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Teen Girls And The “How I Look Journal”

The How I Look Journal was designed for middle school girls in 2007 (revised in 2009), and has been used primarily in group settings, although girls can use it by themselves. Counselors and therapists tend to use the topics as a basis for discussions and teachers prefer using the journal in lesson formats. There is also a companion journal (2009) for mothers called “How I Look at my Daughter, Her World, and Her Future.”

Given I had the week off I decided to review the copies I was sent and am delighted to say that my teenage daughters and I thought the journals are a great idea. The journal prompts help girls identify and celebrate their inner strengths and attributes, manage stress, accept their bodies and dream!

I found myself thinking that the self-talk section was very important as parents cannot hear what teens are saying to themselves in their own heads. We would like to believe that our kids are affirming their healthy and positive decisions and characteristics, but the reality may be that they are using “bully talk” to themselves, saying things like “I am dumb, ugly inconsiderate, mean …” These negative statements undermine their self-confidence, but are difficult to change, especially if they are reinforced by comments parents (inadvertently) make when annoyed..

Given that girls in the U.S. may see about 3 thousand advertisements a day and spend nearly twice as much time in a watching T.V. as in school, we have to do something to combat the pressure these girls feel to reach unattainable beauty goals. There are some great resources listed int he book, although I would have added Nancy Redd’s book “Body Drama.”

The book for moms is particularly important in that we are their role models. My favorite part of the journal for moms were the backstory sections – full of facts and concrete suggestions for how to encourage our children to be healthy! I was surprised the mom journal did not push a little harder for moms to stop commenting on the appearance (clothes, hair, make-up, weight) of people they see and especially greet. I have frequently challenged undergraduate classes to go 24-hours without mentioning anything positive or negative about another person’s appearance – and it is HARD – and upsets those around us, who are dependent on our evaluation of their appearance, and assume if there are no comments that there is something wrong with their appearance.

There is a very strong correlation between mom’s satisfaction with her own body and a daughter’s satisfaction with her own body, so it is important that parents get a grip on what we say about our bodies as well as are non-verbal behavior toward our bodies. These books are a great conversation starter and provide great encouragement to moms to talk with their teens about role models and to bring extraordinary women into their lives!

Given the season, I would like to encourage a New Years Resolution for everyone with teenagers – be conscious of the comments and judgments you make about bodies – your own and other people’s – find the beauty in everyone – and encourage your teens to dream, plan and choose a future full of affirming beliefs about their potential and characteristics!

Photo credit: © 2007 A Better Way To Look™

This post, Teen Girls And The “How I Look Journal”, was originally published on Healthine.com by Nancy Brown, Ph.D..


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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