Challenges and Opportunities for Evidence Based Practice

Challenges and Opportunities for Evidence Based Practice Introduction In recent years Evidence-based practice (EBP) has been advocating in nursing profession, however until now there still encounter many difficulties, conflict impact on evidence-based practice development. In this essay will be discussed the challenges and opportunities of future direction of evidence-based practice in nursing. EBP is a decision making approach introduction in 1992. Sackett et al. (1996) state that EBP is a best evidence method of health care decision making which means to integrate sources from research findings, clinical expertise and consideration of client preferences, clinical setting and other external factors such as cost. (as cited in Hewitt-Taylor, 2002). EBP is a scientific and systematic process rather than traditional approach such as customs, rituals and authority from transmission to improve quality and efficiency of patient outcome (Shaneyfelt et al. 2006). Challenges can be defined as barriers, difficulty during apply the evidence-based practice in nursing. Actually, there are many challenges of EBP development, in the article will try to divide into four types to discuss: Challenge of the nurse, Challenge of the clinical environment, Challenge of the research and Challenge of the organization. The part of opportunities is to analysis how to improve or diminish the gap between research evidence and clinical practice, and discuss the factors that help for the future direction of EBP in nursing. Challenges Challenge of the nurse, Challenge of the nurse relate to the nurses beliefs or attitude to EBP, lack of understanding, knowledge and skills of EBP. A recent study (Oranta, Routasalo Hupli, 2002) indicated nurses have divergence the value between research and practice; some nurses have conservative ideas that do not welcome change the nursing practice. The result reflect nurses have misunderstanding or negative attitude about evidence based care which may create wrong belief i.e. indifference or ignore the value of EBP. Nurse unawareness of research, are not familiar with EBP, and no sense improve the knowledge, not to mention to implement it in clinical care. (Hutchinson Johnston, 2004; Wang, Jiang, Wang, Wang Bai, 2013). Attitudes affect behavior, if nurse attitude remain unchanged, would increase degree of difficulty to carry out EBP in the future. Lack of skills implementation of EBP also a big challenge facing by nursing (Majid et al. 2010; Hutchinson Johnston, 2004). There are multiple components of EBP include asking suitable questions, selecting the best pertinent information, evaluating the evidence and integration of patient preference, research evidence etc in clinical decision making (Shaneyfelt et al. 2006). Nurse requests ability of integration and critical appraisal research skills i.e. information seeking, understand statistical terms, implementation to run through the EBP process. Provide education and training for EBP should be an important concern in the future for nurse. Challenge of the research Next challenge point related to research. Nurses always complain articles from journal are not readily available (Chau, Lopez Thompson, 2008; Gale Schaffer 2009; Wang et al. 2013). Actually findings from different research may not always have high level of reliability and validly, methodologies and presentation inadequacies or misconception may exist. Nurses probably feel confused and difficult to appraisal quality of findings, research reports are lengthy, include many academic, jargon terms and statistical analyses cause difficult to comprehension (Oranta, Routasalo Hupli, 2002). Furthermore, research finding usually not publishes fast enough and lack of guideline to implement in the clinical practice. Develop the research disseminate type to improve clinical utilization is a main direction in future, otherwise presentation of researches increase barrier to use finding in patient care, eventually obstruct EBP implementation. Challenge of the clinical environment Clinical environment seem to be a big challenge which absolute restrict nurse implementing EBP (Lee, 2003). Most studies (Hutchinson Johnston, 2004; Gale Schaffer 2009; Wang et al. 2013) stated that nurses have lack of time and heavy workload influences on utilization of research in practice setting. Take Hong Kong as an example, according to the survey conducted by Association of Hong Kong Nursing Staff at 2013, the average of nurse-patient ratio1:17 (normal: 1:4-6) in public hospitals, the bed occupancy rate is 92.9%. Nurses not only have daily heavy workload, also facing a serious shortage problem. Time and labour restrict and clinical safety concerns, nurse tend to use traditional practices and cannot keep frequently follow update journals during working (Hutchinson Johnston, 2004). The working environment resistant changing tried and definitely threats EBP utilization in future. Challenge of the organization EBP is a complex and multifaceted process, cannot apply by individual, administrative support is very important. However lack of organization support is the common complaint by nurses. According to Chau et al. (2008) and Hutchinson Johnston, (2004) the most important challenge of research utilization are lack of authority and no time to implement new ideas or involve research activity. These concerns related to the organization which include the setting barriers and limitations; e.g. time, resources, support and mentoring. Besides, conservative attitude of organization such as lack of intention in changes or welcome new ideas must influences EBP utilization (Gale Schaffer, 2009). It would limit the development of clinical practice to implement EBP and reduce the health care qualities. In addition, nurse indicated that corporation with other professionals also a barrier of EBP implementation (Oranta, Routasalo Hupli, 2002). Health care is a team working which involve many different professionals, such as physician, physiotherapist etc. during co-operation may cause differences of decision making. In traditional doctor has the most authority in clinical decision making, nurse advice may cause conflict or challenges by doctor. Therefore relationship between medical and nursing is also an organization related challenge of EBP utilization. Although there are many challenges of EBP in clinical utilization, challenges creates opportunities, the following part would analysis how to overcome some barriers between research evidence and clinical practice, and talk about the factors that relate to the future direction of EBP in nursing. Opportunities Firstly, upgrading of nursing education curriculum improve nurses’ professional status and research knowledge. Nursing students learn of EBP show more potential of ability on clinical decision making (Brown et al. 2010). Although the nursing programme in universities already include research skills teaching to implement evidence-based practice, transferring finding into clinical practice still a big problem for novice nurses. The curriculum should be included how to connect the EBP to the utilization, not just focus the part of research skills training. Besides, base on shortage of nurse, there are different kind of organizations provide nursing training such as nursing school, hospital nurse training courses, these courses more focus on clinical practice, but not include teaching EBP. At least the basic concept and skills of EBP should be educated in those courses which to improve knowledge of apply EBP into clinical practice. Second, solidarity and cooperation is also an opportunity to future direction of EBP. No matter clusters, hospitals or ward in Hong Kong tend to working independently and lack of co-ordinate with other. To provide EBP should include cooperate and sharing. The hospitals or clusters can form some research groups from different hospitals or wards; include senior and junior nurses to conduct research-related work. This kind of workshop would improve the stuffs ability to identify the clinical issues, review researches, analysis, promote to implement research finding or conduct research etc. eventually improve the quality of nursing care. Third relate to organization, the inferiors imitate the superiors; if the organization have positive attitude to motivate and reward EBP can raise the awareness to the staffs pay attention to EBP (Gale Schaffer, 2009). To improve future develop of EBP, organizational should be modified the nurse ratios. Provide more time and facilities to encourage nurse for discussing and applying research finding in clinical (Lee, 2003). Fourth, facing of decreasing birth rate, the elderly increasing inevitable, aging population already became a international problem, elderly care must pay more attention in nursing. Community services would be a big tendency and increase outreach services and day care services nursing care. Communities’ services for example community nurse and Nursing Clinic also help to relive the treatment cost, reduce stress and workload of front line nurse and bed occupancy rate. This situation closely relate to EBP because the role of nurses become more arduous and specialization, the case nurse provide professional health care services with integration, multifunction should have both evidence and knowledge to support the practice and patient outcome. The phenomenon provides opportunity to EBP to walk out the hospitals and integrate into the communities. Fifth, in the future nurses implement EBP may not just focus on Western medicine, also include Chinese medicine. In current years, popularity of Chinese medicine increasing in Hong Kong, most elderly tend to use Chinese treatment such as acupuncture, qigong diet regimen. Chinese medicine research and the utilization on clinical should be part of concern in EBP when making decision. As favorable condition of geography and culture in Hong Kong, combine Chinese and Western medicine would be a tendency, as a nurse should have the knowledge integration and application in clinical care. In conclude EBP utilization provide a more scientific method to the clinical decision making lead to improve and maintain health care quality, it is definitely the general direction in nursing future development. Base on the restrictive of policies and environment, working environment and organization seems to be two bigger challenges of EBP utilization. Although there are many challenges of EBP, different limitations from nursing and the external environment such as aging population, Chinese medication become more popularity etc provide some opportunities to indicate the future direction of EBP. Nursing profession need to sensitive to those factors, then appropriate to develop or improve, probably reduce the gap between clinical practice and EBP, also may provide a new direction for EBP in nursing utilization.

Rasta

Shaquille T. Sailsman Literature and Composition March 26,2013 Rastafarianism The Rastafarian religion has many different elements. These elements include: history, beliefs, customs/culture, celebrations, and worshipping. Rastafarians believe in the divine nature of Emperor Haile Selassie I of Ethiopia, whose title before his coronation of 1930 who Ras Tafari (Prince of the House of Tafari). The name Haile Selassie means â€Å"Power of Trinity. † He was the Emperor of Ethiopia from 1930-1974. Haile Selassie never regarded himself as God, nor did he adhere to Rastafari.According to iconn. org, Rastafarians regard Haile Selassie I as God because Marcus Garvey’s prophecy – â€Å"Look to Africa where a black king shall be crowned, he shall be the Redeemer† – was swiftly followed by the ascension of Haile Selassie as Emperor of Ethiopia. Haile Selassie I is regarded by Rastafarians as the God of the black race. The Rastafarian religion began in Jamaica i n the 1930s. The religion was formed after periods of slavery. Rastafarians regarded Jamaica as hell and Ethiopia as heaven.Rastafarians called Jamaica hell because Africans were divided up and sent to destinations throughout the world, in most cases as slaves to whites. This is why many Africans found themselves in Jamaica. Ethiopia, the homeland, was seen as a place of fond memories of freedom and life prior to oppression. This meant it eventually became regarded as heaven. â€Å"Rastafarians believes Jah (God) lives on in some form, and believes that one day he will bring about the return of all black people to their ancestral home in Africa,† (Breuilly, O’Brien, Palmer, 152).When Rastafarians have kids, they raise their kids to believe in Jah and after a certain age they should be able to identify who he is. They are also raised to believe that one day he will be raised from the dead and bring them back to Africa, their supposed homeland. Rastafarians dedicate them selves to preparing for this homecoming, growing closer to Jah, (Breuilly, O’Brien, Palmer). They do this by cultivating peace and harmony with all and by living in a way that is close to nature, mimicking Jah.Another way Rastas try to mimic Jah is by rejecting practices introduced from white culture, which is symbolically called â€Å"Babylon. † The culture of Rastafarian is to condemn the eating of meat. They are all vegetarians. In order to spiritually grow as a person, meat has to be gradually eliminated from the diet. According to www. iconn. org, â€Å"the main reason Rastafarians don't eat meat is because animals try so hard to get away. The fear of the animals can be seen in their eyes.It is evident that they are begging for mercy. Rastafarians will have to show mercy. Within the book of genesis, the LORD gave man dominion over animals. It was not to eat them but to care for them. † An efficient healthy body is very basic. The Rastafarian's diet is desig ned to meet their personal needs. The Rastafarian's food is normally referred to as ital food within the Rastafarian culture. The most traditional way to know a Rastafarian is by their dreadlocks. Some people may wear their hair the Rastafarian way – dreadlocks – without being committed to Rastafarian belief or lifestyle, while many believers feel obligated to abandon the traditional hairstyles for the sake of gaining or remaining in employment,† (Breuilly, O’Brien, Palmer, 152). Rastas wear dreadlocks because they do not believe in cutting or combing their hair. It is also the way some ancient African priests and Israelites wore their hair. Sometimes you see a green, red and yellow colored hat over a Rasta's hair. These are the colors of the flag of Ethiopia.Rastas also wear a turban, which is a headband based on cloth winding, over their head to protect and keep their dreadlocks clean. According to www. iconn. org, the holy herb, or known to most as mari juana or ganja, is used in all major Rastafarian celebrations to enhance feelings of peace and community, aid meditation and inspire religious visions. There has often been controversy concerning the legalization of marijuana. Rastafarians are perhaps best known for their religious use of marijuana, which grows plentifully in Jamaica. In addition to ritual use, Rastas also use marijuana for medicinal purposes, applying it o a variety of ailments including colds. Many followers also believe that marijuana aids in the worship of God, Bible study, and meditation. Although not all Rastafarians use marijuana, most believe it will bring a person closer to God. Reggae music originated as an important part of Rastafarian celebrations – asserting the pride and dignity of black people, rejection of white oppression, the beauty of Africa and visions of a peaceful future. Reggae music is intimately connected to Rastafari and its lyrics often speak of oppression, poverty, slavery, aparthe id and human rights.One of the most important figures in trying to spread reggae music was Bob Marley. Born Nesta Robert Marley (1974–1981), he remains the most widely known and the best-selling performer of reggae music, and is credited with helping spread both Jamaican music and the Rastafari movement to a worldwide audience. A Nyabingi ceremony brings together believers from a wider area, and often last from several days. At these ceremonies, there are chanting, drumming, singing, praying, and dancing as well as shaving of vegetarian food and smoking of marijuana.Some occasions for a Nyabingi are based on the Julian calendar used by the Ethiopian Orthodox Church; with the Rastafarian faith has strong links. Holy days and holidays are periods of solemn times for the Rastafarian community worldwide. The Holy days are to pray and ask for penance, fulfilling 2 Chronicles 7v14, â€Å"If my people who are called by my name, will humble themselves and pray, search for me and rep ent of their evil ways, then I will hear from heaven and forgive their sins and heal their land. † (Himchurch. org).Some Rastafarian celebrations includes: Ethiopian New Year – Sept 11th (represents a holiday, which is, observed with a short Prayer Service from 10am-11am), Christmas Day – Jan. 7th (Rastafarians observed this as a holiday), Haile Selassie’s Birthday – July 23rd, and the Anniversary of his coronation – Nov. 2nd, (Breuilly, O’Brien, Palmer, 153). Influential prophets and teachers may also be commemorated, but there is no official festival calendar. Rastafarians do not have a specific religious building that is set aside for worshipping.They usually meet weekly, either in a believers’ home or in a community center. The meetings are referred to as Reasoning Sessions. They provide a time for chants, prayers and singing, and for communal issues to be discussed. Marijuana may be smoked to produce heightened spiritual st ates. The music used at these meetings is known as Nyabingi, and so when meetings are mostly musical they are often referred to as Nyabingi meetings. Meetings may also include large feasts. Rastafarians lay great stress on individual bible study and interpretation. Rasta Shaquille T. Sailsman Literature and Composition March 26,2013 Rastafarianism The Rastafarian religion has many different elements. These elements include: history, beliefs, customs/culture, celebrations, and worshipping. Rastafarians believe in the divine nature of Emperor Haile Selassie I of Ethiopia, whose title before his coronation of 1930 who Ras Tafari (Prince of the House of Tafari). The name Haile Selassie means â€Å"Power of Trinity. † He was the Emperor of Ethiopia from 1930-1974. Haile Selassie never regarded himself as God, nor did he adhere to Rastafari.According to iconn. org, Rastafarians regard Haile Selassie I as God because Marcus Garvey’s prophecy – â€Å"Look to Africa where a black king shall be crowned, he shall be the Redeemer† – was swiftly followed by the ascension of Haile Selassie as Emperor of Ethiopia. Haile Selassie I is regarded by Rastafarians as the God of the black race. The Rastafarian religion began in Jamaica i n the 1930s. The religion was formed after periods of slavery. Rastafarians regarded Jamaica as hell and Ethiopia as heaven.Rastafarians called Jamaica hell because Africans were divided up and sent to destinations throughout the world, in most cases as slaves to whites. This is why many Africans found themselves in Jamaica. Ethiopia, the homeland, was seen as a place of fond memories of freedom and life prior to oppression. This meant it eventually became regarded as heaven. â€Å"Rastafarians believes Jah (God) lives on in some form, and believes that one day he will bring about the return of all black people to their ancestral home in Africa,† (Breuilly, O’Brien, Palmer, 152).When Rastafarians have kids, they raise their kids to believe in Jah and after a certain age they should be able to identify who he is. They are also raised to believe that one day he will be raised from the dead and bring them back to Africa, their supposed homeland. Rastafarians dedicate them selves to preparing for this homecoming, growing closer to Jah, (Breuilly, O’Brien, Palmer). They do this by cultivating peace and harmony with all and by living in a way that is close to nature, mimicking Jah.Another way Rastas try to mimic Jah is by rejecting practices introduced from white culture, which is symbolically called â€Å"Babylon. † The culture of Rastafarian is to condemn the eating of meat. They are all vegetarians. In order to spiritually grow as a person, meat has to be gradually eliminated from the diet. According to www. iconn. org, â€Å"the main reason Rastafarians don't eat meat is because animals try so hard to get away. The fear of the animals can be seen in their eyes.It is evident that they are begging for mercy. Rastafarians will have to show mercy. Within the book of genesis, the LORD gave man dominion over animals. It was not to eat them but to care for them. † An efficient healthy body is very basic. The Rastafarian's diet is desig ned to meet their personal needs. The Rastafarian's food is normally referred to as ital food within the Rastafarian culture. The most traditional way to know a Rastafarian is by their dreadlocks. Some people may wear their hair the Rastafarian way – dreadlocks – without being committed to Rastafarian belief or lifestyle, while many believers feel obligated to abandon the traditional hairstyles for the sake of gaining or remaining in employment,† (Breuilly, O’Brien, Palmer, 152). Rastas wear dreadlocks because they do not believe in cutting or combing their hair. It is also the way some ancient African priests and Israelites wore their hair. Sometimes you see a green, red and yellow colored hat over a Rasta's hair. These are the colors of the flag of Ethiopia.Rastas also wear a turban, which is a headband based on cloth winding, over their head to protect and keep their dreadlocks clean. According to www. iconn. org, the holy herb, or known to most as mari juana or ganja, is used in all major Rastafarian celebrations to enhance feelings of peace and community, aid meditation and inspire religious visions. There has often been controversy concerning the legalization of marijuana. Rastafarians are perhaps best known for their religious use of marijuana, which grows plentifully in Jamaica. In addition to ritual use, Rastas also use marijuana for medicinal purposes, applying it o a variety of ailments including colds. Many followers also believe that marijuana aids in the worship of God, Bible study, and meditation. Although not all Rastafarians use marijuana, most believe it will bring a person closer to God. Reggae music originated as an important part of Rastafarian celebrations – asserting the pride and dignity of black people, rejection of white oppression, the beauty of Africa and visions of a peaceful future. Reggae music is intimately connected to Rastafari and its lyrics often speak of oppression, poverty, slavery, aparthe id and human rights.One of the most important figures in trying to spread reggae music was Bob Marley. Born Nesta Robert Marley (1974–1981), he remains the most widely known and the best-selling performer of reggae music, and is credited with helping spread both Jamaican music and the Rastafari movement to a worldwide audience. A Nyabingi ceremony brings together believers from a wider area, and often last from several days. At these ceremonies, there are chanting, drumming, singing, praying, and dancing as well as shaving of vegetarian food and smoking of marijuana.Some occasions for a Nyabingi are based on the Julian calendar used by the Ethiopian Orthodox Church; with the Rastafarian faith has strong links. Holy days and holidays are periods of solemn times for the Rastafarian community worldwide. The Holy days are to pray and ask for penance, fulfilling 2 Chronicles 7v14, â€Å"If my people who are called by my name, will humble themselves and pray, search for me and rep ent of their evil ways, then I will hear from heaven and forgive their sins and heal their land. † (Himchurch. org).Some Rastafarian celebrations includes: Ethiopian New Year – Sept 11th (represents a holiday, which is, observed with a short Prayer Service from 10am-11am), Christmas Day – Jan. 7th (Rastafarians observed this as a holiday), Haile Selassie’s Birthday – July 23rd, and the Anniversary of his coronation – Nov. 2nd, (Breuilly, O’Brien, Palmer, 153). Influential prophets and teachers may also be commemorated, but there is no official festival calendar. Rastafarians do not have a specific religious building that is set aside for worshipping.They usually meet weekly, either in a believers’ home or in a community center. The meetings are referred to as Reasoning Sessions. They provide a time for chants, prayers and singing, and for communal issues to be discussed. Marijuana may be smoked to produce heightened spiritual st ates. The music used at these meetings is known as Nyabingi, and so when meetings are mostly musical they are often referred to as Nyabingi meetings. Meetings may also include large feasts. Rastafarians lay great stress on individual bible study and interpretation.

A Guide to Lab Report Maker

A Guide to Lab Report Maker What to Expect From Lab Report Maker? Check with your GTA about which parts you need to keep for additional labs. Avoid utilizing the fume hood to put away chemicals and equipment which could block the air slot in the rear of the hood and adversely impact hood performance and capture, causing chemical exposure to the user. Computer and test equipment cover won't be removed by anyone aside from the lab personnel. High amounts of mold in your body are thought to cause brain damage and consequently causing long-term memory loss If you see any of the aforementioned symptoms, it might indicate your machine is contaminated. The Lab Report Maker Cover Up These regulations are needed for ALL labs. The recognition of maturity is tougher in hemimetabolous insects where late instars might be similar to adults in dimension and shape. Although beaver selection of particular species of trees may be associated with the nutritional price, additional information is required to ascertain why beavers select some tree species over others. You may never underestimate the importance of getting your lab report written by an expert in your area. Our organization is entirely plagiarism free! So your own private statement will be the sole methods to inform you. Therefore once you compose a lab report you always ought to use the 3rd person neutral grammatical individual. Even in case you have very little time to ready the report, don't hesitate to speak to us we're prepared to do the work keeping the tight deadline. A chemical fume hood might provide adequate protection for most laboratory processes if they're used correctly. A lab report ought to be a comprehensive account of an experiment together with the results found. Along with presenting the principal findings of your experiment, it is essential that you indicate how accurate your results are. Write down the aim of your experiment what it is that you're planning to do and what it is you're hoping to attain. You would also need to elaborate on a number of the techniques and methodologies which you're planning to use to accomplish your target. Just take a while to think about a perfect means to collect and organize the outcome and findings before you even start. Writing a lab report isn't easy as everything should be in place and that's why plenty of people make usage of Sample Laboratory Report Templates. While professors may demand students to write superior lab reports, they might not be mindful that some students have little if any skills to make a good report. Most students who take science courses don't have any option except to write lab reports at the same point. If you are getting ready a lab file, it may help to get a template to work from. If you're going to compose your very first experiment file, you may use lab report samples as templates to follow. Probably you're uncertain of the steps which you will need to follow in writing a superb lab report. Getting adequate time to compose an in depth sample lab report might not be easy for most students. The Do's and Don'ts of Lab Report Maker In any case, the report should have a coherent structure which allows readers to comprehend the procedures you followed to find the results. Reiterate all the results that you had calculated and all your findings. Set the data in tables, graphs or any type of presentation that you would think make the data readable and straightforward. Some data wasn't labeled using. What Does Lab Report Maker Mean? Developing a great formal lab report template would involve plenty of steps. The format is dependent upon the intended audience. Table captions a ppear over the table. At any time you truly feel incapacitated to make superior work, always contact lab report writing services that will help you, as you want. If you're taking a science training course, and you have problems writing quality reports, you will need lab report writing assistance from professionals. From the start, it's important that you know that writing a lab report is cumbersome and take a good deal of time to investigate and prepare. Because of this, when you own a lab report example college that needs to be edited or proofread, don't be afraid to get in contact with us for aid. Since you have the ability to see, students are certain to face many challenges should they want to become a member of the buy essay club. A student cannot be considered one without attempting to wrestle with lots of schoolwork. He can't help but despair when they have no one to help them with some of the tedious college tasks such as writing lab reports. Therefore, many students and employees choose to obtain low-cost essay as opposed to writing it themselves.

Compare ccontrast Cognitive Behaviour Therapy Humanistic Approaches Theoretically Practically Free Essay Example, 3000 words

Psychology by definition includes many aspects linked to human consciousness and an individual perspective, which cannot be eschewed if behavior is to be examined. In the 1930’s Skinner however, made a valuable contribution to behaviorism through the development of the operant response and the reinforcement theories (Skinner, 1969). The Cognitive perspective evolved in direct opposition to the shunning of the mental perspective in behaviorism. There was more value attributed to the conditioning forces in the environment as being factors shaping human behavior while the contribution of insight or internal consciousness was largely classified as non observable phenomena. Staddon and Simmelhag (2001) pointed out the inability of Skinner’s theory to explain certain recurring behavioral patterns that cannot be explained by the stimulus-response effect of adaptation of behavior. When Skinner’s reinforcement experiments were carried out by taking time intervals into consideration, inconsistencies developed in the response patterns that appeared to indicate that there was something greater than a pure adaptive response that was g overning and conditioning behavior. The recognition that the underlying cognitive element was an important aspect that was related to behavior assumed importance in the 1970s. We will write a custom essay sample on Compare & ccontrast Cognitive Behaviour Therapy & Humanistic Approaches Theoretically & Practically or any topic specifically for you Only $17.96 $11.86/page Therefore, an application of the cognitive component has been found to be useful in introducing self regulation in aggressive students and has been more effective than purely behavioral controls. (Smith et al, 2005) The cognitive perspective applies the function of behavior as dependent upon two aspects of the thinking process (a) knowledge and (b) appraisal. The first stage of knowledge comprises the knowledge that a person possesses about how things work while the appraisal phase consists of the person’s own internal evaluation of how well he is able to utilize that knowledge to ensure his well being. The result of such appraisal will in turn determine an individual’s behavior and an appraisal that perceives a negative utilization of knowledge is likely to produce mal adjustment.