In this research, the depression, anxiety and stress levels among Cancer patients in their initial and final stages are being measured and compared. For this the patients are divided into two groups: one consisting of cancer patients in their initial stages who are undergoing treatment and the other of patients in their final stages of cancer. Each group consists of thirty male cancer patients from Apollo Cancer Centre, Filmnagar, Hyderabad. These patients are administered the Depression, Anxiety and Stress scale and their corresponding levels of depression, anxiety and stress levels are measured and compared.

INTRODUCTION

A benign tumor is basically harmless whereas a malignant tumor is dangerous and may spread to other parts of the body. The malignant tumor is better known as cancer which is a class of disease in which a group of cells display uncontrolled growth, invade and destruct adjacent tissues and spread to other parts of the body through blood. Depending on the type, location and extent of growth of cancer, different methods of treatment and cure are used according to the stage of cancer. Multiple staging scales are in use. TNM staging is most commonly used. The descriptions of TNM can be grouped together into a simpler set of five progressive stages as 0, I, II, III and IV, based on severity. In the first three stages also known as initial stages, chemotherapy, radiation therapy and surgery are the most common methods of treatment. When cancer reaches the final stage, it is usually no longer treatable and the patient is not expected to live long. People who no longer respond to cancer have to face the fact that they will probably die soon. The person may be in pain, in bed or able to walk only a few steps or may be confused. Different people react in different ways to this stage. They may avoid others and retreat into themselves showing signs of depression as is evident to people around them.

Depression is a general term that has been used to describe transient feelings, a psychological disorder and a health problem that is characterized by a group of related symptoms (Beeber, 1998). Depression is a state of emotional dejection (Sr. Christine Fernandes, 2007). Anxiety is a mood-state characterized by marked negative affects, bodily symptoms of tensions and apprehension about the future (American Psychological Association, 1994). Anxiety is also closely related to depression (Barlow, Chorpita, and Turovsky, 1996; Mineka, Watson, and Clark, 1998). Stress is a condition or feeling experienced when a person perceives that ” demands exceed the personal and social resources the individual is able to mobilize. Stress is a state of tension that is created when a person responds to the demands and pressures that come from work, family and other external sources (Dr. Hans Selye, Stress Management Society, 2009). All people will experience reactions of sadness and grief periodically throughout diagnosis, treatment, and survival of cancer. When people find out they have cancer, they often have feelings of disbelief, denial, or despair. They may also experience difficulty in sleeping, loss of appetite, anxiety, and a preoccupation with worries about the future. These symptoms and fears usually lessen as a person adjusts to the diagnosis.  People who face a diagnosis of cancer will experience different levels of stress and emotional upset.

They may develop high levels of depression, anxiety and stress when going through the process of diagnosis and treatment which include radiation and chemotherapy which may result in symptoms like nausea, fatigue, hair loss, mood swings and pain. They shall need to adjust themselves to these side effects. They are also uncertain of the outcome of the treatment and also of their future. However, incase the treatment is stopped due to their unresponsiveness, then they know for sure what their future holds. Hence they may not be in a constant state of worry over the outcome of their treatment and its side effects. So they may have lower levels of anxiety, stress and depression. This is the basis of the present research in which the depression, anxiety and stress levels of the patients in their initial stages and those in the terminal stages of cancer are measured and compared.

Hence, the hypothesis of this study is that the levels of anxiety, depression and stress are comparatively lesser in patients who are in the terminal stage of cancer than those in the initial treatable stages.

METHODOLOGY

The sample group consists of male cancer patients of Apollo Cancer Centre, Hyderabad. The sampling is convenience sampling through simple random assignment where two experimental groups of 30 cancer patients each, who are in their initial and terminal stages respectively are used. The main statistical methods used are t-ratio and Pearson’s Product Moment Method.

RELEVANCE

Sadness and grief are normal reactions to the crises faced during cancer, and will be experienced at times by all people. Because sadness is common, it is important to distinguish between normal levels of sadness and depression. (Watson, Greer, Rowden, Gorman, Robertson, Blissand and Tunmore, 1991).There have been several studies on the increase in DAS in cancer patients while undergoing diagnosis, medication and treatments( Nordin, Berglund, Glimelius, Sjödén; 2000). However, there have been no researches comparing DAS levels of people in different stages of cancer. The number of people with cancer is on the rise. The study of depression, anxiety and stress levels at different stages in cancer may contribute to and help in increasing the optimal levels of coping among patients

EVALUATION

In order to keep track of all the different variables, only male patients of Apollo hospitals are being taken as a sample. Finding at least 30 patients in their terminal stages of cancer at once may prove challenging. Permission is to be taken not only from the hospital but also from the patient’s family before conducting the study.

CONCLUSION

Hence, in this study, convenience sampling is used in selecting patients from Apollo hospital according to simple random sampling into two groups who are administered the DAS scale to compare their levels. There may be some inconvenience while collecting samples. Since research with these conditions has not been conducted particularly in India and specifically among cancer patients in different stages of illness, this research may prove useful in conducting further researches and in developing and maintaining maximum optimal environmental conditions for the patient’s mental wellbeing.

Abstract

Challenging behaviors are form of a notable part of Autism Spectrum Disorder (ASD) symptomatology. Pertinent to the conspicuous disparity in the popularity of ASD between males and females, the purpose of this study is to compare the presence and severity of challenging behaviors between boys and girls. Hypothesis: Girls with Autism Spectrum Disorder will have more severe challenging behaviors than boys. This study will employ a quantitative comparative design to measure the prevalence and severity of challenging behaviors among diagnosed children (aged 5-10 years) with ASD. The Autism Spectrum Disorder-Behavior Problems for Children (ASD-BPC) scale will be the principal instrument of measurement of the challenging behaviors. Descriptive and inferential statistics will be used to summarize and draw conclusions from the data. The results of this study will shed light on whether, professional counselors and therapists need to use different interventions in the management of ASD in girls and boys. Furthermore, the findings will provide useful insights to parents and teachers of ASD children on the most effective coping strategies.

Targeting Challenging Behaviors Exhibited by Young Children with Autism Spectrum Disorder

Introduction

Background

Autism spectrum disorder refers to several “neurodevelopmental disorders characterized by core deficits in social interaction and communication impairments, restricted, and repetitive behaviors” (Kirkovski, Enticott& Fitzgerald, 2013). Generally, the condition affects 1 in every 50 children in the United States (Blumberg et al., 2013). The manifestation of symptoms in ASD is heterogeneous with some children having severe intellectual disability while others may have above-average level of intelligence. According to prevalence reports, ASD predominantly affects males with a male to female ratio of about 4:1 (Baio et al., 2018).

The gender disparity in diagnosis has been contested by various researchers citing low sensitivity of assessment scales to ASD in girls (Kreiser& White, 2013). Other studies have described theories explaining the gender difference in the prevalence of ASD (Harrop et al., 2014). Yet, there is no concrete explanation of the large male: female ratio.  However, the knowledge gaps extend further than the diagnosis of ASD; a few studies have explored the differences in manifestation of symptoms among male and female children. One of the typical signs and symptoms of ASD is the presence of challenging behaviors. Challenging behaviors in ASD include self-injury, aggression, verbal tantrums and other socially inappropriate behaviors (Beighley et al., 2013). Based on the reported occurrence difference, it is important to study how ASD symptoms may vary between boys and girls.

Problem Statement

ASD is one of the most common developmental disorders in the United States affecting more boys than girls in the ratio of 4:1 respectively. Even though females are affected less frequently than males, girls require a greater symptom threshold for clinicians to settle for an ASD diagnosis (Harrop et al., 2015). This implies that diagnosed cases of ASD in females are more likely to present with severe symptoms. In fact, other reports indicate that the sex ratio becomes evenly distributed in moderate to severe ASD.

Challenging behaviors form a notable part of ASD symptomatology even though they are not a basis for diagnosis (Hattier, Matson, Belva&Horovitz, 2011). In fact, children with ASD are more likely to present with challenging behaviors than any other psycho-developmental conditions (Kozlowski et al., 2012). The commonly cited challenging behaviors in ASD include destruction of property, aggression or injury directed to self or peers, tantrums, among others (Beighley et al., 2013; Hattier et al., 2011). These problematic behaviors can exacerbate the core deficits evident in ASD children leading to extrapolated implications on the child’s learning and social development.

While the prevalence of challenging behaviors among ASD children has been studied by various researchers, a few studies have aimed at advancing the glaring gender difference to these behaviors. Specifically, fewer studies have compared the occurrence of challenging behaviors between boys and girls and the results of pertinent literature are not conclusive. The purpose of this study is to determine the effect of gender on the presence and severity of challenging behaviors. This research is relevant because of the potential to provide useful insights on the management of ASD thus enhancing parenting and education.

Literature Review

Findings of previous researchers comparing the presence and severity of challenging behaviors between boys and girls are inconclusive. Kozlowski et al. (2012) compared challenging behaviors among 185 children with High-Functioning Autism (HFA), Asperger’s disorder, and typical development and their multivariate analysis of variance revealed no difference on challenging behaviors between boys and girls. However, the study reported racial differences in the manifestation of problematic behaviors. In a matched boy-girl comparison, Harrop et al. (2014) noted that boys and girls with ASD are more similar than different in terms of their social communication and children involvement in play activities. Nevertheless, some challenging behaviors in ASD (such as tantrums) are indirectly related to social communication.

On the other hand, Amr et al. (2011) explored sex differences among Arab children (aged 4-11 years) with ASD and identified increased instances of challenging behaviors among effected boys. However, Amr et al. (2011) used a relatively small sample of 37 boys and 23 girls. After analysis of data from the Autism360 online database, Baker and Milivojevich (2013) replicated the findings of Amr et al. (2011) that boys have more problematic behaviors compared to girls. The Autism360 is an online database in which ASD adults as well as caregivers of autistic children anonymously describe the ASD manifestations. Baker and Milivojevich used a sample of 1495 boys and 336 girls aged 2-18 years.

While the results of these studies may be valid, Kirkovski, Enticott and Fitzgerald (2013) noted that gender differences in the manifestation of ASD may be better observed in later stages of life, indicating that studies using toddlers may be limited. As evident in the studies, toddlers form a significant part of the study samples. Another cause for concern is the male dominance in prevalence. This disparity has led to the recruitment of fewer female subjects than males. Studies using significantly fewer female subjects compared to males indicates that comparisons made thereof may be limited. In a review by Kirkovski, Enticott and Fitzgerald (2013), the reviewers observed that Murphy, Healy & Leader (2009) reported no difference on challenging behaviors between boys and girls regardless of the obvious proportionate superiority in expression of challenging behaviors in girls. As Kirkovski, Enticott and Fitzgerald (2013) cited, Murphy et al. (2009) recruited 130 ASD boys and 27 girls. The proportion of girls with challenging behaviors was at 7.4% (2 cases out of 27) while for boys it was 2.3% (3 cases out of 130 boys).

Methods

Research Question and Hypothesis

Prevalence studies on (ASD) have indicated that the prevalence of ASD varies significantly between males and females, with the boys-to-girls ratio of about 4:1 (Baker &Milivojevich, 2013). Therefore, it is important to study how ASD symptoms may vary between boys and girls. This study aims at answering the following research question: Do girls with ASD manifest more severe challenging behaviors than boys with Autism Spectrum Disorder? The proposed study will test the following hypothesis: Girls with Autism Spectrum Disorder will have more severe challenging behaviors than boys.

Participants

The target population for this study are all elementary school children (age 5-10 years) diagnosed with ASD in Alabama. The Centers for Disease Control and Prevention (CDC) reported that the population of 8-year old children with ASD as of the year 2010 was 125 (Centers for Disease Control and Prevention [CDC], 2012). This number accounted for ASD children who were 8-years old at the time of data collection. The population of ASD children could be higher as the CDC surveillance program collected data in only nine counties; Blount, Cherokee, DeKalb, Jackson, Jefferson, Madison, Marshall, Shelby, and Tuscaloosa (Centers for Disease Control and Prevention [CDC], 2012). Nevertheless, the CDC report represents the average age of focus of this study (5-10 years).

For generalizability purposes, the sample should be derived from all the elementary schools in Alabama. However, this would not be possible because of resource constraints (time and money). Therefore, the participants will be selected from elementary schools in one county (Pike County).

This study will employ a probability sampling technique; specifically, stratified random sampling. This method is appropriate because of the well-recognized gender disparity in the prevalence of ASD. The male to female ASD ratio is about 4:1 (Baker & Milivojevich, 2013). Therefore, the accessible population will be divided into two strata based on gender, which is male and female.  Thereafter, participants will be randomly selected from the two strata; 80% of the sample from the male stratum and the other 20% from the male stratum. These sub-samples are representative of how the disorder affects the two groups. Because the participants are elementary school children, they will be recruited together with their parents or guardians. Accordingly, the sample will consist of parent-child dyads and only children whose parents give consent to participate in this study will be included.

Sample Size

The Yamane (1967) formula will be used to calculate the required size of the sample.

Where;      n = sample size

N= Total population

e = margin of error at CI of 95% (0.05)

Since N = 125 (Centers for Disease Control and Prevention [CDC], 2012).

n = 125/[1+(125×0.052)]

n= 95

Instruments

The independent variable in this study is gender while the independent variable is the manifestation of challenging behaviors. Challenging behavior is one of the common manifestations of ASD and include self-injury, aggression, verbal tantrums and other socially inappropriate behaviors (Beighley et al., 2013). The study will measure the presence and severity of the challenging behaviors using the Autism Spectrum Disorder-Behavior Problems for Children (ASD-BPC) scale (Matson, Gonzalez & Rivet, 2008). The ASD-BPC scale is one of a three-part tool used to assess for ASD symptomatology, comorbid conditions (psychiatric conditions), and challenging behaviors. The ASD-BPC has been widely utilized in the assessment of challenging behaviors and generally has high validity and reliability (Matson, Gonzalez & Rivet, 2008). The scale consists of 18 elements that assess for challenging behaviors. The parents or guardians will rate each of the 18 elements (challenging behaviors) depending on their presence and severity with 0 indicating that the challenging behavior is not a problem, 1 implying that it is a mild problem and 2 suggesting that it is a severe problem. After the scale is duly rated, the scores are summed up to get the overall score. The range of ASD – BPC is 0 – 36, with lower scores indicating the child behavior is less challenging.

Study Design

The study will employ a quantitative comparative design. According to Boswell and Cannon (2017), the comparative design is appropriate when the researcher has no intention of manipulating or controlling the independent variable with “the dependent variable being the only variable measured in two or more groups” (p. 115). This description perfectly fits with the procedures of the current study.

The study subjects will be divided into two groups of males and females. The presence and severity of the dependent variable (challenging behaviors) will be measured using the ASD-BPC scale. The total scores of all participants (the overall scores in the ASD-BPC scale) in each of the two groups will be added. Descriptive statistics will be used to summarize the data, including the mean score in each of the two groups. The investigator will then compare the means of the two groups to determine whether there is a difference in the presence and severity of challenging behaviors between the males and females. The researcher will then use inferential statistics to ascertain that the difference in the means (if any) is statistically significant, i.e. it did not arise by random chance. To achieve this degree of certainty, the analysis will employ a two-tailed t-test to determine the significance of the difference between the two means.

Audience Utilization of Possible Results

The results of this study may be useful in advancing the meaning of the gender disparity in the prevalence of ASD. As Baker and Milivojevich (2013) noted, the meaning of the severe gender difference is limited. Importantly, the results will shed light on whether, professional counselors and therapists need to use different interventions in the management of ASD in girls and boys. Furthermore, the findings will provide useful insights to families with ASD children on the most effective coping strategies. This study will also guide teachers who are interacting with ASD children in the development of learning approaches best suited for girls with ASD. Lastly, the contributions of this research may be useful in devising effective coping mechanisms for the challenging behaviors that ASD children may manifest within the school settings.

Related content

• 
  Genetic Findings in Autism Spectrum Disorder
  
• 
  Recreational Therapy (RT) Modalities for Individuals with Autism
  
• 
  Communication Barriers in Provisional Care for Children and Young Adults with Autism Spectrum Disorder
  
• 
  Art Therapy for Autism
  

References

• Amr, M., Raddad, D., El-Mehesh, F., Mahmoud, E., & El-Gilany, A. (2011). Sex differences in Arab children with Autism spectrum disorders.
  
  Research in Autism Spectrum Disorders
  
  ,
  
  5
  
  (4), 1343-1350. doi: 10.1016/j.rasd.2011.01.015
• Baio, J., Wiggins, L., Christensen, D., Maenner, M., Daniels, J., & Warren, Z. et al. (2018). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014.
  
  MMWR.Surveillance Summaries
  
  ,
  
  67
  
  (6), 1-23. doi: 10.15585/mmwr.ss6706a1
• Baker, S., &Milivojevich, A. (2013). Gender Differences among Children with Autism Spectrum Disorder: Differential Symptom Patterns.
  
  Global Advances in Health and Medicine
  
  ,
  
  2
  
  (6), 8-18. doi: 10.7453/gahmj.2013.003
• Beighley, J., Matson, J., Rieske, R., Jang, J., Cervantes, P., &Goldin, R. (2013). Comparing challenging behavior in children diagnosed with autism spectrum disorders according to the DSM-IV-TRand the proposedDSM-5.
  
  Developmental Neurorehabilitation
  
  ,
  
  16
  
  (6), 375-381. doi: 10.3109/17518423.2012.760119
• Boswell, C., & Cannon, S. (2017).
  
  Introduction to nursing research
  
  (4th ed.). Jones & Bartlett Learning.
• Blumberg, S., Bramlett, M., Kogan, M., Schieve, L., Jones, J., & Lu, M. (2013). Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011-2012.
  
  National Health Statistics Reports
  
  ,
  
  Mar 20
  
  (65), 1-11.
• Centers for Disease Control and Prevention [CDC]. (2012).
  
  ADDM fact sheet Alabama: A snapshot of Autism Spectrum Disorder in Alabama
  
  . Retrieved from https://www.cdc.gov/ncbddd/autism/states/addm-alabama-Fact-Sheet.pdf
• Harrop, C., Shire, S., Gulsrud, A., Chang, Y., Ishijima, E., Lawton, K., &Kasari, C. (2014). Does Gender Influence Core Deficits in ASD? An Investigation into Social-Communication and Play of Girls and Boys with ASD.
  
  Journal of Autism and Developmental Disorders
  
  ,
  
  45
  
  (3), 766-777. doi: 10.1007/s10803-014-2234-3
• Hattier, M., Matson, J., Belva, B., &Horovitz, M. (2011). The occurrence of challenging behaviours in children with autism spectrum disorders and atypical development.
  
  Developmental Neurorehabilitation
  
  ,
  
  14
  
  (4), 221-229. doi:10.3109/17518423.2011.573836
• Kreiser, N., & White, S. (2013). ASD in Females: Are We Overstating the Gender Difference in Diagnosis?
  
  Clinical Child and Family Psychology Review
  
  ,
  
  17
  
  (1), 67-84. doi: 10.1007/s10567-013-0148-9
• Matson, J., Gonzalez, M., & Rivet, T. (2008). Reliability of the Autism Spectrum Disorder-Behavior Problems for Children (ASD-BPC).
  
  Research in Autism Spectrum Disorders
  
  ,
  
  2
  
  (4), 696-706. doi: 10.1016/j.rasd.2008.02.003
• Murphy, O., Healy, O., & Leader, G. (2009). Risk factors for challenging behaviors among 157 children with autism spectrum disorder in Ireland.
  
  Research in Autism Spectrum Disorders
  
  ,
  
  3
  
  (2), 474-482. doi: 10.1016/j.rasd.2008.09.008

 

Lies and Dangerous Practices: The Need for Complementary and Alternative Medicine Regulation

Complementary and alternative medicines (CAMs) generally market themselves as an equal alternative to biomedicines. The danger behind this is that they are not. Both CAM therapies and their practitioners do not undergo the same rigorous peer review, regulations, and education as biomedicines and their practitioners. For this reason, CAM practitioners and their therapies require more stringent regulations regarding their education, advertising, and claims of efficacy.

CAMs include homeopathy, naturopathy, osteopathy, traditional Chinese medicine, chiropractic, and spiritual therapies. Many of these are informed and influenced by their cultures of origin. As outlined by Bissoondath (1998) in his essay, “No Place like Home,” Canadian’s pride themselves in their acceptance of cultural practices. However, practices such as CAMs are dangerous. As multiculturalism continues to grow, so has usage of CAMs. 79% of Canadians used complementary or alternative therapy in 2016, up from 75% in 2006 (Esmail, 2017).

I first encountered CAMs during my 3rd week as a nursing student. I was assigned a 57-year-old Chinese woman who suffered a stroke which completely took away her speech and mobility. She also suffered from atrial fibrillation; a potentially dangerous condition characterized by irregular beating of the heart. If uncontrolled, it exponentially increases the risk of a stroke or heart attack. Upon assessment, her heart was beating irregularly despite being on digoxin, a medication meant to normalize the heart. We hypothesized that the patient was taking ginseng, a popular Chinese herbal remedy which, when taken with digoxin, causes rapid and irregular heart rates (Karch, 2017). The patient confirmed she regularly visited a TCM (Traditional Chinese Medicine) practitioner who ‘prescribed’ ginseng to improve energy levels thereby inducing uncontrolled fibrillations. While it is impossible to say whether the ginseng caused her stroke, it undoubtedly contributed to it.

If more stringent regulations existed, it is not unreasonable to argue that my patient would still be able to walk and talk. From prescription to dispensing, a biomedicine such as digoxin passes through multiple healthcare professionals and screening tools prior to being taken by a patient. First, a physician or nurse practitioner prescribes the medication and conducts a medication reconciliation which reviews the medications the patient is already on to determine possible interactions. According to pharmacists Elbeddini and Zhang (2018), when the patient visits the pharmacy, a licensed pharmacist conducts the same reviews. Finally, if admitted to a hospital, the nurse follows the same protocol. Three checks by three professionals, all of whom were instructed to a high standard as mandated by the government and their regulatory bodies. An individual such as a TCM practitioner need not conduct the same review.

Moreover, their education is not held to the same high standards for accreditation as the three aforementioned professionals. Despite this, they can market themselves as being able to control serious chronic health condition like diabetes or asthma using medicine that has not been tested or approved by any government agency. For example, according to a report from Global News, a Vancouver Island naturopath gave a child diluted saliva from a rabid dog to treat his autism. Despite being educated at a recognized institution for Naturopathic medicine and being licensed by the governing body of Naturopaths, she still gave a medication so widely known to be ineffective and potentially dangerous that she was stripped of her Naturopathic license. Incredibly, she is still able to practice as a homeopath and still supports her usage of the medication (Young, 2018).

Compared to a licensed medical doctor, a CAM practitioner such as a Naturopath undergoes much less rigorous and in-depth training. To gain a medical degree, an individual must first attend 3-4 years of an undergraduate program, 4 years of medical school and write a multitude of rigorous, multi-subject tests. Following graduation, a physician then spends a further 2-7 years, depending on specialization, in residency training under the supervision of fully certified, specialized physicians. In total, a medical doctor needs between 9-15 years of rigorous post-secondary education before they can practice independently.

In comparison, the educational requirements of a CAM practitioners are far less stringent. According to Brit Hermes, a former naturopathic doctor, the education for naturopathic doctors “[are] riddled with pseudoscience, debunked medical theories, and experimental medical practices” (Hermes, 2015). Her training was comprised of textbook level comprehension of core medical sciences and lacked actual clinical application. Her classes were taught by unqualified individuals. For example, her embryology class was taught by a doctor of naprapathy, a specialization focusing on chiropractic and homeopathic manipulation of connective tissues. Furthermore, the highly competitive ‘residency’ she found herself in was a total of a single year in length of which only a small amount of time was dedicated to actually treating patients. She concludes that naturopaths are not qualified to practice primary care, which is the area for which they claim to be experts.

As such, CAM practitioners should be subjected to similar regulations as other healthcare professionals. For CAM practitioners, lawyers Trebilcock and Ghimire (2019) argue that provincial-sanctioned self-regulation should be implemented. This would entail a self-governing body comprised of CAM practitioners be given power by the provincial government to grant professional credentials. A few detractors, such as attorney Michael Weir (2005) argue that granting licensure would validate CAM practitioners as licensure does with biomedical practitioners. However, instead of licensing an individual, certification should be given. Formal certification “gives strong incentives for certification bodies and their members to promote their brand and reputational status.” It also does not give the same legal protections as licensure thereby not legitimizing them in the view of the law (McHale & Gale, 2015). The main advantage of certification is normalizing educational requirements thereby setting minimum standards for CAM practitioners

Equally important is controlling how these therapies are advertised. Medical procedures and their efficacy are established by the healthcare professionals themselves. However, the major difference between biomedical professions such as medicine or pharmacy and CAMs are that the prior’s practices are informed entirely on peer-reviewed scientific literature. Regulatory recommendations made by biomedical bodies are backed by extensive, peer reviewed scientific literature. On the other hand, CAMs lack this rigorous peer review and can make claims unsubstantiated by evidence. One such example occurred in BC. Epidemiologists Murdoch, Carr, and Caulfield (2016) found that the majority of CAM clinics claimed that they were able to either diagnoses or treat both allergy/sensitivity and asthma despite using diagnostic techniques that were not supported by the Canadian Society of Allergy and Clinical Immunologists due to the lack of evidence supporting them. Furthermore, these same clinics used potentially harmful treatments such as IV hydrogen peroxide and spinal manipulation. Accordingly, it is vital to regulate CAM advertising to prevent harm to the public.

Lastly, CAMs should

never

be promoted as being a substitute for biomedicine. CAM advertising has been shown to redirect patients from pursuing biomedical treatments despite many of their claims being unproven or fabricated. This has major ramifications to the health of individuals and can prove lethal. A study conducted by the Yale School of Medicine showed that CAMs, when taken as a substitute for chemotherapy and radiation, accounted for a mortality rate 2.5 times greater in cancer patients (Johnson, Park, Gross, & Yu, 2018). When conditions such as these remain untreated, people die. Therefore, advocating for the replacement of proven medical practices with unproven CAMs poses a great danger to the individuals who are the targets of these advertisers. One may argue that CAM practitioners are simply exercising their right to advertise in a capitalist free market. However, there exists a fundamental unfairness to CAM medicines. They can make unsubstantiated claims with little to no ramifications. These claims, in and of themselves, should be regulated. It is illegal in Canada to advertise for pharmaceutical companies to advertise medications directly to consumers (Gibson, 2014). The Canadian government has dictated that individuals lack the expertise to choose a treatment for themselves especially when subjected to purposefully manipulative advertising. Yet CAM practitioners can freely advertise to the public. This asymmetrical advertising model skews members of the general populace to choosing CAM therapies as they are presented as alternatives rather than complements to traditional biomedicine (Johnson, Park, Gross, & Yu, 2018).

This is not to argue that CAMs have no place in healthcare. Canada, and many democratic countries support the right for an individual to choose the treatment they want. Furthermore, CAMs are not without proven benefit. According to a study conducted by the Epidemiologist Staud (2011), several CAMs have scientifically proven efficacy and many of them are being studied for their potential implementation into biomedicine. Despite this, the possible danger they pose cannot be mistaken. Some detractors from regulation, such as bioethicist Sarah Budd (2002), bring forth concerns that regulating CAMs in the same manor as biomedicines may legitimize them to the public. However, failure to regulate them poses even greater problems such as dangerous therapies, poorly educated CAM practitioners, and potentially dangerous advertising. As well, approaching regulation with a laissez faire view may itself cause the public to believe that CAMs are at worst harmless and at best useful. Some, such as medical attorney Michael Cohen (1996) argue that regulation infringes upon the personal freedom of individuals who wish to practice their culture’s health practices. While this remains a legitimate concern, lawyers Trebilicock and Ghimire (2019) argue that CAM regulation should be regulated according to a risk calibration. This entails that CAMs claiming to address life threatening health conditions should be scientifically validated and regulated accordingly. This would allow individuals to practice and market their own cultural practices while still protecting the public from dangerous therapies.

Regulating CAMs is necessary in order to protect the health and wellbeing of the general populace.  The regulatory steps outlined in this essay provide a few basic controls on the uncontrolled CAM market. As the general populace is unable to properly diagnose a disease and consequently pick the appropriate treatment, choosing which healthcare professional is often difficult. Granting professional certification and establishing advertising rules helps protect the general public from dangerous practices, whether they come from biomedical or CAM practitioners. Finally, holding these CAM professionals and therapies to these higher standards protects the population and encourages improvement.

References

• Aronson, J. (2017). Medication reconciliation. BMJ, 356, i5336-i5336. doi:10.1136/bmj.i5336
• Bissoondath, N. (1998). No place like home. Reprinted in
  
  LIBS 7001 course reader
  
  
  2018
  
  (pp. 212-216). Burnaby, BC: BCIT
• Brody, Jane. (2018, October 1). The risk of alternative cancer treatments.
  
  New York Times,
  
  retrieved from https://www.nytimes.com/2018/10/01/well/live/the-risk-of-alternative-cancer-treatments.html
• Elbeddini, A., & Zhang, C. X. Y. (2019). The pharmacist’s role in successful deprescribing through hospital medication reconciliation.
  
  Canadian Pharmacists Journal
  
  , 152(3), 177-179. doi:10.1177/1715163519836136
• Esmail, R., Nadeem, L. (2017). Complementary and alternative medicine: use and public attitudes.
  
  Vancouver: Fraser Institute
  
  ,
  
  1
  
  (1), 11
• Gale, N. K., McHale, J. V., & Taylor, F. (2015).
  
  Routledge handbook of complementary and alternative medicine: Perspectives from social science and law.
  
  London, New York: Routledge. doi:10.4324/9780203578575
• Gibson, S. (2014). Regulating direct-to-consumer advertising of prescription drugs in the digital age. Laws, 3(3), 419. doi:10.3390/laws3030410
• Hermes, B. (2015, May 17). Naturopathic clinical training inside and out. [Blog post]. Retrieved from https://www.naturopathicdiaries.com/nd-confession-part-1-clinical-training-inside-and-out/
• Johnson S., Park H., Gross C., & Yu J. (2018) Use of Alternative Medicine for Cancer and Its Impact on Survival, JNCI: Journal of the National Cancer Institute, Volume 110, Issue 1, January 2018, Pages 121–124,
  
  https://doi.org/10.1093/jnci/djx145
  
• Karch, A. M. (2017). Focus on nursing pharmacology (7th ed.). Philadelphia, PA: Wolters Kluwer.
• Murdoch, B., Carr, S., & Caulfield, T. (2016). Selling falsehoods? A cross-sectional study of canadian naturopathy, homeopathy, chiropractic and acupuncture clinic website claims relating to allergy and asthma.
  
  BMJ Open
  
  ,
  
  6
  
  (12), doi:10.1136/bmjopen-2016-014028
• Staud, R. (2011). Effectiveness of CAM therapy: Understanding the evidence. Rheumatic Diseases Clinics of North America, 37(1), 9-17. doi:10.1016/j.rdc.2010.11.009
• Trebilcock, M. J., & Ghimire, K. M. (2019). Regulating alternative medicines: Disorder in the borderlands. C.D. Howe Institute Commentary, (541), COV.
• Weir, M. (2006). Regulation of complementary alternative medicine practitioners.
  
  Law in Context
  
  , 23(2), 171-198.
• Young, Leslie. (2018, November 8). B.C. naturopath who prescribed rabid dog saliva remedy to child surrenders her license.
  
  Global News,
  
  Retrieved from https://globalnews.ca/news/4644439/bc-naturopath-license-dog-saliva/
• Brody, Jane. (2018, October 1). The risk of alternative cancer treatments.
  
  New York Times,
  
  retrieved from https://www.nytimes.com/2018/10/01/well/live/the-risk-of-alternative-cancer-treatments.html

Introduction

This assignment will critically appraise a qualitative research report from the Nursing Standard titled: Care of older people with dementia in an acute hospital setting.(Fiona Cowell, 2009) (Appendix 1). The critiquing frameworks by Polit and Beck (2010) and Roe (1998) will be used to facilitate understanding of the quality of the study. On a personal level, as a third year student nurse it has been witnessed how some healthcare professionals have difficulty relating to patients with dementia; through lack of understanding and education in dementia care. According to the Alzheimer’s society (2010) there are approximately 750,000 people with dementia in the UK.

The reason for nursing research is to generate knowledge about nursing education, nursing administration, health care services, characteristic of nurses and nursing roles, in which the finding from these studies indirectly affect nursing practice and thus add to nursing body of knowledge (Burns and Grove, 2006)

This part should be in refs section not in main body of essay. If it’s a direct quote it should be in inverted commas including page number of book where it came from

Introduction to the study

According to Gerrish and Lacey (2006) the introduction must convince the reader that the proposed study is important and it should identify how the study will add to previous work and build on theory. For the purpose of this research paper Cowell (2009) has decided to write the introduction separate from the main abstract.

Cowell clearly explains why the study needs to be investigated within the introduction and convinces the reader that the best way to investigate this research would be to use a qualitative approach, to address this gap in knowledge.

Title

According to Parahoo (2006) titles that are too long or short can be confusing or misleading. The title should suggest the research problem/purpose of the study. The title in Cowell’s (2009) study is unambiguous, concise, and highlights with clarity the content of the research study.

Literature Review

A Literature review is to give an objective account of what has been previously been written on the topic (Moule and Goodman, 2009).

In this research the literature review provided a list of data bases that were used to search for relevant articles on dementia between 1980 and 2004, with a list of keywords used within the search.

The articles investigated a range of different subjects however there was limited evidence that these had achieved a demonstrable change in practice due to study limitations and sample size.

The literature review only comments on a (How many is a few, state number)few, out of forty seven articles. In one of the articles mentioned in the review none of the patients had been diagnosed with dementia. Holloway and Wheeler (2010) state that in qualitative studies the discussion of literature tends to be more limited than in other types of research.

The articles that the researches choose to comment on helps to convince the reader that views of nurses on dementia care are limited and that care of dementia patient in acute hospitals needed to be addressed.

Overall the literature review provides detailed references, keywords and information on how Cowell went about the search, but the study fails to provide recent research material in conjunction with the study title. Moule and Goodman (2006) advise researchers to use up to date studies, that is, certainly not more than ten years old and preferable not more than five years old. The reason why Cowell hasn’t used any up to date studies may be because she might not want readers to be influenced by any previous material and that dementia has become a focus of political agendas, which enables the researcher to identify gaps that can be addressed.

Methodology

Cowell has used a qualitative approach to this study and has decided to use naturalistic paradigm. Naturalistic researchers tend to look in detail at a specific group of people or a particular situation (Walsh and Wigens, 2003). This approach tries to gain an awareness and appreciation of how particular individuals or groups of people view and experience the world (Moule and Goodmand, 2009).

Qualitative research is a form of social inquiry that focuses on the way people make sense of their experiences and the world in which they live (Holloway and wheeler, 2010). In contrast, quantitative research seeks to test a hypothesis or answer research questions based on a framework (LoBlondo-Wood and Haber, 2006).

The Cowell tells the reader in the abstract that she will use an ethnographic approach. Ethnography means a “portrait of people” and involves writing about people and culture (Moule and Goodman, 2009).

These approaches use observational and interview data collection methods, which is what the researcher has used within this research article.

The aim of ethnographers is to learn from (rather than to study) members of a group to understand their world view as they perceive and live it and social norms of a particular group, such as nurses (Polit and Beck, 2010).

Overall the researcher has used the best approach to find out the experiences of patients and nurses in relation to care delivered to, and received by, older people with dementia.

Data Sampling

Data was collected during 2005- 2006 from three older peoples’ wards. The researcher mentions that ethnographic observations and interviews were used, and that a total of 125 hours of observation were completed in two five-hour blocks between 7am-8pm. Field notes where transcribed and eighteen interviews were audio taped.

No rationale was given for how the decision about the type of interviews that were going to be used. According to Moule and Goodman, (2009) it should have been clearly presented and justified.

How the data was collected in relation to the methodology used was reasonably explained but limitations to the study for example, small sample size, using patients that had servere dementia who may have had cognitive impairment. Which overall might have had influences on the results. Gerrish and Lacey (2010) say that sample size is not an intrinsic feature of the analysis in qualitative research.

Data Analysis

Data was transcribed and verbatim as soon as possible following the data collection. This method also has implications in that the researcher may have to transcribe the interview (“write out what is said”) (Moule and Goodman, 2009).

Ethical Considerations

Nurse researchers have a professional responsibility to design research that uphold sound ethical principles and protect human rights (Speziale and Carpenter, 2007). I.e. informed consent, gaining access, confidentiality, anonymity and avoid harm.

Cowell has appeared to adhere to the guidelines and adequately safeguard the rights of the participants due to the incorporation of these four principles into her research design.

Ethical approval was also gained from the local NHS research ethics committee and the NHS Trust involved within the study. All participants gave verbal consent before each period.

Results

The researcher used two subs headings within the findings/results she listed them as Patient experience of care and Nursing Staff experiences of care delivery.

Within the findings section the researcher used some direct quotes from both the patients and nursing staff, which the reader found biased and unreliable. This is due to the small size of the patients involved in the study and the severity of the patients dementia. According to the Alzheimer’s society (2010) Memory loss is likely to be very severe in the later stages of dementia. A more trustworthy result would (in the readers opinion) have been obtained if the researcher had included patients in the study who were in the early and moderate stages of dementia; who could have articulated their feelings more clearly.

The strengths of the results was that all the patients were diagnosed with dementia before they were admitted to the wards and Mini-mental examinations where carried out, which results ranged from 0-7 that indicated server dementia.

The researcher also never comments on any organisation or environmental factors that could of influenced the results or have an impact on the patient’s feelings/experiences.

Discussion

The discussion is clearly separate from the actual findings which make it much easier for the reader to read and understand Cowells work. The findings are well discussed within this article and the researcher relates back to her literature review and background information.

The major findings within the article were interpreted, discussed and backed up by references. Cowell does discuss that little is known about acute hospital care from the perspective of people with dementia.

Cowell never mentioned the different types of dementia the patient had been diagnosed with or if cognitive skills were impaired.

Normans (2003) process was used within this article, which is a process that encourages the researcher to take account of his or her influence on the study. The researcher does state to the reader that this could have influenced the data results.

LoBlondo-Wood and Haber (2006) suggest that the research may influence the participants if the researcher observers the participants to collect data.

The researcher decided to use two different methods of collecting data. This is known as triangulation collection. Triangulation is thought to improve the validity of a study, by drawing on multiple reference points to address research questions (Moule and Goodman, 2009).

Researchers using triangulation in data collection are hoping to overcome potential biases of using a single data collection method.

Brewer and Hunter, 1989 says that no one method is perfect, though using a combination of methods can, it is argued, limit the potential deficits and biases of one-particular method.

So with the researcher using both the interviews and observations she has enhanced the reliability, validity and trustworthiness of this research study and its overall quality.

No recommendations of further research were discussed within this article.

Study Limitations

The researcher does mention study limitations in a separate column in which she comments that the study was on a small scale and conducted in one acute hospital. Therefore the findings are not generalised, but may be transferable.

As the work has been interpreted by the researcher she does say openly that the article is biased.

The researcher also says she never returned to the other participants to check data, as she believed it would be a burden to them, and may have limited value. (REF about going back to participants)

She failed to mention the Hawthorne effect could have affected the participant’s behaviour or performance, which could have impacted subsequently on the dependant variable (Moule and Goodman, 2009).

Relevance of the study to practice

The issues that Cowell (2009) identifies have also been seen over the years on clinical placements that prove Health Care Professionals need further education on dementia care. This will help patients in the future receive more patient focused care/individual care and not personalised dementia care.

The author does not think it would be hard to change practice due to the evidence within this study that nursing staff have a lack of knowledge and education in delivering

nursing care to dementia patients

. With most staff wanting to gain more understanding in dealing with patients with dementia the only factor that may be challenging would be resources, cost and time management in the ward area for staff to do the training.

Also by having Nursing journals available in ward areas would help staff attitudes for further training and using evidenced based research in practice.

other factors, such as staffing issues in the wards are affecting patient care, which with the right staffing would improve patient focused care but further research would be needed to prove this.

The comments within Cowdells (2009) article and experience on clinical placement have made the author realise he acts as an advocate for dementia patients and that in the future he will make sure everything is done in the patient’s best interest, instead of the nursing staff convenience.

The use of evidence based studies is the best way to improve quality of care and improve patient experiences is essential (ref).

Evaluation

Cowell (2009) study has been subjected to critique using the Polit and Beck (2010) and Roe (1998) framework, which has helped to gain a more understanding of dementia care.

Cowells article is presented well and flows; which makes it easy to read and understand.

Cowell (2009) chose a good method and approach but there were flaws within her data sampling, which was addressed within the article; this could have posed a threat to validity and reliability.

By critiquing this article it has helped the author to increase his knowledge on reading research articles, understanding the terminology and appraising nursing research. It has also made the author more aware of how dementia patients feel in acute hospital settings and how he can, as a future staff nurse, make a change on how care is delivered to patients with dementia.