication should first be defined. Communication can be defined as "The Process of transmitting messages and interpreting meaning." (Wilson and others, 1995) With therapeutic communication, the sender, or nurse seeks to illicit a response from the receiver, the patient that is beneficial to the patients mental and physical health. Just as stress has been proven to adversely affect the health of individuals, the therapeutic approach to communication can actually help. In any given situation everyone uses communication. Everyone has seen the individual that looks like they are either angry, stressed, feeling ill or maybe sad. These emotions are communicated to others not always by words, but by gestures and facial expressions. A nurse must always be aware of these expressions in clients, for these expressions may be the only way that the nurse can tell if there is something else going on that needs their attention. The term given to this type of non-verbal communication is called, meta-


communication. In meta-communication, the client may look at their amputated stump and say that it doesn't really look that bad, while at the same time tears are rolling down from their eyes.


NEGATIVE CRITICISM Whenever the word criticism is mentioned, it seems to invoke a negative image in our mind. Most of us tend to take it as an insult, discouraging, or offensive, and are unable to handle it easily. And yes, criticism can make a person nervous, mad, and defensive. I have seen people getting offended quite easily and quickly when they hear words of criticism about them. Even a person of high status and considered to be noble, humble, and respectable gets angry when he is being criticized. This has made me to ponder why we cannot accept criticism with an open mind, grace, and joy? Why are we so sensitive about criticism and why do we allow it to affect us in our work, relationship, and productivity? When we say how to face or deal criticism then it implies criticism to be awful, difficult, problematic or troublesome. Criticism in fact is a boon, a beauty, a benediction if we delve deep ino it and dissect its psychology. This article is all about accepting and understanding the true facets of criticism. Lets not be negative right from the beginning. Lets be realistic while we approach this topic then only we will be able to understand and accept criticism wholly and enjoy the beauty it can bring to our lives. Before I offer you my suggestions on how to accept criticism I would also encourage you to take a look at my article How to stop complaining and criticizing unnecessarily as it explores the psychology being our constant complaining and criticizing and provides you with 5 key and effective ways on how to stop your habit of chronic complaining or criticizing purposelessly.



Self-discipline refers to instructing oneself to accomplish certain tasks or to adopt a particular pattern of behaviour, even though one would really rather revert to a passive or nonmotivated state. Self-discipline is also known as self-control where assertion of willpower dominates a persons state of being.

An example of self-discipline is when a person maintains a home-study course over a period of time and completes it within the required time-frame and minimum competency level. Another example relates to maintaining a daily exercise regime despite wanting to do something else like watch television or to lie in bed for a longer period in the morning.

One of the key factors of achieving successful outcomes is the power of self-discipline. Brian Tracys courses on Maximizing Your Performance state that self-discipline is a key success factor to achieving ones goals and objectives. He defines self-discipline as the ability to make yourself do what you should do when you should do it, whether you feel like it or not.


DOES YOUR SUNSCREEN REALLY MATTER? A lot of people used sunscreens but not all are aware of the products contents. The Environmental Working Group (EWG) of the United States Of America found out that among the 800 different brands of sunscreens being marketed only about one-fourth of it had passed the standard for effectiveness and safety. Somehow, one-fifth of the 800 sunscreens werent able to meet the standards because they contain such ingredients like vitamin A. Vitamin A is good for the eyes but not for the skin. While the other sunscreens were rejected because they do not contain active ingredients to block Ultra Violet rays, which was the main purpose, why sunscreens are created. The EWG has also revealed different facts about what we think we already know sunscreens. Advertisements tell us pretty things about sunscreens but what we do not know is that the evidences gathered about sunscreens preventing skin cancers are weak, there are some ingredients in sunscreens that can increase melanoma, there are dozens of high-SPF-products but no proof that theyre better, too little sunlight exposure might be harmful for it reduces Vitamin D levels, sunscreens common ingredient are Vitamin A that speeds up the development of cancer in the skin, and sunscreens made in Europe are much better because they give up to 5 times of UVA protection. We should know this kind of information because as nurses and future ones to be, we wouldnt want advise our patients with things or treatments that will give harm to them.



TRAINING makes perfect. Lifelong learning and continuous education are very important to stay relevant in the world. More importantly, mastering the art of being versatile and adaptable are keys to keep our contributions in our profession and community meaningful and relevant. Though I was a winner of public speaking and debating competitions in the past, I was soon enrolled into the school of life where I had to reinvent my skills in public relations and communications. On a normal day, I was paired up with industry leaders, fellow British politicians and NGO campaigners to share ideas and to learn from them. Thanks to their advice, ranging from ways to organise people to volunteer and raising funds to getting endorsements from relevant authorities, one thing became clear to me: A capable leader needs to be a motivator, an inspiration and a visionary with the ability to communicate, convince and rally up his or her supporters and resources to realise a collective goal. This was when I learnt that the art of communication would play a significant role in my ambassadorial work. I was entrusted with the responsibilities to raise awareness about volunteerism, to co-create and organize projects across different countries, and become a leader by example, a spokesperson for youths.



1. Don't respond to the person who criticizes me immediately, as my response is bound to be emotional and I will later regret it. Take time to figure out if what they're saying has any merit and if it doesn't...respond calmly and maturely or not at all. 2. If the negative criticism hurts and is bringing me down more than it should, seek the encouragement of friends. I did a post of Face book about the foetus comic and within minutes, I had a bunch of friends chiming in with their support and encouragement. That felt wonderful and picked me back up again somewhat (I always take a little while to recover, like I said I have ridiculously thin skin). Friends are invaluable. 3. Keep making art and when the negative thoughts start creeping in, make an effort to remind myself that I HAVE improved over the last several years, that I do the best I can, that I do this because I love it and that there are people who appreciate my art out there, even if theres not that many of them just yet. Also, while making art, turn my music up loud or listen to Radio lab, Ted Talks and Dan Savage's podcast for intelligent, mind occupying distractions from my own silly thoughts. 4. Take negative feedback as a sign of success! My partner does this and I kind of like this approach. If when people are viewing your art, they experience emotions that are so negative that they have to share them... well, at least your art has affected them in some way! 5. Write about it. At the start of this journal entry I was feeling upset and down on myself, now I'm feeling empowered and inspired! Hooray for processing shit!


6. Remember that even if there is a grain of truth in the negative feedback, that it is not the entire picture. No art is perfect and sometimes we have to make truly awful art to learn, that doesn't mean we suck, it just means we're human. 7. Art is subjective! Just because one person, or even one thousand people, don't like your art... that actually means sweet fuck all. There will be people who like your art and they're the ones who should matter to you.


THERAPUETIC COMMUNICATION IN THE NURSING PROFESSION Nursing is a caring profession. It is also a profession that is more and more evidenced based in practice. In as much as the scientific aspects of nursing is increasing due to the complex technological advancement of medicine and the machinery that is used at the patients bedside, the fact remains that the nurse is the first person that the client usually comes in contact with in any emergency or hospital setting. Having said this, the term, "caring" is an essential emotion that all nurses, for that matter, all individuals in the health profession must possess. With caring comes the trained ability of the nurse to facilitate therapeutic communication. One might ask, what is therapeutic communication? To better answer this question, the term communication should first be defined. Communication can be defined as "The Process of transmitting messages and interpreting meaning." (Wilson and others, 1995) With therapeutic communication, the sender, or nurse seeks to illicit a response from the receiver, the patient that is beneficial to the patients mental and physical health. Just as stress has been proven to adversely affect the health of individuals, the therapeutic approach to communication can actually help. In any given situation everyone uses communication. Everyone has seen the individual that looks like they are either angry, stressed, feeling ill or maybe sad. These emotions are communicated to others not always by words, but by gestures and facial expressions. A nurse must always be aware of these expressions in clients, for these expressions may be the only way that the nurse can tell if there is something else going on that needs their attention. The term given to this type of non-verbal communication is called, metacommunication. In meta-communication, the client may look at their amputated stump and say that it doesn't really look that bad, while at the same time tears are rolling down from their eyes.

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In a case such as this the nurse should stay and further explore how the person actually feels. There are many factors associated with the healing and comforting aspects of therapeutic communication. Circumstances, surroundings, and timing all play a role in the effect of therapeutic communication. If a client is being rushed down for an emergency surgery there might not be time for a bedside conversation, but the holding of a hand could convey much more than words to the client at such a moment. Ideally, for therapeutic communication to be effective the nurse must be aware of how they appear to the client. If a nurse appears rushed, for example, they are speaking quickly, their countenance looks harried, and they are breathing heavily, their eyes not on the client but perhaps on an intravenous bag on the client in the next bed. In a case like this, there is nothing that this nurse could say to the client in a therapeutic manner that the client would believe. The helping relationship has not been established and therefore therapeutic communication cannot be facilitated. Some of the emotions associated with therapeutic communication include but are not limited to the following: Professionalism, Confidentiality, Courtesy, Trust, Availability, Empathy, and Sympathy. (Potter, Patricia A., Perry, Anne G., Co. 2003, Basic Nursing Essentials for Practice, pg. 123, Mosby) All of these emotions go into the client nurse relationship, which must be established by the nurse as soon as possible upon first meeting the client. To begin to establish this nurse client relationship, the nurse must assess the overall message that the client is communicating to the nurse, such as fear, pain, sadness, anxiety or apathy. The nurse should be trained in keying into the message that the client is sending. Only then can the nurse determine the best therapeutic approach. Anyone that has to be thrust in to a hospital or emergency room environment has level of anxiety.

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This level can go up considerably when the client feels that they have been abandoned or that there is no one there that really cares about how they feel. When a client is the recipient of therapeutic communication from a caring individual, a level of trust is achieved and more than, that the clients entire countenance can change for the better. Their blood pressure, respirations and levels of stress can simultaneously decrease. When this takes place, the management of pain, if any is involved, can be resolved more quickly. The goal for a nurse is to become proficient in the medical

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WHAT DOES NEGATIVE CRITICISM DO TO A TEEN? When a teen is consistently bombarded by negative criticism by his parent he will begin to internalize the words and believe them, whether they are true or not. This will affect a teen in these five ways: 1. He will have a negative view of himself. 2. He will have poor self respect and respect for others. 3. He will feel insecure about his abilities. 4. He will feel powerless unable to help himself and others. 5. He will have a lower his sense of self-worth.

These feelings of self doubt and insecurity will cause a teen to do these things: (a) He will withdrawal, be less likely to communicate with the parent. (b)He will use lying and not listening as a defense against the negative criticism. (c)He will become argumentative. (d)He will manipulate others and events so that he does not have to take the blame. (e)Reading that list, you can see why avoiding negative criticism is important if parents want to effectively communicate with their teen.

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THE EFFECTS OF FAMILY FUNCTIONING ON SELF ESTEEM OF CHILDREN Family functioning was significantly correlated with the students self-esteem. The main hypothesis, predicted a positive relationship between family functioning and self-esteem was supported. This finding was in agreement with other researches which were done in countries other than Malaysia. As other studies have shown, family functioning seems to significantly predict students self-esteem. This suggests that the better the quality of family functioning, the higher the self-esteem among students. Present study proposes some degree of relationship between family functioning and self-esteem and support the research evidence of other researchers (Mandura & Murray, 2000). who discovered that there is a general uniformity across cultures regarding the magnitude of the correlation between family functioning and self-esteem. This means that there are no significant differences across cultures concerning the relationship between family functioning and self-esteem. Family functioning does play an important role in affecting students self-esteem regardless of culture. A childs own direct experience with success or failure in various areas plays an obvious role. The values a child attached to some skill or quality is obviously affected directly by parents attitudes and values. The degree of emphasis parents place on a childs performance in school works, athletics, or games is an important element in forming the childs aspiration. One recent study found that as family cohesiveness increased, adolescents self-esteem increased over time (Baldwin & Hoffman, 2002). In this study, family cohesion was based on the amount of time the family spent together, the quality of their communication, and the extent to which the adolescent involved in family decision making. In the research of finding out self-esteem and parent-child relationships, easures of self-esteem and parental relationships were administered on 400 respondents. Parents were also interviewed to find out the family relationships. Based on these assessments, the following parenting

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attributes were associated with adolescents high self-esteem: expression of affection, concern for childrens problems, harmony at home, participation in joint family activities, availability to give competence, organized help when children needed it, parents setting clear and fair rules, and allowing children freedom within well-prescribed limits. These findings are correlational, but based on the available data, the researcher must say that they are related to, rather than cause childrens self-esteem. Peer judgments gain increasing importance in adolescence. The correlation between peer approval and self-worth increases during adolescence (Harter, 1990). However, support from the general peer group is more strongly related to self-worth than is support from close friends. Although peer approval is linked with self-worth, parental influence continues to be related to adolescents selfworth and this correlation does not decline until emerging adulthood (Harter, 1999).

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TRAINING MAKES PERFECT. LIFELONG LEARNING AND CONTINUOUS EDUCATION ARE VERY IMPORTANT TO STAY RELEVANT IN THE WORLD More importantly, mastering the art of being versatile and adaptable are keys to keep our contributions in our profession and community meaningful and relevant. Though I was a winner of public speaking and debating competitions in the past, I was soon enrolled into the school of life where I had to reinvent my skills in public relations and communications. On a normal day, I was paired up with industry leaders, fellow British politicians and NGO campaigners to share ideas and to learn from them. Thanks to their advice, ranging from ways to organise people to volunteer and raising funds to getting endorsements from relevant authorities, one thing became clear to me: A capable leader needs to be a motivator, an inspiration and a visionary with the ability to communicate, convince and rally up his or her supporters and resources to realise a collective goal. This was when I learnt that the art of communication would play a significant role in my ambassadorial work. I was entrusted with the responsibilities to raise awareness about volunteerism, to co-create and organise projects across different countries, and become a leader by example, a spokesperson for youths.

CRAFTING MESSAGES Media training is important to help role models and leaders craft their messages and for them to master the art of delivering their stories in the most effective, yet concise manner.

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It was rather nerve-wrecking especially for me to be on the hot seat, simulation training meant mostly for high-profile politicians to learn the art of handling difficult questions or claims from the media world. We were interviewed and handled a debate on a heated topic with journalists. You have to know your facts, be confident and, most importantly, be inclusive in the delivery of your message through the media, where you need to communicate your story in a way that could capture the imagination and the interest of the viewers to support you, while convincing them that they could play a role. Armed with a solid message and a charismatic front for the media, it was time for us to tackle the new media more commonly known as the audience on the social media platform. I was lucky to be trained by professionals who had organised massive social media campaigns and following for the worlds biggest brands or the go-to-company for Facebook & Twitter campaigns in the heart of London. With the evolving trends on social media, keeping ourselves updated with the latest apps, online tools and strategies to build a following is important.

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FAMILY: CHILDREN FROM BROKEN FAMILY Children from broken families are nearly five times more likely to suffer damaging mental troubles than those whose parents stay together, Government research has found. It also showed that two parents are much better than one if children are to avoid slipping into emotional distress and anti-social behavior. The findings say that childrens family background are as important - if not more so - than whether their home is poor, workless, have bad health, or has no one with any educational qualifications.

Difficult start: Children raised by a single parent are more likely to suffer distress. The research adds to a wealth of data that shows children suffer badly from divorce or parental break-up, and that those brought up by a single parent are more likely to do badly at school, suffer poor health, and fall into crime, addiction and poverty as adults. The report, funded by the Department of Health and published by the Office for National Statistics, investigated emotional disorders ranked as those which cause considerable distress and interference with the way in which children perform at school and during play. It also looked at conduct disorders which result in aggressive, violent or anti-social behavior. The researchers studied nearly 8,000 children aged between five and 16 in 2004 and found almost one in ten had disorders. The children were checked again last year. The report said that a child whose parents had split during this time was more than four and a half times more likely to have developed an emotional disorder than one whose parents stayed together. They were nearly three times more likely to exhibit a conduct disorder. Eleven per cent of those children whose families broke up had emotional disorders, against 3 per cent among those whose families were still together. Nearly a third of children found to have mental disorders in 2004 still suffered from them three years later. The

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Department of Health said: The Government is committed to helping children and young people experiencing mental health problems. But academic Patricia Morgan, author of several studies on family break-up, said: This does not come as a surprise, and things are going to get worse. Broken families and serial fathers produce homes full of conflict and chaos and they are terrible for children.

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SONA FAILED TO ADDRESS BASIC ISSUES CRITICS President Aquinos State of the Nation Address (Sona) left many in the dark on the direction of Aquinos administration in the remaining four years of his term as he failed to address what are considered gut issues among Filipinos, critics said. Zambales Rep. Ma. Milagros Mitos Magsaysay said while the Sona had many good points, there were still some areas that leave more questions than answers.My question here is whether or not he is doing the same things with those who are committing wrongdoings under his administration. Those who have abused their power, is he holding them accountable in the same way? There should be equal dispensa-tion of justice, whether you are a court interpreter, or a chief justice, and even when you are an ally, a shooting buddy or a classmate of the President, Magsaysay said. Another point Magsaysay raised was the amount of projects that the President had in mind and where to secure the funds. The Catholic Bishops Conference of the Philippines (CBCP) also branded as not the true state of the nation pictured in the Sona. Speaking during the weekly CBCP Forum, Fr. Edu Gariguez, executive secretary of the CBCP National Secretariat for Social Action Justice and Peace (NASSA), said the President failed to address the very issues that affect ordinary Filipinos. This was shared by Adolfo Paglinawan, spokesperson of the Agrarian Reform Beneficiaries (ARBA) and Anakpawis Partylist Rep. Rafael Mariano, who said during the forum that the basic issue of food security and labor rights were not tackled. Gariguez said gut issues like rising prices of basic commodities and services and even labor were not tackled giving the impression that they were not important to the chief executive.The programs he has outlined were all laudable and if this was going to be the basis of the Sona, he would pass with flying colors, but where are the funds supposed to come from when revenue leakages are still unplugged? Magsaysay said as he noted that the Bureau of customs (BoC) and the Bureau of Internal Revenue (BIR) continue to be remiss in hitting their monthly targets which amounts to

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billions of pesos in lost revenues.Are the people that he put in these agencies truly able to cope with the challenges of fueling the governments current and future projects, and what is the President going to do about this? Perhaps, if he reassesses their performance and replace them with people who are better equipped to fulfill their goals, it would be better, Magsaysay added. On the issue of poverty alleviation, Magsaysay remains adamant against the Pantawid Pamilyang Pilipino Program (4Ps) or the conditional cash transfers (CCT), and said this dole out system is an ineffective way to curb the problem poverty which benefits only a small portion of the population.If the program is effective, then why does the self rated poverty index remain at a high of 51 percent and those who suffer from hunger are around 3.8 million, according to SWS? What has really changed in the lives of the supposed beneficiaries of the program? This truly calls for reassessment as the funds that are being used for the program is being borrowed from the ADB, Magsaysay stressed. Magsaysay also called for clear cut rules in the private public partnerships (PPP) that remain at a standstill because of ever changing policies pertaining to investments.These PPPs should be prioritized because these will create jobs. Jobs that are vital to help bring down unemployment and uplift the lives of our impoverished masses, Magsaysay said. Meanwhile, as oil companies once again increased the price of petroleum products for the third straight week, Bayan Muna Rep. commodities are the basic issues that ordinary Filipinos want to be addressed.

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THE ART OF VERBAL COMMUNICATION It's the stuff of a yoga teacher's nightmare: You're leading your class, and it's going seamlessly. Everything is flowing so perfectly, in fact, that you're starting to wonder if anyone is actually paying attention to the subtle nuances of your instruction. Nothing, you think, can shake your students. Then you attempt to take them from Down-Dog into Warrior I, and the unthinkable happens. You mean to say, "Step your right foot between your hands," but somehow you tell them, "Step your right hand between your legs."

In the time it takes to make this simple yet deeply flawed instruction, your flock dissolves from the cohesion of a well-choreographed ballet corps into abject confusion. Some students, anticipating Warrior I, do what you meant to ask. Others look around in bewilderment. And, yes, others timidly place their right hand between their legs. Suddenly you realize that your students are indeed listening intently, and that language matters.

If you've ever had a moment like this, you know that paying attention to your own words is paramount when you're teaching a class. What's more, a few tricks can make your language so much more vibrant that not only will you stay on your toes and avoid embarrassing slips, but your students will actually grasp what you're trying to tell them. Practice these simple concepts to help make your instructional language alive and effective.

1. Provide landmarks when you give instructions.

Do you remember how confused you were when you first practiced yogafiguring out which foot was your left, which leg was your right, and following the teacher in mirror image?

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There is no easier way to provide your students with clarity than by using obvious landmarks in the room when you give instructions.

Think about teaching twists, for example. Your students' bodies are so tied up, overlapped, and crisscrossed that their left is on their right and their right is on their left. So instead of saying, "Turn your torso to the right," tell your students to "Rotate your torso toward the prop cabinet." I promise that practicing this simple step will make your language more clear and save your students from being thoroughly baffled throughout your class.

2. Learn your students' namesand use them.

As a yoga student yourself, you are well aware that everyone spaces out in class once in a while. Truthfully, whose eyes don't glaze over after 90 minutes of impersonal and generalized instructions? Make your teaching more skillful and intimate by using your students' names. Instead of repeating the same tired instructions, really look at your students, and help them clarify, expand, or deepen their poses by relating to them directly. Try saying, "Jeff, please bend your front knee more deeply" or "Lauren, relax your neck and soften your jaw."

Personalizing instructions is not only a good way to take care of your students, it is the best way to make your communication more direct and relevant. The added bonus is that everyone else in the room who needs to relax his or her neck will probably follow suit. Of course, you should use a soft, encouraging tone when you use names so that people don't feel like they are being singled out or scolded. You should follow up with affirmations such as, "Yes, you've got it," "Excellent," or "Thank you," so that everyone knows your direct instructions are designed to help people rather than make them feel like they are doing the wrong thing.

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3. Pretend you're working with a translator, and allow space between your instructions.

I've been fortunate to participate in several teacher trainings in Havana, Cuba. I speak only English, so I had the interesting and fairly rare experience of teaching with a translator. I learned very quickly that I couldn't ramble on, nor could I give cluttered and unclear instructions such as, "Well, OK, really, really try to extend through your leg if you can." Seriouslyjust try to translate that.

But to tell the truth, that is what your students are doing: They are translating your instructions. If your directions are clear and you provide enough space between each one, your students will be able to follow along. If, however, you give 15 instructions in a row with no breath or pause between, your students will be lost. Always provide time for your students to digest your words before blazing ahead.

4. Three is a magic number.

Don't tell your students everything you know about each pose. Some teachers, your author included, are tempted to fill every second of each class with instruction, precaution, lore, personal revelation, and more. After all, there are few moments when we have a captive audience for an hour and a half.

But this is yoga class, not a storytelling seminar, so don't overcrowd your students or compete with yourself. Stick to an average of three instructions per pose. This probably sounds like too few, but it's as many as your students are likely to handle. What's more, if these instructions are related to each other, richly descriptive, and relevant to the overall theme of the class, they will give your students plenty to work with while allowing them to have their own experience.

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5. Use images and metaphors (preferably your own).

Teaching yoga is not like giving a PowerPoint presentation. Even when it's succinct, teaching should be full of lively insight, experience, and nuance; it's not just a bone-dry recitation of information. So use language that appeals to sensations and feelings as well as language that applies to reason. Surely you've had an Iyengar teacher command you to open "the eyes of your chest," or an Anusara teacher has invited you to "melt your heart." Taken at face value, these instructions are completely nonsensical. While practicing yoga, though, the words deeply inform your practice because they appeal directly to what you are experiencing in your body. They apply to your kinesthetic and proprioceptive awareness; they may even touch you emotionally or awaken your sense of empathy.

The best images and metaphors are those that come from your own practice. It is easier to recycle the words of others, but there is no poetry in plagiarism, and teachers have a responsibility to do their own homework. Sure, we all assume our teacher's voice at times, but recognize that developing your language skills requires the same level of commitment, consistency, and compassion as deepening your backbends. Heartfelt, authentic, and fresh images will convey more meaning and instruction than overused clichs.

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THE HAMBURGER METHOD OF CONSTRUCTIVE CRITICISM Its funny what things stick with you in life. Back when I was in college, one of my professors somehow got onto the subject of constructive criticism and decided to teach the class the method he uses for offering critical advice to people. Its called the hamburger method, and heres how it works:

When offering a critique, you begin with a constructive compliment on something the person does well (Otherwise known as the fluffy bun part). You then get to the meat of the matter, which of course is the constructive criticism part. Finally, you end with another constructive compliment (i.e. the other half of the fluffy bun). Basically, youre sandwiching the constructive criticism between two constructive compliments. In my experience, its been an extremely effective technique, largely due to its disarming effective. It helps people let down their guard, and receive the criticism without being as defensive. Heres an example: Hey Defensive Dave, I noticed you went out of your way to submit your expense report on time every month for the last three months thats great! I do, however, think its a bad idea to call Jane in accounting an ignorant slut. She may not be familiar with that old 1970s Saturday Night Live Television skit and may be offended by your comment. But overall, your interaction with the team has been great thanks for making the effort.

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I once suggested the hamburger method to a client who quickly dismissed the technique as candy coating. Maybe it is, but if it gets a better result, isnt that the whole point? Medicine manufactures candy coat medicine all the time for two reasons:

Also, I think a 2 to 1 ration of constructive compliments to constructive criticism makes sense because it affirms the desired behavior or practice.

So here are a few things to consider before offering criticism: 1. Is the criticism truly constructive? Here are some synonyms for constructive: Positive, helpful, productive, useful, beneficial, and practical. Antonym: Destructive. 2. Why am I offering this criticism in the first place? Is it because Im trying to be helpful or just because Im an a**hole? 3. Is the criticism necessary and appropriate? Does it have a great impact on the grander scheme of things, or am I just being nitpicky. Will focusing on this issue be worth the time and effort in the long run? 4. Do I have the right, or better yet - have I earned the right to speak into this persons life? The difference between management and leadership has a lot to do with the relationship you have with your team. Managers tend to focus on control, whereas real leaders take people to the next level.

5. Finally, have I noticed at least two things to compliment before commencing with the criticism?

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If youve run through the list and are satisfied that the criterion is met, then give the hamburger method a try. I think youll find its a great tool for offering truly constructive criticism.

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CHILDREN STIR UP BURIED AND UNRESOLVED FEELINGS FROM OUR OWN CHILDHOOD Our children often reawaken painful feelings that we long ago blocked from our awareness. The innocence, liveliness, and spontaneity of a child can stir up the hurts in our own childhoods and threaten to reactivate them. Our avoidance of these old feelings can cause us to pull away from relating closely with our children. At times when there is an emotional connection, we may be uncomfortable and even feel anger or resentment toward our child. If we stay defended against the feelings that are being stirred up in us, we will be cut off from our children and mistuned to what they are feeling and experiencing. In the preface to Compassionate Childrearing, R.D. Laing described this: Those outstretched arms open up a well of loneliness [in the adult]. But in these feelings, mixed up in them at once physical smells new and stale of ghosts of awakened sensations in oneself, are evoked, by that dead me, that me that was me, I see in the baby. The baby is still appealing to me with the language of the heart, the language I have learned to forget and to mistrust with all my 'heart.' Instead of continuing to defend ourselves against feelings we suppressed in childhood, we can face them and make sense of any traumas that have been unresolved. Once we understand what happened in our own childhoods, we can be more effective parents and develop more secure attachments with our children. In Parenting from the Inside Out, Dan Siegel states, The integration of our own self-knowledge facilitates our being open to the process of becoming emotionally connected with our children. Coherent self-knowledge and interpersonal joining go hand in hand.

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DO WE NEED PROFESSIONAL CRITICS? The New York Times has prompted an important debate this morning about criticism and critics. The Times asks whether we need professional cultural critics at all in a time when the Internet is teeming with opinion on just about everything. It's a great question, and The Times brings the opinions of several critics to bear. I have lots of thoughts on this, of course, and have been working on a project about a few of the American critics left standing. The art world has been talking about the "crisis of criticism" for as long as I've been alive, and it is interesting for me to see this dialogue spill over into a mainstream discussion. There are a few tired arguments here, to be sure. The idea that old media critics should adapt to new media realities is a real groaner. It's a weird distinction. Some of the best new media journalists work for old media outlets. Also, there is an often-omitted fact that I think is critical context. While the internet has exploded with arts writing of all kinds, some wonderfully experimental and interactive, some incredibly good, those sites typically attract the already are interested among us. So, what does it mean when mainstream publications, newspapers and news magazines, for instance, turn their back on cultural criticism? What does it mean when the curious-aboutthe-world reader of a daily paper or news magazine, who might not be looking for cultural coverage, finds it amid the headlines and sports scores? What does it mean when it disappears, as it has almost entirely in a few short years? One of the many things that struck me was the mix of news and culture represented on the pages of LIFE. A publication like LIFE and other magazines as well, for that matter, were as

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serious about their coverage of politics as they were about art. My how that has changed. The gal in the photograph, by the way, is London-based art critic Charlotte Frost. And you'll spot the cutout of Jackson Pollock in the second image.

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PROVIDING GOOD CONSTRUCTIVE CRITICISM As soon as you hire someone youll need to start providing constructive criticism. Whether you do it in a formal manner (performance evaluations), or you do it on-the-fly at a project-by-project level, doesnt really matter; constructive criticism is part of the game. Constructive criticism is important; employees need to understand where theyve gone wrong, and how they can improve. Its not about treating people like crap, or being negativeits about raising the bar, matching your expectations and helping people improve.

1. Plan before you do it. Make sure you know what you want to say, and why. Have a clear path through the discussion. Leave room for questions and dialogue. Keep the conversation open and flexible, but make sure you plan to get your key points across. 2. Build the person up. Before you get to the criticism itself, focus on positives. Highlight some of the good work the person has done recently, goals that were met or surpassed. Emphasize positive, solid qualities that the person brings to the table. This isnt about over-inflating egos or setting a person up for a fall; its about making sure the person understands they are valued and important, even if the next thing youll be doing is pointing out some problems. 3. Provide clear criticism. Now its time to bring your concerns to the table. Do it as concisely as possible. And as clearly as possible. Dont waffle around. Get to the point. Your approach will differ depending on the person youre speaking to; some would rather you spit it out, others require a slightly more delicate approach. Still, its best to make sure your criticisms are as clear as you can possibly make them. Otherwise it makes it difficult to set a clear path towards improvement.

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4. Build the person up again. Focus on solutions. Focus on re-emphasizing the positive, while keeping an eye on what needs to be done to improve. Open it up for discussionWhat do you think of my assessment? Or What do you think of your recent performance? The goal at the end of a session like this is to leave the employee understanding the problems, and having a path towards resolving them, without feeling like crap. 5. Follow up. This exercise should never be undertaken without follow up. It may be another meeting scheduled with the employee. It may be an impromptu session, where you review the progress made. If the person knows theres follow up, theyre going to feel more confident that the criticism isnt hanging over theyre heads forever. Its not a permanent dark cloud. Follow up can erase constructive criticism, if the person has improved and met goals. Always follow up. Even if its a quick compliment on a job well-done and not a formal second review. Follow up.

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UNDERSTANDING NEGATIVE CRITICISM The general perception of criticism is negative as people judge your actions and work the pass comments on it. In todays world, mostly people criticize to make other person feel bad about his

efforts. It is entirely up to a person to handle the criticism positively and utilize it in order to

improve this work. Criticism if of various kinds and people can criticize almost anything but

mostly either it can be a positive criticism or negative criticism.

It is not that hard to differentiate between negative and positive criticism. If someone is

suggesting you a little bit of changes in your project, he obviously wants you to improve it. Any

criticism that will help in any sort of improvement is known to be a positive criticism. However,

if someone is constantly trying to pull you down by negative remarks and telling you that your

work is not up to the mark or just finding reasons to comment negatively is called negative


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SELF AND FAMILY Traditionally home care in Canada has been provided to adults, seniors and children with acute and chronic illnesses or disabilities by health care professionals (such as doctors or nurses) or home care agencies (such as the Victorian Order of Nurses). Service users are usually assessed by a social worker or health care professional and a plan of care is developed. This model of home care fits under what has been termed a "medical model" in the sense that the patient (patiently waiting) is dependent on expert knowledge and skills both to assess needs and to deliver services For instance, in Ontario until the mid-1990s, home care services, even nonmedical services like homemaking, were accessed only by referral from a physician.

In contrast, an alternate model which has slowly been growing in popularity in Canada since the 1970s, is the self managed care model (Salisbury & Collins, 1999). This model assigns the individual requiring care a more active and central role both in determining care needs and managing care. While individuals as "clients" or "consumers" may still access health care professionals including doctors, the overall care process is guided by the individual who in effect becomes the expert in their own care. The philosophy behind self managed care lies in the Independent Living Movement of the 1970's which states that people with disabilities should have the same civil rights, options, and control over choices in their lives as do people without disabilities (McDonald and Oxford, 2006). Thus, self managed care aims to give individuals the option of self-directing their care and the freedom to make their own choices (Bach, 1998).

A groundbreaking self managed care program was created in 1997 in British Columbia. A group of parents now known as the Woodland's Parents Group whose children had been institutionalised in a large facility called Woodlands School lobbied the British Columbia

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government for funds to support their children in the community. We note here that Woodlands School was operated by the province from 1878 to 1996; it was subsequently closed due to allegations of physical and sexual abuse. Admissions were made under the statutory authority of the Province's mental health legislation, child welfare legislation or as voluntary committals "for persons with mental disorders who required care, supervision and control for their own protection or welfare or the protection of others..." Reflecting a particular historical view of the nature and status of individuals with mental disabilities, Woodland residents were labeled "mentally retarded;" they lived in a highly structured and regimented environment away from their families (McCallum, 2001). As an alternative, the Parents Group believed that if money from the government were allocated directly to individuals, their children could live more dignified and autonomous lives in the community. In 1997 the Community Living Society was formed to assist individuals to leave Woodlands School and acquire needed supports to live within the community (Salisbury & Collins, 1999).

Such initiatives have given impetus to an apparent rise in public support for self managed care which is justified both as a step both toward empowering individuals, and gaining systemlevel efficiencies. For instance, in October 2002, the Report of the Community Living Transition Steering Committee to B.C.'s Minister of Children and Family Development, recommended that the government give greater emphasis to "individualised funding," a variant of self managed care, in which funds are "allocated directly to individuals, or in the case of children, to their parents or guardians, to provide the support necessary to meet disability-related needs, and to assist individuals to become contributing citizens" (p. 25). This reflects the philosophical tenets of self-managed care: individual agency and choice. The report elaborates this philosophy by stating that individualised funding "introduces a market dynamic anchored in consumer choice

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that then leads to improved service quality, reduced inefficiency, lower costs and better value for money than block funded services. In addition, individuals and families who receive Individualized Funding have very high satisfaction levels because they are empowered to direct their own lives".

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The meaning of marriage begins in the giving of words. We cannot join ourselves to one another without giving our word. And this must be an unconditional giving, for in joining ourselves to another we join ourselves to the unknown. We can join one another only by joining the unknown. We must not be misled by the procedures of experimental thought: in life, in the world, we are never given two known results to choose between, but only one result that we choose without knowing what it is.

Marriage rests upon the immutable givens that compose it: words, bodies, characters, histories, places. Some wishes cannot succeed; some victories cannot be won; some loneliness is incorrigible. But there is relief and freedom in knowing what is real; these givens come to us out of the perennial reality of the world, like the terrain we live on. One does not care for this ground to make it a different place, or to make it perfect, but to make it inhabitable and to make it better. To flee from its realities is only to arrive at them unprepared.

Because the condition of marriage is worldly and its meaning communal, no one party to it can be solely in charge. What you alone think it ought to be, I is not going to be. Where you alone think you want it to go, it is not going to go. It is going where the two of youand marriage, time, life, history, and the worldwill take it. You do not know the road; you have committed your life to a way.

Forms join us to time, to the consequences and fruitions of our own passing. The Zen student, the poet, the husband, the wifenone knows with certainty what he or she is staying for, but all know the likelihood that they will be staying awhile: to find out what they are staying for. And it is the faith of all of these disciplines that they will not stay to find that they should not have stayed.

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That faith has nothing to do with what is usually called optimism. As the traditional marriage ceremony insists, not everything that we stay to find out will make us happy.

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LEARNING THE ART OF COMMUNICATION WITH THE NEXT GENERATION Communication is a combination of body language, speech, emotion and a sender and receiver of thoughts and words. There are many factors subsequently to aid in a communication that includes scent, color and personality. The ability to communicate becomes more effective when the mind is opened to facts and figures that the general populous both appreciates and understands. This not only relates to in a societal environment, but in a family unit or one to one relating, be it romantic, professional or a companionship.

Communicating with the next generation has never been more difficult. How did it become acceptable that our primary way of communicating with each other would be limited to 140 characters or less? Beyond that, we lose the attention of our children, students or young employees.

Look around you. In our culture, we often fail at the fundamentals. Having a conversation without an electronic device involved. Writing a thank-you letter. Listening in earnest to a friend in need. Our human exchanges lead us to learn, transform, revolutionize, innovate, connect and love. Communicating with the next generation has never been more important.

People are getting lazier about truly connecting with each other, and the consequences of this trend will be grievous on a large scale. The emotional intelligence of adolescents has dropped in the last 10 years. Their communication is reduced to the superficial via text, tweet or Facebook. The older generation struggles to understand how to break through the filters of young people. Back in the 1960s, America discovered we had a generation gap between adults and Boomer kids. Today, theres a communication gap between adults and Generation Y kids that prevents communicating with the next generation

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HOW TO DEAL WITH NEGATIVE CRITICISM AND CONSTRUCTIVE CRITICISM IN GIVING AND RECEIVING I read a blog post the other day where the writer was slandering a woman, who has an alcohol problem, for drinking and driving with teenagers in the car. It started me thinking on how many times I had to take my own children to functions or school and the only way I could get out of the house and do this was to have a drink to calm the tremors. I was fortunate, by the Grace of God, that nothing terrible happened and I never got a DUI either. When I look back on those terrifying years, it was the only way I could cope with a disease that had consumed my mind, body and soul. Yes, alcoholism has been medically classified as a disease. Like Aids, people tend to shy away from alcoholics and deem them to be the dregs of the earth, the unsavoury. When we take the example of drinking and driving - I agree that it is totally irresponsible - but there are normal people who drink too much at a party and get behind the wheel of a car. What about those who are driving while texting on their cell phones or the mental health sufferers who are under the influence of large doses of Valium or other heavy drugs? Constructive criticism is something that is both hard to give and receive. Yet it can greatly benefit your life if you master your emotions, truly care about people, communicate with compassion, and listen objectively Have you ever received criticism from a person who just wanted to tell you "the facts of life" and Consider and care for a person's feelings before endeavoring to criticize them. Acknowledge a person's strengths and accomplishments before plunging into recognizing their weaknesses. Build them up as a person first before pointing out flaws and dangers. Commit to the person and their organization over the long term as they endeavor to improve and make

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necessary adjustments. Speak from the heart truthfully and graciously realizing that we all are continually growing and evolving personally and professionally. And to receiver constructive criticism Silence your feelings and listen objectively so you can get something from the feedback. Remember feedback is not final. It is only a part of your whole person and performance at any given point in time. Refuse to argue over any points of disagreement big or small. Simply remain open for feedback and input from outsiders where after you can ultimately make you own decisions.

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So much of the information out there about how to be a better parent focuses on techniques for modifying your childs behavior. But it is missing the mark. Research has shown that the one thing a person can do to be a better parent is to focus on developing him or herself. This is where a person has to start in order to be a nurturing, attuned mother or father. When it comes to parenting, there are many reasons for us to look inward and understand ourselves as people if our goal is to become a better parent.

Children stir up buried and unresolved feelings from our own childhood.

Our children often reawaken painful feelings that we long ago blocked from our awareness. The innocence, liveliness, and spontaneity of a child can stir up the hurts in our own childhoods and threaten to reactivate them. Our avoidance of these old feelings can cause us to pull away from relating closely with our children. At times when there is an emotional connection, we may be uncomfortable and even feel anger or resentment toward our child. If we stay defended against the feelings that are being stirred up in us, we will be cut off from our children and misunderstand to what they are feeling and experiencing.

We project our critical feelings about ourselves on to our children.

The ambivalent attitudes we have toward our children are simply a reflection of the ambivalent attitudes we have toward ourselves. All people are divided in the sense that they have feelings of warm self-regard as well as feelings of self-hatred and self-depreciation. Therefore, it is not surprising that parents would extend these same contradictory attitudes toward their

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offspring. Parents' attitudes toward their children are a by-product of their fundamental conflicts and ambivalence toward themselves.

It is not uncommon for parents to disown their self-critical attitudes and negative selfimage by projecting them onto their child. When they do this, they are then overly critical of these projected qualities and traits in the youngster. As a result, children begin to see themselves through a negative filter, which will stay with them throughout their lives..

You are a role model. In this months The Mind by Scientific American, Robert Epstein presents the results of a research study of 2,000 parents about what makes a good parent. In his list of the 10 most important parenting competencies, just 5 of them were about the parent/child relationship; the other 5 related only to the parent. And 3 of those mention modeling: Relationship skills (having a healthy relationship with your partner models relationship skills),Education and learning (having a good education models learning and educational opportunities) and Health (eating healthy and being active models a healthy lifestyle).

Psychologists have found that children really "do as parents do, not as they say." Being a positive role model for good behavior is far more powerful than specific training or disciplinary measures in raising children. These processes of identification and imitation overshadow any statements, rules, and prescriptions for good behavior. Children develop behaviors through observing their parents in day-to-day life. Every behavior that a parent engages in should be worthy of imitating because children will imitate it.

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The fact that our children are looking to us to see how to be is enough of a reason for us to focus on our development as a person. Only if we have developed integrity in the way we live our own lives will we be able to provide our offspring with the necessary model for mature, adult functioning. Our honesty and maturity are far more important in determining the healthy development of our children than any techniques prescribed by child-rearing experts.

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THE ART OF COMMUINICATION Celebrities are constantly telling parents to talk to their kids about the issue of the day. But, what celebrities don't tell you is how to talk to your kids. Clinical psychologist Erik Fisher, Ph.D, says that communication between parent and child is crucial to a child's sense of safety, trust, self-esteem and power. But as children enter high school and become more self-sufficient, communication can be tough. In Fisher's book The Art of Empowered Parenting he gives these guidelines for better communication: Realize the power of No. It's one of the smallest words in our language, but it can be harmful when not used properly. When a child hears 'No's from his parents, it can set a negative frame of reference for how the child feels about himself, his parents, and the world, Fisher says. Instead, parents should try, whenever possible, to use the word Yes and reframe the situation to look at other options that wont leave your teen feeling shut down. Don't lecture. It's not a communication tool, it's a power trip. Don't cut your teen out of the conversation. Short and to-the-point communication which leads to brainstorming possible solutions is the way to go. Also, add in a bit of humor, where appropriate, and don't be afraid to point out your own past mistakes as examples, as your teen gets older. The Family Meeting. This can be a great ice-breaker for families. Everyone in the family should attend and everyone should get equal time to speak without interruption. Consider setting guidelines, and a short and sweet agenda. Always try to end the meeting on a positive note. Building Trust. Sometimes parents can communicate distrust without even realizing it, like when you finish your teen's sentence. Ask your teen straight up how he feels about himself, or about situations in his life and the life of his peers. This will not only help his self-awareness, but will also tell him that his parent is really listening.

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The Power of Praise. It can be as simple as telling your teen how much fun he is to be around. But it's important to consider how praise is communicated. Saying, You did a wonderful job, and I love you for that could imply that you only love your teen when he does a wonderful job.

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CONSTRUCTIVE VERSUS DESTRUCTIVE CTITICISM I would like, today, to discuss the difference between constructive and destructive criticism (which some people may consider flaming). It came to my mind a couple of days ago and I jotted the idea down and decided to write a short editorial on the subject. I wasn't really sure what people knew or thought about criticism, so I thought that it would be worthwhile to give my point of view on the subject.

To me, that small difference between constructive and destructive criticism is extremely significant. Why is it important? The difference between the two is salient because, in order to give proper feedback on other people's work, one needs to be able to distinguish between the two forms of criticism. It is important (or I think it is important) because it applies to every form of art. So, you want to be a critic? Then you should know what you're talking about, and know how to give feedback.

The first point I need to make is that feedback does not necessarily have to be positive. Constructive criticism does not mean praise; you don't need to tell somebody that their work is fantastic if you think otherwise. Contrast, you don't need to tell them that their work is horrible. This is where the difference between the two really comes in.

Constructive criticism entails telling people how to improve rather than simply shooting their work down. Rather than saying that everything is wrong, or even simply pointing out the things that are wrong, point out what needs to change and how they could improve the piece. If you want to spend your time criticizing a photo, make sure that you are knowledgeable enough or dedicated enough to not just point out mistakes, but suggest ways to improve those mistakes. Otherwise, what good is your comment? Without the constructive basis for the critique, all you've done is deliberately belittled somebody's work. If you want to point out something that

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you think is wrong with a piece, explain why you think it is wrong, and then give your suggestions for correcting it or improving future works.

What is destructive criticism, then? It is simply criticizing and pointing out mistakes without taking the time to suggest ways of improvement. It is degrading; it shoots down somebody's work unnecessarily, and unless you are willing to show that person a way to improve, then [in my mind you really have no right to point out mistakes at all. So, when you are posting a critique or even just a comment, keep in mind that you are not to simply there to shoot down their work. What purpose does that serve other than to stroke your own ego? There is a line in the sand between destructive criticism and flaming and constructive criticism, and it has been outlined above, so remember to be constructive rather than destructive when discussing somebody else's work.

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HOW TO TAKE CRITICISM There is no question about it--all criticism is entirely permissible. There are no laws as to your conduct; you are a citizen, free like any other, so you live by your own judgment, tastes and conscience. Hence the question is "How much attention should the individual criticized pay to criticism?" It is sometimes better to let people make mistakes and learn from experience. This may be less harmful than being criticized, and told over and over that something you are doing is wrong or inadvisable. Everyone who launches forth on constructive criticism should bear in mind the fact that it is sometimes hard to put oneself in anyone else's shoes. What might be right for you may be quite wrong for someone else, because they approach life from a different angle. In addition, I think that if you care about people you sometimes allow your judgment to become clouded and criticize with a view to preventing them from doing things which you feel will bring them the difficulties of general criticism when as a matter of fact, succumbing to such considerations would perhaps be more painful than all the outside criticism could ever be. Fear for those we love is one of the reasons that many of us are critical and it is something which we should weigh very carefully before expressing ourselves. To spend your life, however, thinking about "what will be said," would result in a completely unprofitable and embittering existence. Since one of the chief things that human beings can do to be helpful in life, is to be cheerful, it would indeed be foolish to dwell upon the criticism of those who can know little about you, who do not take the trouble to verify their facts, and who frequently have ulterior motives for the things which they say or write.

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HEARTBREAK OF BEING A PARENT This is about a parent whose child got accident. A doctor tried to save her vision in one eye. The parents had noticed when their child was only 2 that her one eye didnt seem to focus on us. They had taken her to an ophthalmologist, and the father told the doctor that her childs one eye wasnt working with the dominant one. And as the dominant one took on more and more of the work load, the other one tended to do less and less, until she was losing vision in it altogether. To try to strengthen the weaker eye, the doctor had us put a patch over the stronger one. But she couldnt see well, and she would tear the patch off, so the father sat down with her child and explained why they had to leave it on. Between their talk and a more permanent patch, the child left it mostly alone. According to the father, it was hard to watch her bump into things while her vision slowly returned to the weaker eye. But even harder was watching other children tease her. At Halloween, to help out, we dressed her as the cutest little pirate ever. Finally, the day came that the patch was removed. They had great hope it had done the trick, but even though her vision had returned, the minute the dominant eye started working again, the weaker one began to slide back into inactivity. That was when the doctor told us that surgery was likely the only option to permanently save her vision.+ It was shortly thereafter they headed for an appointment at Primary Childrens Hospital, a 5 hour drive away. Trying to make the trip fun, we stopped to eat at her childs favorite restaurant, and played her favorite childrens songs on the tape player as they traveled.

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The father steeled his heart for the specialists prognosis, but could still not block the despair he felt in his heart when the doctor told him that surgery had to be done right away. Less than a week later, leaving their other three children with his brothers family, his wife and him took their little daughter to the hospital. He took the child on his lap and explained what would happen, and the child seemed far braver at 3 years old than he felt. And nothing could prepare him for the dread he felt when her child walked off with the nurse for the surgery. It seemed like forever before they told them she was coming out of the anesthesia and invited them into the recovery room. It was almost more than he could bear to see their little daughter with both eyes bandaged. The child was crying from the pain, and he was allowed to take her into his arms. Once she knew it was him, she snuggled in tightly, as if seeking safety, and her cries turned to sniffling and whimpering. When the doctor came to give them the report, he informed them they had been able to do quite a bit, but it would most likely take two more surgeries. With his daughter still curled up in my arms whimpering, he told him he wasnt sure he could watch her go through any more. He looked at him with great understanding as he spoke. Yes you can. As a parent, the hardest thing you will ever do is endure the heartache of watching your child suffer. But there is one thing stronger than your desire to remove the suffering, and that is your love. And since you know it will help her, you will endure it. And he did.

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IMPROVING COMMUNICATION SKILLS Communication skills may be useful to overcome the barriers that inhibit nurses from building healthy patient-nurse relationship. The research done by Duxbury and Whittington (2005) found that while nurses thought the environmental condition and the patients mental illness precipitated the patients aggression, the patient perceived the environmental condition and poor communication as the aggression precursor. According to Robinson and Watters (2010), communication skills can be attained and improved through practice. Effective therapeutic communication skills gather or transmit information successfully and promote healing and recovery of the patient. Active listening is required since hearing without actually listening may cause a problem (Jasmine, 2009). Listening allows nurses to gain essential information, to understand patients, and to provide better care. In addition, communication should be taken in place with minimal distraction. For example, drawing curtains and moving a patient to a private counseling room would provide less distraction. Furthermore, patients may need some encouragement and trust needs to be established to communicate their feelings and concerns to the nurse. Encouragement can be done through using touch, humor, and tears. Among various communication skills, exploring is another essential skill, and it largely involves the use of effective questioning techniques to probe deeper into the issues concerning a patient (Jasmine, 2009). For the better therapeutic communication, open-ended questions can be used to assist the patient to discuss and clarify what he or she is thinking, concerning, and feeling. Then, paraphrasing conversations helps nurses to repeat and reinterpret what has been said during communication (Jones, 2009).

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SPEAK UP FOR GOOD COMMUNICATION At my college of nursing, we teach students the value of therapeutic communication and the techniques to achieve it. Unfortunately, some former students who visit me after graduation tell me that their facility's management emphasizes physical task completion and discourages therapeutic communication with patients and families.

Why is this? Because of cost containment, patients' stays are shorter, limiting the time available for nurse/patient interaction. High-technology physical interventions are considered more important than therapeutic communication, which has been devalued as an intervention strategy. As a result, much of our traditional commitment to learning and using good nurse/patient communication techniques has all but disappeared. Some schools of nursing have even stopped teaching these principles and techniques.

How could this have happened? Skilled, sensitive communication is a defining feature of the core nursing values of caring and compassion. Nurse/patient communication is crucial to helping people deal effectively with their health care needs, and it's essential for patient education. Good communication is the foundation that allows nurses to help patients, families, and other caregivers to manage emotional crises and the pain of physical and mental illness.

Good communication is also the key to effective collaboration with our colleagues, including physicians. But the evidence suggests that nurses and physicians don't always communicate well in the real world. Turn to page 28 for my analysis of a recent national survey on nurse/physician relationships conducted by Nursing2008. Although the results are encouraging in some respects, 43% of respondents report being dissatisfied with their professional relationships with physicians. That's a disturbingly large minority.

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The Centers for Medicare and Medicaid Services, the Institute for Healthcare Improvement, and The Joint Commission all emphasize good staff communication as a critical element in good patient care.

Nurses must take the lead in encouraging good communication, not only with our patients, but also with colleagues. We need to set up formal policies and procedures in our nursing units that encourage nurse/patient and interdisciplinary staff communication. Because patients move between facilities more often than before, we need to set up channels of interagency communication so that we can share information about patients' treatment plans. By practicing effective communication strategies, we can enhance patient safety, minimize errors, and improve clinical outcomes.

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PRACTICAL NURSING BARELY MEETS US MARKET DEMAND Practical nursing (PN) schools in Cebu and around the country have to deal with criticism from the Philippine Nursing Association (PNA) that their course represents a shortcut to green cards and overseas jobs. Jose Jake Marques, president of the Philippine Paramedical and Technical School Cebu, Inc. (PPTS Cebu), dispelled these claims saying there are different levels of competitiveness under the articulation program of the United States in providing health care services. Marques said practical nursing is one of four levels. The other three are for certified nursing aides (CNA), applied science in nursing (ASN-RN) and registered nursing (RN). It is so easy to make a difficult curriculum so its expensive but the important thing is to address competitiveness in every level, said Marques, who is also vice president of American Chamber of Commerce in the Philippines - Cebu chapter. The PNA, an umbrella organization of various nursing groups in the country, earlier said that PN schools only contribute to the dilemma of job availability for registered nurses. But Marques said PN schools like PPTS give people the chance to acquire a basic nursing education without paying the high tuition common in a four-year course. In PPTS, a student can finish a PN course in 12 to 15 months. Even if you stop after two years due to financial reasons, you will still have a certificate which you can use to apply for a state board in the US. The standards we follow are that of Louisana, he told. Marques said the National Council Licensure Examination (NCLEX) can be taken not only by registered nurses, but also by practical nurses.

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The PNA opposed the institutionalization of PN in the country and its insertion by the Commission on Higher Education (Ched) through a ladderization of the nursing curriculum. The organization also said that there is no local demand or specific job positions in the Philippine health care delivery system for practical nurses. It likewise noted that there is no licensure for practical nurses provided in Republic Act 9173 or Philippine Nursing Act to provide legal basis for the institution of practical nursing. Despite this, Marques said this did not stop PN schools accredited by the Technical Education and Skills Development Authority (Tesda) from pushing for the ladderization of PN and ASNRN. Laddering these courses would mean that PN graduates will have the opportunity to proceed to BS Nursing any time, he said. The PPTS and Salazar College of Science and Institute of Technology (SCSIT) signed a memorandum of agreement (MoA) on the ladderization program last September 5 with Ched and Tesda officials. Marques said around 50,000 immigrant visa were issued by the United States to foreign nurses of which 60 percent or 30,000 went to the Philippines. However, only 6,000 Filipino nurses left. That is because the other visas are given to the family members of the nurse. When nurses apply for visas in the US, theyre given green cards which allow them to bring their families, he said. Marques said the US is adopting this practice so Filipino nurses won't have to worry about their families back in the country.

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However, the PNA said this process is not beneficial to the nursing profession since it would mean more nurses lining up to get immigrant visas. Marques acknowledged that the US issued 60,000 working visas in 2006 but ?nobody used them because everyone wants to be an immigrant. PNs, he said, can maximize on these working visas. Filipino nurses are known to be contract breakers in the US because they are confident that they are green card holders already. With working visas, the moment you break your contract, automatically your stay in the US ends because you are there for work,? he said. With a working visa, a nurse will respect the contract. And if you issue 5,000 visas, you get 5,000 nurses, Marques added. Marques said an hours pay for a registered nurse is not far from that of a practical nurse. He said a registered nurse is paid $24 to $25 an hour, while a practical nurse is paid $15 to $19 per hour. Gregory Tyrone Howard, president of the National Federation of Licensed Practical Nurses in America said Filipino PN graduates could qualify in the US if schools introduce a USapproved PN course. Marques said they showed the PPTS curriculum to Howard, a member of the CGFNS board. According to Marques, Howard said the PPTS curriculum exceeds the minimum US requirements. The problem with our country is positioning. Because we made it illegal for others to study courses outside BSN, we have limited the chances of our graduates, he said.

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HAVING A HAPPY FAMILY A family is the central of the nations success. It consists of a father who is the foundation of the home, which has the duty of presiding the home, protecting it and providing for his familys needs; a mother which has a duty of nourishing the children and the kids. The family also makes a community where they live. Having a happy family is important for nation building. They act as agents for its triumph and failure.

Having a happy family is a choice that they made when they started to build one. In order to have a happy family, one must love and cherish one another. They are to seek good things for the benefit of all the members. They have to be one in assessing familys concern such as finances, education, work, recreation and the like. They, as a family should stress out the importance of respect and kindness as well as the participation of all concern in the matters of personal and private family life.

Father and mother is essential tool to make a good family. In having a happy family, they as parents should love, care and respect one another. They should be the best example to their children likewise be a role model having the best attribute to set an exemplar to them. They should also take in charge of all the family affairs such as father providing for the needs and mother to nourish them with good values for the children to become good citizens of the nation. Husband and wife should take care of their children because they are accountable for any manifestations of unorganized behavior toward other child. They should set a standard for the family in giving proper orders and demands which will eventually gain a powerful authority without dominance to the children.

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Children should be respectful, loving and caring for their parents. They are given choices to make right decisions but should not over abuse these rights. They also must conform with all the standards made by the family to make the home a harmonious place to live in. They should also become a paragon to other children in good behavior and attitude. In having a happy family, they should also have the capacity to love and serve one another in virtue.

By doing this, you can have a happy family life. This also adds to the achievement of the government in fighting any sorts of family disputes and will make a nation proud of its people.

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IMPROVING COMMUNICATION AMONG NURSES, PATIENTS, AND PHYSICIANS To Err Is Human and Crossing the Quality Chasm, reports from the Institute of Medicine, stress that good communication is critical to ensuring safe and reliable care.1,2 The current challenge in health care is to create an environment in which open and transparent communication is the norm rather than the exception. One way to do this is by adopting strategies that have been successful in other industries. For example, crew resource management, a training program developed by the aviation industry and adapted to other workplaces, contributes to a team-centered approach by emphasizing shared decision making and interpersonal communication.3 Using communication tools such as situationbackground assessmentrecommendation (SBAR) communication ensures that messages are clear and unambiguous even in stressful situations.3 Another challenge facing health care organizations is attracting and retaining nursing professionals in an environment beset by rapid change and constrained resources.4 At Wentworth-Douglass Hospital, a community, non-profit acute care hospital in Dover, New Hampshire, our leadership grew concerned that new nurses were losing sight of their reasons for pursuing the profession and that experienced staff were disillusioned by processes outside their control, ranging from a fluctuating census and increased patient acuity to unreliable equipment and having to hunt for and gather supplies. As Donna Diers wrote, "Nursing is two things; the care of the sick (or the potentially sick) and the tending to the environment within which care happens."5 We recognized the importance of these challenges and felt that participating in the Transforming Care at the Bedside (TCAB) initiative could help us address them.

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We formed a TCAB team of approximately 20 staff nurses, pharmacists, case managers, physicians, clinical coordinators, educators, and supervisors. The mission statement we developed was to establish a patient-centered healing environment with mutually beneficial partnerships among patients, families, and health care providers in a physically comforting area. Improving communication was critical to achieving this aim. Since becoming involved in TCAB in May 2005, we have implemented three major initiatives: moving the location of the change of shift report to the bedside, implementing the safety huddle, and establishing nursephysician "intentional" rounds at the bedside. A 28-bed medicalsurgical telemetry unit, 3 North, piloted our tests of change. Staff members were task oriented rather than patient centered, there were communication problems, handoffs were time-consuming, and many staff members reported feeling uninvolved and unappreciated. Therefore, the staff and leadership were open to participating in an innovative project that would help them transform the way they worked. We ended up not only improving communication, but also creating a new unit that is centered on the TCAB philosophy.

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LEARN FROM MISTAKES WITH CONSTRUCTIVE CRITICISM Skilled managers use criticism constructively to improve practice - and welcome it themselves from their teams Used constructively, criticism is one of the most useful management tools we have. Used destructively, it can ruin relationships, lower self-esteem and encourage a bullying culture. The word itself has negative connotations. Students receive positive and negative feedback on their work all the time, and clinicians analyse critical incidents to avoid repeating mistakes, discuss protocol and improve processes. Criticism is part of learning. A skilled manager can give constructive criticism and use it to improve practice - and welcome criticism about the way she or he works. Criticism can provoke negative responses from those on the receiving end. They may feel devastated, angry, undermined or simply numb. Reactions to criticism are diverse: people become defensive, blame someone else, feel they are not good enough; cry; or, more positively, listen carefully and see what they can learn. Dealing with criticism should be part of continuous professional development. Learning how to use and receive criticism will result in positive outcomes. Effective managers will ensure that there are regular opportunities to take feedback on their performance. Their whole teams will contribute to analysis of processes and outcomes and ask: what went well? What went wrong? So what? Now what? The skill is to present criticism constructively. Separate the behavior from the individual and discuss learning from an incident in a way that will prevent reoccurrence and develop the individual and the team.

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Obviously, there will be times when the action of an individual is dangerous, unnecessarily disruptive or provocative. Remedial action needs to be taken, following disciplinary procedures. Learning from experience is hard - but it is even harder when you dont know how to make criticism work for your team Always recognize and acknowledge mistakes. Never ignore them Listen carefully to any explanation and feedback your understanding of the incident for clarification. Create a common understanding

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BUILDING FAMILY UNITY AND SIBLING RELATIONS Some parents tell me their kids fight all the time with each other, actually looking for ways to get each other in trouble. Others say the age difference in their children makes it difficult to build unity and enjoy the same activities. When you decide that a really close sibling relationship is your top priority, you will probably see a difference in your childrens behavior within days. Whether your children are toddlers, tweens or teens, or if you have children in all of those stages, focus on each and every activity which older children can do and can teach to their younger siblings. Young children love to learn from older children, especially their own brother or sister. Self-confidence, patience and teaching skills are developed by older children who are given the opportunity to include younger siblings in their activities. Set each child up for success by helping to plan small activities which they can easily do together. Keep expectations high and activity times limited to 15 or 20 minutes. Your time and effort will pay off as friendships are made among siblings.

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NEGATIVE EFFECTS OF DESTRUCTIVE CRITICICM: IMPACT ON CONFLICT, SELF EFFICACY, AND TASK PERFORMANCE In Study 1, 83 undergraduates received either constructive criticism (feedback that was specific, considerate, and did not attribute poor performance to internal causes) or destructive criticism (feedback that violated these basic principles) of their work. Those who received destructive criticism reported greater anger and tension and indicated that they would be more likely to handle future disagreements with the source through resistance or avoidance and less likely to handle disagreements through collaboration or compromise. In Study 2, 106 undergraduates who received destructive criticism of their work on an initial task set lower goals and reported lower self-efficacy on two additional tasks than did subjects who received constructive criticism or no feedback. In Study 3, 108 employees of a large food-processing company rated the importance of 14 potential causes of conflict in their organization. Poor use of criticism was perceived as a more important cause of conflict and received higher ratings than did competition over resources or disputes over jurisdiction.

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Skill in interpersonal communication is one of the most powerful attributes that a professional in any field can possess. It influences all aspects of one's professional life. However, this important topic is seldom covered in the professional training programs designed to prepare healthcare providers to practice in their various disciplines. Interpersonal communication defined

Interpersonal communication involves not only what we say, but also, very importantly, what we do in communicative interactions. What we do may include our manner of dress, our presentation of self, our body language, our use of gestures, our manner of eye contact, and our personal grooming, among the many other tangibles and intangibles that are important elements of interpersonal communication. In many instances, the non-verbal aspects of communication can be just as important as our words. Strictly speaking, interpersonal communication occurs when two or more people interact in a way that involves verbal and non-verbal behaviors and interpersonal exchanges that fit the specific purpose of the communicative interaction. The intended result is a change in attitudes, behaviors, or beliefs of the interactant (the person with whom one is communicating) and, perhaps, constructive resolutions. However, the unpredictability of interpersonal communication makes its mastery particularly challenging.

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HOW FAMILIES WORK Sigmund Freud, dark prophet of the bourgeois psyche, once famously defined sanity as the capacity to "love and work." Yet balancing and integrating these fundamental imperatives, paired enterprises that Freud suggestively termed the "parents of human civilization," has not proved easy for middle-class families from Freud's time onwards. The relentless pursuit of getting and spending in the outer world has long threatened to overwhelm the domestic domain, even if the home fires are in principle exempted from the frigid logic of the marketplace. Home may be where the heart is, but declarations of love are deeply embedded in the symbolic media of material consumption and the workplace-whether one chooses to say it with flowers and diamonds or by developing intricate activity schedules for children. For all of its troubling and troubled aspects, modern work has come in many respects to be thought of as the measure of all things, the pre-eminent source of self-worth and fulfillment. Work promises an escape from the complex, fraught psychic terrain of the family so long ago excavated by Freud and his disciples, while leaving many with the sense that in the pursuit of work they have betrayed key obligations to loved ones. How families work evokes these intertwined paradoxes of middle class domestic life. In most societies for most of human history, the reproduction of the family within larger social frameworks has been a directly economic enterprise, since the family was usually a primary productive unit. The work of kinship in most other societies has been profoundly continuous with other forms of work, the processes through which persons transform natural elements into cultural products and through which they exchange abstract signs of their labor and productive capacity--in the form of shells, cattle, women, money or other valued media. In contrast, since the mid 19th century the western bourgeois family has been formally defined as the social unit

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most directly opposed to the domain of work and commerce. The family has long been idealized as a haven in a heartless world, a secure enclave that protects its members from the predations of wage labor and financial calculation, a clearly-bounded zone within which unconditional love and sentiment reign supreme. "Family time" has in principle long been contrasted with its antithesis, "work time." Nonetheless, the middle-class family has since its inception been intimately enmeshed within the cultural logics and practical necessities of capitalist labor regimes. In normative terms, "making a living" has usually implied supporting a family. Middle class wage levels have, in principle at least, been tied to the cultural ideal of home ownership and reproducing a subsequent generation at least at the same socioeconomic level as its antecedents. Since the high Victorian era the family and home life have been expected to restore and replenish exhausted wage earners, readying them for productive re-engagement in the business world. Middle-class families have been structured, in conjunction with the middle and upper tiers of the educational system, to reproduce a set of dispositions and orientations in each new generation, so as to meet the emerging labor requirements of the managerial and professional markets. Consumer spending for Christmas and other family holidays has for generations been understood as a bedrock of the national economy. In many respects, then, although the site of the "family" is usually formally contrasted with sites of "work," our families are "at work" continuously, laboring to support externally oriented economic productivity while constituting the home as a uniquely privileged site of "love," in both romantic and non-romantic senses of the term.

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DESIGN CRITICISM: HOW TO MANAGE IT EFFECTIVELY Criticism; Good or Bad? Criticism is extraordinarily helpful and, at the same time, can be extraordinarily destructive. It depends where it comes from. We have probably all come across individuals who criticize everything and everybody, for example. Their constant stream of criticism probably comes from a need to assert their sense of superiority, which actually indicates feelings of inferiority or insecurity. All of us have been criticized, sometimes unfairly, and we have all criticized others. When it comes to giving criticism, some of us are tight-lipped while others are outspoken, and some are more effective critics than others. We can categorize criticism as being either constructive or negative. What is the difference? Negative criticism involves putting down or disrespecting the subject. It can arise out of jealousy, prejudice or ignorancethough sometimes it is motivated by good intentions. Negative criticism points out problems (sometimes obvious ones) but offers no solution. Criticism Can Be a Good Thing! Constructive criticism is more effective and more pleasant. It involves offering feedback, both positive and negative. With constructive criticism, you offer assistance to an individual by giving them feedback about possible improvements and apparent problems. This is important for both amateurs and veterans in a trade. Whats more, giving constructive criticism can help establish your credibility and expertise, because the people who benefit from it will likely credit you in some way for their success. Constructive criticism can also keep feelings from being hurt by focusing on successes and possible improvements while avoiding personal attacks and degradation.

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How to Handle Negativity How do you deal with negative criticism? The first reaction, for most of us, is to defend ourselvesor worse, to lash back. Here are a few alternatives. Design is subjective and, like all art forms, has no rulebook. No one can prove that your work is right or wrong, but that doesnt mean you should completely ignore other opinions. Everyone looks at design from a personal perspective. You might have a degree in web design and years of experience, but not everyone will agree with your opinionso dont expect them to. The important thing is to have a positive attitude and be open to new perspectives. Realign your expectations and understand that criticism is part of the process.

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WHAT IS HAPPENING TO THE PILIPINO FAMILY? It is trying to cope with economic, political and social stresses MANILA, Philippines. Any significant event that happens in society has an impact on the family. The family is known as the? Burden carrier of the social order? It is the backbone of the nation. How children absorb and experience these societal or? Extra-familial? Stresses that impact on the family depends on how the parents and other older members deal with them. The children almost always take the cue from the adults, especially the parents. In the recent months and last few years, many significant changes have happened in our country and in the world. These changes have put our families at risk. How is the Filipino family handling these changes? Changing role of women Let us take a look at them now: First is the changing role of women both at home and in the workplace. Most women now hold jobs outside the home either to supplement the husbands? Earnings or to be the main and, sometimes, the only breadwinner in the family. This has led to the phenomenon of? househusbands.? How are the men taking on this role, which challenges their male identity and triggers issues of self-esteem and power? A lot of adjustment needs to be done, not just in the roles they both play, the task and functions within these roles, but also in their feelings and sense of self. When the adjustment does not go well, women become overloaded and fatigued in trying to fulfill their duties as breadwinners working outside the homes and as housewives still taking care of the household.

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How can adjustment in the parental roles be done so that women do not become overburdened and burnt out? What social systems can be of help?

Political instability Then, theres the political crisis. The instability in the government that has led to insecurity. This uncertainty and unpredictability has led to anxiety and a feeling of being unsafe. People dont know whats going to happen next. We can no longer trust the government institutions. And in a country where systems do not work and people cannot rely in the institutions for support, they turn to their families. Studies show that in the Philippines, people feel that they can only depend on? God, my family, and myself.? Another important factor that is related to this political crisis is the moral degradation resulting from pervasive corruption at all levels of government. Children see that the adults in high positions, whom they are supposed to respect and look up to as role models, do wrong but are not punished. In fact, they dont even admit that they are wrong. They show no remorse and they deny their wrongdoing. Wrongdoers are not punished but are even rewarded at times! This has made young people become disillusioned and cynical when what they need are good role models to emulate. How can children learn right from wrong?

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NURSING COMMUNICATION: HOW TO MAKE SURE PATIENTS FEEL OUR CARING Ineffective nursing communication occurred at one hospital as illustrated in the following example: A patient complained that no one had been in all night to check on her. The Patient Relations Rep went to find out if that was true. She found out that the patient's nurse had in fact been into the room four times, doing things for or to the patient each time. Four times! The nurse had been there physically and felt caring, yet the person who was the patient didnt feel she received any quality contact or caring from the nurse. Nurses are caring. Its a given. Yet, in today's pressured work environment of endless multi-tasking and multiple priorities, they run the risk that their caring may not come across effectively to the patients and families they serve. Connection to their caring mission can fade because of the stress of endless to-do lists and intense workloads. This is anxiety-provoking for patients and draining for nurses and the organization. Clearly, spending more time with patients isn't the answer. The fact is, unless barriers are removed and staffing and processes improved, there is no more time for nursing communication. Any suggestion that nurses should spend more time -- time that they dont have -- is maddening and breeds resistance to improvement strategies. Therefore, it's helpful to focus not on the quantity of time nurses spend, but on the quality of that time with their patients and families. The challenge is to make certain that their caring comes across to the people they serve during the precious time they do spend with them. So how can nurses make certain that their caring is felt by patients and families during the precious time they spend with them? If I could advance one skill in nursing communication that would create breakthroughs in the patient experience and job satisfaction, it would be the skill of "presence." This learnable skill

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involves controlling your attention so the person on the receiving end feels like the center of your universe during the precious moments you have with them. The payoffs: Patients feel your focus and caring, you connect with them, and your work becomes more meaningful. When you practice presence, the patient feels important -- that they are your sole focus. They also feel like your soul focus. This helps them feel supported, less anxious and they actually heal faster. Also, when you are fully present, you dont miss valuable cues about the person's thoughts and feelings -- cues that help you meet people's needs exceptionally well. The pivotal skill of presence doesn't take more of your time. It makes every moment of connection with the patient precious so your caring comes across loud and clear. Tips for Practicing Presence: Take a deep breath. Bring your attention to the present moment. Physically shift to a posture of presence. Place your legs evenly on the floor. Open your palms. Face the person fully. Aim your heart at theirs. Lean in. Tune in. Smile and make eye contact. Open your ears, eyes and heart. Listen to the persons thoughts and feelings. If you become distracted, take notice and tell yourself to return your focus and caring to the person in the present moment. NOT Being Present: The Signs Eyes wandering; looking away Maintaining eye contact, but not really listening Doing something else while someone is talking to you

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Chatting with a coworker while customer is waiting Allowing interruptions by any and all people or calls Allowing an important interruption without excusing yourself and explaining Acting tired, bored or distracted Looking at your watch Interrupting the person talking Turning your back without apologizing or explaining Walking away with no explanation or goodbye

Help your team enhance nursing communication through the pivotal practice of presence. Ask them to experiment with a small number of patients and family members. Then set a date to discuss the results. The Impact Is Amazing In my experience as a healthcare consultant, working with teams who have focused on the practice of presence, I have seen how energizing it is for the staff and how healing it is for patients and families - when nursing communication is grounded in the nurse's caring presence.

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CONSTRUCTIVE CRITICISM Part of improving your performance is learning from other hospitalists on a regular basis. You can do this through observation or discussion, andwhen appropriateby offering or receiving constructive criticism. There are two types of physician-to-physician constructive criticism: When discussing perceived poor handling of a patients case, comments should take place within a formal peer review. Concerns about a physicians non-clinical performance, such as communications problems or lack of availability, can be handled in a one-on-one conversation. Herein well examine the peer review process; next month well take a look at how and when to give constructive criticism to a peer informally. Why Use Peer Review? When a hospitalist notices a colleagues clinical error or lack of judgment, it should be addressed in the programs next peer review meeting, both for legal and procedural reasons. The key thing to understand is that peer review offers certain protections for physicians and their colleagues, explains Richard Rohr, MD, director, Hospitalist Service, Milford Hospital, Milford, Conn. Ordinarily, if I discuss [another physicians] case and render my opinion, thenin principleif that patient were to file a lawsuit, they could subpoena me to testify about what I thought about their case. In the past, this had a chilling effect on peer review. Due to state laws passed years ago, peer review meetings now offer protection against subpoena. Peer review meetings are protected, says Dr. Rohr. They cant be used in court,

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and this makes it possible to have an organized peer review where you look at physicians work and provide an opinion about that work without fear of being drawn into a legal situation. The bottom line: If you want to talk to another physician about their case, do so within [the peer review structure] so youre legally protected, says Dr. Rohr. Focus on Improvement When discussing a specific case or physician, remember that the reason for doing so is to improve quality of care. Every practice should sit down, look at specific cases, and talk about possible areas of improvement, says Dr. Rohr. You need to take minutes of these meetings that are marked as confidential. The key to improvement is having an open discussion in each peer review meeting. A good meeting is educational, says Dr. Rohr. The objective is to support each other and improve performance. A lot depends on the attitude that people bring to it. You have to not be afraid to say something; you must be willing to express opinions, or youll have a wasted meeting. Sometimes you may find that the problem goes beyond a single physicians actions on a case. If there is a problem with a case, find out whether its an aberration or if the problem needs to be addressed, says Dr. Rohr. Some things are not a physicians fault, so much as [they are] signs that a medical system doesnt work as effectively as it should or [that there is] a general lack of training. For example, an ER [emergency room] doctor misses a fracture. Was finding that fracture outside his competency? Does he need training reading X-rays, or can you manage to get radiologists in to check X-rays fast enough to become part of the process?

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Use a Set Structure Its up to the hospital medicine program director to set up a peer review process, which should be done within the structure established by the hospital. Peer review meetings should be done on a regular basis, advises Dr. Rohr. How often depends on the volume of the program, but a typical group should meet monthly. Youll probably look at three or four cases, which is a reasonable number to cover in one meeting. Look at unexpected mortalities or complications you have a responsibility to the public to examine these. You might do best by bringing in an outside facilitator for the meetings. This creates an impartial atmosphere for discussions. We bring in an external facilitator from a local teaching hospital, says Dr. Rohr. Its good to have an educator lead the meeting; someone from academia will have a greater fund of knowledge and [a stronger] grasp of the medical literature, which helps bring the discussion to a more educational level. Everyone respects medical science. Note that the facilitator may need to be credentialed as a member of the medical staff in order for the proceedings to be protected from legal discovery. Peer review is difficult in smaller practices, because everyone knows everyone and they may be uncomfortable addressing problems, explains Dr. Rohr. Here, its especially helpful to have a leader from the outside who can render opinions and get everyone to chime in and render their own opinions. Remember that your peer review system is reportable. As part of the hospitals peer review structure, youll have to report findings from the meetings, adds Dr. Rohr. If someone

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is showing a pattern, these things have to be trended. Do they need training, or should they be dismissed? Giving Feedback through Peer Review When you participate in a peer review discussion, dont let your comments get too personal or subjective. The most important thing is to keep it professional and make it educational to the greatest extent possible, says Dr. Rohr. Reference facts in the medical literature as often as possible. Point to something thats been published to support your opinion. Base your comments on whats known, and apply that to your analysis of the case. An evidence-based opinion doesnt have to cite specific details; as long as youre aware of major papers on the topic, you should have a grounded opinion. Finally, as a physician participating in a peer review discussion, think before you speak. Peer review works best when you have a basic respect for each other, as well as basic humility, he says.

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TIPS FOR CARING YOUR CHILD ALONE No one ever said that raising a child alone would be easy, but sometimes every single parent needs help. Here are some tips for single parents to help ease the stress of going it alone. Youre Not the Only One It is easy to feel alone when you are a raising a child by yourself, but according to Parenting Without Partners, more than 12 million families in the United States are single parent families because of a death, divorce or separation. Families with only one parent are becoming the norm, and resources are becoming more available for single parents. Take advantage of your local resources for single parenting by contacting your local welfare office. They will have lists of single parent workshops, community groups, and counseling that you may want to take part in. They may also refer you to organizations that will be able to help you find daycare, after school programs, and other needs. You can also find support groups for single parents online. This can be helpful for parents who dont have time to attend traditional face-to-face meetings. To find these groups simply type single parent online support groups into your search engine. Before joining any particular group, try to find out as much as possible about the group and how it works. You may find that some groups work better for you than others. The Importance of Filling the Gap Since your child only has one parent, you may want to find a role model who can help to fill in the gap left by the parent not in your childs life. For example, moms raising a child by themselves may find it helpful to enlist an uncle or friend to be a male role model for their child. A father may find an aunt or friend to fill the place of a female role model for his child.

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This way, the child has a female and male to learn from and gets a more balanced view of the world. You also have someone to turn to when your child asks you gender specific questions that you feel uncomfortable with. For example, a father may have a hard time explaining the use of feminine products to his daughter. But, if the child has a trusted female role model, then she has someone to talk to that has experience with feminine products. Some places to find a good role model:

Big Brother-Big Sister agencies Aunts, uncles, grandparents, cousins Religious leaders in your community Coaches Teachers

Keeping Family Ties Strong Finding ways to spend time with your child can make all the difference in building strong family ties. Showing them that you care doesnt have to come in a huge, grand gesture, though. Kids appreciate the little things that you do for them. Here are some ideas:

Read a book to them before bedtime. Play a five minute game of hide-and-seek. Have a sit-down dinner together and talk about your day. Take pictures whenever possible and let your child decide where to display them in the house.

Write your child a little, loving note and stick it in their backpack or lunchbox.

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Take Care of Yourself To be the best parent you can be, remember that if you arent happy, your child isnt happy. Take care of yourself and the rest will come more easily.

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BECOMING A PARENT The nursery is decorated, the tiny clothes are washed and folded, the hospital bag is packed and you're eager to begin your new life with your newest family member! While nothing can quite prepare you for those first weeks of parenthood, there are many practical ways to help ease the transition. After all, taking care of your baby will be a round-theclock job, and the only way to learn is through observation, education and experience. Between the feedings and diaper changes, the sleepless nights and unexplained crying spells (Yours or your baby's!), fatigue and stress can quickly take a toll. So before you're officially a parent, take some time to "baby proof" your life. Organize your home before the baby arrives. Face the fact now: You won't take on the role of mother or father; first, you're a maid or butler. Prepare for the constant Feed me! Change me! Put me to bed! demands newborns make. Create a listfrom clothes to toys to bottles and bibsof what you'll need; then sort, wash and store ahead of time. Plus, use any opportunity to stock up on your favorite foods, healthy snacks and pre-made meals. After all, it's much easier to tote a fussy infant to the kitchen than to the grocery store. Take time for yourself and your spouse. The demands of parenthood make it all too easy to focus exclusively on the baby while putting your needs as a couple aside. So you'll feel like you're swimming rather than sinking, make a concerted effort to support one another like a team. One spouse, for example, could give the other spouse fifteen minutes a day of alone time to decompress, to get some fresh air and to spend a few quiet moments for resting mind and body. As a couple, pray together and talk about the dayafter the little one is sleeping soundly. And, as difficult as it is, make it a priority to find a babysitter you can trust. Go on a date as often as

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you caneven if it is for a cup of coffee. A little time away from the crying and spitting up can help put a harried life back into perspective. Modify your expectations. After bringing the new bundle of joy home from the hospital, many parents anticipate a peaceful, intimate transition. Yet caring for an infant can be exhausting, emotionally demanding and boring not to mention incredibly stressful. Lighten up when it comes to housework, phone calls, thank-you notes and errands; your regular routine can wait. The birth of a baby is, without a doubt, miraculous. Still, this major life change can rattle relationships, emotions and finances. How will you safeguard your marriage against the inevitable distractions, frustrations and busyness? How can you minimize the financial hit while meeting your child's needs? How do you listen to copious amounts of advice without becoming overwhelmed?

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THE APPLICATION OF THERAPEUTIC COMMUNICATION IN THE CLINICAL SETTING Nursing is a caring profession. It is also a profession that is more and more evidenced based in practice. In as much as the scientific aspects of nursing is increasing due to the complex technological advancement of medicine and the machinery that is used at the patient bedside, the fact remains that the nurse is the first person that the client usually comes in contact with in any emergency or hospital setting. In a case such as this the nurse should stay and further explore how the person actually feels. There are many factors associated with the healing and comforting aspects of therapeutic communication. Circumstances, surroundings, and timing all play a role in the effect of therapeutic communication. If a client is being rushed down for an emergency surgery there might not be time for a bedside conversation, but the holding of a hand could convey much more than words to the client at such a moment Application of the therapeutic communication in student-patient interaction is best observed in the clinical hospital setting. Typically, student nurse begin each preconference, which is the preparation time prior to the student-patient experience with a focus for the day. In the post conference hour at the end of each clinical day, students discussed the ways therapeutic communication had enhanced their care giving. To complete the student evaluation, I asked patients to offer feedback about the level of satisfaction with the students care. In post conference, students reported on their patients, often recounting the personal stories, struggles, and successes that patients had shared. Students also reported positive practices of assertive communication that claried misunderstanding, and helped to gather necessary information or contribute

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Reassurance. Ideally, for therapeutic communication to be effective the nurse must be aware of how they appear to the client. If a nurse appears rushed, for example, they are speaking quickly, their countenance looks harried, and they are breathing heavily, their eyes not on the client but perhaps on an intravenous bag on the client in the next bed. In a case like this, there is nothing that this nurse could say to the client in a therapeutic manner that the client would believe. The helping relationship has not been established and therefore therapeutic communication cannot be facilitated. Some of the emotions associated with therapeutic communication include but are not limited to the following: Professionalism, Confidentiality, Courtesy, Trust, Availability, Empathy, and Sympathy.