Paranoid Schizophrenia free essay sample

Positive symptoms or overt behavior not normal in normal individuals include delusions (beliefs that are not reality based), hallucinations (visual and or auditory; sometimes weighted in the individual’s unique cultural experiences), and incongruent or illogical language (Kohn, n. d. ). Negative symptoms or absent behaviors associated with normal individuals include â€Å"flat† affect or mood, social isolation or withdrawal, and lack of spontaneity (Kohn, n. d. ). This disorder has four sub-types, all of which has its own prominent feature. The subtypes are Catatonic (marked by bizarre motor behavior), Paranoid (marked by a significant suspiciousness and a strong sense of persecution), Disorganized (fragmented or illogical speech), and Undifferentiated (having mixed or more than one symptom) (Kohn, n. d. ). 2. Briefly describe the client’s background. Valerie had a normal childhood and was good at work and school. She went to college and graduate school and got married. In Valerie’s late 20’s she began developing delusions of persecution, reference, and grandeur. We will write a custom essay sample on Paranoid Schizophrenia or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Because of these delusions Valerie’s husband and church pastor had her committed to a mental institution. Valerie was placed on different medications, and after more than eight years Valerie was able to accept her diagnosis of schizophrenia. Once she accepted the diagnosis doctors could stabilize her medications. Valerie is able to hold a steady job since she is medicated properly and has her symptoms under control. Valerie once had dreams of traveling and getting her PhD, but she is now content just going to work and going home (where she lives with her parents). She has no interest in being in an intimate relationship (Kohn, n. d. ). 3. Describe any factors in the client’s background that might predispose him or her to the disorder. Predisposition can be attributed to the Diathesis-Stress Model (Kohn, n. d. ). This model states that genetics, biology, and stress can be determining causal factors. Valarie and her family relocated numerous times before she began college. She described herself as a social outcast. She grew up in the church as her parents were teachers in the church; therefore her core was church and religion based. Valerie stated that when she and her husband married, her husband made two distinct agreements with her that he did not uphold. The agreements were to have children and to relocate. These disregarded agreements appeared to be significant stressors for her (Kohn, n. d. ). In the interview, Valarie reported she was the only family member with mental health issues; therefore no genetic causal factor was noted. She stated her delusions and hallucinations associated with religion. Delusions and hallucinations are often associated with an individual’s culture. Citing she was a social outcast is a symptom of abnormal behavior that impairs social and emotional functioning. She reports the onset of Schizophrenia with delusions at age 28 during a time when her marriage was unstable (broken agreements) and she was unhappy (Kohn, n. . ). These stressors are causal factors in the onset or erupting of the disorder. Observations 1. Describe symptoms that you observed that support the diagnosis of the individual. When Valerie spoke of her memories and the occurrences that she experienced they supported the diagnosis, although at the time of the interview she showed no re adily apparent indications of paranoid schizophrenia. Valerie spoke of the delusions that she experienced in her late twenties where she believed that people were plotting against her and that she was a martyr for her church and her beliefs (Kohn, n. . ). When she was institutionalized, she believed that she was actually imprisoned and that her captors were going to experiment on her. She described how terrified she was the time she thought that people in the hospital were going to surgically remove her breasts. She was connected to the church and believed that people were infiltrating the church and trying to destroy it; making matters worse, when she expressed this fear to her husband and the church leader, she was taken to a Catholic hospital to be institutionalized which only affirmed her fears of the Catholics (Kohn, n. . ). She thought the medicine that she was being given was in the hospital was actually poison and that the hospital personnel would kill her in her sleep or th at the medication would kill her while she was sleeping. On one occasion she tried to smother her roommate in the hospital with a pillow (Kohn, n. d. ). 4. Describe symptoms or observations that are inconsistent of the disorder. Valerie seemed very functional and articulate, and did not present as being disconnected from reality. She was clearly able to meet the ordinary demands of life. Her thoughts, moods, and perceptions did not seem distorted; she was not illogical or incoherent in her ability to communicate. Valerie was likeable and animated. She had specific recall about experiences that she enjoyed, especially when she described the enjoyment she experienced when she studied abroad. She expressed her happiness in finishing graduate school before becoming mentally ill (Kohn, n. d. ). She seemed to have a clear understanding of her disorder and was able to employ coping strategies, function in society, help others, and hold a job. She expressed her frustration with the doctor’s disregarding her complaints about the medication, and felt she was not treated with a high degree of respect and did not like not having any privacy (Kohn, n. d. ). She seemed very connected to reality and to her memories; she was able to provide insight to her background in a matter of fact manner that was very descriptive. Although she stated that she is mentally ill, she did not present herself as mentally ill. Valerie did not typify one’s expectations of a paranoid schizophrenic although her references to her past affirmed the correct diagnosis. . Describe any information you observed about the development of the disorder. She started to have some gradual changes that led in to the diagnosis of Schizophrenia. At the onset of her disorder she started to believe that there were individuals that were starting to infiltrate the church and try to take over. She told her husband who went to the church leader at the time whic h was a priest and they both concluded to get her admitted to the psychiatric unit for some help, this was her first admission. When this first incident started to occur, she had a strained marriage and was around the age of 29. Her marriage was strained because her husband who earlier in the relationship had agreed to moving from Southern California and to having children after she was done her Graduated School decided that he did not want to follow his agreement. This was a devastating event to her and is what started the downward trend in her in her mental health. She feels that the stress of the strained marriage is what brought out her diagnosis of Schizophrenia. While on the psychiatric ward she had fears that the staff there were out to kill her, and she felt the medicine they were giving her was poison, and that she was caught trying to smother her roommate. She had hallucinations while in the psychiatric admission, that the staff there were going to do a surgery to remove her breast, and the medications would put her in such a deep sleep that this procedure could be done without her knowing. She has had auditory hallucinations, and also she had visual hallucinations with this disorder. While off her medications since she believed she did not have a mental illness she started to have delusional thoughts. While she was not taking her medications she had delusional thoughts that the cars in the United States were on a computer systems and if she did not drive for hours upon hours people in her family would die. Throughout the interview you can see she has had very delusional thoughts over the years that she has had been diagnosed. She has also had the two types of positive symptoms of delusions and hallucinations. She also described that she felt that she was going to be persecuted for many different reasons throughout her years of diagnosis which can be described as Paranoid Sub-type. Therapeutic Intervention 1. In your opinion, what are the appropriate short-term goals for this intervention? Paranoid schizophrenia is a chronic condition that requires lifelong treatment, even during periods when you feel better and your symptoms have lifted. You may feel as if you dont need treatment, and you may be tempted to ignore treatment recommendations. In my opinion, the appropriate short term goals would be for Valerie to continue taking the drug Haldol. Valerie has had great success with taking this drug she has taken it for several years and it has managed her symptoms. If at some point her medication stops working she can have her dosage increased. 2. In your opinion, what are the appropriate long-term goals for this intervention? In my opinion, the appropriate long term goal for Valerie would be psychotherapy. Valerie would benefit from the emerging techniques in psychotherapy. Psychotherapy with a skilled mental health provider can help Valerie learn ways to cope with the distress and daily life challenges brought on by paranoid schizophrenia. Cognitive therapy will help Valerie overcome her attention difficulties. The social skills training and the milieu therapy can teach her more socially acceptable behaviors. In turn these skills should allow her to keep stress levels down thereby reduce her risk of a relapse. 1. Which therapeutic strategy seems most appropriate in this case? Why? Based on the case study patient Valerie there were some significant factors that helped her to achieve success in her battles with schizophrenia. The first step was her acceptance of her disorder. Once she realized that she did have a mental illness she began to take steps to help in her recovery process. She then coupled herself with the best provider she could. This provider committed himself to gradually walking her through the process. Instead of starting her on heavy doses of psychotherapeutic drugs, he started her on a lower dose with gradually increases to reduce her symptoms and decrease side effects. Because of the gradual process Valerie was able to start taking interest in fulfilling activities in her life such as working, and having a social life. 6. Which therapeutic modality seems most appropriate in this case? Why? Patients who suffer from schizophrenia no longer need to live their life in an asylum being subject to electro-shock treatments, or lobotomies. There has been a significant amount of success with the use of neuroleptic drugs. Thorozine, Haldol, Prolixin drastically minimize the effects of schizophrenia. These drugs alter the dopamine neurons. These are neurons that directly impact mood, thoughts, and feelings. The use of these drugs can also reduce psychiatric symptoms and assists patients with the ability to lead normal and active lives. However, there can be side effects such as: uncontrollable shaking, muscle tightening, or involuntary eye movement. These side effects can exist in 20%-40% of patients and can be permanent. Another important technique is psychotherapy. These techniques include: cognitive therapy, social skills training, and milieu training. Overall, 30% of patients treated significantly recover and avoid reoccurrence for many years. Kohn, A. (n. d. ). Paranoid Schizophrenia. Retrieved March 22, 2012, from Faces of Abnormal Psychology: Interactive: http://www. mhhe. com/socscience/psychology/faces/bigvid. swf

Sample Paragraph Essay Outlines

Sample Paragraph Essay OutlinesA sample paragraph essay outline is a common part of college assignments and is often used by those who are trying to figure out how to write their own. Of course, it does not have to be a lengthy outline. It can be just a single paragraph of one's favorite ideas.There are many reasons why someone would want to look at a sample. The main ones being:o Now that it's paper, it's time to look at how it reads and see if you could improve on the original. This is something that all writers need to do. Doing this will ensure that you are writing correctly, and that you won't forget any of the things that you need to include in your essay.o Next, you can look at your previous writer and see what kind of essays they have written before. Do they have one that is similar to yours? You'll get a good idea of what kind of person you are, and you can also get a better understanding of what type of essay you want to write.o Just to let yourself feel it out a bit. Remem ber that you are going to have to write your essay regardless of the material. You don't need to worry about any of the other aspects of your life as much as you'd like, because that will be on the paper itself.o Lastly, you can look at a sample to see what kind of structure you should use. The best thing to do when this happens is to ask someone who has a lot of experience writing essays to give you some tips on where to begin with your writing.Look at some different sample paragraphs and try to compare the structure of each. If you have a lot of knowledge in your subject, it will make it much easier for you to write your essay.There are many reasons why you might want to look at a sample paragraph essay outline. Remember that all writers want to be good at their craft, and that you shouldn't worry about the other aspects of your life. Just start to learn the skills that you need, and when you become good at writing, then you can move on to other things.

Monasteries in the Middle ages essays

Monasteries in the Middle ages essays Monasteries dotted Europe during the medieval period. They were large houses where men, known as monks, lives quiet lives of prayer and work in an effort to get close to God. Larger monasteries were headed by an abbot, who was elected by the other monks to rule over them, and these monasteries were also known as abbeys. Monks made vows, solemn promises to God of obedience, stability and conversion of their lives to the life of a monk. Monastic life was generally an order of hard physical work, scholarship and prayer. The day of monks was regulated by regular prayer services in the abbey church. They prayed for others souls. It was a harsh life St. Benedict had established which reflected the two primary principles of monastic life Ora et labora and Prayer and work. These services took place every three hours, day and night. When the services were over, monks would be occupied with different tasks. Other specialists took care of the sick, buildings, masonry and education. The cellelar was in charge of food, storage and preparation. Abbeys grow their own food and healed common maladies with herls from their gardens, and taught local children. They imbibed on wine from their vineyards. Out in the field, monastic farmers were the agricultural experts taking on any craggy outcropping and turning it into a verdant field. Monks were by far the best educated members of society and monasteries acted as libraries for ancient manuscripts. Many monks were occupied with laboriously copying sacred tasks generally in a room called The Scriptorium. Printing didn not exist in Europe until 1450, so every document and book had to be copied by hand. Moral structure governed monastic life and it was a communein which all possessions were held in common. If nothing different happened in their daily routines, every monk spent their time on t ...

The Colossus at Rhodes

The Colossus at Rhodes Located on the island of Rhodes (off the coast of modern Turkey), the Colossus at Rhodes was a giant statue, about 110 feet tall, of the Greek sun-god Helios. Although finished in 282 BCE, this Wonder of the Ancient World only stood for 56 years, when it was toppled by an earthquake. Huge chunks of the former statue stayed on the beaches of Rhodes for 900 years, drawing people around the world to marvel at how man could create something so enormous. Why Was the Colossus of Rhodes Built? The city of Rhodes, located on the island of Rhodes, had been under siege for a year. Caught up in the heated and bloody battle between the three successors of Alexander the Great (Ptolemy, Seleucus, and Antigonus), Rhodes was attacked by Antigonus’ son, Demetrius, for supporting Ptolemy. Demetrius tried everything to get inside the high-walled city of Rhodes. He brought 40,000 troops (more than the entire population of Rhodes), catapults, and pirates. He also brought a special corps of engineers that could make siege weapons specially geared to break into this particular city. The most spectacular thing these engineers built was a 150-foot tower, mounted on iron wheels, that hosted a powerful catapult. To protect its gunners, leather shutters were installed. To protect it from fireballs hurled from the city, each of its nine stories had its own water tank. It took 3,400 of Demetrius’ soldiers to push this mighty weapon into place. The citizens of Rhodes, however, flooded the area around their city, causing the mighty tower to wallow in mud. The people of Rhodes had fought back valiantly. When reinforcements came from Ptolemy in Egypt, Demetrius left the area in a hurry. In such a hurry, that Demetrius left nearly all of this weapons behind. To celebrate their victory, the people of Rhodes decided to build a giant statue in honor of their patron god, Helios. How Did They Build Such a Colossal Statue? Funding is usually a problem for such a large project as the people of Rhodes had in mind; however, that was easily solved by using the weapons that Demetrius had left behind. The people of Rhodes melted down many of the leftover weapons to get bronze, sold other siege weapons for money, and then used the super siege weapon as the scaffolding for the project. Rhodian sculptor Chares of Lindos, the pupil of Alexander the Great’s sculptor Lysippus, was chosen to create this huge statue. Unfortunately, Chares of Lindos died before the sculpture could be completed. Some say he committed suicide, but that is probably a fable. Exactly how Chares of Lindos constructed such a gigantic statue is still up for debate. Some have said that he built a huge, earthen ramp that got bigger as the statue got taller. Modern architects, however, have dismissed this idea as unpractical. We do know that it took 12 years to build the Colossus of Rhodes, likely from 294 to 282 BCE, and cost 300 talents (at least $5 million in modern money). We also know that the statue had an exterior that consisted of an iron framework covered with bronze plates. Inside were two or three columns of stone that were the main supports for the structure. Iron rods connected the stone columns with the exterior iron framework. What Did the Colossus of Rhodes Look Like? The statue was to stand about 110 feet high, on top of a 50-foot stone pedestal (the modern Statue of Liberty is 111 feet high from heel to head). Exactly where the Colossus of Rhodes was built is still not certain, although many believe it was near the Mandraki Harbor. No one knows exactly what the statue looked like. We know that it was a man and that one of his arms was held aloft. He was likely naked, perhaps holding or wearing a cloth, and wearing a crown of rays (as Helios is often portrayed). Some have guessed that Helios’ arm was holding a torch. For four centuries, people have believed that the Colossus of Rhodes was posed with his legs spread apart, one on each side of the harbor. This image stems from a 16th century engraving by Maerten van Heemskerck, which depicts the Colossus in this pose, with ships passing under him. For many reasons, this is very likely not how the Colossus was posed. For one, legs open wide is not a very dignified stance for a god. And another is that to create that pose, the very important harbor would have had to have been closed for years. Thus, it is much more likely that the Colossus was posed with legs together. The Collapse For 56 years, the Colossus of Rhodes was a wonder to see. But then, in 226 BCE, an earthquake struck Rhodes and toppled the statue. It is said that the Egyptian King Ptolemy III offered to pay for the Colossus to be rebuilt. However, the people of Rhodes, after consulting an oracle, decided to not rebuild. They believed that somehow the statue had offended the real Helios. For 900 years, huge pieces of the broken statue lay along the beaches of Rhodes. Interestingly, even these broken pieces were huge and worth seeing. People traveled far and wide to see the ruins of the Colossus. As one ancient writer, Pliny, described after seeing it in the 1st century CE, Even as it lies, it excites our wonder and admiration. Few people can clasp the thumb in their arms, and its fingers are larger than most statues. Where the limbs are broken asunder, vast caverns are seen yawning in the interior. Within it, too, are to be seen large masses of rock, by the weight of which the artist steadied it while erecting it.* In 654 CE, Rhodes was conquered, this time by Arabs. As spoils of war, the Arabs cut apart the remains of the Colossus and shipped the bronze to Syria to sell. It is said that it took 900 camels to carry all that bronze. * Robert Silverberg, The Seven Wonders of the Ancient World (New York: Macmillan Company, 1970) 99.

Rights and freedom Essay Example | Topics and Well Written Essays - 1000 words

Rights and freedom - Essay Example This paper will feature analysis of the clauses of the First Amendment of the United States Constitutions, examine the significance of the Bill of Rights and discuss the process of amendment of the Constitution. There are several freedoms which are guaranteed by the Constitutions which are extremely relevant to me personally. First of all, it is the freedom of speech. I strongly agree with the scholars who point out that the existence of a clause that allows people to express themselves freely might be regarded as a reflection of a healthy as well as fully developed political environment (Anastaplo, 2007, 150). I do acknowledge that there are some reasonable limits when it comes to freedoms of speech; nevertheless, I am thankful that no citizen is able to prevent me from speaking my mind out within the permitted framework. If even I write this paper, I know that I can put all my thoughts as they exist in my mind and insist on the validity of my claims even though they might contradict with the point of view of my classmates or my professor. The next freedom which directly applies to me is freedom of peaceful assembly. Thus, I have adopted a proactive civil position and consider it important to express my mind about the social issues which, in my opinion, should be resolved so that the society where I live might prosper. I think that a fair share of the assemblies which I attended could not have happened if it had not been for this particular clause of the First Amendment. When it comes to analyzing the significance of the first ten amendments which are usually referred to as the United States Bill of Rights, one can not exaggerate its significance. Indeed, the above mentioned amendments establish legal framework which guides behavior of the individuals in virtually every field of social life and does it in the most positive as well as effective manner. For example, other than the already

The Mental Capcity Act Essay Example | Topics and Well Written Essays - 1000 words

The Mental Capcity Act - Essay Example The law also applies to common decisions involving personal care, diet, movement and grooming. In practice, the MCA generally provides for making decisions based on the victim’s best interests. In working out what the best interests of a vulnerable party looks like, the proxy must not tamper their decision with other unrelated issues such as the principal’s age, looks, condition or behaviour. Secondly, they should consider postponing important decisions for persons who cannot make decisions due to temporary conditions. Thirdly, they should involve the individual who does not have mental capacity in decision-making processes (Murray, 2013). In contrast, the Act requires decision-making processes to be based on the vulnerable individual’s past principles. It is also important for proxy decision-makers to factor in the perceptions of others, especially care providers and other parties who are interested in the individual’s welfare (Symington, 2007). In addition, any such decisions should not be inclined towards taking the life of the vulnerable party if they still have a chance to recover. The MCA has since substituted an Enduring Power of Attorney (EPA) with a Lasting Power of Attorney (LPA). An LPA is a licit document allowing persons to select an individual who can decide about their health and assets in the event that they become incapable. In this case, the attorney is the party mandated to draw conclusions on their behalf. In addition, with the LPA’s property and affairs option and the personal welfare option, vulnerable individuals have, since the MCA was implemented in 2007, enjoyed all-encompassing protection when they become incapacitated. The property and affairs LPA provides the attorney(s) the authority to decide about the victim’s financial and other physical property issues, such as car or managing rental property. In contrast, the personal welfare LPA empowers the attorney(s) to decide on the victim’s health and individual welfare,

Role of the Midwife as an Educator

Role of the Midwife as an Educator The researcher has used the terms â€Å"tutor† and â€Å"midwife† in an interchangeable format. Midwifery is about far more than delivering babies. The skills that a midwife needs to carry out her job successfully are legion. In this essay we shall specifically consider the role of the midwife as an educator, and her ability to impart information successfully to a group in a planned parenting session. In order to do this successfully it is obviously important for the midwife (or tutor) to appreciate how adults learn optimally in a different way from children. In this essay we shall explore both the theoretical and practical principles which underpin the delivery of a successful course for prospective parents. We shall also consider the importance of course evaluation in the construction and presentation of future courses. It is important to appreciate that adults learn optimally in a different way to children. The dichotomy is often refered to as pedagogy and andragogy. The fundamental difference between the two is that pedagogy is essentially the process whereby the tutor instructs the students and andragogy is the process which involves more of an interaction between the two, with the tutor guiding the students. (Cervero, R. M et al 1999) In the prospective parenting classes clearly the group are likely to be mainly young adults (the researcher states that they are making a number of assumptions here) and an alternative name for andragogy is experiential learning. This involves the tutor drawing out various experiences that the group, collectively, have had and using them as a basis for discussion and communal learning. (Donaldson, J. F et al. 2000) One could reasonably assume that the participants in the group have not had previous direct experience of parenting, but this does not preclude this method of teaching in this circumstance. They certainly will have observed friends, family and others bringing up their children and of course will have their own experiences with their own upbringing which will have formed a number of their opinions, expectations and values. These can usefully be explored and brought out in discussion for the whole group to use as a learning experience. It is likely that a typical group will include participants from different social backgrounds, ethnic groups and classes. This is also a valuable asset which can be exploited for the benefit of all. Specific examples could be the breast feeding and weaning habits of different ethnic communities and how they differ from what is currently considered to be best practice. Clearly this type of learning is quite different from that which could be used for children (pedagogy) who have very little life experience to draw on. (Johnson-Bailey, J et al 1997) Obviously the midwife will have their own professional learning and agenda together with a vast wealth of practical experience. This should ideally be presented in a sensitive but authoritative way, so that the group can have the opportunity to discuss, evaluate and adopt those elements that they collectively feel are or value and importance to themselves. (Ross-Gordon, J. M et al 2002). Although adults will clearly need to assimilate information – as this is a basic definition of learning – they are far more amenable to techniques which involve self motivation and self-directed learning. (Sheared, V et al. 2001). In this context it is important that the midwife, in addition to simply acting as a tutor and resource, should also suggest other sources of information. Local libraries, NHS leaflets, Local Authority pamphlets and of course the Internet, are all valuable resource options that the prospective parents can access themselves. Part of the information providing responsibility incumbent on the midwife, is the generation of interest which will allow the group members to feel empowered to make further exploration of the area themselves. (EHC 1999) The concept of metacognition is also important in this area. Traditionally a midwife might expect to give a talk on various important points of parenting and the prospective parents would sit passively and absorb the elements that they felt were important to them. The talk would finish and the group would disperse. Metacognition is the ability of the student to appreciate the overall context and content of what they are learning about. This is primarily a two way interaction between student and tutor. (Smith, M. C et al. 1998). If the midwife is able to establish a dialogue between herself and the group it is easier to evaluate and assess the gaps in knowledge and then to suggest strategies for filling them. Equally, it is a valid strategy to establish where the gaps are and then to encourage the student to find the information for themselves in order to bring back to the group for discussion on the next occasion. (Titmus, C 1999). When the tutor is constructing the course, if the andragogical approach is chosen as the most appropriate then they should: Encourage the group members to participate and put forward their own life experiences as much as possible in order to utilise them as exploratory and discussion tools for the group as a whole. Demonstrate to the group how their collective life experiences can be adapted and utilised within the framework of the current discussion (after Merriam, S. B et al. 1999). This is a difficult topic since evaluation is ultimately the most appropriate tool to assess whether the particular course has been successful. There are basically three appropriate viewpoints of evaluation – whether the tutor feels that they have delivered the course successfully, whether the student feels that they have benefited from the course and whether an independent assessor would consider the course appropriate. (Vaske, J. M et al 2001). There is not space to fully appraise all of these eventualities, but clearly it is utterly appropriate to consider the student’s appreciation of the course, whether it fulfilled their expectations and needs together with an assessment of the various areas where they felt that the learning experience was either good or lacking. This is clearly vital, not only from the point of view of deciding whether it is appropriate to continue delivering the course as a public service, but possibly more importantly, to provide feedback to the tutor on just how their delivery was perceived and received. There is obviously no value in presenting a course which is neither appreciated nor useful to the recipients (Tice, E. T et al 1997). Conclusions It is clear that the presentation of a successful adult-orientated course is not just a matter of chance and an informed professional standing up and presenting a series of facts. It is obviously important to optimise the impact and usefulness of the effort involved with an appreciation of the theory and practice of adult learning. The involvement of the audience group, particularly with an invitation and an expectation to share and learn from their own collective experiences, is clearly an important learning tool and should be maximally exploited by the tutor. It is also important to the overall optimisation of the learning experience for the student, that the tutor should develop clear and concise learning objectives for the group and tailor the structure of the group to those objectives. Central to that process is the formulation of an appropriate learning plan, which, in this particular format does not necessarily have to be a formal written plan, but can take the form of either notes or a mentally organised format by the tutor. (Taylor, K et al 2000). Cervero, R. M., and Wilson, A. L. 1999 Beyond Learner-Centred Practice: Adult Education, Power, and Society. Journal for the Study of Adult Education 13, no. 2 (November 1999): 27-38. Donaldson, J. F.; Flannery, D. D.; and Ross-Gordon, J. M. 2000 A Triangulated Study Comparing Adult College Students Perceptions of Effective Teaching with Those of Traditional Students. Continuing Higher Education Review 57, no. 3 (Fall 2000): 147-165. EHC 1999 Effective Health Care. Getting evidence into practice. York: University of York, 1999. Johnson-Bailey, J., and Cervero, R. M. 1997 Beyond Facilitation in Adult Education: Power Dynamics in Teaching and Learning Practices. In Crossing Borders, Breaking Boundaries. Proceedings of the 27th Annual SCUTREA Conference, edited by P. Armstrong et al. London: Birkbeck College, 1997. (ED 409 438) Merriam, S. B., and Caffarella, R. S. 1999 Learning in Adulthood. A Comprehensive Guide. 2d ed. San Francisco, CA: Jossey-Bass, 1999. Ross-Gordon, J. M., ed. 2002 Contemporary Viewpoints on Teaching Adults Effectively. New Directions for Adult and Continuing Education no. 93. San Francisco: Jossey-Bass, Spring 2002. Sheared, V., and Sissel, P. A., eds. 2001 Making Space: Merging Theory and Practice in Adult Education. Westport, CT: Bergin Garvey, 2001. Smith, M. C., and Pourchot, T., eds. 1998 Adult Learning and Development. Perspectives from Educational Psychology. Mahwah, NJ: Erlbaum, 1998. Taylor, K.; Marienau, C.; and Fiddler, M. 2000 Developing Adult Learners. San Francisco, CA: Jossey-Bass, 2000. Tice, E. T. 1997 Educating Adults: A Matter of Balance. Adult Learning 9, no. 1 (Fall 1997): 18-21 Titmus, C. 1999 Concepts and Practices of Education and Adult Education: Obstacles to Lifelong Education and Lifelong Learning? International Journal of Lifelong Education 18, no. 5 (September-October 1999): 343-354. Vaske, J. M. 2001 Critical Thinking in Adult Education: An Elusive Quest for a Definition of the Field. Ed.D. dissertation, Drake University, 2001. ############################################################# Word count 1,611