2. No. Topic Slide numbers
1 Terms 3
2 Counselling- meaning , introduction ,skill , benefits 4-6
3 Dying & Death- over views and introduction, concept,
DABDA, role of family, counselling and need of dying
patient
9-19
4 HIV-AIDS cause, need for counselling, areas of counselling,
Pre-post test and guidelines
22-33
5 Unwed mother –meaning, introduction, causes, incident,
risk factors, complication,
counselling
34-49
6 Research article 50-54
2
3. Terms
• Counselling :professional assistance and guidance in resolving personal or
psychological problems.
• Death : end , passing
• HIV/AIDS :human immunodeficiency virus /Acquired immunodeficiency
syndrome
• Unwed :not married.
3
4. Terms
• Dishonoring :bring shame or disgrace on.
• Crisis :a time of intense difficulty or danger.
• Imbues: inspire or permeate with (a feeling or quality).
• Hospice care : a type of care and philosophy of care that focuses on the
palliation of a chronically ill, terminally ill or seriously ill patient's pain and
symptoms, and attending to their emotional and spiritual needs.
4
5. Counselling is
The process of assisting and guiding clients, especially by a
trained person on a professional basis, to resolve especially personal, social,
or psychological problems and difficulties.”
5
6. • Counselling is:
• The process that occurs when a client and counsellor set aside time in order to explore
difficulties which may include the stressful or emotional feelings of the client.
• The act of helping the client to see things more clearly, possibly from a different view-point.
This can enable the client to focus on feelings, experiences or behaviour, with a goal to
facilitating positive change.
• A relationship of trust. Confidentiality is paramount to successful counselling. Professional
counsellors will usually explain their policy on confidentiality, they may, however, be required
by law to disclose information if they believe that there is a risk to life.
6
7. Counselling Skills
• Communication skills are obviously of utmost importance to counsellors, these
skills including : active listening, clarification, reflection and effective questioning
skills.
• The counsellor will attempt to build a certain amount of rapport with their client,
but not to an extent that would allow them to become emotionally involved.
• Counsellors need to be empathetic, seeing things from the client’s point of view,
rather than sympathetic (feeling sorry for their clients). Empathy can help the
counsellor to ask appropriate questions and lead the client to positive conclusions.
7
9. Loss, Grief, Dying, and Death
• Loss
• An aspect of self no longer available to a person
• Death
• Cessation of life
• Grief
• Pattern of physical and emotional responses to bereavement
• Grief Work
• Adaptation process of mourning a loss
• Mortality
• The condition of being subject to death
9
10. Historical Overview
• Not all losses are obvious or immediate
Obvious Losses
Death of a loved one
Divorce
Breakup of a relationship
Loss of a job
Not-So-Obvious Losses
Illness
Aging
Changing schools, jobs, or neighborhoods
10
15. Stages of Loss, Death and Dying
1. DENIAL
2. ANGER
3. BARGAINING
4. DEPRESSION
5. ACCEPTANCE
15
16. Counsellor must explain “The Role of the Family”
• The family must serve as therapist to the dying person, they must have all the
virtues of the therapist and, in addition, courage. The person they are caring
for will feel less frightened if at this critical moment they, themselves, are not
afraid. But patients should not be plied with false optimize or in some other
way treated like a child. Families must be patience . If the dying person
becomes irritable or unreasonable, they should not become personally
offended. The important task that they can do for him/her better than
anyone else is simply to be there.
16
21. HIV/AIDS
HIV is the virus that is a sexually transmitted disease (STD). This is
because of the following reasons. They are:
• an increased number of sexual partners
• IV drug use
• anal intercourse
• any sex (oral, anal or vaginal) without condoms
• alcohol and other drug use (sex is more impulsive and use of
condoms less likely if under the influence of alcohol or other
drugs)
• tattoos and body piercing with contaminated (unsterile)
needles or instruments
21
22. Why counselling is needed?
• To improve the patient’s understanding about the disease and its
management
• To improve the medication adherence behaviour and improved therapeutic
outcomes
• To adopt healthy lifestyles
• To improve the quality of life
22
23. Areas to counselling
• Before doing the test (pre-test)
• After the test (post-test)
• Crisis counselling.
• Adherence counselling
23
24. Pre test
• This is the counselling that is given to the person who
is willing to test for HIV
Steps in counselling.
• Making the patient comfortable
• Reason for testing
• Concepts and misconceptions
• Clarifications about HIV and AIDS
24
26. Post test (Positive)
• Medical plan
• Plan for the future
• Reduction of high risk behaviour
• Networking
• Support the patient
26
27. Crisis Counselling
A person who is HIV positive will face many crises in life. He/she needs to be
counselled.
• The patient should decide the best option for their situation.
• The patient should report back to the counsellor and tell about the progress
that he/she is making.
27
28. Adherence Counselling
• It involves change in behaviour so that the patient is disciplined and
conditioned to take medication
• It should start from the time the diagnosis of HIV.
28
29. HIV POST-TEST COUNSELLING
GUIDELINES
• Informing the client of the result
• It is important that the result of the test, whether it is positive or negative,
be given in person.
• The results should only be given if the counsellor has proof (a laboratory
report) in front of him/her. This is important for two reasons:
• To avoid confusion/mix-ups arising
• As proof to the client who may wish to see the result in the written form
29
30. HIV POST-TEST COUNSELLING
GUIDELINES
DEPRESSION
Helplessness over physical decline
Hopelessness due to the fact that there is no cure, and limits imposed by ill
health
Reduced quality of life
Self-blame and recrimination for past behaviour
30
31. Cont…
ANXIETY
About reactions from others
About isolation, abandonment and rejection
About risk of infecting others
About partner’s ability to cope with their infection
About loss of cognitive, physical, social and work abilities
About possible disfigurement and disability
31
34. UNWED MOTHER
• Unwed mother is the lady who has become pregnant without legal
justification of physical intimacy between man and woman .
• In the traditional societies like India the physical relationship
before marriage or becoming mother before marriage is
considered as a sin.
• Therefore the result of such women in the traditional societies is
very bad.
34
35. Causes, incidence, and risk factors
• Adolescent pregnancy is a complex issue with many reasons
for concern. Kids age 12 - 14 years old are more likely than
other adolescents to have unplanned sexual intercourse .
They are more likely to be talked into having into sex.
• Up to two-thirds of adolescent pregnancies occur in teens
age 18 - 19 years old.
35
36. Risk factors
• Younger age
• Poor school performance
• Economic disadvantage
• Older male partner
• Single or teen parents
36
37. Cause of unwed mother
• Teen age mistake:
Many teen age girls due to inefficient decision making make a mistake that
make them an unfortunate mother unwed mother.
Improper sex education:
Due to lack of improper sex education among teen agers and
adolescent , the unwanted pregnancy is an emerging issue.
37
38. Cont…
Prostitution :
Prostitute is an individual who for sake of some reward engage in illegal
sexual act with various individual either of same or opposite sex.
The tragedy of this prostitutes is also being unwed mother.
38
39. Cause of unwed mother
• Poverty:
The foundation of unwed mother lies somewhere in poverty.
It is well known that very unfortunate parents due to their poverty sell their daughter.
The reality of this statement is well established by the newspaper and news telecast on TV .
Many of these girls end result is unwed mother.
• Contraceptive failure:
Contraceptive failure can also be a reason of unwed mother.
If sexual relationship before marriage is made but used contraceptives does not work them it result in an
unwanted pregnancy making the lady an unwed mother.
39
40. Counselling :
• All options made available to the pregnant teen should be
considered carefully, including abortion, adoption, and raising the
child with community or family support.
• Discussion with the teen may require several visits with a health
care provider to explain all options in a non-judgmental manner
and involve the parents or the father of the baby as appropriate.
40
41. Cont…
• Early and adequate prenatal care, preferably
through a program that specializes in teenage
pregnancies, ensures a healthier baby.
• Pregnant teens need to be assessed for smoking,
alcohol use, and drug use, and they should be
offered support to help them quit.
41
42. Cont…
• Early and adequate prenatal care, preferably through a
program that specializes in teenage pregnancies, ensures a
healthier baby.
• Pregnant teens need to be assessed for smoking, alcohol
use, and drug use, and they should be offered support to
help them quit.
42
43. Cont…
• Adequate nutrition can be encouraged through education and
community resources.
• Appropriate exercise and adequate sleep should also be
emphasized.
• Contraceptive information and services are important after
delivery to prevent teens from becoming pregnant again.
43
44. Cont…
• Pregnant teens and those who have recently given birth should be
encouraged and helped to remain in school or reenter educational
programs that give them the skills to be better parents, and
provide for their child financially and emotionally.
• Accessible and affordable child care is an important factor in teen
mothers continuing school or entering the work force.
44
45. Cont…
• Women who have a baby during their teen years are more
likely to live in poverty
45
46. Complications
Pregnant teens are at much higher risk of having serious medical complications
such as:
• Placenta praevia
• Pregnancy-induced hypertension
• Premature delivery
• Significant anemia
• Toxemia
46
47. Cont…
• Infants born to teens are 2 - 6 times more likely to have low birth
weight than those born to mothers age 20 or older.
• Prematurity plays the greatest role in low birth weight, but intrauterine
growth retardation (inadequate growth of the fetus during pregnancy) is also
a factor.
47
48. Voluntary counselling and testing: uptake, impact on sexual behaviour, and HIV incidence in a rural
Zimbabwean cohort
• Objectives
To examine the determinants of uptake of voluntary counselling and testing (VCT)
services, to assess changes in sexual risk behaviour following VCT, and to compare
HIV incidence amongst testers and non-testers. Methods: Prospective population-
based cohort study of adult men and women in the Manicaland province of eastern
Zimbabwe. Demographic, socioeconomic, sexual behaviour and VCT utilization data
were collected at baseline (1998–2000) and follow-up (3 years later). HIV status was
determined by HIV-1 antibody detection. In addition to services provided by the
government and non-governmental organizations, a mobile VCT clinic was available at
study sites.
48
49. • Result :
Lifetime uptake of VCT increased from under 6% to 11% at follow-up. Age,
increasing education and knowledge of HIV were associated with VCT uptake.
Women who took a test were more likely to be HIV positive and to have greater HIV
knowledge and fewer total lifetime partners. After controlling for demographic
characteristics, sexual behaviour was not independently associated with VCT uptake.
Women who tested positive reported increased consistent condom use in their regular
partnerships. However, individuals who tested negative were more likely to adopt more
risky behaviours in terms of numbers of partnerships in the last month, the last year
and in concurrent partnerships. HIV incidence during follow-up did not differ
between testers and non-testers.
49
50. Conclusion :
• Motivation for VCTuptake wasdriven byknowledge and educationrather than
sexual risk. Increased sexual risk following receipt of a negative result may be
a serious unintended consequence of VCT. It should be minimized with
appropriate pre- and post-test counselling. 2007 Lippincott Williams &
Wilkins
50
51. Dying, death and bereavement: a qualitative study of the views of carers
of people with heart failure in the UK
This paper explores carers views of dying, death and bereavement for family members who
had recently died with heart failure adding to a growing literature on end of life experiences for
people with conditions other than cancer.
• Methods :Twenty interviews were conducted with bereaved carers of older people with
heart failure who had been participating in a longitudinal study. Carers were approached in
writing 3 months after the death. Interviews were transcribed verbatim and analysed
thematically with the assistance of NUD*ISTest.
• This study, conducted between 2003 and 2006, was approved by a Multi-centre Ethics
Committee (Cardiff), with research governance approval obtained from relevant Primary
Care Trusts.
51
52. • Participants were the bereaved carers of patients taking part in a larger quantitative survey
exploring palliative care services for 542 heart failure patients over a two year period.
• Results
Findings were grouped into three time periods: prior to death; the death itself and
bereavement. Most carers found discussions about end of life with their family member prior
to death difficult. Dissatisfaction with the manner of the death was focused around hospital
care, particularly what they believed to be futile treatments. In contrast deaths in the home were
considered 'good'. Carers adopted a range of coping strategies to deal with grief including
'using their faith' and 'busying themselves' with practicalities. There was some satisfaction with
services accessed during the bereavement period although only a small number had taken up
counselling.
52
54. Rising incidence of unwed mothers in India; associated social
parameters & institutional guidelines for managing them
• Abstract :
Background: Globally the incidence of unwed mothers is rising. While the incidence
is higher in western countries, developing countries like India are soon catching up.
Methods: Ours is a retrospective study from January 2009 to December 2013
analyzing 51 cases of unwed mothers for - changing incidence of unwed mothers in
India, to look for predisposing social & family pressures which may have led to the
pregnancy, to study neonatal outcomes in such mothers & to analyze the role of
social worker intervention in the management of such pregnancies.
54
55. • Results: Our study showed a 50% rise in the incidence of unwed mothers in our institute over the
years with a majority (49%) of them being teenaged girls. 68% unwed mothers were uneducated
or had only primary education & 58.9% unwed mothers had some predisposing factor which
might have contributed to the pregnancy. 52% unwed mothers (who delivered) opted for
institutional admission till term and 35.4% of these underwent a caesarean section at term
(higher than institute LSCS rates). 21.5% unwed mother united with father with social worker
intervention.
Conclusions: Social and demographic parameters play a significant role in the incidence of unwed
mothers. Several of these parameters are subject to external regulation & can reduce incidence of
unwed mothers. Also the role of a social worker is priceless in management of these patients.
• Int J Reprod Contracept Obstet Gynecol. 2014; 3(4): 942-946,Rajshree Dayanand Katke, Mohit
R. Saraogi, Priyanka Pagare.
55
