Assignment #4

Pre-Engagement

            Mr. Anthony is an elderly man who was first admitted to The Lilly because of a fall.  Unfortunately, Mr. Anthony is stuck in the nursing home because of insurance problems.   I have been working with Mr. Anthony for almost two months now and have gotten to know him pretty well.  We have been working on helping him gain more independence give his current situation, and to motivate him. 

Narrative

            When working with Mr. Anthony, we have begun to figure out some of the things that peak his interest.  He told me that he really loves to read and he would like to have more opportunities to read.  As a result, we have decided that Mr. Anthony will begin to take weekly trips to the library, and as time goes on perhaps he will make more visits.  In addition, there are many recreational activities which are offered to the residents of The Lilly, I would like Mr. Anthony to participate in these activities as well.  He said that he would be interested, but he does not always have the motivation to get himself up to go to these activities. 

            Mr. Anthony and I began to look at intrinsic motivation theory.  I explained to him that extrinsic reward will affect intrinsic motivation.  The more he does for himself, the more motivated he will be to do more, and the more independent he will feel.  Interestingly, soon after we spoke about this Mr. Anthony related that lately he has been feeling more motivated to do things for himself.  He said that he was able to tell himself that there are so many people in the nursing home who are in much worse shape than he is.  He said that so many people just sit around in their wheel chairs unable to speak or to move due to a stroke or something of that nature.  He feels that they are just sitting around and waiting.  Mr. Anthony was able to see the good in his situation and was able to use this to help his motivation.  I realized that the strength perspective would be an extremely helpful approach to this case.  Mr. Anthony was able to break the bad cycle which he was in.    

            Mr. Anthony reported that he has been going to the library more often and he is feeling better about himself.  In addition, Mr. Anthony told me that he had gone to an activity which included potting plants.  He mentioned that this was extremely helpful to him.  He has had issues with his wife and son because of all of the problems with his insurance, and he feels that they are not doing enough to help him.  Unfortunately, Mr. Anthony is not able to help himself whrn it comes to his insurance.  This played a very large role in Mr. Anthony’s mood and lack of motivation.  Mr. Anthony has been able to help himself to do things in order to get his mind off of his situation.  In addition, Mr. Anthony has been able to see the good in his situation, and he has realized that he has so much to be thankful for. 

Impressions

            Working with Mr. Anthony has been an extremely educational experience.  I have learned a great deal by applying learned theories into real life situations.  In addition, I have learned a great deal from Mr. Anthony.  For example, Mr. Anthony taught me that finding the good in a person’s situation can play a very large role in helping the person accept it.  This would have been a very good approach to work with, for Mr. Anthony is a naturally positive person who was going through a hard time.  As a result I have used the strengths perspective with other clients since Mr. Anthony.  I find that it is a good way of helping people who are feeling down to feel more positive.  Mr. Anthony is now living a better life in the nursing home.  He is able to find the strength to get himself out of his room and participate in his choice of activity.  Mr. Anthony has been able to make a schedule for himself to follow in order to keep himself up and positive. 

Plans for Future Action

            In the future when working with other clients, I will know how to better assess them when we first begin.  I will be more likely to use a self-anchoring scale, for it helps both the client and myself to get a better idea of how the client is feeling.  In addition, I would be more likely to encourage the client to keep a journal.  Sometimes when a person is not feeling the way he was yesterday, he is not able to recall his specific emotions and thoughts.  By keeping a journal and writing things down, it is easier to go back to a certain situation and discuss the feelings which were involved with the scenario.   

Assignment #3

            Through my many meetings with Mr. Anthony, it has become quite clear that what he lacks most is motivation.  There is so much he would like to do, yet he does not make a large enough effort to do what he wants.  It is hard for him to stop focusing on the fact that he is stuck in a bad situation. Together, Mr. Anthony and I have decided to help him to become more motivated.  I hope this will enable him to be able to make the best out of a bad situation. 

            To start, I asked Mr. Anthony to use a self-anchoring scale, and to tell me where he was holding in terms of motivation.  He reported that he was feeling to be somewhere in the middle, around the number five.  The reason for this is he has good thoughts, he knows that he would like to be doing more, but he is not acting on these thoughts.  Mr. Anthony would like to be more independent, but he feels that because he is living in a nursing home this goal is virtually impossible.  If he were to start doing more things on his own, he would see that he has more control than he realizes.  When it comes to therapy being effective, research shows that motivation is imperative (Ryan, Lynch, Vansteenkist, & Deci, 2010).  It is important to find out what will peak Mr. Anthony’s interest.  Once that is done, we can move on to finding things for him to do which will be interesting for him.  I would like for him to slowly start doing some of the things which are offered to him.  For example, he enjoys reading, there is a library at the nursing home which is well stocked.  To start, I would like Mr. Anthony to push himself to go down to the library once a week to read or look at books.  He will then see that he will be a little bit happier.  Research has shown that motivation may be effected by the concern people have for self-enhancement (McCasli, Petty, & Wegener, 2010).

            Many people are not motivated to change because they do not like change, others put on a show of being motivated and wanting to change, but deep down they are not interested in change.  When someone is motivated, it helps him or her to act (Ryan, Lynch, Vansteenkist, & Deci, 2010).  By looking for things for Mr. Anthony to do which will make him feel more independent and motivated, he will be more motivated to keep doing these things.  It is a cycle. 

It important to mention the intrinsic motivation theory.  This theory states that a person feels that he or she would like to do something because he or she knows that it will be a pleasant experience.  It is something that one may get pleasure out of (Quigley, Tesluk, Locke, & Bartol, 2007).  When Mr. Anthony experiences the pleasure felt by doing something that he wants to do, when he wants to do it, he will feel more motivated to do it again, and perhaps in different ways.

Mr. Anthony is currently lost in a bad cycle.  He is not motivated to help himself, and is therefore is stuck making the worst out of a bad situation.  He has the power to change this vicious cycle, into a more pleasant and healthier one.  Mr. Anthony can do this by getting himself out of his room.  It is important for him to realize that he is not in the worst situation imaginable, and that he is able to make a difference in his own life. 

References:

McCasli, M. J., Petty, R. E., & Wegener, D. T. (2010). Self-Enhancement and Theory Based Correction Processes. Journal of Experimental Social Psychology , 830-835.

Quigley, N. R., Tesluk, P. E., Locke, E. A., & Bartol, K. M. (2007). A Multilevel Investigation of the Motivational Mechanisms Underlying Knowledge and Sharing Performance. Organization Science , 71-88.

Ryan, R. M., Lynch, M. F., Vansteenkist, M., & Deci, E. L. (2010). Motivation and Autonomy in Counseling, Psychotherapy, and Behavior Change: A Look at Theory and Practice. The Counseling Psychologist , 194-242.

  

Assignment #2

     Mr. Anthony is an extremely sweet man who was given a raw deal.  When one first encounters him, he seems to be very content in his surroundings.  Unfortunately, Mr. Anthony has been stuck in a nursing home for the past few months because of problems with his insurance.  He is a man who has worked all his life and is, but did not make the kind of money which is needed to privately hire a home attendant.  Mr. Anthony is now being punished by the government for not being poor and not being rich.
     When one refers to behavior, he or she is referring to what people do, not a disorder that a person may have.  Behaviors include how peoplem the way they think, and the way they move.  For example, the amount of time a man may spend with his family after a long day at the office (Bloom, Fischer, & Orme, 2009).  This would be an over behavior, something that other people can see.  On the other hand, there are also overt behaviors; things that other people cannot see, rather thoughst a person may have.  Mr. Anthony is the type of person who likes to be productive.  He enjoys reading, walking, listening to music, and many other things.  After his fall, Mr. Anthony came to the nursing home for what he thought was a short visit to regain his strength.  As it turns out, Mr. Anthony is now stuck, and is unable to do the things he loves most.  Mr. Anthony feels as though he has lost his independence and he feels that the things that interest him most are no longer available to him.  In addition, Mr. Anthony is having negative thoughts which are beginning to bring him down.  For example, there is a library in the facility, but the books that are offered do not peak his interest, and he is unable to go out and get a book which is more to his liking.  Mr. Anthony has said that he would like to go home and live out the remainder of his life where is he comfortable, but because of his insurance problems this is not an option.
     Mr. Anthony needs 24 hour care, and he is not able to afford to privately hire an aid.  His current insurance company will not pay for Mr. Anthony to get more than a few hours of help per day.  Mr. Anthony's wife and son are trying to get Medicaid for him, but he has a very large spend down and his wife is not sure that she wants to have to give up so much money.
     It is important to discuss the client's concerns whent trying to figure where to start.  This way the social worker may the client to stay focused on what he or she has decided to work on (Bloom, Fischer, & Orme, 2009).  Mr. Anthony has tried extremely hard to stay positive throughout all of this.  He feels that being positive is the only way to get through the hard time he is facing.  Unfortunately, he has become increasingly sad.  It is important to figure out how mant behaviors will be worked with.  The reson for this it may be confusing and frustrating to be working with too many things at once (Bloom, Fischer, & Orme, 2009).  We have decided that for now we will work on keeping him positive and motivated.  Mr. Anthony's feelings of negativity are not feelings one is able to see just by looking at him or speaking to him for a few minutes, one must know him in order to see it.  I have asked him to try and keep track of how often he is feeling down and how often he is feeling more positive.  This way we may be able to start working on how to make him feel a little bit better.  The reason I have asked Mr. Anthony to start keeping track of the amount of time he is feeling sad is, only Mr. Anthony himself know what he is feeling.  He is the only one who really knows what his overt behaviors are.  Others are not able to keep track of his overt behaviors because they cannot see them (Bloom, Fischer, & Orme, 2009).  Mr. Anthony and I will soon begin using a self-anchoring scale.  The scale will include all numbers between one and ten.  One will represent extreme lack of motivation and the number ten will represent extreme motivation, and Mr. Anthony feeling like he would like to make new friends or go to an activity.
     When told about being a part of this study, Mr. Anthony was a little apprehensive and first, but after he understood that everything was to be kept completely confidential, he felt more confidant and even a little excited.  It seems like even though Mr. Anthony is stuck in the nursing home, he feels like he is doing something good by helping me learn to become a better social worker.
     My supervisor was a little bit hesitant about this assignment at first.  She seemed a but overwhelmed at the thought of it.  We work on one of the busiest floors in the facility, and to give me up for so much time when she is desperately in need of extra hands, is overwhelming.  However, she puts my education first and allows me to go speak to Mr. Anthony whenever I need to.

References

Bloom, M., & Joel, F. (2009). Evaluating Practice: Guidelines for the Accountable Professional (6th ed.). Boston, MA: Pearson Higher Education.

Blog Assignment #1

     I am currently working in a nursing home which for the purpose of this assignment will be called, The Lilly. This nursing home caters to the various different needs of the elderly, the types of services offered range from short term rehabilitation to long-term independent living.  I am currently working on the rehab unit, and therefore do not see the same clients long-term.  The people I am working with are usually people who may have had some sort of surgery or stroke, and have now come to The Lilly to regain their strength.  

     It is very common to come across people on the unit who feel that due to their circumstances they have failed both themselves and their loved ones.  Many people feel that they could have avoided their current situation, and due to their foolishness ended up in a nursing home.  Some feel depressed due to their lack of independence.  there is a great deal of denial on the unit, people are unable to comprehend that they are no longer as strong or as independent as they once were.  When it comes time for a resident to be discharged, he or she is told that there will be a home care agency coming to the resident's home for several hours a week to help the resident out with activities of daily living.  Often times the resident will feel the need to fight this, for the resident may feel that he or she is capable enough to do everything without the help of an aid.  

     There are some times when a resident is not able to return home, and he or she may be moved to a different unit in the facility.  For the purpose of this assignment, I have decided to find a resident on a different unit who came from the rehab floor.  I decided to speak to a man named Mr. Anthony.  Mr. Anthony started out at The Lilly in the beginning December of 2010, due to a fall.  Mr. Anthony was supposed to be discharged at the end of December, but was unable to go home due to complications with his insurance.  As a result, Mr. Anthony will be staying at The Lilly until his insurance problems are resolved.