Compliance Between The Patient And Medication

Compliance Between The Patient And Medication Introduction Medication compliance is a significant issue in the care of people with mental health conditions, particularly if the mental health condition is of an enduring and severe nature. The reason for this is that there is an increased likelihood of symptoms returning without the individual maintaining adherence to a prescribed medication regime. Conditions such as schizophrenia, psychosis and bi polar disorder fall under the remit of severe and enduring mental illness and it is reported that medication non compliance is likely to have severe implications to an individuals psychological health and wellbeing (Le Page, 2010). Leahy (2006) estimates that up to 70% of recurrent depression patients and around one half of schizophrenia patients are noncompliant with their prescribed medication and there is also a direct relation between medication noncompliance and an increased need for hospitalisation. This in turn has a whole range of implications in terms of the impact this has on employment, relationships, income, and parental responsibility and of course the impact on resources provided by health providers such as the NHS should also be acknowledged. This assignment will examine and reflect on the case of a 40 year old gentleman with a diagnosis of schizophrenia. The gentleman, who shall be referred to as Mr Smith for the purpose of this assignment (names have been changed to ensure client confidentiality as per NMC guidelines) has been receiving neuroleptic depot medication (Flupenthixol) to treat the symptoms of a schizophrenic condition, however Mr Smith has stated that he no longer was willing to accept the administration of the depot injection because he felt better. The assignment will start by briefly exploring the concept of compliance and the consequences of Mr Smith declining to take the prescribed medication and the potential impact this will have on his mental health. The second part of this assignment will reflect on how the practitioner responsible for the care of Mr Smith addressed the issue of facilitating the ongoing adherence to prescribed medication by focusing on theoretical frameworks that supported and encouraged Mr Smith to review his decision and continue to accept his depot injection. Consideration will also be made to legal and ethical frameworks that should be adopted in clinical practice when addressing the issue of medication compliance. Defining Compliance in Mental Health Care The term compliance is defined by the Cambridge dictionary (2010) as being a process where people obey an order, rule or request and that individuals become willing to do what others want, particularly if the other person is a figure of authority. A core definition of compliance provided by Harvey (2004-09) suggests that compliance is the undertaking of activities or establishing practices or policies in accordance with the requirements or expectations of an external authority. Compliance has been defined as the extent to which a persons behaviour coincides with medical or health advice (Haynes, 1974) and although this is an outdated definition the term compliance persists in mental health care today. In contemporary mental health care there are suggestions that the term compliance has negative connotations and it infers that an individual who does not comply is not doing as they are told by the mental health professional (Gray, 2002). Language and communication is an important tool in mental health and it is important to place the individual with mental health problems first by using terminology that is widely acceptable to both service providers and service users (Manzi, 2008). Repper Perkins (1998) support this point of view and indicate that the use of words like compliance infers that patients are passive recipients of health care who should obey instructions from professionals. As modern mental health care is concerned with developing therapeutic alliances to improve outcomes (Hakan and Jan-Ake, 2010) consequently it has been proposed that the term concordance (Gray, 2002) or the phrase medication adherence (Velligan et al., 2009) should replace the use of the word compliance in an attempt to remove the unequal and passive tone the word compliance has. For the purpose of this assignment the word compliance will be substituted by the term adherence as this implies a more collaborative approach between service providers and service users to approach the issue of medication and treatment. Consequences of Medication Non Adherence in Schizophrenia Schizophrenia is a complex condition and diagnosis is made on the evidence of an individuals reported experiences (symptoms) and observable behaviours (signs) which commonly may include; delusional thinking; hallucinations, thought interference; ideas of reference, thought disorder; social withdrawal; anxiety and depression (Keen, 2003). Psychiatric treatment for individuals almost always involves drug therapy to stabilise psychotic symptoms and to reduce the individuals risk of relapse (Barker, 2003). There are many different pharmacological preparations available for the treatment of symptoms experienced by an individual diagnosed with schizophrenia and they may include preparations that are taken orally or delivered by intramuscular depot injection. Our Client Mr Smith had been having a depot injection called Flupenthixol to treat the symptoms he experienced following his diagnosis of schizophrenia; as a result it is reported that he had felt better and therefore did not want to have the depot any more. Mr Smith had made a decision not to accept his depot medication any longer however it is well documented in the research and evidence base that this course of action and decision will have a significant impact on his health and global well being. Novick et al. (2010) indicates that non adherence with anti psychotic medications, such as Flupenthixol for patients with schizophrenia and psychosis, is significantly associated with an increased risk of relapse, hospitalization and suicide attempts. There is a significant body of evidence that highlights that the symptoms of schizophrenia return without pharmacological treatment and medication adherence and that there are potentially devastating consequences to the individual with a serious mental illness such as schizophrenia if this behaviour of non adherence is adopted (Velligan et al., 2010). Therapeutic Interventions to Promote Adherence As a mental health practitioner it would not be uncommon at some point to experience a clinical interaction with a patient who has made a decision not to continue with their prescribed medication, however the practitioner has the responsibility to understand the reasons behind the patients decision making process and to provide the patient with the biggest opportunity to make an informed and educated decision about declining treatment for a chronic and enduring mental health condition such as schizophrenia. It is important for the mental health practitioner to obtain an understanding of the reasons behind Mr Smiths decision to discontinue his depot medication and to do this the modality of cognitive behavioural therapy can be implemented. Cognitive Behavioural Therapy (CBT) is a form of psychological therapy and aims to help understand the link between thoughts, emotions and behaviour. It teaches individuals skills to overcome problematic thoughts, emotions and behaviour and to find ways of overcoming negative thinking and challenging unhelpful and inaccurate thoughts or beliefs (Royal College of Psychiatrists, 2008). The most favourable outcome from CBT is for the individual to develop skills and techniques that enables them to approach situations in a more reasoned and balanced manner which supports problem solving and increases the feelings of being in more control (Royal College of Psychiatrists, 2008). An important consideration in relation to implementing CBT and for that matter other therapeutic interventions is that there needs to be an established therapeutic relationship between the client and the mental health practitioner to increase the opportunity for success and for both parties to engage in working towards a common goal; for example for Mr Smith and the mental health practitioner to work towards exploring the issues surrounding medication adherence. NICE (2010) recommends that managing the process of engagement requires professionals to have sensitivity to the perspective of the individual and to understand that the condition can have a profound effect on the persons judgment, their capacity to understand their situation and their capacity to consent to specific interventions. The process of engaging successfully with individuals with schizophrenia may at times require considerable persistence and flexibility from professionals and the establishment of trust is crucial. Both parties may have differing views on what the main problem is and how it should be addressed, however the professional can help with finding common ground and this common ground can establish trust and collaboration (NICE, 2010). To address the issue regarding Mr Smiths decision to no longer adhere to his treatment plan and accept his depot medication for the symptoms of schizophrenia the mental health professional will need to enter into conversations to gain understanding of the patients perspective. One way of achieving this is for the mental health practitioner to adopt motivational interviewing so that the two parties can explore the decision (stopping of the depot injection) and negotiate behaviour change (acceptance of the depot) through the individual (Mr Smith) being able to identify, understand and articulate the benefits (remaining mentally well and symptom free) and costs involved (physical, emotional, family, employment for example will all be impacted upon greatly if symptoms return). Rollnick et al. (2010) indicate that simply giving patients advice to change decisions or behaviour is often unrewarding and ineffective and by adopting motivational interviewing a guiding style helps to engage with patients, helps clarify strengths and aspirations, evoke their own motivations for change and promote autonomy of decision making. The four central principles of motivational interviewing are described by Treasure (2004) as being; the use of reflective listening in an empathetic manner to convey understanding of the patients point of view; tease out ways the behaviour or choice conflicts with the wish to be good or viewed as good; respond with empathy and understanding rather that confrontation and finally support the patient in confidence building to understand change is possible. For Mr Smith and his decision to decline any further depot injections of Flupenthixol it may be very easy for the mental health practitioner and Mr Smith to become embroiled in conflict as the practitioner has the evidence base and clinical knowledge to know that a relapse is somewhat inevitable and the impact on Mr Smiths global wellbeing and function would be significant; however Mr Smith believes that he is now well and therefore no longer needs treatment. By using motivational interviewing techniques the mental health practitioner can actively listen to Mr Smiths reasoning behind the decision he has made in relation to medication adherence; support Mr Smith to see the pros and cons of his decision; assess his confidence and elicit a view on his feelings fears and aspirations; exchange information; support with decision making and goal setting. To give an example of how motivational interviewing may be implemented the practitioner may ask questions such as; I want to try and understand Mr Smith about your decision not to have your depot anymore; can you give me your perspective on why you want to stop taking it? So Mr Smith if you were to stop taking your depot, where do you think that would leave you in terms of remaining well? How important is taking this medication for you right now? Would you mind if I shared with you some information and evidence I have about how the depot injection helps people with schizophrenia remain well and symptom free? And; Okay, can I check with you your understanding of the risks of not accepting the depot anymore? This approach to supporting adherence to medication is reported to be beneficial and it is suggested that the body of evidence continues to grow in support of its effectiveness (Rollnick et al., 2010) and with the many applications in psychiatry it is particularly helpful for use in settings where there is resistance to change (Treasure, 2004). However there are some considerations that need to be identified that may impact on the efficacy of motivational interviewing as a technique to support medication adherence. Firstly one issue to consider is that motivational interviewing is a skill that mental health practitioners need to develop and practice and although the principles are described as easy (Treasure, 2004) putting these principles into practice may not be that simple. There potentially could be many different variables as to why adopting motivational interviewing may not be effective in supporting medication adherence. Barriers that may impact on the success of motivational interviewing in supporting Mr Smith to maintain his medication adherence may include; there not being a therapeutic alliance established between the mental health practitioner and Mr Smith. The reasons for this can be numerous, for example Mr Smith may only recently have been discharged from hospital and the mental health practitioner is his new community psychiatric nurse that he has only met a couple of times; Mr Smith may prefer male workers to female workers and vice versa or even Mr Smith may not feel comfortable having mental health practitioners come to his home and feel unable to engage or discuss issues of importance. Another reason that may impact on the efficacy of the motivational interviewing process to support Mr Smiths adherence to medication is that the mental h ealth practitioner may be constrained by time and resources and therefore not able to deliver the therapeutic process accurately or in a timely. Another issue to consider is that Mr Smiths adherence to medication and decision not to continue to accept the depot may actually be based on the schizophrenic condition relapsing and the decision to withdraw from treatment is being made due to reduced insight and understanding. It is suggested that there are potentially a large range of risk factors that can be present and that are related to the patients individual behaviour and understanding of the impact of schizophrenia and psychosis. These variables are classified as patient related and include poor insight, negative attitude towards medication, symptom severity, history of previous non adherence, substance misuse and cognitive impairment. Other variables may also include treatment, environmental and societal issues such as side effects and complexity of medication regimes family support, side effects, financial problems and lack of access to treatment (Citrome, 2010). Legal and Ethical Considerations It is important for mental health practitioners to understand that there are occasions where more assertive and restrictive approaches such as treatment orders or inpatient hospital care are the only way for adherence to medication to be sustained (Chaplin, 2007). The Mental Capacity Act (2005) provides a framework for the making of decisions for people who lack capacity in England and Wales. Under the Capacity Act healthcare professionals are advised that they must work on the presumption that every adult patient has the capacity to make decisions about their care, and to decide whether to agree to, or refuse, an examination, and investigation or in this instance treatment. A patient is regarded as lacking capacity once it is clear that, having been given all appropriate help and support, they cannot understand, retain, use or weigh-up the information needed to make that decision, or communicate their wishes. Therefore in this instance Mr Smith must be presumed to have capacity to make the decision not to adhere to the treatment plan unless there is evidence that he is no longer able to provide reasoned information to support his decision due to the presence of severe mental illness. It would be at this juncture that the mental health practitioner would look to ensuring Mr Smiths best interests are explored and this may result in an assessment under the Mental Health Act (1983), however until this time the mental health practitioner may continue to use the therapeutic alliance and CBT and motivational interviewing techniques to support the adherence process. The success of a therapeutic alliance is often based on trust and to establish trust the mental health practitioner must respect the patients ethical right to autonomy. Autonomy for Mr Smith would be the right to decide and determine whether or not to accept or decline his depot injection even if the refusal meant that his mental health would deteriorate and the consequences to his global wellbeing become severely impaired. It would be unethical for the mental health practitioner to coerce, threaten or manipulate Mr Smith into having the depot injection particularly if he has the mental capacity to make the decision to decline further treatment. For the mental health practitioner to behave in this manner would not only be a breach of professional and ethical conduct it would also potentially jeopardize any therapeutic alliance that had been developed. Addressing Risk Mr Smiths decision to become non adherent to prescribed medication presents a requirement for detailed risk planning and assessment to ensure the well being of Mr Smith, his family and friends and those providing care to him is sustained. Mental health practitioners have a duty of care to assess risk using a formulated tool that has been adopted by their employer and mental health service. The calculation of risk must be based on the practitioners knowledge, skills and competence and value should be placed on the process of risk taking, following assessment and in the context of appropriate management, as it will increase the practitioners ability to help clients to achieve their potential. However, there should be awareness that there may be conflicts between professional accountability and the autonomy of the client (UKCC, 1998). Risk issues that may be identified for Mr Smith are individual and related to the course and nature of his experience of Schizophrenia, this is why it is important for the practitioner to have established a therapeutic alliance with him so that discussions can be held about risk issues and care planning can be done collaboratively to reduce the risk impact. Conclusion Medication adherence in schizophrenia is a complex issue with the consequences of non adherence impacting significantly on the global function and mental well being of individuals who make the decision to not adhere to their medication treatment plan. Through the process of collaboration and the development of therapeutic alliances between mental health professionals and patients it is suggested that adherence can be improved and sustained and that interventions such as CBT and motivational interviewing makes psychoeducation a cornerstone of many adherence interventions (Zygmunt et al., 2002). Mental health practitioners should have an understanding that medication adherence is less likely to occur in patients with severe mental illness who are not engaged with mental health services and who are not exposed to a good therapeutic relationship. One of the most common themes that have been identified throughout this assignment and in the evidence base is that the therapeutic alliance between a patient and mental health professional should never be underestimated particularly when it comes to supporting medication adherence in the treatment of schizophrenia.

Representations of Women in Early Irish and Welsh Literature Essay

Although there are parallels between Irish and Welsh sagas of elopement, the powerful self confident women depicted in these narratives do not represent the real women of Medieval Ireland and Wales. Proinsias Mac Cana has suggested that the dominant roles of Deirdre and Grainne in their respective tales (Longes mac nUislenn and Toruigheacht Dhiarmada agus Ghrainne) are ‘literary variations on the exemplar of the sovereignty goddess’ (Doan, 1985: 90). Bitel (1996: 2) asserts that Celticists have been seduced by these dominant female characters viewing them as representative of real women with considerable power over men, a depiction which if true should be reflected in the law tracts or ‘custom in action’(Stacey, 2002: 1107). This paper will argue that the ecclesiastical and legal tracts of both Ireland and Wales offer many images of women, judgements about women, and regulations for women. They do not however present the stereotypical medieval woman as the sovereignty goddess depicted in the secular sagas. Because women left no written records, we are dependent on male literature (probably all of the texts written in early Ireland and Wales) for a definition of woman and her cultural role. These male authors wrote of women in: ‘saint’s lives; poems; sagas and myths; gnomic texts; histories; chronicles; genealogies; folktales; theological tracts; and extensive ecclesiastical tracts; and secular laws’ (Bitel, 1996: 12). Although these texts offer insights on women they must be viewed through the hermeneutical lens of the socio-historical context of the era in which they were written. Early medieval Ireland was a patriarchal society and a woman’s role and identity was determined by patriarchal norms and conventions. The literati of this era did not define woman as an independent individual. Women existed only in relation to men and therefore their representation in literature was not entirely objective or according to Bitel consistent. Tensions exist between various texts. The portrayal of women as ‘capricious beasts’ (Bitel, 1995:137) presented in the eighth century wisdom text Tecosca Cormaic contrasts sharply with the recognition of a woman as home-maker and wife with limited recourse to the law depicted in Cain Lanamna or the law of couples (O Croinin, 1995: 127) . The majority of the extant Irish law books were composed between the seventh and ninth centuries. At this stage the Irish literati were members of the nobility educated in monastic communities. Many were monks but this elite group also included jurists, historians, poets and story tellers. Mc Cone has suggested that these learned elite produced literature for the monastery which was heavily influenced by Biblical texts (Bitel, 1996: 14). Donnchadh O Corrain, Liam Breatnach and Aidan Breen have argued that there exists a close connection between ecclesiastical law and Irish vernacular law (Stacey, 2002: 1108). Stacey asserts that although the legal sources from Wales (compiled in the twelfth and thirteen centuries) are later than the Irish sources there is also a significant link between ‘legal, poetic and ecclesiastical learning’ (2002: 1108). The Irish penitential books written between the sixth and the ninth centuries reveal conflict between the ideals of Christian leaders and the customs of early Irish communities. These penitentials were designed as moral guides for confessors in attributing penance in the rite of confession (Gula, 1989: 25). According to Bitel, Christian clergy were intent on transferring social control of sex from the kin group to the individual Christian (1987: 67). Fox concurs with Bitel, asserting that by liberating the individual from the bonds of clan and family, the church was attempting to reduce kinship to ‘its lowest common denominator [the nuclear family: the lowest kinship group that is compatible with reproduction] while appearing to support basic kinship values’ (1993: 109-110). The Clergy in promoting Christian morality for the individual attempted to reorganize Early Irish society. According to Bitel, the kin group were influential in controlling sexual activity. This was necessary to ensure the survival of the community as an interdependent group. Archaeological evidence suggests that houses consisted of one room. This allowed for little individual privacy and sex was a natural and visible part of family life. Illicit encounters had to take place outside of the home, and even then they were monitored by the community. Any kind of sexual relationship that had to be conducted in secrecy was considered dangerous. The survival and welfare of the clan depended on social stability and this principle determined the attitude of the pre-Christian Irish toward sexuality. Sex in itself however was not considered immoral. Celibacy was not portrayed as a virtue in the secular literature. Cu Chulainn’s sexual exploits are recorded in the sagas; however his casual encounters did not threaten the community (Bitel, 1987: 70-71). Bitel asserts that ‘the tension between individual desire and community need had always to be resolved in favour of the community’ (1987: 72), and herefore marriage was a contractual arrangement determined not by romance or love but by the necessity of producing children and the survival of the kin group. Woman’s reproductive capacities themselves are integrated into the economic life of the society. The image of woman depicted in Cain Lanamna is a woman whose social emotional and economic orientation is directed towards the family and home. Early Irish Law, commonly known as Brehon Law was a series of civil laws which governed every aspect of daily life including marriage and divorce. Marriage and divorce were interlinked by virtue of a contract agreed and a contract dissolved. Under the Brehon system, women were free to marry in one of nine ways, although the primary type of marriage, lanamnas comthinchuir was the most common. Both partners enter this marriage with equal financial resources. In the second type of marriage, lanamnas for ferthinchur, the woman contributes little or no financial assets to the marriage. In the third category, lanamnas for bantinchur, the woman contributes the greater share of the marriage assets. These three categories required formal pre-nuptial agreements. With the remaining six types of marital union (including cohabitation with a woman with family consent, voluntary eloping without family consent, voluntary abduction without family consent, illicit rendezvous, marriage by rape and marriage of two insane people) marriage entailed the assumption of financial responsibility for child rearing (O Croinin, 1995: 128). Corresponding to the wide variety of marriages recognized by law, there were many grounds for divorce. A woman might divorce a man who failed to satisfy her sexual needs because he was sterile, impotent, bisexual or homosexual. In this instance she was entitled to be paid her coibche in addition to a fine in compensation. A woman could divorce her husband on the grounds of indiscretion should he discuss intimate details of their marriage outside of the home. A woman could also divorce her husband should he abandon her either for the church or for a life on the road as he would no longer be in a position to maintain her. Physical abuse was also considered legitimate grounds for divorce. Even if the original blemish disappeared, a woman was entitled to the equivalent of her bride price as compensation. The laws are quite clear about the validity of female testimony in matters concerning consummation of marriage. This testimony is verified by a physical examination of the woman by female dignitaries. In a case where a woman refuses her husband his conjugal rights either because of a problem pregnancy or her menstrual cycle, the law regarded her objections as valid. A woman could also choose to divorce on grounds of infidelity although extra marital relations were recognized by law (O Croinin, 1995: 129). O Croinin suggests that in general terms many women were recognized by the law in ‘their capacity as wives and in their own right as individuals’ (1995: 133) Law texts are clear that a woman’s rights in divorce are specific to each type of marriage and related marriage contract. Lanamnas Comthinchuir was regarded as the most common type of marriage at this time. It was a dignified state for the wife, she was known as a be cuitchernsa, literally ‘a woman of joint dominion, a woman of equal lordship’ (O Croinin. 1995: 128). If this category of marriage ended in divorce, the woman received what she had initially contributed to the marriage in addition to a share of the profit accrued from the couple’s joint activities during the marriage period. O Croinin records that the division of property was in accordance with fixed proportions: ‘one third went to the partner who provided the land; one third to the partner who provided the stock; and one third to the partner who provided the labour’ (1995: 128). This last provision recognized the woman’s work in the home and on the farm. The second type of marriage lanamnas for ferthinchur represented a different kind of divorce settlement. Since the woman provided neither land nor stock, she was entitled to half of her own handiwork and one sixth of the dairy produce in store. If she had worked diligently on the farm and in the home she took one ninth of the corn and cured meat in store. She also received a sack of corn for a specified time. Divorce in the third category of marriage, lanamnas for bantinchur, ensured that the woman retained a life interest in the farm. She could not however transfer any rights to the estate to her children. She could however marry one of the heirs to the property and preserve her children’s right to inherit. Although the Irish lawyers appealed to Scripture, particularly to Leviticus to justify parallel cousin marriages, church law declared parallel cousin marriages incestuous (O Corrain, 1985). The Welsh tractate ‘the laws of women’ contains rules governing marriage and division of property in medieval Wales. There are four redactions of Welsh law manuscripts: the Cyfnerth and the Blegywryd redactions both derive from south Wales; Iorwerth is classed as a north Wales redaction; and finally the Latin manuscripts (there are similarities between the Latin laws and the Welsh redactions). Although the sources from Wales are dated to the twelfth and thirteenth centuries, women in the Welsh tractate like women in Cain Lanamna are portrayed as wives and home-makers (Roberts, 2008: 58-59). Stacey asserts that the most ‘striking’ passage of the ‘Laws of Women’ outlines the domestic and agricultural goods granted to each partner in cases where the marriage had lasted longer than seven years (2002: 1109). This passage is common to each of the Welsh redactions of the law books and can also be found in four of the five Latin compilations. The couple must divide their possessions equally, the pigs become the property of the man and the woman takes ownership of the sheep. If there are only sheep and goats, the sheep go to the man and the goats to the woman. The children are also divided between the couple ‘two parts go to the father, the eldest and the youngest, and the middle to the mother’ (Stacey, 2002: 1111). The division of household goods is itemised: all milk vessels, except for one pail and one dish becomes the property of the woman. The man is entitled to all of the drinking vessels and the riddle while the woman is entitled to the sieve. The man is entitled to the upper stone of the quern and the woman to the lower stone. The bed clothes which cover the couple becomes the property of the woman while the clothes which they lay on belong to the man. The man receives the cauldron and the blanket and the pillows from the bed together with the wood axe, coulter and all the sickles except for one which the woman obtains. The woman is granted the pan, the broad axe, the bill hook and all of the flax, linseed and wool. She also receives the plowshare. Any gold or silver is divided equally between the couple. The man is entitled to the corn above and below the ground, all of the hens and one cat. The remaining cats become the property of the woman. The woman receives the salted meat but if it is hung it becomes the property of the man. The woman is also granted as much flour as she can carry along with the cut meat and the partly used cheese. They each retain their own clothes except for their cloaks which must be divided equally. Any balls of wool in stock become the property of the sons (Stacey, 2002: 1111). Like Irish Marriage Law, the Welsh Laws of Women attempted to secure a measure of financial independence for each partner in the event of divorce . Unlike Irish marriage law however which divided property according to specific marriage contracts, some rovisions in the Welsh divorce law appear illogical. Jenkins suggests that the Welsh division of property on divorce, attempts to ensure that each partner has the necessary provisions to survive but he asserts that the division of the quern stones is ‘curious’ since they cannot be used independently (Stacey, 2002: 1111). Similarly the coulter is granted to the man while the plowshare is received by the woman. Since both blades would have been required for planting this division appears to make little logical or practical sense. Stacey also points out that the man receives all of the corn and hens but only one cat to protect them from vermin while the woman receives the remaining cats although she has no grain or hens to protect (Stacey, 2002: 1113-1116). Welsh divorce law does not seem to be based on the wealth brought to the marriage by each party or indeed on the status of the marriage. In Irish Law the apportionment of property is determined by both of these factors (Stacey, 2002: 1113). Stacey suggests that the division of property in a Welsh divorce is symbolic of the destructiveness of divorce and failed marriage. He asserts that this was a secular ‘homily’ on the improvident nature of divorce (2002: 1124). Although the marriage property is divided the woman ultimately is disadvantaged because under Welsh Law, she has no claim to land and must be satisfied with portable goods. Although women under Welsh law were afforded the opportunity to divorce their husbands due to his impotency, leprosy or bad breath (Roberts, 2008: 63), Nerys Patterson suggests that the woman was further disadvantaged in the wake of marital separation: female virginity was highly valued and her loss of virginity would affect her chances of remarriage (2002: 1121). These medieval divorce laws clearly situate the woman in the home, rearing children, cooking, spinning wool and working on the farm. It is tempting to view these laws as depictions of a progressive egalitarian society, however the political and social realities of a woman’s life suggest otherwise. A woman’s legal definition derived from that of her father, brother or her legal husband. A legal tract on honour price (dire) defined women’s legal and social position ‘her father had charge over her when she is a girl, her husband when she is a wife, her sons when she is a [widowed] woman with children . . the Church when she is a woman of the Church [i. e. , a nun]. She is not capable of sale or purchase or contract or transaction without the authorization of one of her superiors’ (Bitel, 1996: 8). According to Bitel, these legally and socially incapacitated women were the real Medbs of medieval Ireland. When measuring a woman’s status, the laws measured women against the legal norm of the free adult male and as such a woman’s worth remained only half that of her male guardians honour price. The Irish literati along with many medieval authors considered female bodies as ‘less valuable copies of mens’ (Bitel, 1996: 19). This principle is reflected in the only extant Irish medico-legal tracts namely Bretha Crolige and Bretha Dein Checht which accorded women less medical attention and food rations than men (Bitel, 1996: 21). Women therefore were considered physically and psychologically less than man, less than human (Bitel, 1996: 23). The ninth century Triads text, Trecheng Breth Fene unveiled some basic assumptions about the nature of woman. The Triads suggested that ‘the three drops of a wedded woman’ were drops of blood (a good wife was a virgin at marriage); sweat; and tears (a good wife should be willing to suffer hardship to support her husband and children). One of the three misfortunes of a man was proposing marriage to a bad woman. According to the Triads, women were their husband’s property and were akin to animals. ‘When a man loaned either a woman or a horse, he had to expect it to be used by the borrower’ (Bitel, 1996: 23). The wisdom text also suggested that ‘like a cow’s udder, women through her womb, was one of the three renovators of the world’ (Bitel, 1996: 24). Another wisdom text Tecosca Cormaic suggested that women ‘should be feared like beasts’ because they were ‘capricious beasts’ (Bitel, 1996: 24). A woman’s physical characteristics and fertility therefore were animal like and unreliable. The eighth or ninth-century wisdom text Senbriathra Fithail considered the characteristics of ‘a good wife’ (Bitel, 1996: 27). Advising his pupil Cormac mac Airt, Fithal (a druid) asserted that a good woman had ‘common sense, prudence, modesty, excellent Irish, delicacy, mildness, honesty, wisdom, purity and intelligence’ (Bitel, 1996: 28). All of these attributes according to Fithal were necessary for a woman to become a desirable wife. A bad wife on the other hand was characterised by ‘wretchedness, stinginess, vanity, talkativeness, laziness, indolence, noisiness, hatefulness avarice, visiting, thieving, keeping trysts, lustfulness, folly and treachery’ (Bitel, 1996: 28). Fithal asserted that it was possible to detect a woman’s character based on her physical appearance. He suggested that Cormac should avoid: ‘the fat short one’; ‘the slender short one with curling hair’; the fair tall one’; ‘the dark-limbed, unmanageable one’; ‘the dun coloured yellow one’; and ‘the slender prolific one who was lewd and jealous’ (Bitel, 1996: 28). Fithal determined that the worst wife was a be cairn or a whore. A successful marriage however could be assured by a union with the ‘tall, fair, very slender ones’ (Bitel, 1996: 28). Fithal admitted to Cormac however that the ideal woman may not exist and that most women had character flaws. The author of Tecosca Cormaic was adamant that all women were ‘chronically dissatisfied, bad tempered, untrustworthy, wanton, manipulative, ambitious, greedy, arrogant whiners’ (Bitel, 1996: 29). Bitel suggests that the real problem with women is that they were not men and the writers of the gnomic tracts could only define them by their many indefinable natures: they had similar physical bodies to men but were not men; they had reproductive characteristics and temperaments similar to animals but were not animals. The only certainty appeared to be was that women must be controlled and her inferior position in society maintained (Bitel, 1996: 30). The writers of ecclesiastical canons suggested that women could only be redeemed by denying their female characteristics and their female sexuality. Bitel argues that canonists established a ‘gender hierarchy’ (Bitel, 1996: 32). Unlike the typologies found in secular and wisdom texts, the cannon scribes attributed a moral value to virginity and abstinence. Nuns were accorded a high moral value as were ‘widows who took the veil’ (Bitel, 1996: 32). Thomas O’ Loughlin suggests that the Collectio canonum hibernesis, a systematic collection of law, codified certain patristic theories producing an understanding of marriage ‘as a state secondary to virginity’ (1997: 188). The canonists justify their position by quoting Jerome who asserts that ‘virginity follows the lamb wherever he goes’ (O’Loughlin, 1997: 192). Jerome expands on this theme suggesting that ‘earth is populated by marriage, so heaven is by virginity’ (O’Loughlin, 1997: 192). The underlying concept is clear, virginity is exemplified and sexuality creates problems. According to O’Loughlin this principle was the basis of ecclesiastical thinking on marriage throughout the middle ages and Jerome’s opinion that sexual activity was ‘inferior and earthy’ in comparison to virginity which was ‘noble and superior’ has been held responsible for the cult of virginity and celibacy in the Latin church (O’Loughlin, 1997: 193). Augustine also considered sexuality dangerous but (quoting Paul in 1 Corinthians 7) asserted that while celibacy was the desired state, ‘lawful marriage is to be preferred to burning with desire and fornication’ (O’Loughlin, 1997: 193). The dangers of sexuality therefore were to be contained within the institution of marriage. Although canonists admitted that clerics could fall to sexual temptation, the general consensus was that women as the weaker sex were more likely to succumb to sexual temptation.

Midweek review

Since the start of this course the collaboration between us went well. At the first meeting we made several arrangements concerning communication, availability and responsibilities. We decided to communicate through Backbone and we made meeting appointments a couple of days In advance. We came together before the analytical skills meetings and compared our results for Improvement and better understandings.With both of us attempting all the questions before we met to check If the answers were correct and helping the other If he did not understand how to do the question. The first presentation was set up In parts by our self with a high frequency of communication. Due to the structure of the presentation, we had to have constant communication with each other to ensure coherence between our parts and to ensure that we reach a common final conclusion. We will continue our current method because we think it has been successful so far.We have not had any immunization misunderstanding, and by using Backbone as a way of communication it allows us to get our points across immediately and efficiently without having to waste time traveling to a certain meeting point to discuss. We do agree that with respect to the final presentation, we might need to also increase the amount of personal meetings. And thus we have decided to start the research for the project early so that we could have meetings after tutorials. With respect to the time management during the course so far, we can be satisfied.Every assignment was finished properly in time according to our arrangements. We learned from the first presentation that it will be better to start earlier for the next presentation so we could do even more research. Furthermore we are really satisfied the way our cooperation worked out and we do not see any problems for the rest of this course. We followed our own composites arrangements and helped each other out where necessary. As learning point It might be useful to do more resea rch for presentations.Our way of communication does not deed any Improvements since we are always replying quite fast to each other. We talked about the feedback from the presentation and gave each other and thought about personal Improvements. In overall we feel that despite coming from different cultural backgrounds, we are able to work together as a team. We believe that we will not have any problems working together as we both want to do the best for this module, and have set certain standards for our projects. Midweek review By moratorium Midweek evaluation of teamwork and working procedure (Team Report) Queue JinnLiana – 16063163 meeting appointments a couple of days in advance. We came together before the analytical skills meetings and compared our results for improvement and better if the answers were correct and helping the other if he did not understand how to do The first presentation was set up in parts by our self with a high frequency of arrangements and helped each other out where necessary. As learning point it might need any improvements since we are always replying quite fast to each other. We about personal improvements.

Evaluation Of The Data Collection - 1166 Words

Based on the sequential design shown above, the analysis of the data collection is completed. The next step is to meet with the participants separated by individual departments to share and discuss the analyzed data. By meeting in this manner aids the researcher in pinpointing exactly where the internal problems lie (Cooper Schindler, 2010). The researcher acknowledges that the focus groups comprised a total of 90 participants. 1. Sales/Marketing 40 2. Customer Service 25 3. Training 10 4. Compliance/Audit 15 The researcher wants all to understand the unevenness in the breakdown is due to department size and because of the nature of the business. The next phase of the research design consists of measurement instruments. The†¦show more content†¦The XYZ validity rate was set a 90%, and the next stage in the research would be to confirm whether or not the validity rate was reached. Date Collection Measurement As stated previously in the research design section of this paper the data collection methods used were by using survey questionnaires, interviews, focus group interviews and observations. The instrument design will be a set of question comprised of free-response, structured and unstructured responses, multiple-choice, double-barreled and rated questions. The reasoning behind the researcher using so many instruments is because there are four departments involved in the study. The ultimate goal is to determine exactly what is lacking in each individual department and XYS as a whole. Data Analysis Survey questionnaires were conducted for all participants and the protocol was comprised of questions to determine if the participants understood the regulations that govern RR’s as shown below. 1. Before licensing, were you informed about the RR guidelines. 2. After licensing, did you ensure the regulatory paperwork was completed in its entirety. 3. Was all outside activity reported. 4. Have you forgotten to document any outside activity. 5. Have you reported any financial difficulties. Focus group questions were another part of the data collection and those questions were as follows. 1. How many here understand the SEC guidelines 2. How many are sure that they are