Personal Leadership and Career: Becoming a Total Leader

Personal Leadership and Career: Becoming a Total Leader Some people are born leaders and some people become leaders by learning to lead. Learning to lead helps you to understand leadership, develop leadership ability and grow as a leader (Adair J, 1988.). This report describes my personal and professional leadership development. First section focuses on critical review of the article to become a Total Leader. Second section reflects on my 360-degree feedback and third section summarises what experiments I undertook to develop my understanding of leadership and career related competencies during October 09 to March 10. 1. LITERATURE REVIEW Be a Better Leader, Have a Richer Life Article by Stewart D. Friedman Stewart Friedman is a professor of management at the University of Pennsylvanias Wharton School of Business. He runs a programme called Total Leadership at the Wharton Business School, at companies and workshops around the word. Essence of Be a Better Leader, Have a Richer Life article revolves around his idea of Total Leadership. It is all about being a good leader by developing the power to understand and manage yourself better. Friedman emphasises that integrating work, home, community and self, will make you a whole person and a better leader. The article begins by presenting a case behind the total leadership concept. The author states that his research and experience over the past two decades has found that many executives feel unfulfilled because they are focusing more on work aspect and less on other aspects of their lives. Friedman emphasises that it is possible to achieve excellent performance in all four domains of life work, home, community and self, and refuses to believe that we need to trade off one domain of life for the betterment of other, which is the main idea behind his Total Leadership programme. The article then starts building upon how people can improve their performance in multiple domains of their lives through simple but thought-provoking experiments. Friedman then tries to convince the readers by presenting the strong evidence of his study of more than 300 business professionals over the period of four months. His evidence shows that, the total leadership approach has increased the satisfaction of professionals in their work lives, home lives and in their community lives. In addition, the most significant satisfaction for the professionals comes in the area of themselves their physical and emotional health and their intellectual and spiritual growth. The author explains that authenticity, integrity and creativity are the three main attributes of the Total Leadership process. The process starts by indentifying our own core values, vision and important people in our life. Once we have a complete picture of what we want to achieve in our life, we begin to see new ways of achieving our goals. Friedman asks professionals to think about various possibilities/combination of various components through nine types of Total Leadership experiments. He encourages readers to design and test experiments that will create meaningful and sustainable change that benefits themselves and important people around them. He urges the reader to take the notion of innovation through experimentation beyond the work role to other aspects of their life. He encourages leader to start small experiments and emphasises that small steps lead to a big win. Friedman also gives examples of measuring progress of various experiments. He points out importance of setting practical ways to measure outcomes. The experiments and follow-up reflections help readers learn to focus more on the things that matter to them and the people around them. He concludes that total leadership approach helps people to generate more support and feel more connected to the important people in their life. It helps people to become more resilient in response to the impulse of our turbulent world. It gives readers a blueprint of how to be real, be whole, and be innovative as a leader in all four parts of their life. As per Venables J. and my personal experience, in the UK, working late is a sign of dedication to the job and normal corporate culture. I have also seen my father worked extremely hard throughout his life to achieve his goals. Therefore, I was particularly drawn to this article and the subject of being successful leader while maintaining your personal life. The article takes a positive approach towards becoming a successful leader. The authors central concept is about identifying our inner values and using those values to improve our leadership in four areas. Authors key remark is, to be a leader one must be whole and balance in all aspects of life work, home, community and self. The concept of whole person as good leader in this article is similar to the view of Bartolome F. add Evans P. in the Harvard business review book Executive success, that executives who are able to maintain balance in their private and professional life are able to do things better than the other executives, but different to the point of view of John Adairs situational leadership. This article gives importance to the key stakeholders in work as well as all aspects of leaders life. This is very different to the view of article Leadership Lessons from India (Cappelli, P., et al., 2010), where the article mentions working with employees and focusing on their issues within the company and giving them importance rather than giving importance to the company shareholders only. The articles main strength is that it is very easy to follow and understand. It is a structured approach to produce measurable changes in our life. It takes readers through, various simple experiments and practical examples on how to be a successful leader in all domains of life. The examples and experiment suggested by the article are so simple that anyone can try them without being a subject expert. This article emphasis on developing leadership qualities based on authors holistic perspective. The only criticism I have about this article is in its approach. It provides broad sets of simple experiments to create a positive change around you. But in reality, situations are more complex. The article does not take account of any organisational factors. If it is that simple and easy to develop skills as suggested by the author, then everyone will be a good leader. Authors arguments have great deal to do with our understanding of leadership and careers because self concept is essential in understanding the leadership. As per one of the greatest leaders, Mahatma Gandhi Be the change that you want to see in the world. In other words, if you want to see change, you start with yourself. If you cannot do it, then how can you expect others to want the change? To lead others we must learn to lead ourselves and leadership starts from within. Power to see yourself brings with it a new depth of motivation and a sharper sense of direction. This article is really helpful for those who are trying to learn about becoming a better leader and interested in initiating a self-dialogue about professional and personal values. It shows simple experiments about how to be a great leader not just at workplace but also at home, in the community and above all being yourself and become a whole human. Total Leadership is a sensible and practical approach about finding out what makes you a great leader. I favour authors notation that an effective human being is a better leader. Inspired by this, I designed an experiment of doing yoga every morning with my wife to improve home and self aspects of my life. The results of the experiment were great and I noticed that I was feeling more energetic and happier in personal life, but I have not seen any changes in my leadership style at work and in community. As a result of this, I am encouraged to design some more experiments to improve my performance in work and community domains. There are no rules for leadership, but there are certain skills that every good leader should have. It is important to see different authors approach to develop your leadership skills and this article definitely gives different perspective to it. 2. CRITICAL REFLECTION ON MY 360-DEGREE FEEDBACK 2.1 Competing Value Framework From my Competing Value Framework feedback in October 2009 I learnt that, out of 12 managerial and leadership competences my scored average on 5 competences, good on 2 competences and very good 5 competences as shown in Appendix iii. I learnt that I need to develop my following leadership/managerial skills: Emphasizing speed, Initiating significant change at my work place Controlling my projects well Inspiring people and Clarifying policies I started focusing my efforts to develop my leadership skills in the areas mentioned above and by January 2010, I could see that perception of my leadership quality was improved as a result of my efforts. I always encourage my colleagues to develop their career by supporting them in their daily activities. I learnt that not all people share my view of working in a team, improves performance. I felt that some people in the team would like to work on their own, as they had their own views and ideas. I was willing to leave them in peace as far as they are doing the right thing for them and for the company. Therefore I decided to take a step back and not to interfere, but always checked the quality of work they produced. Over the past few months I have trained myself hard to work faster through various technical trainings. And I can now produce good quality work with greater speed than I was expecting before four months. I still think that there is no alternative to hard work. All this views are reflected in my 2010 feedback. I am now making sure that everyone who is involved with the task is fully aware of formal guidelines and what they are doing and have a clear understanding of company procedures and policies. I now do regular team meetings and try to keep close eye on how the project is going and keep them under control. I have also suggested new ways of doing traditional things by introducing latest software which will enhance employees performance and will also benefit the project by faster outcomes and achieving the deadline more promptly. I also attend client meetings with my seniors and try to understand what they expect from us at the end of the project and what we need to do emphasis more on to win the future projects. I have made some small changes in my team and group which will enhance the performance and quality of the outcome. According to my Competing Values Framework Feedback report in Appendix iii, my peers and colleagues also have similar views about myself in areas of Control, Performance and Creativity. Their views differ from my views to some extent in the category of Collaborativenes. They think I am not encouraging people to have work- life balance, but expect from everyone to work hard to create quality work. They feel that I am not making sure that everyone has a career development plan and not handling their career issues. I was really surprised that my leaders thought of me as a less collaborative person. Because I have always given importance to the work-life balance and have tried to understand other peoples need. From my competing values framework, I learnt that my peers think of me as a less collaborative person then I perceive myself to be. Therefore, I should try to make more efforts to improve my skills towards developing other people, encouraging them in active participation and acknowledging their needs. 2.2 Cultural Intelligence As we enter the twenty-first century, we live and work in a social and organisational world that is increasingly diverse and offers more opportunities for interaction among people who do not share a common history or culture. (Caproni P., 2005). Cultural Intelligence is persons ability to function efficiently in situations characterised by cultural diversity (Earley Ang, 2003). Culture often relates to peoples perspective on their values, beliefs, stories or rituals. Cultural differences can influence peoples preferences, expectations and behaviours at work. In modern organisations, the ability to function effectively in multi-cultural situations is important attribute for employees and managers. Corporate culture rests in distinctive capacities and incapacities that are built in to the attitudes and approaches of organisational members. (Morgan G., 1997) Cultural Intelligence provides insights about how to interact with others in multi-cultural society and organisations, engage in cross-cultural interactions appropriately, and perform effectively in culturally diverse work groups. From my 360-degree feedback report, I learnt that my perception of ability to act across different cultures has changed between October 2009 and January 2010 as shown in Appendix iii. This change reflects that my recent experiences differ from my expectations. When compared with how others perceive my cultural intelligence, it is higher than what I perceive. I learnt that people see me as a person with good cultural diversity skill. It reflects my good understanding of cross culture knowledge. I need to be aware of how my behaviour affects others. I need to pay attention to the social context in which I am working. I need to continue to think in broad way and integrate diverse information and see uncertainty as an opportunity to develop my cultural intelligence. 2.3 Qualitative Feedback Qualitative feedback from my peers shows that I am open minded, friendly, hardworking and committed person. I realise that I must take advantage of these attributes to develop good relationship with my colleagues and interact with them more frequently. My peers suggest that I should become more pro-active and articulate my ideas rather than keeping them to myself. They also suggested that I should develop smart ways to work faster and effectively while producing quality work. What surprised me most was that my peers noticed that I sometime think that my superiors are infallible. I believe that, this is partly due to my cultural beliefs. I need to ask questions to my superiors about their assumptions to change their perception. 3. REFLECTION ON PROFESSIONAL DEVELOPMENT AGENDAS Between October 2009 and March 2010 I have focused on developing three leadership qualities based on MBTI /ICCS assessment, class room notes, my past job performance, my current and future career requirements. These qualities are: Effective Communication Trust Building Networking The table below reflects on my leadership self-development process. It reflects on my commitment of developing right attitudes to become a good leader. It describes what I did to develop the above mentioned skills. It also mentions the results of my experiments and how these qualities will be useful to me in future. Table 1 Developing Leadership skills (Adapted from Kolbs Learning Cycle) Developing Effective Communication Skills Activities: Communicating Effectively workshop 09/02/2010 Power and Influence workshop 10/02/2010 Managing Conflict workshop 11/02/2010 Coaching and Developing Others workshop 11/02/2010 Reading related books and articles (Oct09 Mar10) Reflective Observation: I am very confident, comfortable and clear in communicating my message across to my family and friends and I generally adopt communication style which suits peoples culture. Although, I have observed that I am not an effective communicator in the public and at workplace due to fear of: Cultural differences Lack of self confidence and Lack of trust Sometime while taking criticism I become defensive rather than being more open to accept it. So, I need learn to respond to criticism with empathy. Concept and Generalisation: To be a good leader communication is the utmost important aspect. Thinking about great leaders in modern times: Mahatma Gandhi, Churchill, Hitler and Martin Luther King, its clear that they were powerful leaders because they had ability to communicate their vision and inspire people to follow them in achieving their goals. Communication is a two-way process. Knowing how to listen is just as important as being able to communicate (Venables J., 2002). Application/Experiments: Apply active listening method to improve communication skills. Try to give full attention to the speaker and listen with empathy. Try to be more confident and maintain eye contact during conversations. Try to see my facial expressions and observed what others will perceive from it and learn how I can improve. Try to be more open and friendly with colleagues to over-come my fear of cultural differences and lack of trust. Try communication skills experiments in my organisation, group meetings, client meetings and presentations. Outcome: As a result of above experiments, my self-confidence has grown and I have overcome some of my fears of speaking with colleagues. I have received good response from my colleagues and team mates regarding my presentation style. This skill will be helpful to me in communicating effectively with my clients and coaching and developing my team. Developing Trust Building Skills Activities: Reading related books, journals and research papers (Oct09 Mar10) Believe in Myself (Oct09 Mar10) Be Truthful, Reliable and Fair (Oct09 Mar10) Set Boundaries (Oct09 Mar10) Reflective Observation: I feel I am Open-minded, trustworthy and reliable person. I am highly regarded and trusted in my friend circle and been asked for advice regularly. But I feel I am not always involved in the decision making process in my organisation and family. I am not sure if this is for a good reason or a sign of mistrust. And therefore, I feel that I need to develop ability to earn trust of my fellow colleagues, clients and family members, to build good relationship and to develop positive emotions and atmosphere around me. I also feel that workers in the organisations should not be judged against quantitative goals such as profit, cost and other numerical scale, which are to be ineffective as motivational tools against qualitative values of trust, responsibility and innovation. Concept and Generalisation: If you trust yourself, you know you made the right choice. And thats a strong foundation on which to build trust. Trust is critical to managerial effectiveness and building client relationship. Great relationships and organisations are made and broken on trust. Trust helps clients deal with market uncertainties and risk, ultimately resulting in increased satisfaction and loyalty in the client relationship. Breach of trust can lead to breaking of relationship and confidence. According to Robert Bruce Shaw, author of Trust in balance The importance of trust becomes clear when we try to imagine a world without it. Application/Experiments: Always try to be truthful. Set realistic deadlines and make every effort to achieve them Delegate work to juniors and help them with their problems Attend client meetings Outcome: I have been truthful and learnt to say no to unrealistic deadlines. Being truthful does not always work in my favour. I have mange to develop good relationship with my juniors and earned their trust. I understand importance of client needs from business perspective. This skill will be very helpful to maintain trust of colleagues, clients and family members for the years to come. Developing Networking Skills Activities: Reading related books, journals and research papers (Oct09 Mar10) Develop good working relationships with colleagues (Oct09 Mar10) Make new friends and attend social events (Oct09 Mar10) Develop friends community on social networking website (Oct09 Mar10) Reflective Observation of my Networks: I have come here from India and my network here is limited to my family, university friends and work colleagues. In addition, I am very introvert person (also indicted by my MBTI assessment) when it comes to making new friends. When I meet the quality kind of people who share my interests, I have been friends ever since with them. I feel strongly that friends are forever. I feel society tends to value extroverts more highly than introverts and I sometimes feel sensitive to social rejection. I sometimes fear that other people might not understand and hurt my feelings. I desire to improve my networking skills. I fell that I need to stay open to new ideas. I need to develop relationships with clients, my senior colleagues, old school friends and sport friends. Concept and Generalisation: Networking is a deliberate, systematic process of building and maintaining relationships based on mutual benefits. The quality of relationships with your subordinates, bosses and peers significantly influences your task effectiveness, careers development and personal well- being. (Caproni P., 2005) Businesses thrive on relationships. The more people you meet, the better the chances will be to find good, new, personal and professional opportunities. Networking is helpful in sharing knowledge, experience, opinions and differences which helps to develop a broader worldwide view. Application/Experiments (inspired from Kerr C., 1999): Business networking: I have joined Business Networking website BNET. Attended Institution of Civil Engineers evening meetings. I invited my work colleagues for a dinner at my home. I invited my previous boss at my place for a long weekend. I have joined my organisations cricket and badminton club. Personal Networking: I have joined health club with my friend and a neighbour. I have joined School friends group on Facebook. Call friends and family frequently. Attended my little sisters engagement party in India. Outcome: At first no one joined my school friends community and had a disappointing start to my experiments. I tried finding the contact numbers of my old friends and after a few quick calls to old friends the community has grown to 15 members, but a few are still not convinced. I have also managed to develop good relationship with my colleagues and I feel more open to express my views and accept different opinions of other colleagues. I am able to engage in discussions. Initially, I found social events boring and exhausting but now I am starting to enjoy it. I have experienced that networking requires a lot of time, perseverance and efforts. Therefore, I need to focus on important relationships and not waste valuable time to convincing people who lack enthusiasm and similar interests. Networking is more effective when people share similar interests. Through these experiments I have made new friends. I have become happier, more open to new ideas, possibilities, aware of differences in opinion and less worried out rejection. All in theses networking experiments has boosted my confidence to make friends develop relationship with important people. I am thinking of starting to arrange a social events club for my organisation. I need concentrate my efforts more to develop a network of clients. I am also thinking of taking part in a charitable activity over the next year. Networking skills will help me to develop and progress my personal and professional life in years to come.

Care of the Malnourished Elderly Patient

Table of Contents Page numbers Abstract†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 2 Chapter 1 / Introduction Origin of the Problem†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 Significance or Importance of the Problem for Nursing†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦6-8 Problem Statement†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 8 Purpose of the Study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦. 9 Hypothesis- Null and Research†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦.. 9 Definition of Terms.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 9-10 Assumptions†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 10 Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦. 10 Chapte r II/Review of Literature Review of Literature†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦11-16 Chapter III/Methodology and Research Design Research Design†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 17 Variables†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦17-18 Selection of Subjects and Research Setting†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦. †¦Ã¢â‚¬ ¦. 18-19 Data Collection Instruments †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦.. †¦Ã¢â‚¬ ¦ †¦. 19 Statistical Analysis†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦. †¦. †¦. 20 Data Collection Procedure †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦. 20 Limitations†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 21 APPENDICESA. Request for Permission to Survey Participants†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦. †¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦. †¦. 22 B. Nutritional Assessme nt Survey†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦23-26 REFERENCES . †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦27-28 Chapter I. Introduction Origin of the Problem In our society, malnutrition and under-nutrition is a rising problem for the older adult population. Approximately 35%-85% of residents living in a long-term care facility, 60% of hospitalized older adults, and an estimate of 5%-10% of older adults living in community settings are malnourished (Maher and Eliadi, n. d. ).These statistics sadly show that hospitalized and long-term care patients are more likely to become under nourished compared to the elderly population in the community. According to the Joanna Briggs Institute (JBI, 2007), malnutrition ca n lead to serious or adverse health outcomes. Malnutrition has been linked to lengthy hospital stays with higher complications, morbidity, mortality, and frequent visits to their general practitioner (JBI, 2007). There are several risk factors (i. e. physical, psychosocial, social, and medical factors) that lead to malnutrition (Maher & Eliadi, n. . ). It is predicted that by 2030, the elderly population in the United States will double in size and exceed 70 million people. In light of these predictions, addressing the nutritional needs of the elderly will reach epic proportions and become a complex issue. Based on clinical observation, the signs and symptoms of malnutrition and under nutrition are often overlooked. Observing residents in a clinical setting at a local long- term health care facility precipitated our interest in this problem with malnutrition.The majority of elderly people living in care homes either have dementia, suffer from some form of physical disability, or hav e difficulty swallowing, which restricts them from adequately hydrating and nurturing themselves. With dementia, they usually do not remember how to eat or how to chew. With various physical disabilities, such as upper extremity contractures, their ability to feed themselves is often limited. In the event of swallowing difficulties, their food preference is often altered to prevent choking or aspiration.This often discourages them from eating due to the texture of the diet ordered. With the issues fore-stated, the residents often have to rely on the staff to assist them with meals. Caregivers often contribute to the problem of malnutrition because not enough time is devoted to assisting and supervising the residents to ensure they are eating properly. It is our job as caregivers to know the signs of malnutrition and risk factors that lead to malnutrition so that it can be detected and reported to the physician or dietitian early, before major problems occur.Various nutritional scree ning tools, assessment tools, studies, and research programs are available to help isolate and provide aggressive preventive treatment strategies for those at risk. The Nutritional Form for the Elderly (NUFFE), Malnutrition Screening Tool (MST), and the Malnutrition Universal Screening Tool (MUST) are instrumental in detecting and providing interventions to decrease morbidity and mortality. These various studies help support the fact that malnutrition is overlooked, unrecognized, and left untreated by nurses and healthcare professionals.Other studies find that even though malnutrition was identified, no interventions were put into place to treat this growing concern. Significance of the Problem for Nursing In a hospital based setting, there are several different groups and departments that deal with patient care. These departments and groups consist of nutritionists, doctors, social workers and other disciplines. However, the nurses are ultimately responsible for the entire care of the patient throughout their stay.Nurses realize that many elderly patients come into the hospital undernourished or malnourished related to their being on a fixed income, having reduced access to food, having poor knowledge of nutrition, or being dependent on others for food preparation. These elderly patients sometimes have chronic illness such as depression, cancer, diabetes, renal failure, and cardiovascular disease that leads to malnutrition or under- nutrition (Briggs 2007). Under-nutrition is a wide spread problem that usually results in the elderly staying in the hospital longer related to a delay in recovery, more complications, and higher mortality rate.That is why it is important for nurses to do a detailed assessment upon admission to prevent these issues or problems. It is the nurse’s responsibility to gather all the background information about a patient during the assessment period. This will help to diagnose the nutritional status from the beginning of the pat ient’s care. Some of the information that is collected during this time, such as the patient’s mental status, allows the nursing team to identify if the patient is oriented or has problems with dementia.According to Briggs’ 2007 article, dementia is a common cause of under nutrition, as are the adverse effects of medications, such as digoxin and some anti-depressants. Antihistamines, angiotensin-converting enzyme inhibitors, and lithium zinc deficiency can alter a patient’s taste and smell. For this reason, the nurse needs to collect a medication list that is current (Briggs 2007). During this process, nurses should ask questions that will reveal information about the patient’s medical history. This is done to identify possible diseases that have an effect on the patient’s nutritional status.Nurses should use all resources available to them after collecting data to assist with care of the patient. It is important for the nurse to know the po licies and procedures at the current hospital to consult specialists in order to improve patient care. This allows each department access to review the patient’s medical information and provide patient care as needed. Nurses are the primary caregivers for elderly patients in the hospital. When a malnourished patient is admitted nurses often develop plans of care to assist patients with improving their nutrition.Some of the ways that have been recommended are serving food at the appropriate temperature, providing food that is packed with nutrients, offering food that the patient enjoys eating, and giving oral supplements throughout the day to increase caloric intake. A good tip that nurses could use would be to always offer food or drinks when entering the patient’s room. From this research we know that poverty is one reason for malnutrition. When developing a plan of care for this patient the nurses can solicit the help of a social worker to help find resources to save money and provide food (Mayo Clinic, 2011).Malnutrition is a significant problem in nursing because it alters the type of care a nurse can provide. For instance, if a wound already exists, malnourished patients are at a higher risk for decreased wound healing. The nurse will then have to improve the nutritional status before proper wound healing can occur. The malnourished individual can become very weak and is thereby prone to falls. The impoverished elderly patient may not only be malnourished but have insufficient funds to purchase needed supplies, such as diabetic test strips and glucose monitoring systems.This could also lead to weakness and the development of further complications. Nurses need to ensure that daily weights and labs are obtained to track the progress of each patient. Malnutrition may seem secondary in nature, but it can grow into a monumental problem. Problem Statement Do registered nurses use evidence-based standards in the care of elderly hospitalized patient s who are undernourished? Purpose of Study The purpose of this study is to examine registered nurses usage of evidence-based standards in the care of undernourished elderly hospitalized patients.Hypothesis Research Hypothesis: Registered nurses use evidence-based standards in the care of undernourished elderly hospitalized patients. Null Hypothesis: Registered nurses do not use evidence-based standards in the care of undernourished elderly hospitalized patients. Definition of Terms For the purpose of this study, the following terms have been defined: 1. Undernourished- defined as an imbalance of nutrients caused by either an excess intake of nutrients or a nutritional deficit. (Maher & Eliadi, n. d. ) 2. Older Adults- Age 64 or older. Maher & Eliadi, n. d. ) 3. Associate Degree Registered Nurse- Registered nurses (RN’s) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members. Registered nurses must also become licensed by passing a national licensing examination. An associate degree is an academic degree awarded on satisfactory completion of a 2-year course of study, usually at a junior college. (Bureau of Labor Statistics, 2012) (Elsevier, 2009) 4.Evidence-Based Practice- the use of scientific evidence, integrated with clinical experience and incorporating patient values and preferences in the practice of professional nursing care. (Houser, 2012, p. 12) 5. Hospital Setting- a health care facility that provides inpatient beds, continuous nursing services, and an organized medical staff. (Elsevier, 2009) Assumptions 1. If caregivers feed elderly patients, then the proper amount of the meal will be consumed. 2. Registered nurses help to prevent malnutrition in elderly patients. 3. The adequate amount of protein consumed in an elderly patient’s diet prevents malnourishment. . Registered nurses provide help with dietary interven tions of the undernourished. 5. If the proper screening tools are performed on admission, the elderly patient’s weight will improve. Summary People in this nation are living longer. As recognized throughout this research, malnutrition in the elderly patient is at an extremely high level. It is not only the nursing home patients experiencing undernourishment but the hospitalized elderly patients also. Malnutrition is prevalent throughout the elderly community. Through using evidence based practice tandards, malnutrition tools, and education strategies this dilemma can be improved. CHAPTER II. Review of the Literature Undernourishment has long been a prevalent problem among the elderly, especially in an acute-care setting. It has been a long-standing challenge for health-care providers to determine the most effective process for identifying those that are undernourished, at-risk for undernourishment, as well as intervening promptly and appropriately. A review of literature was done to examine registered nurses usage of evidence-based standards in the care of undernourished elderly hospitalized patients.Much of the literature supports the use of nutritional screenings to identify undernourished patients and reduce the number of those patients in the hospital setting. Undernourishment is often referred to as malnutrition. The effects of malnutrition, which is the inadequate consumption of essential nutrients, are very devastating to the health of an individual. As well-known among healthcare providers, inadequate nutrition can prolong wound healing, suppress the immune system, lead to increased length-of-stay, and increase the risk of mortality from comorbidities.The article entitled, â€Å"How well do nurses recognize malnutrition in elderly patients,† describes how well nurses are able to recognize the problem of undernourished patients and if care is being provided to these patients. There are numerous methods that can be used in determining if a patient is malnourished. In this study Mini Nutritional Assessment (MNA), Body Mass Index (BMI), and a detailed questionnaire was used. The MNA is a simple, reliable, and well-validated tool used to determine a patient’s nutritional status.MNA gives a maximum of 30 points. A score of less than 17 indicates the patient is undernourished, while a MNA of 17-23. 5 shows a patient is at risk for malnutrition. BMI is another tool used in determining the status of a patient’s nutritional state. In this study a BMI of less than 20 is considered to be high risk for malnutrition. A questionnaire was given to nurses to determine daily routines related to nutritional care such as amount of food consumed at each meal, snacks between meals, and any oral nutritional supplements given.The study examined elderly patients in a long-term care unit in Helsinki City hospitals in Finland to determine if nurses are able to recognize undernourished patients and if adequate care was provided ( Suominen, Sandelin, Soini, & Pitkala, 2009). The above study included 1,043 elderly hospitalized patients for a two-week period. The nurses measured the BMI of patients as well as their MNA, but the nurses were not aware of the values to determine an undernourished state. In addition, the nurses were asked if they believed the patients were malnourished by simply marking yes or no.The nurses that performed the study participated in a 3-hour course to learn how to organize the study, assess the patients, and to complete the questionnaire (Suominen et al,. 2009). The results of the study, â€Å"How well do nurses recognize malnutrition in elderly patients,† revealed that malnutrition is not recognized by nurses and therefore results in the inability to provide evidence-based care to the patients. The results showed that 56. 7% were malnourished with an MNA

Animal Sounds in Italian

Understanding Gaslighting and What Victims Can Do

Gaslighting is a harmful form of psychological abuse in which a person or entity attempts to gain power over others by making them question their own recollection of events, perception of reality, and ultimately  their sanity.  Ã‚  Ã‚   As used in clinical research, literature, and political commentary, the term comes from the 1938 Patrick Hamilton play â€Å"Gas Light,† and its film adaptations released in 1940 and 1944, in which a murderous husband slowly drives his wife insane by progressively dimming their home’s gas-powered lights without her knowledge. When his wife complains, he convincingly tells her that the light has not changed.   Since almost anyone can fall victim to gaslighting, it is a common tactic of domestic abusers, cult leaders, sociopaths, narcissists, and dictators. Gaslighting can be perpetrated by either women or men. Often especially convincingly charming liars, gaslighters consistently deny their devious actions. For example, physically abusive persons involved in intimate relationships may gaslight their partners by passionately denying  they had acted violently or by trying to convince victims that they â€Å"deserved it,† or â€Å"enjoyed it.† Ultimately, gaslighting victims lower their expectations of what constitutes true affection and start to see themselves as being less deserving of affectionate treatment. The gaslighter’s ultimate goal is to instill a feeling of â€Å"I can’t believe my eyes† causing their victims to second guess their perception of reality, choice, and decision, thus increasing their level of trust in and dependence on their abuser for helping them â€Å"do the right thing.† Dangerously, of course, the â€Å"right thing† is often the â€Å"wrong thing.† The longer the gaslighting continues, the more catastrophic its effects can be on the victim’s psychological health. In the most serious cases, the victim actually begins to accept the gaslighter’s false version of reality as the truth, stop looking for help, reject the advice and support of family and friends, and become completely dependent of their abuser. Techniques and Examples of Gaslighting The techniques of gaslighting are cleverly designed to make it hard for victims to recognize. In most cases, the gaslighter purposely creates situations that allow them to hide the truth from the victim. For example, a gaslighter might move his partner’s keys from their usual spot, causing her to think she had misplaced them. He then â€Å"helps† her find the keys, telling her something like, â€Å"See? They’re right where you always leave them.† According the Domestic Abuse Hotline, the most common techniques of gaslighting include: Withholding: The gaslighter pretends not to understand or ignores his or her victims. For example, â€Å"Oh, not this again,† or â€Å"Now you’re trying to confuse me,† or â€Å"How many times have I told you†¦?†Countering: The gaslighter wrongly blames the victim’s faulty memory, even when the victim’s recollection is accurate. For example, â€Å"You’ve been forgetting things more often lately,† or â€Å"Your mind is playing tricks on you again.†Blocking or Diverting: The gaslighter keeps changing the subject or questioning their victim’s mental health, For example, â€Å"I bet your crazy friend (or family member) told you that,† or â€Å"You’re just making things up so you can use them against me.†Trivializing: The gaslighter makes the victim’s needs or fears seem unimportant. For example: â€Å"You’re mad at me for a little thing like that?† or â€Å"You’re going to let that come between us?†Forgetting or Denial: The gaslighter falsely claims to have forgotten what actually happened or denies promises made to the victim. For example, â€Å"I told you I was going to be late,† or â€Å"I never told you I would pick you up.† Common Signs of Gaslighting Victims must first recognize the signs  of gaslighting in order to escape the abuse. According to psychoanalyst Robin Stern, Ph.D., you might be a victim if: You seem to be second-guessing or doubting yourself more often,You constantly wonder if you might be â€Å"too sensitive.†You often feel confused, possibly to the point of doubting your own sanity.You constantly feel you need to apologize to your partner.You wonder why, with so many good things in your life, you are so unhappy.You frequently feel the need to make excuses for partner’s behavior.You often withhold information about your partner’s behavior from friends and family.You know something is very wrong, but can’t quite figure out what it is.You struggle to make what should be simple decisions.You constantly feel that you need to be a â€Å"better person.†You feel hopeless and joyless.You wonder if you are â€Å"good enough† partner. Since some of these signs of gaslighting—especially those involving memory loss and confusion—could also be symptoms of another physical or emotional disorder,  persons experiencing them should always consult with a physician. Recovering from Gaslighting Once they recognize that someone is gaslighting them, victims can recover and regain their ability to trust their own perception of reality. Victims often benefit from re-establishing relationships they may have abandoned as a result of being abused. Isolation only makes the situation worse and surrenders more power to the abuser. Knowing they have the trust and support of others helps victims recover the ability to trust and believe in themselves. Recovering gaslighting victims may also choose to seek professional therapy to gain reassurance that their sense of reality is correct. Again able to trust themselves, victims are better able to end their relationship with their abusers. While gaslighter-victim relationships can be salvaged, doing so can be difficult. As relationship therapist Darlene Lancer, JD, points out, both partners must be willing and able to change their behavior. Willing partners sometimes successfully encourage each other to change. However, as Lancer notes, this is less likely to happen if one or both partners has an addiction or personality disorder. Key Points About Gaslighting Gaslighting is a harmful form of psychological abuse.Gaslighters attempt to gain control over others by making them question their own memory, reality, and sanity.Gaslighting is a common tactic of domestic abusers, cult leaders, sociopaths, narcissists, and dictators.The first step in recovering from gaslighting is realizing it is happening.As with all forms of psychological and domestic abuse, professional help is often needed. Sources and Additional References Firth, Shanon. â€Å"What is gaslighting?† The Week onlineJacobson, Neil S.; Gottman, John M. When Men Batter Women: New Insights into Ending Abusive Relationships. Simon and Schuster. ISBN 978-0-684-81447-6â€Å"What is Gaslighting.† Domestic Abuse Hotline. Online. May 29, 2014â€Å"7 Signs You Are a Victim of Gaslighting†. Divorced moms .comâ€Å"11 Warning Signs of Gaslighting.† PsychologyToday.com. January 22, 2017Stern, Robin, PhD. The Gaslight Effect: How to Spot and Survive the Hidden Manipulation Others Use to Control Your Life. Harmony. ISBN 978-0-7679-2445-0â€Å"Gaslighting Definition, Techniques and Being Gaslighted.†Ã‚  HealthyPlace.comâ€Å"Gaslighting.† GoodTherapy.org onlineLancer, Darlene JD, LMFT. â€Å"How to Know If Youre a Victim of Gaslighting.† PsychologyToday.com. January, 13, 2018Stout, Martha. The Sociopath Next Door. Random House Digital. ISBN 978-0-7679-1582-3.