Economic Essay Example | Topics and Well Written Essays - 1000 words - 5

Economic - Essay Example Some basic examples of underdeveloped regions are Asia, Africa and Latin America. Bangladesh, Bhutan, Nepal, Myanmar, Somalia and Cambodia are some countries that fall into this category. (Gerard Chaliand, n.d) Different countries generally face different problems depending upon the level of development and progress made by the country. Naturally, the ones that are developed will face a lesser number of problems and also of a different kind. Underdeveloped countries are bound to face a mountain of difficulties and of a severe kind. The characteristics of an underdeveloped country are actually what its problems are. The basic challenges faced by people in underdeveloped countries are the unavailability of shelter, clothing, food, health services and even water for every person living. This is due to large populations and little resources. Educational standards are very low – lack of qualification means unemployment. Plus, there is a lack of funds with the government that can be spent on health services and other welfare of the people. Technologically speaking, these countries are almost close to nil. (Poverty in Underdeveloped Countries—The Poorest of the Poor - The Poor In Africa, n.d) Firstly, we have the problem of the lack of resources. Not only is there a lack but there is only a specific type of resource available. Most underdeveloped countries are agricultural economies; that is, they earn by selling primary goods such as tea, wheat, cotton etc. These goods, no doubt, have a huge market but they are not as helpful in progression a country as are industrial and manufacturing goods. Developed countries mainly depend on the export and import of manufacturing goods, also known as, capital goods – these are machineries that enhance the efficiency and production of consumer goods. The usage of these machines in a country helps augment living standards. It is clearly

Just Culture Model and its Impact on Patient Safety as Part of the Research Paper

Just Culture Model and its Impact on Patient Safety as Part of the Roles of Clinic Nurse Specialist - Research Paper Example For nurses, they may also expand their knowledge by studying further and advance their career into clinical nurse specialists which may give them the chance to work at the management level in the clinical setting. They would have the knowledge on the healthcare systems and find ways on how to improve the efficiency of the healthcare organization through policies and culture that caters the growth and learning of the staff nurses. To improve the competencies of the clinical nurse specialists, just culture model may be used as framework. It gives importance to patient safety and increase in accountability among members of the healthcare organization. Just Culture Model and its Impact on Patient Safety as part of the Roles of Clinical Nurse Specialist Introduction The healthcare sector has been growing as the demands for health assistance is increasing. It is the sector that will never die out as people need the basic services or even the sophisticated care in that area for survival and to prolong life. People need health assistance when they are sick, injured or weakened. The need for healthcare has also been growing due to its primary importance to human survival. Whenever people get sick, they visit the hospital to get solutions for their health problems. Care is also provided in the hospital for patients with aggravated situations and helps them to recover. When people are sick, they are very fragile as their bodies are weakened. They need the support to totally bring back their healthy bodies. In the search for health assistance, various health staffs are prepared to assist the patients with their specific needs. From food intake to drug administration, the healthcare staffs are there to assist them. The professionals that assist the patients usually require long and intense training and license before they can perform their tasks to care for the patients. One of those health professionals is the nurse. Nurses have been important as they assist the doctors in the medical field to provide health assistance to patients in hospitals, at home or in the community. They are entrusted to help in the health restoration of the patients from their current weak condition to a healthy one. Nurses then may work on their own as they specialize on various roles or take part in a group in planning and evaluating the health care performance. They also attend trainings to further enhance their knowledge and skills to better support the health needs of the patients (Smith, 2004, p. 3). They are also updated with the current breakthroughs in their field of career through scholarly journals. Nurses may opt to specialize further through studies and further trainings to become clinical nurse specialists. As clinical nurse specialists (CNS), they must have more than the undergraduate degree in nursing and the education must be provided by accredited CNS institutions (Callara, 2008, p. 57). They are highly specialized to cater the specific needs of the patients that may depend upon the kind of diseases or illnesses the patients have. The CNS may also work on hospitals, houses, communities or specific units of the hospital such as emergency room and operating room. They also assist in surgeries or clinical procedures (Dreher et al., 2011, p. 78). In general, there are five duties each CNS may do like hospital work, management, education and instruction, research and

Study On The Definition Of Evidence Based Practice

Study On The Definition Of Evidence Based Practice I have studied Nursing for 4 years in the Philippines and I have not encounter the term Evidence Based Practice. It took me by surprise that such subject exist. On my first day of class at Thames Valley University I have learned that EBP is about exploring a medical intervention through research of published research articles based on clinical trial conducted by various researchers and clinicians. The process starts by proposing a research question, and I chose to focus on Pain Management but I have notice that pharmacological management is too common. For such reason, I have decided to aim the attention of my research to Non-pharmacological Management such as Diversional Therapy. This kind of therapy is seldom used in the clinical setting because a lot of medicines are being discovered and used as often. As the process continues, I have learned how to properly critically appraise an article and notice its importance no matter how old it was and enhance my problem solving skills. Fur thermore, adjusting and somehow changing the learning method is a big alteration I have encounter as I need to spend a lot of time reading and making the paper. After all the amplitude I put into making this Folder of Evidence, I consider the entire course a success. I have learned so much of new things that somehow I ignored before. Mapping Grid: Module Learning Outcomes Evidence 1 Evidence 2 Evidence 3 Evidence 4 Identify and critically examine priorities for improving practice. Page 12 Para 1 [P] Asses the ability to identify evidence and critically appraise its value. Page 15 Para 2 [P] Critically analyze the change description and understanding about the nature of evidence in health care practice. Page 12 Para 1 [C] Page 18- 21 Para 2, 3, 4, 5, 6 [P] Evaluate the possibility and effectiveness of evidence for change in practice. Page 24- 25 Para 2, 5 [P] Learning Log: Study Day 1: 11th October 2010 Topic Understanding the Nature of Evidence Key Concepts/Issues Evidence Based Practice History Development Teaching/Learning Lecture Group Discussion Information Skills Development Classroom Activity AM Exploration of the Concept of Evidence Based Practice. PM Sources of Evidence Developing Search Skills Library Session (1) Brief Notes Evidence based practice is providing the best evidence of treatment to facilitate effective treatment/intervention. A discussion of what to be expected from folder of evidence as it highlights how the folder will be collated and how to set aims and objectives for FOE. Study Day 2: 25th October 2010 Topic Questioning Practice/Research Questions: Finding Evidence Key Concepts/Issues The relationship between questions and types of evidence; Questioning own practice explore types of research questions. Developing simple and structure search strategies Teaching/Learning Lecture Group Discussion Group Presentation Information Skills Development Classroom Activity AM Group Presentation: Evidence Based Practice Group Poster Presentation Concepts Definitions and Understandings Session Relationship Between Questions and Types of Evidence Descriptive and Relational Questions PM Writing Searchable Questions for Evidence Based Practice PICO Identifying Preliminary Search Terms Developing Search Skills Library Session (2) Brief Notes We discussed how to proposed a searchable question and how important it is. I formulated a topic based on my own interest and experience beforehand. Revision of question also was supervised and breakdown using PICO framework. Study Day 3: 8th November 2010 Topic Differentiating Between Research Paradigms. Key Concepts/Issues Evidence Based Practice Experimental Research Naturalistic Research Teaching/Learning Lecture Group Discussion Quiz Information Skills Development Classroom Activity AM Quiz Review Research Designs Discussion of Types of Questions (researchable and unsearchable questions). Group Work to Refine Final Practice Issue and Search Question Refine PICO Framework for Search PM Inclusion and Exclusion Criteria Appraisal Tools, CASP, SIGN, AGREE Group Work Assessment and Discussion of Two Papers Retrieved Last Week. (Question, Design, Methods and Results). Brief Notes I have learn the different types of research designs that supports my research scheme for the 5 primary articles together with supporting documents that will be used in making EBP. This session also emphasizes the importance of PICO as this will help how to refine searches. Different appraisal tool was also discussed and its importance as this provide effective filter for the reliability and validity of published literature. Study Day 4: 29th November 2010 Topic Systematic Reviews/Meta-analysis: An Introduction Appraising Evidence Part 1. Key Concepts/Issues Systematic Reviews Developing Critical Appraisal Skills Teaching/Learning Lecture Group Discussion Group Presentation Individual Exercise Classroom Activity AM Group Presentation Features of Systematic Review Group Discussion How Does an SR Differ From a Traditional Review? Appraising a Systematic Review Individual Exercise and Group Discussion. PM Using Appraisal Tools Appraising of an RCT and a Qualitative Study Using CASP or an Alternative Appraisal Tool. Group Discussion Analysing the Appraisal Process and Effectiveness of the Appraisal Tool. Brief Notes A systematic review is a study that identifies, appraise, select ans synthesize a collection of research articles with relevance to each piece of work. Critically appraising a systematic review article excludes lesser quality studies to minimize error and bias in the findings. It Assess the validity of research by means of determining whether the methods used during the study can be trusted to provide a genuine, accurate account of the treatment being studied. Study Day 5: 6th December 2010 Topic Establishing the Quality of Evidence Key Concepts/Issues Making Judgements About the Quality of Evidence Synthesising Evidence Teaching/Learning Lecture Group Discussion workshop Individual Exercise Classroom Activity AM GRADE How to Move from Evidence to Recommendations. Workshop- Grading Evidence PM Tutorials Independent Work or Further Electronic Searches. Brief Notes As I appraise each primary articles collected, a summary of critical appraisal of the 5 primary articles was made. This strategy helped me to make an apprehension toward the affirmation of each articles towards making the summative 3. Study Day 6 13th December 2010 Topic Implementing EBP Key Concepts/Issues Translating Evidence Into Practice Implementing EBP Guiding Principles for Implementing EBP Barriers to Implementing EBP Teaching/Learning Lecture Group Discussion Group Presentation Individual Exercise Classroom Activity AM Group discussion Identify Barriers to Implementing Evidence Base in Practice Identify Strategies to Implementation that Avoid/Overcome these Barriers. PM Students to work in pairs to devise a search strategy for use in one electronic database to identify an article that describes and evaluates the introduction of evidence based change in practice. Brief Notes Implementation has its various barriers to consider such as time, support, lack of knowledge, lack of motivation of the workers and too much research evidence. As a group activity we critique an implementation article as to determine the process of implementation of the studied intervention. Study Day 7 10th January 2011 Topic Evaluating EBP Key Concepts/Issues Evaluating Changes in Practice Application of a Framework for Evaluating Change. Final Module Evaluation Teaching/Learning Lecture Group Discussion Group Presentation Individual Exercise Classroom Activity Measurement for Improvement/Change Sustainability of Change Examine Effectiveness of Evaluation Strategies. Module Evaluation and Individual Tutorials Brief Notes It discussed about the evaluation process of a study and the use of guidelines in each step. Evaluation meant by achieving a research aims and objectives and most importantly if the study conducted able to answer the hypothesis, as this entails whether the study is effective or not. SUMMATIVE WORK Summative 1: Concept of Evidence-based Practice The challenge for best quality of care, combined with the need for recommended usage of resources has heightened the pressure on health care professionals to ensure that clinical procedures is based on sound evidence. Frequent change and advancement in treatments, an increasingly numbers of research information, and the increase of expectations from clients to provide the best care possible, place high demands on healthcare providers to maintain a service that is based on current best evidence. (Bennett and Bennett, 2000). Evidence-based practice (EBP) is a clear path to healthcare wherein health professionals use the best evidence possible, such as the most suitable information available, clinical decisions for individual patients. EBP values, enhances, and builds on clinical expertise, knowledge of disease process, and patho-physiology (McKibbon,1997). Evidence-based practice presume knowledge of and skills in literature searching, research methodologies apprehension , appraisal an d apprehension of research. It also requires healthcare professionals to have access, critique and coordinate literature study with clinical experience and clients aspect. In order to gain a greater interpretation about the nature of evidence in the context of health care, consideration needs to be given to the history of the evidence-based health care movement while the concept was originated in medicine, it has influenced a wide range of health professions (Trinder Reynolds, 2000). In addition, it is an approach to decision-making that has permeated all aspects of healthcare. Its characterize can be seen in many of the leading health systems and government health policies across the world. EBP model highlights the value of research as a source of information which is potentially less biased than other sources for informing practice, it also clearly acknowledges the importance of integrating this research with clinical expertise and clients perspectives (Sackett et al., 2000). Moreover, it involves complex and reliable decision-making based not on available evidence alone but also on patient characteristics, situations, and preferences. Changing practice is not easy to do therefore careful selection of the topic is very significant. For the benefit of the patient is of first importance when selecting a topic, however it can not be the main basis as to literary evidence is inadequate to figure what are the benefits. Researchers must also consider the time, level of consumption and other resources for the study. Research evidence is most frequently found in peer-reviewed journals as this is where results are first published and where enough detail on methodology exists to make informed judgements on the validity and clinical relevance of the findings (Bury Jerosch-Herold, 1998). Research using the strongest and most appropriate study design for the question being studied, will provide the best evidence. Summarizing the evidence is a vast intellectual endeavor according to Fitzpatrick (2007). Healthcare workers must be capable combining ideas and recommendations from an extent of references to make appropriate advices. Implementing a plan is consider challenging because standards and regulation of an organization can either help or ruin an EBP approach to care. Evaluation process involves short term and long term coverage to provide essential data. Word count= 503 Reference List: Bennett S Bennett J (2000) The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal. 47 p171-180. McKibbon K (1997) Evidence-based practice. Bulletin of Medical Library Association. 86(3)p396-401 Trinder, L., Reynolds, S. (Eds). (2000). Evidence-Based Practice A critical appraisal. Oxford: Blackwell Science. Sackett D, Richardson W, Rosenberg W, Haynes R (2000).Evidence based medicine: How to practice and teach EBM (2nd edn). Edinburgh: Churchill Livingstone. Bury T Jerosch-Herold C. (1998). Reading and critical appraisal of the literature. Evidencebased healthcare. A practical guide for therapists Oxford: Butterworth Heinemann. p136-161 Fitzpatrick J (2007. Finding the research for evidence-based practice,part one: The development of EBP 103 (17) p.32-33 Summative 2: Critical discussion on formulating question using PICO There are many times that new information is required when contemplating clients in order to analyze clinical problems and make treatment resolutions, and these questions pertains to a specific client or groups of people. Questions usually arise concerning the effectiveness and choices of an intervention, how treatments are best implemented and whether there are any associated difficulties included (Bennett and Bennett, 2000).The question for this study is about the effectiveness of Diversional Activities as a form of pain management to paediatric clients. Pain management is the alleviation of agony and suffering of a patient with the use of Pharmacological and Non-pharmacological treatment or nursing intervention. Diversional therapy is a non-pharmacological approach and a client centered practice that recognizes the leisure and recreational experiences of an individual (Diversional Therapy Association of Australia,2008).Through the act of psychological and behavioral factors regard ing pain, complimentary medicine are significant in altering pain experiences. These interventions bears to minimize fear, worry, pain and heighten a clients bodily process. According to Bennett and Bennett (2000), when there is uncertainty, the need for information can be interchange into a clinical question. Clearly framing a question not only clarifies what to aim, but it can also facilitate the search for answers. Sackett et al. (1997) point out that the identification of congruent data for answering a particular clinical question may be facilitated by diving the question into components including: A client or a dilemma being considered, an intervention or indicator being considered, outcomes of interest you would like to measure or achieve and a comparison. PICO represents an acronym for Patient, Intervention, Comparison and Outcome. These four components are the essential elements of the research question in EBP and of the construction of the question for the search of evidence (Santos et al. 2007). The PICO strategy can be used to compose several kinds of research analysis, originated from clinical practice, human and material resource management, the search of evidence assessment instruments, among others. The research question allows for the correct definition of which evidence is needed to solve the clinical research question, focuses on the research scope and avoids unnecessary searching (Fleming, 1999). Based on the clinical question formulated and utilization of PICO, a literature search strategy can then be formulated that includes search terms reflecting each component of the question. The next step in the evidence-based practice process is to search the literature for evidence that may assist in acknowledging the question posed. The literature search will be focused by the clinical question that has been identified with use of PICO, as well as other relevant information (Bennett and Bennett, 2000). While evidence for informing clinical decisions may come from various sources including clinical experience, education, textbooks, discussion amongst colleagues and from clients, evidence from well-performed research may be less prone to bias or to the tendency to believe what we want to believe ( Tickle-Degnen, 1999).The internet and the portals of open-access journals allow for accessibility to knowledge, keywords such as non-pharmacological, complimentary medicine and diversional therapy were used to search for the 5 primary articles to be used for this study. An article must be good and interesting, should be well written, and old articles are also considered. Moreo ver, comprises a body of knowledge in academic and scientific based from an original research. Word count= 548 Reference List: Bennett S and Bennett J (2000) The process of evidence-based practice in occupational therapy: Informing clinical decisions. Australian Occupational Therapy Journal. 47 p.171-180 Diversional Therapy Association of Australia(2008) what is diversional therapy?[online]. Available at:http://www.diversionaltherapy.org.au/Home/tabid/38/Default.aspx Flemming K.(1999) Critical appraisal 2: Searchable questions.NT Learn Curve 3(2) p. 6-7. Sackett DL, Straus S, Richardson S, Rosenberg W, Haynes RB (2000) Evidence-based medicine: how to practice and teach EBM. Churchill Livingstone. 2nd edition. Santos C, Pimenta C, Nobre M.(2007) The PICO strategy for the research question construction and evidencesearch. Rev Latino-am Enfermagem maio-junho. 15(3) p.508-11. Tickle-Degnen,L. (1999). Organizing, evaluating and using evidence in occupational therapy practice. American Journal of Occupational Therapy; 53 p.537 539. Summative 3: Synthesis of research findings. This part of work is the review of the 5 primary articles chosen for the topic effectiveness of diversional activities for pain management to pediatric clients. The articles will be analyzed by using CASP tool, examining each relevant findings and by compare and contrasting ideas of each authors, thus, resulting to further evaluation of such intervention in hospital and non-hospital setting for its efficacy. This research desires to have a thorough understanding of non-pharmacological intervention in managing pain to children that soon will complement pharmacological management by provide stronger evidence. Pain is a dreadful feeling and emotional experience related to injury or damage to children s body, it is usually caused by trauma, disease, medical procedure or surgery. Pain may affect children s appetite, sleeping patterns and lessen energy level hence disabling child to do things. Pediatric pain is complex and often difficult to assess, that is why effective pain management in children is a challenge to medical practitioners because there are many special considerations when providing treatment. On the other hand, non-pharmacological therapies or diversional activities are treatment that do not use medicines to decrease or control child s pain. They may convey comfort to the patient during a long standing condition or illness. Certain activities may help improve the child s state by making him/her more comfortable and relaxed. It involves methods such as teaching and leading your child through thinking exercises and other techniques. It can also be used before and after a child undergoes painful experience, such as medical procedure or surgery. Vessey et al. (1994) stated that, Distraction is the single most commonly used diversional activity among children. Fernandez (1986) stated that distraction refers to the direction of attention to a non-noxious event or stimulus in the immediate environment. When a patient worries too much about his/her pain causes more pain than what is really there. Vessey et al (1994) surveyed 100 children, aged 3 years to 12 years, majority are males (62%) to examine the effectiveness of Distraction method during venipuncture or needle prick, the child s memory may lead to stressful psychological responses, such as crying, and physical responses such as venous constriction during the procedures. It is important that in conducting a study the respondent s age, developmental level and prior hospital experience must be considered during the selection, Broome (1985). Furthermore, Researchers uses the Wong-Baker FACES pain rating scale in evaluating children s perception of pain. Wong-baker pains scal e is know to be a reliable and valid device for children 3- 18 years of age in evaluating their pain,Wong and Baker (1988). In using distraction, the patients may paint, play with friends, watch TV and play with board games or video games and other novelty toys to help them relax and deflect their attention during the procedure since it provokes curiosity and require children to use their auditory, visual, tactile and /or kinesthetic senses. These activities may keep them from thinking about the pain. Weekes et al (1988) Distress is known to cancer patients for years during and after the completion of anti cancer treatments. According to National Institute of Clinical Excellence (NICE), (2005) the role of imagination can play in a childs ability to cope with painful operations. The NICE concluded that there was a strong evidence for the use of hypnosis in alleviating chronic pain associated with cancer. Richardson et al (2006) mentioned that hypnosis is a method where the subject is guided by another to respond to suggestions for changes in subjective experience such as perception, sensation, emotion, thought or behavior. It can be utilized in a variety of ways to cut down stress, acquire coping strategies and halt the experience of pain. Self-hypnosis tends to ease self management of symptoms, hence providing a sense of self-efficacy and control over pain and distress, however, it creates less therapeutic benefit compared to therapist- directed hypnosis. It is evident that patien ts who underwent hypnosis reported less anxiousness and pain while using direct and indirect forms of hypnosis, demonstrating leveled effectiveness. Though, there is some evidence that under hypnosis, girls exhibited more distress behavior compared to boys, Katz et al (1987). Richardson et al (2006) concluded that hypnosis has potential as a clinically valued intervention that could impart to the establishment of procedure- related pain and distress in pediatric cancer patients. Oshikoya et al ( 2008) reported that complementary and alternative medicine has been advantageous for children by some parents, such benefits includes prevention of illness, maintenance of good health, relief of musculoskeletal pain, control of asthma symptoms, treatment of mild respiratory problems, relief of sickle cell anemia and enhancement of the immune system in cancer. 80% of the parents used alternative medicine to cure their children during the study, however, 7% discontinue the use of such practice because the symptoms of the illness come about in their children with exacerbation after their regular medications had been discontinued. Moreover, Kemper et al (2010) expressed that pediatric patients benefit from stress reduction by means of using complimentary medicines and techniques such as biofeedback which teaches the child to control and calm body s reactions when there is pain, it is one of the treatments researched most extensively for migraine, Allen (2004). Guided ima gery is used by letting the patient imagine that he/she is his/her favorite place, the patient will feel safe and relaxed and pain may be decrease. Relaxation and self-hypnosis methods that re mostly used for migraines and headache by asking the child to breathe slowly and deeply and let the patient imagine that his/her muscles are relaxing.. Holroyd and Drew (2006) stated that cognitive behavioral therapy has been utilized successfully to help manage headaches, depression, and anxiety, Lawler and Cameron (2006). This practice has proven effective in reducing migraine headaches, improves mood and cognitive function through an experiment. Also, Acupuncture and Massage can help both adults and pediatric patients who have chronic headache and can be provided by family members, which allows for more regular, inexpensive and favorable treatments. Salantera et al (1999) investigates 265 nurses about the knowledge and abilities of nurses towards pain management of pediatric clients. Health care practitioners such as nurses, are well placed to provide such supportive interventions in both pharmacological and non-pharmacological treatments. According to Ross et al (1991) Healthcare providers lack of knowledge and negative attitudes may lead to under medication and under treatment of pain. Nurses are close to the children the whole day and have more chance to use non-pharmacological pain management methods in their work. Clarke et al (1996) that education about pain was most inadequate in areas of non-pharmacological interventions to relieve pain, the difference between acute and chronic pain, and the anatomy and physiology of pain. Nurses knowledge differed according to their age, education, and place of work, and uses a fairly wide range of non-pharmacological pain alleviation methods, most of the time the nurse was in the activ e role and the child was passive, restricting the child to take an active part in their own pain comfort. Studies shows that children like to have some responsibility for their own care. Furthermore, Pederson and Harbaugh (1995) explicit that there are obstacles in terms of using non-pharmacological pain management in hospital setting and found to be that excess workload, lack of proper materials, lack of knowledge and skills, and not knowing the child were the most common problems nurses confronts. Some of them felt that they receive very brief education on non-pharmacological pain management, and 90% had no documented evidence of the use of any non-pharmacological modalities to relieve pain that will serve as nurse s guidelines. The nurses who thought they had good knowledge about non-pharmacological management got a lower score from the survey, nurses consider themselves knowledgeable in stress reduction but not in play therapy and hypnosis method. Effective pain management in ch ildren requires cognition of both pharmacological and non-pharmacological methods. There are evidence found that nurse s characteristics, such as age, knowledge, experience, intuition, attitudes and beliefs, as well as nurses personal experience with pain, determines their implementation of pain interventions and knowledge about it. Nurses should be encouraged to actively seek new information and extend their training. More comparative, dismantling, constructive, and process oriented research strategy is required in the area of non-pharmacological pain management and different practice of pain alleviation should be generalized. Non- pharmacological approach has been found to be an effective adjunct method for the control of pain. A wide range of complementary and alternative medicine therapies are being used by children, including herbs and dietary supplements. Given the influence of psychological and behavioral factors on pain, non-pharmacological interventions are important in altering pain perception/behaviors. Diversional activities are intervention used for managing pain in both children and adult to reduce fear and, minimize distress and pain and increase a childs sense of control. For these techniques to be effective, it must be appropriate to patient s age and developmental abilities and must also be appealing to the recipient. There is still continues need to educate the medical community regarding the long term outcomes of pain control. Word count = 1514 Reference List: Allen KD (2004) Using biofeedback to make childhood headaches less of a pain. Pediatric Annual. 33: 241-245 Broome M (1985). The child in pain: A model for assessment and intervention. Critical care quarterly, 8: 47-55 Fernandez E (1986). A classification system of cognitive coping strategies for pain. Pain. 26: 141- 151. Holroyd KA, Drew JB (2006) Behavioral approaches to the treatment of migraine. Seminar Neurology. 26: 199- 207 Katz E, Kellerman J, Ellenberg L (1987) Hypnosis in the reduction of acute pain and distress in children with cancer. Journal of Pediatric Psychology; 12: 379- 394 Kemper K, Breuner C, (2010) Complimentary, Holistic, and Integrative Medicine; Headaches. American academy of pediatrics, 31(2) p.17- 23 Lawler SP, Cameron LD (2006) A randomized, controlled trial of massage therapy as a treatment for migraine. Annual Behavioral Medicine. 32: p50-59 National Center for complimentary and alternative medicine, NIH (2007) Non-pharmacological pain management therapies for children. Available at http://nccma.nih.gov National Institute for clinical excellence (NICE) (2005) Service guidelines for improving outcomes in children and young people with cancer-second consultation. Available at http://www.nice.org.uk/pdf/cacancer_2ndcons_manual.pdf Oshikoya K, Senbanjo I, Njokanma O, Soipe A ( 2008) Use of complimentary and alternative medicines for children with chronic health conditions in Lagos, Nigeria. BMC complimentary and alternative medicine 8 (66), p.1- 8 Pederson C, Harbaugh B. (1995) Nurses use of Non-pharmacological techniques with hospitalized children. Issues comprehensive pediatric Nursing; 18: 91- 109 Richardson J, Smith J, Pilkington K (2006) Hypnosis for procedure-related pain and distress in pediatric cancer patients: A systematic review and methodology related to hypnosis interventions. Journal of Pain and symptom Management, 31 (1) p.70- 83 Ross RS, Bush JP, Crummette BD (1991) Factors affecting nurses decisions to administer PRN analgesic medication to children after surgery: an analog investigation. Journal of pediatric Psychology, 16: 151-167 Salantera S, Lauri S, Salmi T, Helenius H (1999) Nurses knowledge about pharmacological and non-pharmacological pain management in children. Journal of Pain and symptom Management, 18 (4) p. 289- 299 Vessey J, Carlson K, McGill J (1994) Use of Distraction with Children during an acute pain experience. Nursing Research, 43(6) p. 369-372 Weeeks DP, Savedra MC (1988) Adolescent cancer: coping with treatment- related pain. Journal of Pediatric Nursing; 3: 318- 328. Wong D, Baker C (1988) Pain in children s comparison of assessment scales. Pediatric Nursing, 14: 19- 17.

Comparing Winterbourne and Prufrock :: Daisy Miller, Love Song of J. Alfred Prufrock

  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  When creating his famous poem, "The Love Song of J. Alfred Prufrock", T.S. Eliot was inspired by a character depicted in the novella known as Daisy Miller, written by Henry James. This character, Winterbourne, was intertwined and considered when creating the timid character of Prufrock. It is evident that both men share similar personalities and characteristics that link them together, both being prime examples of emptiness and despair told through theses writings.   Ã‚  Ã‚  Ã‚  Ã‚  The central concern in Daisy Miller is of the "analogies and differences" between people. In this story, a young American man, Winterbourne, is confused and intrigued by the behavior of a young American woman, Daisy Miller. Winterbourne had wondered about all of the cold shoulders that had been turned towards her, and sometimes it annoyed him to suspect that she did not feel at all. He said to himself that she was too light and childish, too uncultivated and unreasoning. Then at other moments he believed that she carried about in her an elegant and perfectly observant consciousness from the impression she produced. He asked himself whether Daisy's defiance came from the consciousness of innocence or from her being, essentially, a young person of the "common" class. After getting to know Daisy, he was confused about getting to know his and her emotions. It is far evident that Winterbourne does not come to conclusions about people easily. He was very much influenced by the biases of his upbringing in culture, and he questioned them occasionally.   Ã‚  Ã‚  Ã‚  Ã‚  "The Love Song of J. Alfred Prufrock" is about a timid and downcast man in search of meaning, of love, and in search of something to break from the dullness and superficiality which he feels his life to be. Eliot lets us into Prufrock's world for an evening, and traces his progression of emotion from timidity, and, ultimately, to despair of life. He searches for meaning and acceptance by the love of a woman, but falls miserably because of his lack of self-assurance. Prufrock is a man for whom, it seems, everything goes wrong, and for whom there are no happy allowances. The emptiness and shallowness of Prufrock's "universe" and of Prufrock himself are evident from the very beginning of the poem. He cannot find it in himself to tell the woman what he really feels, and when he tries to tell her, it comes out in a mess. At the end of the poem, he realizes that he has no big role in life.

Current Event Analysis Essay

JCPenny has just launched its new marketing strategy on Feb 1, 2012, which include improving its brands, refreshing its new stores, and the most important part—the new pricing model. The new pricing model is so called â€Å"Fair and Square† pricing strategy. This new pricing strategy includes three parts. The first one is â€Å"everyday† regular pricing, which is about 40% off 2011’s retail price without discount or promotion. The second one is the â€Å"month-long value† pricing, which offers even better price on specific merchandise. The final one is the â€Å"best price† pricing, which are clearance deals on the first and third Fridays of each month. In my point of view, I think JCPenny’s new marketing strategy is necessary for their further development in such tough competitive environment. According to Martis-Olivo, a retail analyst for Thomson Reuters, JCPennt’s sale performance is poor compared to Macy’s in 2011. Although Macy’s offers less discount and promotion, it posted a much stronger same-store sales average. Consumers now think department stores usually offering items at high prices, then offering discounts or coupons, so use such discount or coupon promotion to attract sales is not as much efficient as before. Furthermore, internet sales are jump up significantly in recent years due to the lower price and more convenience. So JCPenny’s new marketing strategy is launched in time to tackle these challenges. The â€Å"everyday† pricing is about 40% off 2011’s retail price without discount or promotion, which will give the consumers better value products to increase the chances that consumers will visit more and purchase more because of the lower prices. The â€Å"month-long values† on specific items, which will also keep the customer mentality from waiting for additional price drops, and this will also attract consumers come to the store more frequently, instead of only come into the stores when promotion. Finally, the â€Å"best price† pricing on the first and third Fridays of each month will help the stores to clean up their piled up inventories to avoid additional carrying cost. JCPenny’s new marketing strategy actually coincides with the marketing mix, which we usually called 4 Ps: Price, Promotion, Product and Place. As we discussed above, the important role of the JCPenny new marketing strategy is the new pricing model, which give the lower everyday price and month-long values to the consumers. So their new pricing position is focusing on better price-value relationship. Also, they hold promotion on the first and third Fridays of each month, which is the new name for clearance, or the lowest price you’ll ever see for a particular item. Secondly, brands are actually the products to department stores like JCPenny. The improvement of brands is refer to improve their products, as Wahlstrom described, J. C.  Penney has put its focus on fewer, â€Å"more relevant† brands, and less on private brands that are â€Å"less efficient,† such as Arizona and Worthington. These will provide consumer with quality instead of quantity. The final P is referring place, as we mention at the beginning, JCPenny is refreshing its new stores, which may give consumers more convenient accessibility. Furthermore, the new marketing strategy is also coincides with what we just learned from the class– Acquiring & Retaining customers. The lower price is to change consumers’ perceived cost and then will change the perceived value. The lower price acquiring new customers and retain customers to come to the store more frequently. Also, new brand marketing is to improve their products and service, which change the perceived benefits and again will change the perceived value, and change the customers’ preference. These combinations of quality, service and price are called â€Å"customer value triad, as value increases with quality and service and decreases with price. These aim to coagulate JCPenney’s relationship with its loyal customers and attract new ones.

Nutritional Requirements Of Individuals With Dementia Essay

You must provide answers to each question that allow your assessor to properly assess what work duties you are doing or what role you have within your work. It expected that you would need approximately 300 words per question. The more detail you provide the less likely your account will be sent back for more clarification. You must answer each question in your own words and written in the first person meaning â€Å"I do this†. A tip is always to keep in mind the â€Å"who, why, how, where and when† in each answer. Learning Outcome 1-Understand the nutritional needs that are unique to individuals with dementia 1.1 Describe how cognitive, functional and emotional changes associated with dementia can affect eating, drinking and nutrition Symptoms associated with dementia, can have a harmful effect on individuals, if they are not addressed and resolved. In my workplace if the resident’s cognitive ability is impaired they could forget to eat and drink, as well as think that they haven’t been fed, I might also think they had a drink or eaten their food where as they might have tipped their drink down the sink or thrown their food away. If the functional ability changes it could mean that they can’t hold cutlery or hold a drink, therefore they are unable to feed themselves properly. When the emotional state changes they may become stressed and not want to eat or drink and may also forget that they need to eat and drink. For example, Miss K was a big lady who had mixed dementia. She was able to  talk and hear but needed full support at meal times due to her nutritional needs. At meal times she would normally sit at the table but she loved talking to herself most of the time. To divert her attention, as it was already lunchtime, first, I used to greet her in an appropriate manner and explained that it’s already time to eat. She used to look at me and smile. She accepted her meal with happiness and excitement on her face, as she was already hungry. I placed her food and drink in front of her on the table and after a while I left her on her own, I then noticed that she stared at her drink and I could tell that she didn’t actually know what she was doing as she had forgotten what to do with the items in front of her. Read more:  The Nutritional Requirements She used to play with her food and after a few seconds she would usually tip her drink onto the floor and throw her food onto the curtains hanging by the window. In order for her to stop this behaviour I always tried to calm her down in the gentlest way possible. After calming and settling Miss K down I carried out the cleaning and sanitising of the floor as well as the curtains to ensure proper hygiene and cleanliness thus avoiding any potential infections or contaminations. I always made sure that I documented the status of Miss K so that all events were on record for future reference. I also made it a priority to mention any changes of Miss K to the senior member of staff on duty so that they were kept up to date with her condition. After a few reports from the carers she was eventually given one to one care during mealtimes to assist and support her during eating and drinking. 1.2 Explain how poor nutrition can contribute to an individual’s experience of dementia. Poor nutrition can result Miss K becoming more confused and stressed as she is not getting all the nutrients she needs, and because of her becoming more confused which may result her in forgetting to eat and drink more then she became more distressed which made her more ill. Good nutrition helps the way all human beings look, feel and think and if someone with dementia that doesn’t get enough nutrition, it will certainly show by them losing weight and not feeling very well. Due to Miss K’s lack of interest in eating and drinking her mobility was affected. She became unsteady on her feet, which made her use the wheelchair from time to time. I always tried to give her motivation and encouragement to drink and eat as well as other staff members. It also important for me and other staff members to maintain good nutrition to prevent ill health whilst at workplace. I made sure that I am physically fit, had ate and drink well before going to work because sometimes if carers are unwell and have not eat or drink the level of patience and passion to care for the service users were affected which could make them becoming more agitated and distressed. 1.3 Outline how other health and emotional conditions may affect the nutritional needs of an individual with dementia An example of how other health and emotional conditions could affect the nutritional needs of an individual with dementia is depression, as this could lead to a loss of appetite and also a lack of interest in food and drinks. For example, Mrs B has been depressed for quite sometime due to the death of her husband. She would prefer to be on her own most of the time. As a result of her lack of socialisation she became socially isolated. This affected her nutritional needs, as she didn’t feel like eating. It took a long time until she agreed to go to the dining room at meal times. Once dinner was served she would lose interest in eating and tended to return to the lounge without touching the meal. I consistently done my best to try and encourage her to eat. I offered her the choice of what she wanted to eat in the hope that she would choose something she desired rather than not eating at all. I noticed that she became frustrated and anxious when questioned several times. When this became apparent to me I would leave her in the lounge and I would ask other staff members to try and talk to her to see if they could help. I updated her records so that other staff members could see that she hadn’t eaten. I also had to report the matter to the manager so that they were kept in the picture too. 1.4 Explain the importance of recognising and meeting an individual’s personal and cultural preferences for food and drink It is important to recognise an individual’s personal and cultural preferences to food and drink as this can make people feel like they are respected and included. This will encourage individual to eat and drink, but also it will increase their emotional and physical well-being. Asking people with dementia about  their mealtime preferences, when and where they like to eat and what foods they enjoy is vital to ensure all staff provide food and options at mealtimes that are familiar to them. People may have different views about foods depending on their cultural background. Providing range of familiar foods can help make individual feel at home, safe and welcomed. An example, Mrs E, a Spanish lady who has no dementia, is self-centred and has her own eating and drinking preferences from time to time. It is very important for me to identify what Mrs E likes to eat and drink and what she doesn’t like because she tends to shout at carers if these are unmet. If I don’t recognise these I am not meeting her preferences and that will cause her to not eat and drink instead of realising that it is something she doesn’t like. This will then make her feel unhappy, anxious and stressed. If all members of staff know what she likes the management always assure that there is always something available. Due to her nationality it is also important to identify her cultural needs e.g. religion, various times of the year where she may not eat or will only eat certain foods. Every time I am unsure and have questions regarding her diet I always double check with her care plan or I ask one of the members of staff who are more aware of her dietary needs. 1.5 Explain why it is important to include a variety of food and drink in the diet of an individual with dementia It is very important to include a variety of food and drink in the diet of residents with dementia, as they may forget what they didn’t like before and suddenly start eating it. For example, Mr M has suffered from a bowel cancer and other health problems. He was under the palliative care due to his severe condition. He was unable to chew and swallow normal food but still able to drink properly. After few weeks of not eating well Mr M had lose weight. He was checked by his GP and prescribed an Ensure drink for him, which contains the right amount of nutrients that will serve as alternative to his food. I also made sure to ask Mr M if he had any preferences of food and drink e.g. any flavour of drink or soup. He then told me that he likes chocolate flavour drinks. I then informed the senior regarding his wishes, this was immediately passed on to his GP and products were dispatched after a day. It is important that  there is always a variety for Mr M and other residents to make sure that they are always eating something and getting the right nutrients in their bodies. After giving Mr M his drink and food I then recorded it in his observation sheet so that other members of staff would be aware how much fluid intake he had and to continue to monitor Mr M’s condition. Learning Outcome 2-Understand the effect that mealtime environments can have on an individual with dementia 2.1 Describe how mealtime cultures and environments can be a barrier to meeting the nutritional needs of an individual with dementia Mealtime cultures such as meal sizes, number of courses, specific meal times, order of food etc., may not be conducive to the needs of an individual with dementia. In my workplace, cultures can be a barrier because some of the residents may not know how to eat the food that is in front of them and in the correct order. Please see example 1.1. There are some residents who don’t want to eat with other residents at the same time as everyone else in a noisy, busier environment such as communal dining rooms. Communal areas can be a distraction for an individual with dementia as they can become overwhelmed. For example, a resident who requires assistance to eat, I always make sure to ask him if he would prefer to stay in the main dining room or in a separate, more private room where he feel he won’t be watched. I always ensure that the environment for residents is calm and relaxed in order for them to be able to concentrate on the food they eat. This could avoid them becoming agitated, anxious and stressed due to distraction of other residents. Also, all staff was trained to the right standard to deal with mealtimes so that they run as smoothly as possible to avoid conflicts. 2.2 Describe how mealtime environments and food presentation can be designed to help an individual to eat and drink In my workplace, when I was assigned the kitchen duty I made sure I washed my hands thoroughly before and after entering the kitchen and before and after handling food. Before mealtimes it was my responsibility to ensure that all dining areas were neat and clean, cutlery was set on the table and that a variety of drinks were prepared and ready for the resident’s. I also checked the floor to look for any spillages on the carpet to avoid cross contamination and tripping hazards. Furthermore  it was my responsibility to distribute all the trays to the residents that remained in their bedrooms as well as the food trolley for the residents in the lounges. I made sure that the food was served in a relaxed and unhurried manner. I checked with my colleagues to make sure that all residents were ready for their meals, allowing them to feel calm and relaxed in order to focus on their meals. The presentation of each dinner table and the presentation of the food itself were important too. Prints on plates and tablecloths can be very confusing for residents with dementia, especially if they have visual perception difficulties. Foods had to be easily identifiable; plain cream plates were used and were useful in helping to show up colourful foods. The presentation of the food itself had considered colour, texture, smell, and overall appeal. No one wants to eat a plate of unappealing food, and residents with dementia respond well to sensory stimulation. 2.3 Describe how a person centred approach can support an individual, with dementia at different levels of ability, to eat and drink There should always be a person centred approach to food and nutrition to all individuals receiving care, as well as those with dementia. In my workplace, there are various courses provided to all members of staff regarding person centred approach, food hygiene and communication to make sure that they are knowledgeable and skilled enough to support individual’s nutritional needs. Ensuring that mealtimes are sufficiently staffed to provide assistance to those who need it is also greatly important when providing a person centred approach. For example, Mrs R had undergone a nutritional screening prior admitting in the home that was carried out by the line manager. This involved records of her dietary needs and preferences and any assistance she needs at mealtimes to ensure that members of staff act on this. Based on her care plan Mrs R had a normal diet, could eat and drink well but needed encouragement from time to time due to her condition. When assisting Mrs R I always ensure to respect her rights and dignity through providing assistance discreetly e.g. giving her serviettes to protect clothing, provide adapted crockery and  cutlery to enable her feed herself where appropriate. Making sure that food looks appetising and keeping foods separate to enhance the quality of the eating experience is also important. Whilst socialising during mealtimes should be encouraged, I also offer privacy to those who have difficulties with eating, if they wish, to avoid embarrassment or loss of dignity. I made sure that I give Mrs R and other residents time to eat because they should not be rushed. I made sure to not to make assumptions about their preferences on the basis of their cultural background- I ensure to ask them what their preferences are. My communication skills were also important when supporting Mrs R and others because some of them were unable to understand properly due to their dementia. I always made sure to approach and interact them in a nicest and in a properly manner. Visual aids, such as pictorial menus, and non-verbal communication were also used to help to make choices. I also ensure to record food and fluid intake of those resident’s who were monitored due to poor nutrition. As needs and abilities change, these requirements will require review, to make sure that nutritional needs are consistently met. Also knowing Mrs R, and how, where, what times, and by which method she can best consume food and drink will help to support her and her needs. Learning Outcome 3-Be able to support an individual with dementia to enjoy good nutrition 3.1 Explain how the knowledge of life history of an individual with dementia has been used to provide a diet that meets his/her preferences I was off at work when Mr O was first admitted in the home. I had no idea about his personal life, health condition, nutritional needs and preferences. When I came back to work I made sure to check his care plan and daily report form to gain knowledge about his life history before dealing with his personal needs. Having knowledge of his life history has helped me and other staff members provide a diet that meets his preferences. This helped me to find out what he likes to eat, what are his favourite foods, what he don’t like to eat and if he has any allergies to foods. By reviewing the care plan I found out that Mr O was diabetic, liked blackcurrant juice and black coffee but needed a carer to remind him to eat and drink during meal times as he  used to forget them and only sleeps if not encouraged and supervised. By using his preferences shows that I am sticking onto his care plan, wishes and desires when meeting his needs. Recording any changes on his preferences was also recorded in his daily report form and I also handed in information to the senior in charged so that other staff would be aware. 3.2 Explain how meal times for an individual with dementia are planned to support his/her ability to eat and drink In my workplace, meal times are planned according to the individual’s condition and choices, some residents will sit at the table and eat with others and some will not eat at all if they are in the company of others- these are residents who preferred to stay in their bedrooms. My colleagues and I always ensure that residents are in the most comfortable place they want to eat and drink, and that they are happy with it. In between mealtimes my colleagues and I offered them snacks with various drinks and food e.g. tea, coffee, hot chocolate, Horlicks, Ovaltine etc., biscuits and cakes whilst staying in the living room or their bedroom. There are also residents who are unable to feed themselves. I always make sure that I assist them with feeding and drinking and also be planned to make sure that they are comfortable and to know what they are going to be eating or drinking in case there is something that they do not want. Any changes on residents nutritional preferences I always checked it with my manager or other staff before giving them other choices because they may have a special diet or allergic to something. 3.3 Explain how the specific eating and drinking abilities and needs of an individual with dementia have been addressed Getting to know the specific needs and the eating and drinking abilities of an individual should be addressed when helping the individual to make a choice in what they want to eat and drink. Also knowing the individuals abilities should also be in their care plan. I always ensure to check each individual’s care plan before providing them food or drink especially when he/she is first admitted in the residential home. I also double check their dietary needs with my manager or senior care staff to avoid errors that may affect resident’s behaviour and health. In my workplace, most of the resident’s changed their mind from time to time although there was a specific preference listed in their care plan. This will depend on their situation because some residents were unable to decide for themselves and were able to. I always made sure to consult them as they may forget of what they want or they may get fed up of sticking to one drink or food all the time. For example, based on Mr O’s care plan he likes orange juice but when I offered him the drink he refused to accept it. He asked me if he could have a blackcurrant juice instead. I respected his choice and gave him the blackcurrant juice. I also passed my experience to the other staff members for them to become aware of his new preference but he might also change his mind in other time. It was also important to observe and monitor a resident before taking an action to address them in eating and drinking. Another example, Mrs C had a normal food and drink diet, as her dementia progresses, she has developed a difficulty in swallowing and drinking. When I saw her suffered I immediately called the attention of my Senior to check and observe Mrs C’s condition. She then called the GP to further assess her and also speech language therapist was involved. After few assessments Mrs C was then changed onto liquidised meal and 1 scoop of thickener in every 200mls drink. Her care plan was reviewed and this information was also documented in her daily report so that other members of staff will be informed regarding her nutritional changes. 3.4 Explain how a person centred approach to meeting nutritional requirements has improved the well-being of an individual with dementia The person centred approach to meeting nutritional requirements has improved the well-being of an individual by improving their state of mind and their physical health. Based on 1.1 examples, by giving Miss K a one to one assistance during mealtimes she was able to eat and drink properly. Her ability to stand and walk was developed and I have noticed that she was calmer, polite and gentle when responding to carers. She also took her medication without any refusal or problem. The care and support my colleagues and I have given to Miss K has improved her sleep patterns, reduced confusion and anxieties as well as infections making her live a happier and healthier lifestyle. I always ensure to record any changes and important information regarding her physical and emotional condition to help  further assessment and also this will serve as an evidence practice for future observation and findings.