Instructions
Write a program and flowchart. The program should store the ages of six of your friends in an array. Store each of the six ages using the assignment operator. Print the ages on-screen using a “for” loop.
Here is what the output looks like.
Some may argue that In Vitro Fertilization, commonly referred to as IVF, is immoral and wrong, as it is thought it could possibly damage the health of the mother or the embryo during the process. Women should not face opposition in choosing In Vitro Fertilization due to the beliefs of others. People think that this is immoral for the woman, in which it attacks her self-respect since the barrier of human dignity through contraception has been broken, but I argue that it is not immoral because it is still contraception, just through a different way. Others believe that IVF should be funded fully by the government, as it is part of healthcare.
“The definition of a fetus is a being of at least 8 weeks of gestation, and before said gestation it is classified as an embryo. This is after the major structures have formed, including the vertebrae structure, limbs, and mouth and eye indents” (Shiel Jr). With IVF, the embryos are transferred into the uterus after they have been fertilized, and will attach to the uterine walls six to ten days after implantation. The total process will takes roughly four to six weeks. People have been using this method to conceive since 1978, which gives it a great track record with rare complications. Techniques will be progressing near the future, as technology is invented and improved every day.
IVF is an option for everyone, although it is mainly used by those who have no other way of conceiving a baby. Women-usually over 40- may have problems with ovulating, or their egg quality may be poor or low. Their fallopian tubes could be underdeveloped. Of course not all problems consist of females, men can have problems such as being stressed, a narrow urethra, or celiac disease. In Vitro Fertilization is bringing new hope to these couples who want to start a family. If you or your significant other has a genetic disorder that could be passed down to the baby, you may choose IVF for the pre-implantation genetic screening to make sure the embryo you transfer is healthy. IVF is the most common Assisted Reproductive Technology (ART) procedure. ART is specifically an umbrella term that includes all types of fertility treatments in which both the eggs and the sperm are handled. Eighty-five to Ninety percent of infertile couples in treatment do not require IVF, in which case a different form of ART may want to be used including Intracytopasmic Sperm Injection, Assisted Hatching, Frozen Embryo Transfer, Sperm or Egg Donations, Surrogates, or Gestational Carriers. You may want to choose on your own, but your fertility specialist, your endocrinologist, or your physician will work with you to choose the correct treatment for you.
The first In Vitro Fertilization baby conceived was Louise Joy Brown, born July 25, 1978 in Lancashire, England. Her parents had been trying to conceive for 9 years but were unable to due to blocked fallopian tubes. In 2010, a Nobel Prize for Physiology went to medical researcher Robert Edwards for his work to impregnate Louise’s mother, Lesley Brown. “Dubbed a “test-tube baby” by the press, Louise Brown was the subject of persistent media attention, not only during the pregnancy and after her successful birth but also many years later” (Manganaro). After her birth, which was hailed as a medical miracle, IVF has been used multiple times with over eight million babies born worldwide.
“On January 6, 1984 in Melbourne Australia, the world’s first IVF quadruplets were born, and they were all boys. “The babies, delivered by Caesarian section, were born six weeks premature in one-minute intervals beginning at 10:47 a.m.” (UPI).
The mother’s identity was kept secret for her safety.
The idea of IVF first began in when a paper published by Gregory Pincus and EV Enzmann at Harvard University raised the possibility that mammal eggs could still proceed through development in vitro. In 1959 that claim was finally laid to rest when Min Chueh Chang was the first to achieve live births of a mammal, a rabbit, by using IVF. The first reported In Vitro pregnancy was reported by the Monash research team in Australia in 1973, but resulted in an early miscarriage. Just 5 years later the first IVF birth happened in England of 1978, baby Louise Joy Brown. In 1983 it was proven the eggs don’t even need to be yours, just compatible with your body, as a woman without ovaries became pregnant using donor eggs with IVF.
Many believe In Vitro Fertilization to be wrong. Of course this is just due to their beliefs and religion. It all comes down to what the woman wants first, and what she believes. The common belief of IVF is that frozen eggs will prevent infertility. This is false; the biological clock is always ticking. Egg freezing may just slow down time enough. People think this is wrong for the egg to be frozen, as it is unnatural and uncared for. Eggs would be locked up in cold hard bins and left in storage for years untouched until used again. The longest successful thaw period was 14 years, meaning a woman had her eggs retrieved, then had them thawed and implanted 14 years later. Eggs are safely stored in a high secure facility, usually in a long-term storage unit. When you are ready, the eggs will be thawed in a lab environment. The egg will be fertilized and allowed to develop into an embryo for a few days. The embryos will then be transferred back in to your uterus.
There is major concern that some women may be pressured into using In Vitro Fertilization as so many people around them are pushing them to get that treatment that no other options are considered. Asides from IVF, some other options available are adoption, Intrauterine Insemination, Gamete Intrafallopian Transfer, and Gestational surrogacy. People should not be pulled towards one direction because everyone else is getting it. Many women are in fact pressured in to just having children in general.
As a result of the high value of children, the social consequences of infertility can be severe. For example, infertile women often face considerable stigma, mental distress, and potential exposure to domestic violence (Parent24).
This is why so many women are stressed into getting help to try to have children, to help themselves not get hurt.
“Social pressure, especially on women, is at the heart of much of the drive for biologic parenthood. Nevertheless, the fact that many infertile couples are willing to spend thousands of dollars and risk the physical and mental demands of IVF rather than adopt a child suggests a strong emotional need for biologic offspring that is not influenced by social pressures” (Goldworth).
People believe having a baby and going through the whole process together will strengthen the relationship with your significant other, so they may want to focus on this when searching for solutions for their infertility.
Women shouldn’t have to face these problems. Men do not face the same backlash from infertility as females, as there is a social stigma that society provides that sets a double standard. In fact, childless women are now becoming a trend. More and more women are realizing that they don’t want to have children, especially when others push their ideas onto them of what is the right thing to do in their position of society. The American birthweight has gone down to 3.8 million babies in 2017, and it’s expected to get lower. That was a historic low, and a new record. Only 60.2 births per 1,000 women, which had gone down from 62 in 2016. Women are also more active in the workforce in the present day, leaving less time to have a baby, much less to care for it. “Women are blaming themselves as individuals for something that is a deeply structural and societal problem” (Collins qtd in Forde). American women aren’t having enough babies to replace the current population, but experts weren’t at all surprised, citing the causes as the lack of mandatory paid family leave, supportive workplace policies, and affordable childcare.
Most people are unaware that gender selection doesn’t even exist, but with In Vitro Fertilization the option to choose the sex of your baby happens very often in fertility clinics. “When those embryos are a few days old, the prospective parents can choose to have them screened for genetic abnormalities using pre-implantation genetic diagnosis” (MacMillan). This means that the embryos are looked at closely underneath a microscope and a few cells are peacefully removed to be inspected to ensure they have the proper genetic makeup by looking at the pairs of chromosomes. Doctors look at the X and Y chromosomes for abnormalities, and in doing this the sex of the embryo will become obvious. Patients can choose which embryos to use, although their fertility doctor may suggest otherwise, or may choose to freeze other healthy embryos in later treatments.
Although IVF is an option for everyone, it is mainly used by those who have no other way of conceiving a baby. Women-usually over 40- may have problems with ovulating, or their egg quality may be poor or low. Their fallopian tubes could be underdeveloped. Of course not all problems consist of females; men can have problems such as being stressed, a narrow urethra, or celiac disease. In Vitro Fertilization is bringing new hope to these couples who want to start a family. If you or your significant other has a genetic disorder that could be passed down to the baby, you may choose IVF for the pre-implantation genetic screening to make sure the embryo you transfer is healthy. IVF is the most common Assisted Reproductive Technology (ART) procedure. ART is specifically an umbrella term that includes all types of fertility treatments in which both the eggs and the sperm are handled. Eighty-five to Ninety percent of infertile couples in treatment do not require IVF, in which case a different form of ART may want to be used including Intracytopasmic Sperm Injection, Assisted Hatching, Frozen Embryo Transfer, Sperm or Egg Donations, Surrogates, or Gestational Carriers. You may want to choose on your own, but your fertility specialist, your endocrinologist, or your physician will work with you to choose the correct treatment for you.
Despite the large number of live births due to IVF, the success rate doesn’t go over 40%. For women 34 and below the success rate is 40%. For women 35-37 it’s 31%. For women 38-40 it’s 21%. For women 41-42 it’s 11%, and lastly for women 43 and over the success rate is only 5%. Despite these small percentages, In Vitro Fertilization has an excellent track record. It’s the oldest assisted reproductive technology (ART) procedure. As of 1978, there have been no medical problems linked to this treatment. At first early studies did suggest that fertility drugs could lead to a risk of ovarian cancer or cancer of the female reproductive system but that has since been disproven. Many IVF treatment centers provide family planning options for the selection of donor eggs or donor sperm for those who are completely infertile, or for the LGBTQ+ community. In Vitro Fertilization success rates have been increasing more rapidly than its other partners of contraception. Intrauterine Insemination, for example has not gone through the same level of improvement of IVF and no ART procedure has had a record lasting as long as this. IVF is the suggested first option for single women and for same-sex couples.
Along with the happy stories come the sad. And that’s the reality of things, that IVF only works roughly 40% of the time if you’re lucky. You’re at a great risk for multiples, although this may be great news depending on the kind of person you are. The chance of having more than one baby increases by 20%, but this also increases your risk for miscarriage and preterm labor. Your chance of an ectopic pregnancy- when a fertilized egg implants outside the uterus-increases, and can severely injure the mother. Not only can IVF be risky for you and your baby, but it can cost a lot of time and money. There’s always the chance that your treatment may be cancelled simply because not enough follicles had developed, which in most cases happens up to 20% of the time. Sometimes In Vitro Fertilization side effects are undesired, painful, or humiliating. Some smaller side effects include headaches, hot flashes, bloating, irritability, bruising, acne, weight gain, and fatigue. More serious side effects include nausea, ectopic pregnancies, dizziness, and ovarian hyper stimulation. IVF takes up a lot of time and requires several trips to the doctor’s office to track the treatment process. This includes ultrasound imaging, blood tests, suppositories, retrieval of the eggs, and placement of the embryos.
On average in the United States, one cycle of In Vitro Fertilization costs roughly $12,400 for a couple using their own sperm and eggs. In Canada, the government is starting to fund parts of the IVF treatments, but only with limited coverage. “The Pre-Implantation Genetic Screening (PGS) costs on average $3,500 in the United States. Embryo Biopsies can charge $1,000-2,200. For single gene defects there will be additional costs” (Advanced Fertility Center of Chicago). Combining IVF with PGS usually costs between $17,000-25,000 in the United States including the hormonal medications needed for ovarian stimulation. Using donor sperm, donor eggs, or a gestational carrier would have additional costs. Families are looking for a way to lower the costs of IVF treatments and medications. Some parts of the treatments of cycles, such as ultrasounds or bloodwork, may be covered by your insurance. The older a woman gets; the more cycles she may need. This means that with each cycle, she will be forced to pay thousands of dollars more to conceive a child. In Vitro Fertilization is partially funded by the government in parts of Canada, so you will not have to pay for your treatments there. Four provinces- Ontario, Manitoba, New Brunswick, and Quebec- provide financial assistance for In Vitro Fertilization. Each province has a separate policy, and you must live in said province to gain credit. In other parts of Canada, treatments can cost about $10,000- $15,000.
Many believe that infertility is just the fault of the woman in the relationship, as she is the one in charge of growing and carrying the baby.
Infertility affects men and women equally. In couples experiencing infertility, approximately 35% is due to male factors, 35% is due to female factors, 20% of cases have a combination of both male and female factors, and the last 10% are unexplained causes (Reproductive Medicine Associates of Pennsylvania).
Therefore, it must be noted that both man and woman should be evaluated before drawing false conclusions, as it is fairly equal in tests that infertility affects both genders. Some lifestyles can contribute to infertility, like smoking, drinking, extreme heat, and drug use. Male infertility, along with some female infertility, can possibly be treated with lifestyle chances, medication, or surgery. “When modern men can fail in myriad ways in the eyes of society, even today, a woman is deemed by many to fail most conclusively, tragically and grotesquely when she hasn’t been able to bear children” (Ellen). One in 20 men have a low sperm count, and yet there are rarely any fundings on researches for the male fertility system. It was originally believed that since sperm is made over time in the male body, the quality is always high. The Harvard Medical School in Boston reported that sperm quality declines with age which makes it harder to father a child, and could affect the health of a child. Men’s sperm counts have reportedly reduced by more than 50% since 1970s, according to a study by Hebrew University of Jerusalem. Professor Sharpe said:
Apart from its dependency on high levels of testosterone, the mechanism of sperm production remained a “big black box” (Knapton)
Not much is known about male conception or contraception, and it is a running joke that there hasn’t been a new acceptable male contraceptive since the condom. Although it’s just as common as female infertility, male infertility usually goes undiagnosed and untreated more regularly. Fertility clinics must also accept that men are part of the problem and treatment as well. Some clinics suggest using their counselling services to deal with their responses and feelings to infertility and treatments.
It’s a known fact that multiple pregnancies can occur from IVF treatments when more than one embryo is implanted into the uterus. “Full government funding of IVF treatment would lower rates of multiple pregnancies and their associated risks of complications for mothers and babies…” (Cockerell). This would be healthier for the mother and baby, and it is recommended that the Government fund a full three cycles worth of IVF. According to Tarek El-Toukhy, the lead author of the report:
Multiple pregnancies are the greatest avoidable risk of IVF. The health and financial burden it places on women, families and the NHS cannot be overstated (qtd. in Cockerell).
Recently in Ontario, Canada, it has been announced that there will be limited coverage for In Vitro Fertilization, making it the third Canadian province. “Sure, infertility isn’t a life-threatening problem, but reproduction is an indelible part of human functioning” (Dvorsky). Not being able to have a child is heartbreaking to some people. If they do not have enough money to be able to pay for the treatment of IVF, they will do irrational things. Therefore, when the government steps in to fund the treatment, families will be grateful and happy.
Whether it was fully or partially, if In Vitro Fertilization was funded by the government it would certainly cause repercussions to the economy. Although common, IVF is an expensive way of remedying infertility in the United States, and it does not address the cause of fertility, only allows reproduction. The European Society of Human Reproduction an Embryology in Prague as recently been researching in infertility, IVF treatments, and government funding. According to Professor William Ledger from the University of Sheffield, leader of the team:
“For each baby born, the economy makes a net gain. The average $17,088 that it costs to create a baby using IVF is far exceeded by the average of $210,318 in taxes and insurance that will be paid by an adult in full-time employment. Thus for each state-funded IVF baby, our economy apparently benefits by a net gain of $193,244” (qtd in Smajdor)
This is not at all accurate, as Smajdor relays in her report. If large numbers of people are born through IVF rather than through natural conception, than this loss would continue growing and become rather significant. Therefore, citizens who are not born as a result of IVF save the economy $17,088 per person born compared with that of In Vitro babies, only if it is NOT state or government funded. Some want the government to fund IVF purely to reduce the number of multiple births. It is a well-known fact that IVF treatments significantly increase the woman’s chance of giving birth to multiple babies, which could lead to miscarriages, complications, or could be fatal. If this is the case, why do physicians not already do these procedures? Of course, if the government did in fact gain control of funding in IVF treatment they would be able to control the embryo transferal rate. In Quebec, Canada the state pays for a single IVF treatment and doctors will implant only one embryo. “Multiple births in Quebec have dropped from roughly 30% to 5% after IVF coverage from 2010 to 2015” (Hendry).
Although IVF may be irrelevant, immoral, or disgusting to some, it can be heartbreaking, frustrating, and debilitating to others. Men and women are already suffering enough through the In Vitro Fertilization process, any opposition would be unbearable. Therefore, nobody should face any trouble or discrimination when going through the IVF treatment. It is their own choice and they are their own human beings with legal rights.
Works Cited
Comparing Barriers to Healthcare in Diabetic Ethnic Minorities in Urban Versus Rural Settings
Issue/Problem
There has been abundant research done in the study of ethnic minorities and their access to healthcare. Attention has been paid to common barriers such as language, knowledge and communication, which are all culturally influenced. Most of this research has focused on general access to healthcare and not specific diseases. There is very little reserach on comparing barriers that exist depending on location. The issue I would be exploring in my study is determining the differences in potential barriers that exist in access to healthcare among ethnic minority diabetic individuals in urban versus rural settings. The potential barriers in access should differ depending on the location since the type and amount of resources present varies in both settings. This study hopes to contribute to the literature by focusing on diabetes and determining the differences in barriers that exist for ethnic minorities in the urban versus rural settings.
Background
The regions with the greatest incidence of diabetes are Africa and Asia, where the rates are expected to rise two or three times (Oldroyd, Banerjee, Heald & Cruickshank, 2005). The three countries with the highest prevalence of diabetes are USA, China and India (Oldroyd et al., 2005). The largest increases are expected in Brazil, Indonesia, Bangladesh , Pakistan and Japan (Oldroyd et al., 2005). Type 2 diabetes is most common among ethnic minority groups residing in developed countries (Oldroyd et al., 2005). Diabetes is a chronic illness that requires continuing medical attention as well as self-management education (American Diabetes Association, 2002).
Renfrew et al. (2013) reported on barriers to care present in a Cambodian population near Boston. The study highlighted the importance of a culturally sensitive healthcare system for Cambodians (Renfrew et al., 2013). The researchers found the following barriers in access to healthcare: patients’ views of chronic disease, diabetes management, communication, psycho-social factors, diabetes etiology and explanatory models and fears of interacting with the healthcare system (Renfrew et al., 2013). The researchers were advocating for a culturally sensitive approach to healthcare for this population because most of the barriers identified were culturally influenced. Some of these culturally influenced barriers were patients’ mistrust in the western model of health, replacement by alternative medicine, belief that western medicine is an ‘instant’ cure, and desire to please the practitioners (Renfrew et al., 2013). Researchers found these barriers among other which were influenced by cultural beliefs of the patients (Renfrew et al., 2013).
Smith, Garie, and Schmitz (2014) illustrated self-reported use of diabetes healthcare services in a Quebec community-based sample. The study found that people with major depression were more likely to be high users or non-users of diabetes healthcare services (Smith, Garie, & Schmitz, 2014). People with major depression reported more problems with accessing diabetes healthcare services (Smith, Garie, & Schmitz, 2014). People with major depression perceived more problems with the healthcare they received (Smith, Garie, & Schmitz, 2014). The results also showed that people with major depression perceived problems with the length of time they had to wait to see a doctor, that there is a lack of specialist care in their area and are more likely to report having problems getting to the doctor due to transportation and health problems (Smith, Garie, & Schmitz, 2014). The low service users represent a particularly vulnerable group who may need to be targeted by interventions in order to encourage them to visit a doctor (Smith, Garie, & Schmitz, 2014). The finding in this study was important because it showed that perceived problems with accessing healthcare services could impact utilization of healthcare.
Wagner et al. (2013) reports on the effects of trauma on the risk for disease development and access to healthcare. Mental health problems among Southeast Asian refugees are well known but the long term affects of mass violence as re-settled refugees age are less well described (Wagner et al., 2013). This study investigated any potential relationship that may exist between trauma symptoms, self-reported health outcomes, and barriers to healthcare among Cambodian and Vietnamese persons in Connecticut (Wagner et al., 2013). Healthcare access and occurrence were measured regarding patient-provider understanding, cost and access, and interpretive services (Wagner et al., 2013). Individuals with greater levels of trauma symptoms were associated with greater lack of understanding, cost and access problems, and the need for an interpreter (Wagner et al., 2013). Although these Southeast Asian immigrants arrived to United States as refugees more than 20 years ago, there continues to be high levels of trauma symptoms among this population which are associated with increased risk for disease and decreased access to healthcare services (Wagner et al., 2013). This article was interesting because it didn’t mention the usual barriers we talk about when it comes to access to healthcare (such as language).
The last article I found was titled, ‘Diabetes care quality is a question of location’ by The Press Association. The article talks about the standard of diabetes healthcare in England depending on a postcode lottery (The Press Association, 2013). The quality of care patients receive depends whether it’s provided by a GP or a hospital, it depends on the location (The Press Association, 2013). The report found big regional differences in patients’ access to quality, integrated care (The Press Association, 2013). Some areas were four times more likely to get annual checks needed to manage their conditions (The Press Association, 2013). This article is similar to my research project however instead of rural and urban settings, it focused on location in terms of where healthcare was sought, a clinic, hospital, or GP (The Press Association, 2013).
Purpose/Aim of your Project
The aim of my research proposal is to identify any potential barriers that may exist in access to healthcare among ethnic minority diabetics in rural versus urban settings. My original research proposal was investigating potential barriers in access to healthcare among ethnic minority diabetics without the location factor. When I started looking up literature, I found there was already enough information in this area and my research wouldn’t add anything distinctive to this field. I started reading more articles and doing a literature review, I didn’t find any studies comparing potential barriers in urban and rural settings. After reviewing the comments I received from the professor after the first assignment, I was actively looking for gaps in research when reading articles. Therefore, I decided to alter my original question after I found this gap. If there are differences in the types of barriers present in these two distinct settings, then hopefully my research would bring this to the forefront of healthcare providers and policymakers and would result in equitable care in urban and rural settings.
Rationale/justification
Canada is known for its multiculturalism with Ontario being the most ethnically diverse province [3]. Almost 13.4% of Canadians identified themselves as being a visible minority in the 2001 census [3]. Since diabetes is most prevalent in ethnic minorities and Canada is one of the most ethnically diverse countries, it’s understandable why there is an abundance of research in this field.
There is a currently a gap in research that my research would potentially fulfill. While reading articles present in my field of interest, I couldn’t find any that compared barriers in access to healthcare present in urban versus rural settings. This sort of information is necessary for policymakers to reduce or even eliminate these barriers to achieve high quality of care for diabetic individuals in the future. If the results conclude that the barriers present in the urban settings differ from the ones present in the rural setting, then there is work to be done. We must ensure health equity when it comes to access to healthcare and eliminate any geographical factors that come into play. We must ensure healthy places for all individuals but especially diabetics who require a lot of social and medical support. Also, the need for culturally appropriate health care to accommodate the unique needs of ethnic minorities. The other research gap I found was studies didn’t talk about information loss during translations, either during patient and practitioner interactions or researcher and patient interactions. I think it’s an important factor to consider in studies consisting of subjects who speak another language. For instance, in one study the researchers found that patients didn’t understand the concept of chronic disease and I believe that this was due to information loss during translation. Therefore, the purpose of this study is to provide healthcare professionals with information on the different barriers that exist among urban and rural settings in order to achieve health equity.
Researchable research question
The research question for my study is: What are potential barriers in access to health care among ethnic minorities with diabetes in the urban versus the rural settings?
Intellectual guideposts
Ontology is the theory of being or what reality fundamentally is, in social sciences it is closely linked with ethical implications (David & Sutton, 2011). The basic premise of phenomenological ontology is that for humans reality is not something separate from its appearance (David & Sutton, 2011). The way we think about ourselves is fundamental to what we are (David & Sutton, 2011). For me, I think that health is a fundamental aspect of being human, it’s a basic right and an underlying factor in our existence. All individuals should have access to healthcare and this access should be equitable, regardless of one’s location.
The particular ‘epistemological’ (theory of knowledge) stance (positivist, critical theoretical or interpretivist) will be grounded in assumptions about the basic character of being human (David & Sutton, 2011). My research project is rooted in the interpretivist paradigm because I believe that access to healthcare is an important aspect of being human. Health is an important part of being human and to achieve this health, we need a culturally sensitive and acceptable healthcare system for ethnic minorities.
Axiology is about the values each individual has and its influence on their research [print]. There are no value-free sociologies, values are foundational for knowledge-producing systems [print]. The topic of this study began with a personal experience I have with diabetes but eventually filtered out to form a researchable question that could add value to the field. Coming from a background in biology, we are taught that there is something wrong with the body and it needs to be fixed, that health is solely a biological factor. This was purely based in a positivist paradigm which is aligned with quantitative research. I believe that healthcare access regardless of ethnicity, location, age, sex, or gender is crucial for all humans. Coming from a country with a poor healthcare system also influences my view in terms of healthcare access. I believe that health has a strong social component which cannot be measured quantitatively and thus I adopted an interpretivist and qualitative approach for my study.
The best way to undergo my study would be by utilizing a qualitative approach, more specifically, open-ended interviews. I want to gain insight into the barriers that are present for each individual from these ethnically diverse backgrounds. I want to understand their perspective and beliefs, and how these influence their use of the healthcare system. After I understand these barriers, I will compare the difference in the types of barriers that are present among those living in the urban and rural settings. Since I am using open ended interviews, I believe the best rhetorical choice would be passive. I believe the participants in the study should have the freedom to talk in depth about the issue at hand. I don’t want to influence their answers in any way but at the same time they should have the opportunity to freely express themselves. Especially in my study which includes ethnic minorities, there may be language barriers present so this freedom to answer freely would be a plus for the participants.
Interpretive/theoretical frame
My research project will be embedded in the interpretive paradigm. More specifically, I will be adopting the constructionism theory. “Constructionists focus on how people create meaningful social reality for themselves through their interactions and thereby create a sense of order through shared beliefs… (David & Sutton, 2011).” Constructionists adopt qualitative approaches such as interviews and unstructured observation (David & Sutton, 2011). I believe that culture is important in defining health, it influences our behaviour in terms of how we access and utilize our healthcare system. For example, Renfrew et al. (2013) talked about how people’s perceptions on chronic illness affected their use of the healthcare system. One’s culture, beliefs, views and attitudes affects their behaviour in terms of healthcare use. This is relevant to my research project because I want to understand the barriers that exist for ethnic minorities with diabetes but with the added element of comparing these barriers in two settings: urban and rural.
References:
American Diabetes Association. (2002). Standards of medical care for patients with diabetes mellitus.
Diabetes Care, 25,
533-549.
David, M., & Sutton, C. (2011). Social research: An introduction. London : Sage Publications.
Oldroyd, J., Banerjee, M., Heald, A., & Cruickshank, K. (2005). Diabetes and ethnic minorities.
Postgrad Medical Journal, 81,
486-490.
Renfrew, M. R., Taing, E., Cohen, M. J., Betancourt, J. R., Pasinski, R., & Green, A. R. (2013). Barriers to care for Cambodian patients with diabetes: Results from a qualitative study.
Journal of Health Care for the Poor and Undeserved, 24
(1), 633-655.
Smith, Garie, & Schmitz (2014). Self-reported use of diabetes healthcare services in a Quebec community-based sample: impact of depression status.
Public Health, 128,
63-69.
The Press Association. (2013, December 10). Diabetes care quality is question of location.
Nursing Times.
Retrieved from
http://www.nursingtimes.net/home/clinical-zones/diabetes/diabetes-care-quality-is-question-of-location/5066307.article
Wagner et al. (2012). Trauma, healthcare access, and health outcomes among Southeast Asian refugees in Connecticut.
Journal Immigrant Minority Health, 15
, 1065–1072.
Peer Feedback Form
Yes, the author is studying healthcare access by immigrants from two different backgrounds: those from developed countries and those from underdeveloped countries. It is evident in the assignment what the researcher will be trying to determine and why they have chosen to do so. There is a gap in understanding barriers in access to healthcare that exist between immigrants from developing countries and those from developed countries.
The approach is qualitative and this is a suitable choice. Since the researcher wants to understand why people over or under use the healthcare system and wants their opinion/views, it’s best to use a qualitative approach. By using interviews, for example, they can gain insight into the factors that influence people to use or not use the healthcare system in their country.
Yes, the author has clearly explained why they want to do this research and what gap it will fill. They have mentioned that previous research has been done on immigrants and access to healthcare, however, none have focused on the differences in this access based on country of origin (developed/developing).
Yes, the aims are quite clear. The author wants to understand the factors that prevent immigrants from using the healthcare system based on their country of origin, the Western or Eastern countries. They want to compare these factors and understand if any differences exist.
The question is clearly stated and is researchable. It will fit with the qualitative approach that the researcher has chosen because it will allow them to understand from the immigrants’ views why they chose or didn’t choose to utilize the healthcare system. They want to understand the barriers that exist for them individually and thus, the best approach is to use qualitative methods.
Yes, the author used the intellectual guideposts to explain her position on each one. The use of the constructionism theory in this research proposal makes sense. They want to understand the barriers that exist for each individual and this is influenced by how people create and perceive their realities, the basis of constructionism.
It is quite evident that this research is based on the interpretive paradigm. As she stated in this assignment, “The largest factor guarding our interpretations of the social world is culture.” This perfectly fits with this research study because I’m sure that most of the barriers that exist in access to healthcare are influenced by culture. This is especially true for most immigrants who come from countries that are different culturally.
Overall the assignment was very well done, however, I’m just wondering if you are concentrating on new or long term immigrants. I think this would potentially affect the types of barriers that are present. For example, language or knowledge would be more of a barrier for newer immigrants. Maybe you could control for this aspect, as it could be a potential confounder. Good luck!
1
Nurses as Leaders in Health Care Reform
As healthcare delivery in the United States continues to evolve, either through mandates, improved technologies, and training, or other drivers, nurses remain at the forefront in facilitating the success of new initiatives. In 2010, the Institute of Medicine formed a committee of experts to address the following question: “What roles can nursing assume to address the increasing demand for safe, high-quality, and effective health care services?”
Question:
Identification of the characteristics of mentors that have been (or could be) most successful in recruiting and training diverse nurses and nurse faculty.
Post a description of the priority above and select the benefits and challenges of further researching this area. Provide an overview of the articles you found (using appropriate APA citations) relating to this priority, and highlight any key findings. Explain how continued research in this area could strengthen the ability of nurses to lead in both individual organizations and as advocates of health care reform.
Topic 2 Mandatory Discussion Question
The American Cancer Society (ACS) is a nationwide, community-based, voluntary health organization dedicated to eliminating cancer as a major health problem. Together with its supporters, ACS is committed to helping people stay well and get well by finding cures and by fighting back.
Critical Thinking Questions:
1. Imagine that a family friend or colleague has just been diagnosed with cancer. Explain how the American Cancer Society might provide education and support. What ACS services would you recommend and why?
2. According to statistics published by the American Cancer Society, there will be an estimated 1.5 million new cancer cases diagnosed each year over the next decade. What factors contribute to the yearly incidence and mortality rates of various cancers in Americans? What changes in policy and practice are most likely to affect these figures over time
3. Select a research program from among those funded by the American Cancer Society. Describe the program and discuss what impact the research will have on the prevention or treatment of cancer
The International Council of Nurses and the World Health Organization defined nursing as a profession or practice that involves independent as well as collaborative care of all individuals, families, communities and societies, sick or well in all state of affairs. Nursing includes the promotion of health, prevention of illness, and the care of ill and provision of rehabilitative services to terminally ill patients and those living with disabilities to maintain the optimal health and the quality of life aspect in the definition of health (ICN 2012).
Nursing is both art and practice thus making it a complex profession that requires vigilant competent and committed personnel to provide services to the public taking considerations to key nursing roles such as advocacy, promotion of a safe environment, research, and participation in developing and reviewing of policies and inpatient and health systems management, and continued education (ICN 2012). Like any other profession, nursing is governed by a set of ethical principles/requirements; high level of education commits to the professional code of ethics/code of conduct and to protect the interest of the public. According to Brown, (n.d.), the code of
ethics for nurses
focuses on the professional behaviour and on making sure decision making is client oriented as much as possible and outlines ethical responsibilities of the nurse. It is the responsibility of the whole nursing fraternity to have a copy of the code available at all times, know and understand the content, abide by the code as well as a duty to effectively and carefully practice their profession.
It is very important for the nursing profession to have and understand their code of ethics. This paper will discuss the code of ethics in details including the purpose and the implications of the code of ethics.
The Nursing and Midwifery Board of Australia, (2018), refer to the code of ethics for nurses’ as an important document that outlines the legal requirements, professional behavior and conduct expectations as well as obligations for all nurses, in all areas of practice. The code further describes the principles of professional conduct guiding safe service delivery and clearly summarizes the conduct expected of nurses by their clients/patients, colleagues and the community at large (Lachman 2009). The code is developed such that it is in harmony with the country’s Law.
The code consists of seven principles of conduct, grouped into focus areas “domains”, each with an explanatory statement and practical guidance to demonstrate how it is applied in nursing practice. Supporting the code of ethics is the expectation that nurses will use their professional judgment to deliver the best results in their area of practice (Gibbons S. & Jeschke E 2012 and Haddad & Geiger 2018).
The code of ethics is a very important tool for nurses to have because nursing is a very complex and dynamic profession that deals with human lives; omissions, substandard of care and negligence are not tolerated. The code reminds nurses of their primary focus which is centered around the care and the rights of their patients. Limentani (1999) mentioned that when patients seek medical assistance they often feel at risk yet; there is a need to share intimate and vital information about their lives thus the need of the code to shape the behavior of the nurse as she/he takes care of the patient professionally.
Nurses are expected to provide nursing care the correct way at the very first time they provide the service according to the code. The code should be ethical effective to provide guidance on managing ethical issues ‘dilemmas’ that might arise at the societal level, the administrative level, and the clinical level.
According to the ICN (2012) an ethical effective code act as; a brief statement of the ethical obligations and responsibilities of every individual who enters the nursing profession, profession’s non – negotiable ethical standard and an expression of nursing’s own understanding of its commitment to society to avoid unnecessary misconduct. Nursing nationally and internationally is expected to function according to the code.
LSUA, (2016) made it clear that patients have the right to make decisions about their healthcare and decide to accept or refuse treatment, however, they should expect to receive accurate and complete information about their conditions from nurses who are taking care of them and make informed decisions based on the information shared to them.
While taking care of the client there are many ethical issues that the nurse may encounter where only the code can defend the practicing nurse thus it is very important in nursing profession (Zahedi, et. al 2012). Nurses should be observant of these ethical issues as they might sometimes conflict with the very same code of ethics, nurse’s values and beliefs resulting.
Consideration should be made especially for the first four (4) principles (autonomy, beneficence, justice, and non-maleficence). According to Haddad & Geiger (2018), nurses should remember that all patients have a right to be treated fairly and equally while healthcare workers including nurses have a duty to refrain from maltreatment, minimize harm, and promote good health towards patients (beneficence).
Nurses are also expected to assist patients with tasks that they are unable to perform on their own such as bathing a bedridden patient, keeping side rails up for a restless patient, and/or providing medications as prescribed and on time. Failure to adhere to the principles of the code may result in suspension from work, dismissal, lawsuits as well as forfeiting certificates by nurses. So it is for those reasons it is very important for nurses to be up to date with their code of ethics.
The code of ethics for nurses is a guide for action based on social values and needs. It has meaning only as a living document if applied to the realities of nursing and health care in a changing society. To achieve its purpose the code must be well understood, internalized and used by nurses in all aspects of their work. It must be available to nurses throughout their work lives.
List of References
A patient’s authorization for disclosure of PHI must include the purpose of the disclosure and what information is to be released if the PHI relates to A. treatment for substance abuse. B. sexually tr
A patient’s authorization for disclosure of PHI must include the purpose of the disclosure and what information is to be released if the PHI relates to A. treatment for substance abuse. B. sexually transmitted diseases. C. pregnancy and genetic diseases. D. adoption.
The belief of the restorative powers of fresh air and sunlight by a nurse in charge of a premature unit in a hospital in Essex, England in 1956 showed the way to the discovery of sunlight as treatment for jaundice infant thus lead to the invention of phototherapy devices to treat jaundice (Stokowski, 2006). Although sunlight helps in the treatment of jaundice, the American Academy of Pediatrics (AAP) (2004) mentions that the practice is not considered safe or reliable for jaundice treatment. Ultraviolet irradiation coming from sunlight and artificial therapeutic lamps possess toxic effects that we should be concern about (Matsumura and Ananthaswamy, 2003).
The writer is a staff nurse currently employed in a neonatal intensive care unit of a tertiary hospital. The aim of this essay is to critically appraise available literature pertaining to the efficacy of conventional phototherapy in the newborn with hyperbilirubinemia. Nurses in our unit depend on doctors on how many phototherapy devices we are suppose to expose the infant with elevated serum bilirubin levels. From the ordinary fluorescent lights to the fibre optic ones, we could not possibly determine which is most effective to be used in the treatment of hyperbilirubinemia. Majority of nurses know that it lowers bilirubin levels but without knowing what device suits best. Through research and evidence practice, data accumulated will be used in determining which technique or method produces greater positive result.
In this literature review, the writer will examine different studies on how to determine the efficacy of a phototherapy device, methods to enhance a phototherapy’s irradiance and the manner which bilirubin react to light. The treatment approach will greatly affect patient care if nurses know how technical they are delivering phototherapy for the newborn. Continuous phototherapy may not be as effective as intermittent (Stephenson, 2000). Shortening the length of exposure to phototherapy means shortening hospitalization therefore the infant could spend more time with his or her parents (Djokomulijanto et al. 2006).
Articles used in this critical appraisal were mainly acquired using the electronic database CINAHL and Medline on EBSCOHOST, Cochrane, and PubMed. Search engines were also used particularly Google Scholar. Some articles were hand searched; others given by colleagues, medical books on hand and the hospital library were also employed. The search strategy utilized in search of the relevant literatures used the following keywords and phrases either combined or alone, phototherapy, hyperbilirubinemia, jaundice, efficacy, preterm and newborn. There are 886 articles leading to the topic thus limits were applied to the date of publication and language used, but 20 articles were used out of this limits due to the significance of its content. The literatures are classified as quantitative research, literature reviews and some are opinionated materials.
The framework for extracting information from research based literature (Appendix A) was used as a very useful tool in this review. After marking the articles’ relevance to the review, the marking with higher ratings was given more emphasis.
It is estimated that neonatal jaundice is likely to occur in 60% of term newborns in the first week of life (Chou et al. 2003; Maisels and McDonagh, 2008). Hyperbilirubinemia is increased levels of the bile pigment in the blood with symptoms of jaundice, lack of appetite and fatigue (Glanze, 1996). Phototherapy is the use of visible light for the treatment of hyperbilirubinemia (Stokowski, 2006). The use of phototherapy is to reduce the increasing level of bilirubin to prevent exchange blood transfusion (Stephenson et al. 2000; Gomella et al. 2004). It converts bilirubin into products that can pass by the liver’s conjugating system and be excreted to the bile or in the urine (Maisels, 2006). If delayed treatment or untreated, it might lead to a neurological disorder called kernicterus and may possibly affect the infant’s development in the future.
The widely accepted choice for both controlling and preventing hyperbilirubinemia is phototherapy (Granati, 1983). Phototherapy is a simple treatment however, its application does not have a standard. Newman et al. (2009) contends that one gap in evidence in the use of phototherapy is the number needed to treat with phototherapy from the guidelines currently recommended. The factors to consider in determining it’s efficacy according to Vreman et al. (2007) are the distance of the infant from the light, length of time to be exposed, body surface area to be treated, the severity of jaundice, and the phototherapy device itself.
Phototherapy evaluation was determined by the potency of the light (bandwidth and peak emission), the dose (irradiance or intensity) where light reaches the infant and the total body surface area (BSA) the light can treat (Vreman et al. 2007). In a level one nursery hospital in Malaysia, a randomized controlled trial clinical trial conducted by Djokomulijanto et al. (2006) was made. The study was made to determine the efficacy of phototherapy if used with white reflecting curtains. In this trial, 100 infants are included, 50 in each group and were randomized either to receive phototherapy with curtains on both sides or without the white curtains. The unit from the infant is set to 45cm as standard distance. The primary outcome measure is the decrease in bilirubin level 4 hours after the initiating phototherapy against the baseline. The secondary outcome measure is the length of time the infant is under phototherapy treatment. In the control group, 49 infants are allocated while 51 infants for the intervention group. 3 of the infants, 1 from the intervention group and 2 from the control group were exited in this study due to high levels of bilirubin close to the exchange transfusion level. If TSB levels nearly reaches or exceeds 12mg/dL, an exchange transfusion should be considered (Gomella et al. 2004).
In the intervention group the mean standard decrease of bilirubin after 4 hours is 27.62(25.24) µmol/l while for the control group is 4.04 (24.27) µmol/l (p<0.001). The median duration of phototherapy is 12 hours (25th quartile 7h, 75th quartile 14h ) in the intervention group and 34h(25th quartile 17h, 75th quartile 40h) for the control group.
The median duration of phototherapy for the intervention group is shorter by 22 hours compared to the control group. The mean standard deviation serum bilirubin level 24 hours after phototherapy was discontinued is not significantly different between the intervention and control group. This is in congruent with Tan (1982) study which demonstrates that further phototherapy after a decrease of 5mg/dL diminishes the efficacy of phototherapy. The infants do not need repeat phototherapy for rebound hyperbilirubinemia. None of the infants have temperature instabilities either hyperthermia or hypothermia. Significant weight lost was not also seen with the infants. All infants passed the otoacoustic emissions test on both ears. No neurodevelopmental abnormality was noted before the infants discharge.
Although the author made a good clinical trial, the writer believes that some key factors were omitted in this study. The author failed to mention if the infant was nursed in a double walled incubator or in an open cot. The use of 6 blue fluorescent bulbs is an uncommon combination seen in phototherapy units in the writer’s workplace. Blue lights are discomforting for staff in hospitals because it causes nausea, headaches and dizziness (Levene et al. 1980). The use of blue and white combination of lights is less disturbing to staff and gives a better visual assessment of the infant.
The American Association of Pediatrics Policy Statement on Jaundice (2004) states that the distance of the light source from an infant has a dramatic effect on the spectral irradiance, thus affecting treatment. It is possible to bring the infant as close as 10 cm to the fluorescent tubes (AAP, 2004). Maisels and McDonagh (2008) also states that “The dose and efficacy of phototherapy are also affected by the infant’s distance from the light (the nearer the light source, the greater the irradiance).” Although the AAP (2004) established these guidelines, their recommendations do not indicate that it is a standard for medical care.
Stephenson et al. (2005) recommends that the ideal distance of the infant from the phototherapy unit is 45cm, if the infant is inside the isolette there should be a 5cm distance between the wall and phototherapy. The walls of the isolette will protect the infant from ultraviolet irradiation but not from the irradiation needed in treating hyperbilirubinemia (Stephenson et al. 2005). Recent studies outlined by Walker et al. (2007) suggest that delivering phototherapy treatment to a full term healthy infant in an isolette is not as effective as giving it in an open cot.
Further quantitative research should be made because the writer can not presently locate at the moment any study or research that used specific distance of the infant from the phototherapy unit as the factor showing the efficacy of the phototherapy lights.
In a qualitative study conducted by Granati (1983), he investigated the in vivo and in vitro relationship between the hematocrit (HCT) and the effectiveness of phototherapy and the varying effect of skin area exposed to light. For the first study of the in vitro effect of different HCT on bilirubin photodegeneration, they prepared 4 bilirubin solutions. These samples are exposed in blue lights for 24 hours in a 3 cm petri dish. The irradiation at the level of the solution is 22 µW/ cm²/ nm and the wavelength was between 425 and 475nm. The solution was then placed in a 20 incubator continuously agitated. After the incubation, the bilirubin concentration was measured. For the in vivo effect of different HCT on bilirubin photogeneration, 57 infants who had undergone phototherapy for development of nonhemolytic hyperbilirubinemia were utilized. The group is divided into two; each group is similar to age, sex, weight, gestational age, time of treatment, and baseline serum bilirubin level but differs in HCT during the phototherapy period. The mean HCT of the first group of 30 infants is 67 ±5% (60-74) while the HCT for the second group of 27 infants has a mean HCT of 50 ±5% (45-58), p < 0.01 using the student’s t test.
The hyper viscous group did not manifest any significant symptoms related to cardiovascular, respiratory, gastro intestinal or central nervous system. After 24 hours of phototherapy 6 of the infants were treated prophylactically with partial exchange transfusion. The decision to perform or not to perform partial exchange transfusion was decided by a physician who is not involved in the study, and the physician’s basis is the evaluation of clinical data. In the test involving multiple direction phototherapy versus single direction phototherapy, 20 full term infants with developmental jaundice (nonhemolytic hyperbilirubinemia) are divided into to groups. For the first group multiple direction phototherapy (MDP) was used. The phototherapy had an intensity of 22µW/cm²/nm at wavelengths of 425-475 nm located both below and above the level of the infant with initial serum bilirubin levels of 12.5 ±0.4mg/dl. On the second group the intensity is similar to the first group but only placed above the infant with baseline level of 12.8 ±0.5mg/dl.
The use of Photo-Ictometer was used in acquiring the bilirubin concentrations. To check the presence of metastable geometric isomers, the serum bilirubin solution is washed in the dark with chloroform and then the use of petroleum ether. The results show on the first study that bilirubin photodegradation is high if HCT is low. For the in vivo, there was no significant difference in the decline of bilirubin concentration for the high HCT group or normal HCT group. The results show that hematocrit does not influence the efficacy of phototherapy but the area of skin exposed to light does have a great contribution in the light treatment.
Bilirubin is absorbed toward longer wavelengths at around 475nm, and lights that have longer wavelengths penetrate deeper into the skin. Green lights may penetrate deeper into the skin with a photon of 510 nm but they have the possibility not to be absorbed by bilirubin (Rubaltelli, 2007). Bilirubin is absorbed beneath the skin in light treatments, since preterm infants have lesser skin layers compared to a term or near term infant, they have greater bilirubin absorption. This observation is confirmed by Montcrieff and Dunn (1976) where “Phototherapy seems to control the plasma bilirubin level satisfactorily in very low birth weight infants, but frequent measurements on the second or third day of life are advised.”
This is in contrast with Pritchard’s (2004) randomized control trial of preterm infants with birth weights greater than 1500g and less than or equal to 36 weeks gestational age were randomized to be nursed naked or partially clothed with only disposable nappies being used. 59 babies were included in this trial. 30 infants were assigned to the partially clothed group while the 29 were assigned in the naked group. These babies were exposed to conventional overhead phototherapy treatment with irradiance of 6µW/cm²/nm and wavelengths of 425-475nm, double walled isolettes and 35cm beneath the lamps. After 24 hours of treatment mean TSB for the group with nappies was 15.4% (while for the naked group was 19% () with a mean difference 3.6% 95% CI -5.1, 12.3. It is concluded that there is no significant difference in reducing total serum bilirubin levels using either practice.
It is also a common thing to cover the genitals of naked babies under phototherapy. Ennever (1990) claims that “The practice of covering the gonads of infants under phototherapy has little scientific basis.” He claims that the amount of genotoxic irradiation received babies under phototherapy is only a fraction of the genotoxic irradiation an infant will receive for the first year of their life.
Different studies showed various results in trying to determine the efficacy of phototherapy in treating hyperbilirubinemia in the newborn. According to Pritchard et al. (2004), nursing the infant with or without nappies had no significant difference to decrease total serum bilirubin levels while Maisels (2006) claims that skin exposure is an important factor in improving the device’s efficacy. The use of a white cloth around the cot in Djokomulijanto et al. (2006) study could possibly be the most simple efficient device attachment enabling the increase in a conventional phototherapy’s efficacy. Although the results are promising, some other relevant situations in the NICU were not tested. Wentworth (2005) states that phototherapy devices are manufactured differently from each other and not all are effective. Care should be taken in considering what kind of phototherapy device to use. The combination of important criteria identified, the more informed decisions we make. Not all infants are the same hence their treatments may be considered in a case to case basis.
It would be a good and probably the best preference if a hospital or clinic will procure the best equipment out there. Being the best doesn’t mean to be the most expensive equipment, but being the most efficient in trying to reduce bilirubin levels in infants.
There is no doubt that phototherapy is considered to be the primary choice in treating and preventing hyperbilirubinemia in the neonates (Vreman, 2008). Although research studies have proven that phototherapy decreases TSB levels, there is no specific numbers to treat hyperbilirubinemia. The AAP (2004) established a guideline but does not consider itself as the treatment regimen. After reading the articles on hand, the writer recommends that more quantitative research studies should be conducted particularly in measuring irradiance and serum bilirubin levels in various sites of the infant.
Outcome 1 – Understand working relationships in health and social care
1:1
explain how a working relationship is different from a personal relationship:
A working relationship
is where your attitude is to be more reserved yet professional. You will be placed with people that you would work with as part of a team, each of you will work towards achieving the same priorities of care, working together knowing the procedures of the workplace. You must be aware of your responsibilities for any errors or mistakes, being aware that you are accountable for your actions. You are not in the job to like the people you work with but, having respect for your fellow work colleague is vital as well as obtaining the same in return. So then your personal opinions and feelings are best kept to yourself. A working relationship must have good professional communication skills.
A personal relationship
is a relationship through your own choices, like a friend that can share the same things as yourself, such as hobbies and interests. You may share your thoughts and opinions, the relationship is reciprocated because of the friendship you have formed with them, also; with a personal relationship you can say what is on your mind without the worry of being reported for stepping out of line. This is where trust bonds a personal relationship and communication is relaxed.
1:2
Describe different working relationship in health and social care setting:
Two types of working relationships in social care are;
(It would be disrespectful to talk to a Doctor for example in the same manner as your work colleague)
Outcome 2 – Work in ways that are agreed with the employer:
2:1
describe why it is important to adhere to the agreed scope of the job role:
It is important to adhere to an agreed scope because by straying outside of this I may put individuals at risk, such as patients in my care and fellow work colleagues. Knowing that I was employed for my skills and qualifications that are in the job description, my employer would be assured in my capabilities for the position. You must not undertake a job role if you are not trained or qualified to do as this can put people in danger as well as yourself, and you will be made accountable. If I was asked to undertake a task that was not in my job role; I would have to refuse as I may not be qualified for that particular task. My colleague should be understanding in my refusal as I wouldn’t want to put anyone in danger.
2:2
Access full and up-to-date details of agreed ways of working:
Agreed ways of working includes policies and procedures. The employer would have given me my role and responsibilities for my scope of practice; this is to make sure that the information given to me for my role is done in the correct manner. They also trust me that I shall do my job within the role with a professional attitude.
2:3
Implement agreed ways of working:
It is important to update policies to reflect changes in legislation and make sure that staff understands them, as these will give a general guidance on how you should carry out your duties within the workplace. If something changes and you are not so sure on the proceedings then you should ask your senior or workplace manager for advice. They will be pleased that you have taken notice of any changes and asking them for advice.
Outcome 3 – Work in partnership with others:
3:1
explain why it is important to work in partnership with others:
By working in partnership with others we can use their expertise and provide more effective care, as you will be providing more of a holistic type of care. You will be looking at the individual as a whole person and you will be in touch with their family and friends, also you would be in contact with other carers, social workers and Doctors. You are all taking part as a team of support providers that will benefit the individual with their overall care.
3:2
Demonstrate
way of working that can help improve partnership working:
Working in small teams and regular meetings and keeping good communication all improve partnership working. This will include keeping any information to the relevant persons involved. Having agreed values or outcomes. Ensuring confidentiality.
3:3
Identify skills and approaches needed for resolving conflicts:
Skills needed for resolving conflict include diplomacy, patience, empathy and good communication skills. There will come a time where a conflict will arise between work colleagues service users or others that you may have to encounter. Working together as part of a team you can put together knowledge and any ideas to resolve the matter. There will be social factors, values and also conflicts from differences in opinions; these can add fuel to the fire. Communication problems can arise with a lacking of listening skills; this can build up the walls so lack of information sharing can falter. You must find a quiet area where conflicts can be discussed so things cannot be misread; using mediation skills between parties involved you should therefore use the example below:
3:4
Demonstrate
how and when to access support and advice about:
References
Caroline Morris, 2011. Level 3 Health and Social Care Diploma. By Caroline Morris, Val Michie. Edition. Hodder Education. 96-108
Doane, GA, 2002. Beyond behavioural skills to human-involved processes: relational nursing practice and interpretive pedagogy. Journal of Nursing Education, 41 issue 9, 400-404.
Higgins, M, 2013. Use your influence for good. Nursing Standard, 27 issue 49, 62-63.
Tingle, J, Cribb, and A 2002. Nursing Law and Ethics. 2 Edition. Wiley-Blackwell. 22. 2.2
Webb, K, 2013. Stand up and be accountable care. Nursing Standard, 27 issue 29, 26.
Sharon H Ferguson-Guy / NVQ3 Diploma ECA
1
of
2
Describe African-cultural values beneficial to African-Americans Describe
the African cultural values that have benefited African Americans in their struggle against bigotry
.
The paper should be written in the student’s own words, and no more than 4 pages in length, including a title page and reference page. This means two pages of content, which requires clear and focused writing. Avoid excessive use of quotations. Include page numbers, clear and accurate writing, following APA (7
th
ed.) style. Use double spacing, 10-12 font, with 1-inch margins. Proper reference style for citations must be used within the paper and in the reference list.
A “similarity” score should be under 20%. Please
check the Q &A post on Canvas
if you
have any questions
.
A “similarity” score should be under 20%.
Please
check the Q &A post on Canvas
if you
have any questions
.
To submit your paper:
Evaluation Criteria for Paper
A “similarity” score should be under 20%.
Please
check the Q &A post on Canvas
if you have any questions
.
(10%) Resources used as rationale for approaches and as sources of content
_____ 5. (20%) write paper in a scholarly manner
(4%) Format includes title page, body of paper, & reference page, with pages numbered
_____ 5. (20%) Write the Paper in a scholarly manner
(4%) Format includes title page, body of paper, & reference page, with pages numbered
APA style
(4%) Limit the paper to 4 pages in length, which includes title page and reference page
(4%) Cite references in the paper according to APA style
(4%) list References on the reference page according to APA style
(4%) Grammar, language, spelling, and sentence structure are at a college writing level
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Learning Disabilities: The Hidden Handicap
Though learning disabilities may not be visible to the naked eye, seven million, or fourteen percent of all public school students, are affected by this quiet handicap (nces.edu.gov). Learning disabilities are neurologically-based processing problems. People with all forms of learning disabilities function just the same as their peers and elders but they grapple with a hidden handicap that is widely misunderstood, often incurable and has unknown origins ranging. Learning disabilities also have an impact on the biological and social development of those affected by them. Depending on the severity of the learning disability, fundamental and basic learning skills are challenging and can range from needing more time to complete the task of being unable to understand how to accomplish the task (Ozernov-Palchik et al., 2017). Learning disabilities have origins in either environmental factors, family history, including the genetic makeup of the child’s DNA as well as prenatal or neonatal risks.
Scientists, doctors, researchers, educators, and parents wonder where learning disabilities originate. There is evidence to support that disability runs in families just like any other trait or disease. Certain people may be more predisposed to inheriting learning disabilities, just like they may be more likely to inherit specific traits such as eye color, hair color, or behavior patterns. The National Center for Learning Disabilities has research showing that risk factors are usually present from birth. In addition, they also tend to run in families and in most cases, “children who have a parent with a learning disability are ten percent more likely to develop a learning disability themselves” (Butterworth et al., 2013). Researchers have found that mutations of the genes that may have increased risk for learning disabilities are found on the X chromosome. Since males have only one X chromosome, the intellectual disease is passed down in a recessive manner. Women can be affected, but only if both of their X chromosomes carry the defective genes (Hu, H., Haas, S., Chelly, J.
et al.
, 2015). There are many family inheritance and genetic factors that influence the likelihood or development of learning disabilities and how they may be expressed.
To further support the genetics associated with learning disabilities, scientists have found that poor brain development causes learning disabilities in two to three percent of the population (Sample, 2009). Nine genes are likely linked to poor brain development, which contributes to learning disabilities in young men after analyzing the genetic makeup of more than 200 families. The work of Tarpey supports this, showing that men who carry the faulty genes can only pass to their daughters through their X chromosomes, making it a recessive trait (Tarpey PS et al., 2009). This is important to note that males may be more prone to genetic disorders in general. This is only true for X linked intellectual disability. A study conducted by Webber, Hehir-Kwa, Nguyen, de Vires, and Veltman and published in Public Library of Science found that the DNA changes associated with learning disability contained higher than expected numbers of genes affected the nervous system. The study and its results show and suggest that the loss and disruption of such genes could result in learning difficulties.
Learning disabilities can be better understood by investigating the genetics of parents and offspring and environmental factors. As there does not seem to be specific genes that relate to offspring having learning disabilities, environmental factors such as fetal alcohol syndrome can also relate to offspring developing learning disabilities. Research and studies from the Mayo Clinic and the Learning Disabilities Association of America highlight that exposure and use of alcohol or drugs before being born, poor growth in the uterus, premature birth, prolonged labor, lack of oxygen, and meager birth weight have been shown to have direct correlations with learning disorders (Mayo Clinic Staff, 2019). Another risk factor for children in utero or after birth is exposure to toxins. Children are smaller and closer to the ground; they receive a much more concentrated dose of toxicant. Besides, young children have an immature detoxification system, and the blood-brain barrier is not fully formed until about a year old, which creates a difficulty when processing a toxicant. This therefore allows easier passage of a toxicant into the brain (McElgunn, 2001). Due to the size and surface area, children have a higher sensitivity to any toxin around them. Children will also be affected in a more significant way to toxin exposure developmentally as their brains are still developing, and a poorly developed brain leads to an increase in learning disabilities (Weiss, 2000). Learning disabilities can be better understood by investigating the genetics of parents and offspring and environmental factors. As there does not seem to be specific genes that relate to offspring having learning disabilities, environmental factors such as fetal alcohol syndrome can also relate to offspring developing learning disabilities. Research and studies from the Mayo Clinic and the Learning Disabilities Association of America highlight that exposure and use of alcohol or drugs before being born, poor growth in the uterus, premature birth, prolonged labor, lack of oxygen, and meager birth weight have been shown to have direct correlations with learning disorders (Mayo Clinic Staff, 2019). Another risk factor for children in utero or after birth is exposure to toxins. Children are smaller and closer to the ground; they receive a much more concentrated dose of toxicant than adults would. Besides, both a fetus and infant have an immature detoxification system, and the blood-brain barrier is not fully formed until about a year old, which creates a difficulty when processing a toxicant, allowing for easier passage of a toxicant into the brain (McElgunn, 2001). Due to the size and surface area, children have a higher sensitivity to any toxin around them. Children will also be affected in a more significant way to toxin exposure developmentally as their brains are still developing, and a poorly developed brain leads to an increase in learning disabilities (Weiss, 2000). The Food Quality Protection Act, known as FQPA, was established in 1966. The FQPA’s role was to look at the risks to children of the exposure to pesticides found in food or chemicals. The FQPA provided the following risk assessment factors such as safety factors for children in utero exposures and cumulative effects of pesticides. Fetal development is a highly sensitive stage of the life cycle, and exposure to pesticides at this stage are shown to cause damage later in life. Although individual chemical exposure levels may fall within the legal limit range, these levels can still be toxic to the fetus or child due to their vulnerability. Some examples of chemicals that can be toxic are both lead and polychlorinated biphenyls (PCBs). Research has shown that PCBs can reduce intelligence quotient (IQ) scores. Similarly, exposure to toxic chemicals may come from other sources such as produce residues, pesticide deposits from spraying trees in areas such as schoolyards where children play, contaminated drinking water, and residential neighborhoods that have a lot of children present.
One of the most persuasive arguments for additional protection for children is what might be called the ecology of childhood (Weiss, 2000). These factors include activities like young children spending much time on floors; they stir up and breathe dust and residues, and exposure to dust may be ten times greater than adults. Also, children exhibit exploratory behavior, especially as toddlers or young children as they literally lead a hand-to-mouth existence. Everything is picked up and put in their mouths, which is why safety is so essential around this age. Also, the consumption of breast milk, which can transmit lipid-soluble agents are at risk. Children’s activities take place close to ground level, and children’s size and height are important factors—thick vapors such as mercury collect at much higher concentrations near the floor than at adult waist level. With their activities, children also stir up floor dust that they then inhale (Weiss, 2000). Safety is vital at all ages, but embryos and children can have the harshest effects for life when not protected from toxins or dangerous situations.
According to an article by the Centers for Disease Control and Prevention, “nearly half a million infants are born prematurely in the United States each year” (CDC, Martin, Osterman, 2018). Because of this statistic, another element in the equation of learning disabilities are prenatal or neonatal risks as if pregnancy is a high risk, there can be complications. Some of these complications can occur during delivery, which may result in a lack of oxygen to the brain. Unless there is a significant loss of oxygen, this is very hard to diagnose. Often the learning disability is not seen until there is a delay in learning when the child begins learning or a pediatrician observes that the child is missing significant benchmarks in their growth. According to the Albert Einstein College of Medicine “preterm children also experience difficulties with visual-spatial and working memory that affect their mathematics performance, information retention and retrieval, ability to pay attention, task planning and completion, and comprehension capabilities” (Albert Einstein College of Medicine, Shulman, Lesser, 2013). Early birth is hard on infants, medical staff, and families, but the effects can range many years past initial birth and even remain for life in various disabilities or disorders.
Despite the evidence against learning disabilities, some question if learning disables fade with time and corresponds with a low IQ. They fail to see how impactful learning disabilities can be on how one learns. Those who believe learning disabilities are a myth think that students have a low IQ and cannot be successful. The National Association of Special Education Teachers states that students with learning disabilities usually “have average or above-average intelligence” (National Association of Special Education Teachers NASET, 2011). In terms of not being successful when having a learning disability, many famous and influential people such as Thomas Edison, Albert Einstein, Winston Churchill, Walt Disney, John F. Kennedy, and Steve Jobs have all found extreme successes while living with learning disabilities (Health Research Fund HRF, 2014).
As learning disabilities are usually invisible, most do not understand what is entailed and how debilitating learning disabilities can be. Learning disabilities affect everything from social development, processing of information, achievement academically, and other more abstract skills. Because of the array of learning disabilities and the various levels in which they affect people, it is hard to ascertain why or how they come about. This hidden handicap still has a stereotype of low IQ, laziness or lack of motivation just because it is misunderstood. Such questions are answered by looking at a combination of genetics, family history, prenatal and environmental factors as there is evidence to support that all of those factors contribute to the development and diagnosis of learning disabilities.
Works Cited
