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In place of his usual concentration on small groups bipolar depression research study cheap 150 mg bupron sr with visa, Goya here presents a human mass depression and insomnia buy cheapest bupron sr, distinguishing the women, both in the center and on the sides of the composition, so that the princesses would identify more easily with the painting. The Wedding, 1791 - 1792 In this cartoon Goya portrays the wedding procession just after the vows have been pronounced, when, according to the earliest description of the scene, "They lead the bride and groom to their house in the company of the Priest and the Godparents. This configuration, forming a low, extended frieze set below a bridge- the sole architectural reference to the urban world-suggests an allusion to "the ladder of life" or to a vanitas. In the center appears the lovely young woman, and just behind her comes her rich but ugly husband. Since the married couple would otherwise prove difficult to distinguish in this setting, where Goya works with pale colors based on light earth tones, he dresses the bride in rich blue attire and her husband in a red frock coat. The spatial system is significant: it is based on the horizontal planes of procession and bridge and conforms with the demand in neoclassical painting for compositional simplicity, a concept Goya will again employ when, as has been noted in the literature, he sets the royal family against a bland, neutral wall in the monumental Family of Charles /F(cat. Weddings, and particularly rustic weddings, were a much-treated topic among seventeenth-century genre painters; for example, David Teniers and Philips Wouwerman. At the start of the eighteenth century Antoine Watteau elegant fкte galante, a stately festivity. Leandro Fernбndez Moratнn criticizes this behavior in his plays El viejo y a niсa (The Old Man and the Girl) from 1790 and the 1806 El sн de las niсas (When Girls Give Consent). The painter does riot, however, depict the bride as victim of a union forced on her by the men in her family, who consist solely of her father and her husband. The earliest description of scene dates from 1794 and is cited by Sambricio 1946, 171 and 274, no. The Straw Mannikin, 1791 - 1792 Oil on canvas 267 x 160 cm the action of the Straw Mannikin takes place in the countryside. Four laughing girls wear the authentic head adornments of true majas-netted snoods, ribboned coverings, coifs, and carambas. The girls are tossing into the air a straw mannikin, breaking its fall in a blanket. Tossing a doll in a blanket has its origins in the pre-Lenteii carnival and enjoys a long iconographie tradition. It was depicted by Andrea Procaccini in his tapestry series on Don Quixote, a series rewoven several times beginning in 1730, with Sancho Panza as the victim. The book illustration prefigures the grouping of four figures, tossing the very Guzman of the title, who is being attacked by "devils with dresses, hairdos, and masks. His efforts as cartoonist were vital to his court beginnings, but over time became an obstacle to his intellectual and professional development. Not only did the work take a great deal of time, but he knew that the cartoons would never reach a public, because once copied they were stored in the factory vaults. Besides, he was comfortably established after being named court painter, and both his style arid his technique were now fully mature. He fell ill toward the end of 1792 and after his recovery never returned to this series intended for the monarch, who had wanted in his study "rustic arid comic themes" similar to those the master had provided on other occasions. Kress Collection, New York Sketch, Armand Hammer Foundation, Los Angeles Livinio Stuyck y Vandergoten, 1791-1795 Royal Tapestry Factory of Madrid Palacio Real, Madrid Patrimonio Nacional, Madrid E X H I B I T I O N S: New York 1917; Paris 1919; Bordeaux 1951; Basel 1953; Madrid 19960; Jackson 2001. Maria Teresa de Borbуn y Fallabriga, later Countess of Chinchуn, 1783 Maria Teresa de Borbуn y Vallabriga was the daughter of the Infante Don Luis Oil on canvas 34-5 7-5 National Gallery of Art, Washington, Ailsa Mellon Bruce Collection, 1970. Goya placed the model against a rustic Gredos mountain landscape, marked by dense, dark forest and enormous rocks bathed in a silvery light. The painting was paired with the portrait of her brother Luis Marнa de Borbуn, which survives only in a study (private collection). To accentuate their majesty, Goya portrayed both children full-length and standing, using a slightly lowered point of view. She wears court attire and a white lace mantilla that covers her hair, adorned with a blue ribbon and a small flower. She mimics, gracefully, an adult stance, her left hand on her hip, extending one foot forward to show her blue slipper, topped with a golden buckle. This image is poised between the older tradition of aristocratic portraits of children seen as miniature grown-ups and of the child portraiture of the Enlightenment, with its preference for a more naturalistic representation. Even in this portrait, in which the child imitates conventional adult bearing-her headdress is excessively complicated, as is her court gown, which obstructs movement-Goya skillfully and accurately discovers her psychological profile. Her face displays the characteristics of the new fashion in child portraiture; her red lips and shining eyes attest to her health.
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Specific knowledge and skills needed include the identification and treatment of basic psychological conditions depression definition medical cheap 150mg bupron sr visa, such as depression mood disorder questionnaire history order 150mg bupron sr, an understanding of both pharmacological and non-pharmacological interventions, and effective patient and Clinical Practice Guidelines for Quality Palliative Care, 4th edition 23 Domain 3 Domain 3: Psychological and Psychiatric Aspects of Care family education strategies specific to the mental health diagnosis in the context of serious illness. In addition, clinicians benefit from an understanding of the psychological reactions to serious illness, grief, and loss. Clinicians need expertise in care coordination between providers when patients have a cognitive and/or communication impairment or incapacity or are experiencing extreme mental distress. Practice Examples Practice Example D3-A A long-term care facility in a suburban area is concerned with the high hospitalization rate of its residents, especially near the end of life. They meet with the case management group at the local hospital, along with leadership of two area hospices, and strategize how they can work together to improve the outcomes of their patients. They identify shared metrics and outcomes and implement shared palliative care education for all staff. The long-term care facility invests in further training for the social workers and supports one individual as she works towards certification in palliative care. The facility enhances the psychological assessment for all residents and improves the distress screening for new admissions to long-term care. It standardizes training in facilitating goals of care discussions and documenting advance care plans with patients and families. Furthermore, it offers access to grief support for patients and their families, along with bereavement services for families and staff in collaboration with its hospice partners. Team members express concern regarding caregiver stress and capacity for couples living in the assisted living community or independent living when one member of the couple has dementia. As a result, the practice hires an advanced practice registered nurse certified in both geriatrics and hospice and palliative care nursing; he facilitates the development of an expanded assessment of patient and family caregiver needs and distress. Procedures are developed to guide symptom assessment and management 24 Clinical Practice Guidelines for Quality Palliative Care, 4th edition Domain 3: Psychological and Psychiatric Aspects of Care with an emphasis on the psychological needs of both patients and family caregivers, including validated screening for depression. The hospice provides additional spiritual care resources and grief and bereavement support for all families served. Practice Example D3-C A large inner-city homeless shelter clinic delivers primary care to seriously ill homeless people. The homeless shelter clinic collaborates with the hospital palliative care service, including palliative care training for all the homeless shelter staff, clinic social workers and psychologists, and volunteer chaplains. The clinic establishes procedures for screening and managing depression and other emotional responses to illness, as well as screening for physical illnesses and symptoms. The homeless shelter clinic forms collaborative relationships with hospices that offer inpatient care in long-term care facilities or inpatient units when needed for end-of-life care. When a young girl with newly diagnosed metastatic cancer developed severe anxiety in the presence of clinicians, the palliative care team worked with the child and her parents to gain trust and assess the causes of her distress. Co-therapy sessions were facilitated to help the child and her identical twin process their feelings and anxiety as the disease advanced, providing opportunities for the child to identify and communicate what was most important to her at end of life. The hospice agency recognizes the opportunity to improve their care of Veterans with dual diagnoses of advanced medical conditions along with psychiatric illnesses. This leads to shared educational sessions for both entities and improvement in medication and symptom management for the patients. Clinical Practice Guidelines for Quality Palliative Care, 4th edition 25 Domain 3 Domain 4: Social Aspects of Care Social determinants of health, hereafter encompassed in the term "social factors," have a strong and sometimes overriding influence on patients with a serious illness. Palliative care addresses environmental and social factors that affect patient and family functioning and quality of life. Assessing and supporting emotional aspects of care and improving quality of life (see Domain 3: Psychological and Psychiatric Aspects of Care) b. Collaborating with community-based services and supports and the organizations providing them d. Applying care management and care coordination techniques and evidence-based models of care transitions. Is aware of the implications on care when patients are uninsured, under-insured, undocumented, homeless, or under the custody of the county or state b. Is cognizant of the financial impact of serious illness, including the cost of medications and other treatment, as well as the costs to the family c.
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The Salish had a tradition of public confessional dancing anxiety 1206 buy cheapest bupron sr, and some later adopted the Shaker religion in which public confessions of "sin" were common depression helpline buy bupron sr with amex. Given these traditions, the public confession aspect of 12-Step groups and the loose democratic organization of those groups may ft well with Salish culture, and Salish people in recovery from substance abuse have generally felt very comfortable with the practices of 12-Step groups. Part 1: Providers Part 2: Administrators Cultural Perspective on Behavioral Health (West) Part 3: Researchers Although the material that follows is useful, it is very general. You will beneft from further exploring the specifc health and healing beliefs of the American Indian and Alaska Native cultures to which your clients belong. The Part 3 literature review (available online) summarizes some resources that may be of assistance. Talking to medicine men and women, healers, and spiritual guides from the cultures you work with would be especially helpful. Even traditional native cultures differ considerably regarding specifc beliefs about the causes of illness and how best to treat them. As discussed further below, most American Indians and Alaska Natives try to balance traditional and mainstream views of health and healing, and many will seek help from both mainstream providers and traditional healers. Certain basic principles apply to health and illness as they are understood by most, if not all, American Indian and Alaska Native cultures: · · · Health is viewed holistically. One aspect of health is believed to affect the others; addressing a problem at one level may help heal problems at other levels. A holistic view also means that prevention and treatment are not divided but seen as part of the same process. The holistic view of health may also extend to the relationship between the individual and his or her community. This also means that healing the community can positively affect individual health and that the process of healing may need to occur at the community level to be effective for the individual. Illness occurs when an individual is out of harmony, and healing is a process of restoring balance. Another potential source of imbalance is cultural; American Indians and Alaska Natives may feel a loss of balance or harmony in trying to fnd equilibrium between the values of two cultures. This is one reason why healing may involve reconnecting with a traditional culture. Remember that your clinical training is infuenced by the culture and common practices of mainstream health care. These practices can confict with or be insensitive to American Indian and Alaska Native beliefs. Likewise, they may view discussing prognosis or consequences of a behavior or illness as a prediction or prophecy, believing that thought and language have the power to shape reality and the future. An illness may be purposeful, in the sense that it occurs because an individual or a relative has broken some cultural taboo or natural law, which creates a state of disharmony and hence a state of illness. These violations may have occurred recently, in the past, or in a previous generation. Because of this, in some American Indian and Alaska Native cultures, a person may be held at least in part responsible for developing an illness, and the individual who has the illness may see it as his or her responsibility to bear the symptoms. An illness may also be personifed in the sense that it has a spirit, and that spirit may need to be addressed as part of the healing process. Traditional medicine and healing the traditional view of medicine and healing is signifcantly different from that of the mainstream healthcare system. Even the word "medicine" has a different meaning in American Indian and Alaska Native tradition. Medicine, in native cultures, is the essence of being or spirit that exists in everything on Earth (Garrett, 1999). Therefore, caring for individuals who are transitioning may be perceived as sacred work. When counseling American Indian and Alaska Native clients with drinking problems, one provider suggests to clients that alcohol is medicine and that by taking it without proper knowledge, the drinker is practicing a form of witchcraft on himself or herself by consciously ingesting bad medicine (E. Traditional healing usually involves physical actions like participating in ceremonies or taking herbal remedies. Often, a whole family or community is involved in the healing process through group rituals. Traditional healing can beneft clients in a number of ways (see the "How Does Traditional Healing Work? Healers may have no specifc label for a problem but will focus on what may have caused the problem.
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