With reference to current relevant literature, discuss the importance of both lifelong learning and the ability to use evidence/research-based practice in your professional development as a nurse.

Professional nurses obtain their qualification and their registration as evidence of competence, knowledge, skills and ability to render safe and effective nursing or health care thus certified fit to practice. However, there are many challenges due to advancing technology, economics situations and multifaceted nature of the health care system which require competent, dedicated and motivated workers. Nurses must therefore avail themselves to the learning opportunities to meet up with the current standards through lifelong learning (McMaster et al, 2018). In fact, nursing is part of the professions changing rapidly in complexity and technology (HealthStream, 2017) a habit of lifelong learning for nurses is therefore necessary (IOM, 2011). An experienced nurse must be ready to move her traditional practice to one that is steeped in current evidenced based practice. Evidence based practice involves steps which are easy to learn and teach but could be challenging (McFadden, 2009). Nursing is a profession that entails great skills and close contact with the patients in a rapid changing technology. In view of the delicate position occupied by the nurse one cannot afford dealing without knowing and updating himself with the rapid transformation and renovation that go on every time. Therefore, a nurse must endeavour to keep abreast of these development by regularly updating himself to be current and relevant in the profession. Therefore, the aim of this essay is to discuss the importance of lifelong learning and the ability to use evidence-based practice in my professional development as a nurse. Likewise, to be discussed is my preferred learning style according to Peter Honey and Alan Mumford (1968), by assessing my strengths and weaknesses. Patients management has gone beyond the routine administration of tradition techniques and general practice to individualization of treatment based on evidence-based practice. Issues in patient’s management can be resolved by inquiry through information technology. Development and acquisition of new skills and knowledge is possible through lifelong learning of evidence-based practices. Yet, because of the flexibility of human nature, what may have worked for patient A may not be applicable to patient B occasionally which may be due to patient’s desire or the expertise of the nurse. This brings about some limitation in application of some evidence-based practice in all cases as many factors may have to be considered. One must be aware what evidence-based practice is not as he goes on in the profession and the ethical issues in its application. Yet, there are many benefits of lifelong learning and evidence-based practices achieving better outcome in patient’s management when combined with the nurse’s experience and the patients desire. Nurses must continually get involved in continuing education which can be in various forms either as in-service learning, self-directed learning, attending professional courses and conferences despite the tight schedule of the profession. These again are affected or influenced by the individual skills and some factors like ambition and career goals.

According to Salcido (2013), lifelong learning has been described as continuous, voluntary, and motivated by personal desire for knowledge for professional or personal reasons, mainly for personal and professional development, but also competitiveness and employability. Lifelong learning is defined by the three key components which are an understanding of evidence-based health care and critical appraisal, good knowledge of informatics and literature search and retrieval strategies, practice-based learning and improvement methods, self-evaluation which are knowledge driven (Macy Foundation, 2010). The main goal of lifelong learning is to enable health professionals to be up to date with the rapid development of evidence-based information. Lifelong learning is an essential part of professionalism for health care professionals (Novak et al., 2014). Lifelong learning entails the ability to deal with issues through inquiry, seeking resources, and independent/continual assessment of one’s own learning needs. Lifelong learning is significant to acquiring and building up knowledge and skills in nursing. Continuous learning is essential in nursing to remain current on trends, practices, and the newest treatments. There must be an environment to support and promote the educational growth for advancement in the nursing profession. Nursing expertise is basically rooted on evidence-based practice. In clinical practice of nursing, success in research and experience depend on evidence-based practice and lifelong learning both of which are essential tools in health care service delivery (Eason T, 2010).

Learning is behavioural change that occurs through action or experience according to behavioural theory. It is also a series of activities in which one relates new thought or idea to his previous experiences to have insight as defined by the cognitive theory (Tummons,2014). According to Laal, there are various forms of learning which include formal learning occurring in an organized structure that may be formally recognized. Non-formal learning occurring mostly in workplaces acquired as skills but not actually designated as learning. Then, the informal learning occurring from daily activities gained as experiences. To be a good learner you must be dynamic in research, knowledge seeking and communication. (Laal, 2011). Learning has two main conceptions. The first projects learning as an essential continuous process that may not have an objective, but it is useful. The second projects learning as functional for specific purpose in a disciplined structured pattern (UNESCO, 2016). This was re-emphasized by Alsop that learning occurs in two forms; incidental learning experience and the learner having a structured educational experience which can be by formal or informal approach (Alsop, 2013). One of the driving forces in lifelong learning is to appreciate learning and achieve one’s desired goals. The desired result is to improve oneself and gain the trust of the society. However, the process is hindered by inadequate time, stress and fatigue and routine activities (Qalehsari, 2017). They also noted that some notions which influence lifelong learning include the person’s intelligence, spirituality, the physical and mental capability. Essential attributes that a learner must have include an inquisitive mind, taking new initiatives, good interpersonal and group relationship and skills (Candy, 2000 in Alsop, 2013).

There are different and sometimes unique way by which students learn and these affect their performances. These are what the different learning theories try to explain. The behavioural theory promoted by Pavlov and Watson (1927). They emphasized classical conditioning in which the person reacts to the environment as demonstrated by his dog experiment. Skimmer on the other hand emphasized operant conditioning. Learning through this theory is brought about by reinforcement or repeated action (Gould, 2009). Motivators that improve behaviourism could be extrinsic like promotion, salary increase or social like wide acceptance or approval by colleagues and admiration. The fear of punishment is another factor. The changes that come about in behaviour due to the extrinsic motivator may be temporary or short lived once the reward has been obtained. This may not be too good in a nursing in a nursing profession as the experienced gained must not be forgotten in one’s lifestyle. Yet a nurse learns by repeated actions reinforced by one’s experience over time.

The cognitive theory on the other hand uses head reasoning. Learning is achieved by processing information through organization and assessing relationship between different pieces of information. For an action to be carried out, the information must be interpreted and processed. Therefore, previous experience must call to play. Learning from the cognitive approach is a change in the way events are perceived, organised from experiences to have an understanding. Learning is achieved through insight. Kochler emphasized this through his “Sultan the chimpanzee” experiment on retrieving banana outside its cage with a stick. He demonstrated that the material to solve the problem has always been present but not recognised until the relationship was established. Motivation is derived intrinsically through self-satisfaction. Bruner and Ausubel (1963) built on the work of Piaget that new learning develops on previous learning with understanding and meaning. Knowledge therefore must be structured and organised. This kind of knowledge can easily be retained and applied as personal efforts have been put into it. Ausubel emphasised meaningful reception learning which means one acquires new knowledge which is linked to existing knowledge that can easily be retained and applied. Bruner on the other hand emphasised on discovery learning in which the learner discovers information and its relationship himself. This allows him to remember the information for a longer period and better heart application of the new knowledge. He also explain sequence in learning from enactive in which learning is based around object or actions iconic in which learning is based around images too symbolic in which learning is based around abstract object.

Evidence based practice is defined by Sackett 2000 (Lipscomb, 2015) as unifying best research evidence with clinical experience and patients desire to make clinical decision. By this, the effective patient’s care is given. Research which is one form of and the strongest of the evidence-based practice can mislead if taken out of context. Nursing research is a scientific way of validating and upgrading previous knowledge to generate new knowledge that influences clinical practice either directly or indirectly (Grove, 2014). Evidence based practice allows the nurse to be well informed as her patient for a good clinical decision. Embracing this practice results in cost-effective practice, improved clinical outcome and better job satisfaction. The cost effectiveness affects the patient, family members, the health care provider and the entire system. A nurse practitioner who wants to be relevant seeks up to date and best evidence associated with a case, reflects on her experiences and expertise and in combination with the patient’s preference makes decisions about care. A nurse can make positive impact by her potential to make change from best evidence. Barriers to implementing evidence-based practice are inadequate knowledge in identifying and critic research outcomes, misconception and wrong approach to research and evidence-based care, large number of patients and lack of adequate time to search for evidence, pressure from colleagues to follow traditional methods and patient’s preference for some types of care (Hopp, 2012). Now in the UK, NMC 2015 makes sure that qualified nurses are responsible and accountable to provide safe, personalised, evidence-based care. Knowing the best outcome research and guidelines without paying attention to the clinical expertise nor the patient desire is not evidence-based practice. It is also not just asking a colleague’s opinions about an appropriate care (McFadden, 2009). It was through evidence-based research that the best route of administration of medications were established. One will as a nurse impact the newest ways of patient’s management when one gives adequate attention to research.

In conclusion, because of the nursing profession which is more dynamic and practical in its approach, a nurse must regularly develop herself through lifelong learning and apply evidence-based practise to be relevant in the profession. Though there may be many challenges because of the nature of the work, determination with availability of resources will make good success of one’s career as a nurse.

References:

• Chiang. V. C. L. et al (2013). Building lifelong learning capacity in undergraduate nursing freshmen within an integrative and small group learning context. Nurse Education Today, 33(10), 1184-1191. doi: 10 1016/j.nedt 2012.05.009
• Josiah Macy Foundation, American Association of College of Nursing (AACN) and the Association of American Medical Colleges (AAMC), ‘Lifelong Learning in Medicine and Nursing Final Conference Report.’2010
• John, J. M., & Lisa, J. T. (2009). Evidence-Based practice for long-life learning, Journal of Infection control – evidence based 77(6), 423-426
• Salcido, R. (2013). Lifelong learning. Advances in skin and wound care, 26(10), 440-440.doi: 10.1097/01.ASW,0000434952.89478.e0.
• Tummons, J., & Powell, S. (2014). A-Z of lifelong learning. Maidenhead: MC Graw- Hill Education.
• Rose McMaster, Violeta Lopez, Michelle Cleary. Lifelong learning and Professional Practice. Nurse Health Sci. 2018; 20:1-3
• Barbara L. Nichols et al. The Future of Nursing: Leading Change, Advancing Health. Institute of Medicine.National Academies Press (US); 2011.
• John McFadden, Lisa Thiemann. Evidence-based Practice for Lifelong Learning. AANA Journal 2009;77(6):423-426
• Marjan Laal. Lifelong learning: What does it mean? Procedia – Social and Behavioral Sciences. 2011; 28:470-474
• Mojtaba Qanbari
  
  Qalehsari
  
  , Morteza Khaghanizadeh, Abbas Ebadi. Lifelong learning strategies in nursing: A systematic review. Electronic Physician (2017) 9:10;5541-5550
• Novak, Malorie Kosht, PT, PhD, DPT, et al., “Measuring Health Professions Students’ Orientation Toward Lifelong Learning,” Journal of Allied Health, 2014; 43(3): 446-449.
• UNESCO Institute for Lifelong Learning 2016. Conceptions and realities of lifelong learning. https://unesdoc.unesco.org/ark:/48223/pf0000245626
• Gould, J. (2010;2009;). Learning theory and classroom practice in the lifelong learning sector. Exeter: Learning Matters.
• Easton T. Lifelong Learning: Fostering a Culture of Curiosity. Creative Nursing. 2010; 16(4):
• Lifelong Learning is a Vital Effort for Nurses.
  
  https://www.healthstream.com/resources/blog/blog/2017/05/23
  
• Alsop, A. (2013). Continuing professional development in health and social care : strategies for lifelong learning. Retrieved from
  
  https://ebookcentral.proquest.com
  
• Lipscomb, M. (2016;2015;). Exploring evidence-based practice: Debates and challenges in nursing. London: Routledge. doi:10.4324/9781315764559
• Hopp, L., & Rittenmeyer, L. (2012). Introduction to evidence-based practice: A practical guide for nursing. Philadelphia: F. A. Davis Company.
• Grove, S. K., Gray, J. R., & Burns, N. (2014;2015;). Understanding nursing research: Building an evidence-based practice (6th; Sixth; ed.). Saint Louis: Elsevier Health Sciences.

“In recent years there has been … a significant shift in the definition of disability from a medical orientation … to a socio-political perspective” (Hahn 1997, 172). In a context of equality, describe and evaluate significant differences between medical and social models of disabilities.

In my essay I will discuss the movement from the medical model of disability to the social model of disability and how it has moved from an individual perspective to an environment/socio political perspective.

I shall first give a description of what both models entail and consist of. I will be looking at certain readings from the course to do so, including the papers from Mike Oliver, Colin Cameron, John Swain and Sally French, Jenny Morris and Shelley Tremain’s paper on Foucault’s Governmentality, and critical disability theory.

Firstly I will describe what both models entail. I shall then evaluate the major differences and major implications both models have on society, by looking at the differences between them, in the way that they evolved. I shall also look at how the affirmation model has a crucial role to play in the development of the social model. These models of disabilities are particular understandings of disabilities, within the period of time that they were made. The relationship between disability and society has been ever changing over time. It has been different in the past, it is different today and it will be different again in the future. Why is this though? Foucault thinks that it was society’s ways of managing a problematic element of society. So these changes that we see within our theories of disabilities, is perhaps more a reflection on the way in which society is managing these problem elements of society.

Medical Model

The medical model of disability quintessentially states that the disability lies with the individual. “Any economic or social deprivation encountered by disabled people was located within the individual and their impairment.” (Swain, French, 2003).

It is inherent in the person. This illness or “disability” effects the person in their day to day lives, leading to a diminished quality of life, and may cause serious implications to how one is to lead a “normal” life and the disadvantages that this may cause the individual.  The medical model believes that the way to approach disability or illness is to identify the illness or disability within the individual and then look for a way to “cure or treat” it. It is done by the use of medical professionals, who are trained to deal with such “disabilities”. Foucault speaks of the “psy” sciences and how their influence somewhat shows how the medical model approaches the matter of disability. It is/was seen as a compassionate outlook that with better funding and training of these experts would lead to a more profound view of these individuals needs and there for, be advantageous in helping them have a more “normal” life. The medical professionals are seen within this model as the fundamental responsibility in the area of disability. Off course this was the first model written up and there have been advancements and different outlooks as to what disability actually is or the way it is portrayed. This I will look at later. However staying with the medical model, I would like to look at some of the advantages of this first before we look at any other models.

Although there is a huge critique to the medical model and it is undoubtedly outdated, there are some positives from it. It does provide support to the individual or “disabled” person who needs help.  It gives the individual a better understanding of their impairment and in doing so provide the tools to be pro active in their daily lives. Chatting to medical professionals would inspire a positive reaction, as it makes their situation more “normal” and acceptable to the person. It helps create a better understanding to the individuals needs, and to use the term loosely “normalise” their situation somewhat. However the implication of a “cure” being the only solution has many more negative responses than it does positives. However I do feel it important to point out, that this model was the first significant shift in support to those that needed it. It was the first small step in the conversation of what disability actually is. However dated it is, it still provides the foundation and promotion in awareness to a field which is evolving every second. Our awareness and knowledge has vastly improved and will continue to do so with more open conversation.

Social Model

A change in the way we understand disability and society.

This denies anything to do with personal characteristics or flaws.

Disability is the outcome or a product of the relationship between the individual and the society which they live in. This society creates barriers which exclude people, and it is these barriers that create disability. Disability is therefore not a personal characteristic; it’s a social or a political product. As Mike Oliver says, what produce’s a disability is the barriers presented within society. This can be a number of things, handles on doors too high, doors wrong size etc. It is basically a form of discrimination. The social model encourages us to think about disability as a question of equality that will produce a different mindset, in to how we approach researching the matter.

The social model evolves in a way where governmental issues are not just to provide financial support or assistance to those who need it, but to improve the civil rights of these individuals. The “disability” is a social construction of environmental matters. This can be broadened to include attitudes within society or social behaviours. These behaviours are a result of the attitudes of the institutions that exist within our society and the values in which they reflect. This influences the way in which society as a whole views what disability is, and what is normal in the range of the functionality of human beings.

“All disabled people experience disability as social restriction, whether those restrictions occur as a consequence of inaccessibly built environments, questionable notions of intelligence and social competence, the inability of the general population to use sign language, the lack of reading material in Braille or hostile public attitudes to people with non-visible disabilities”. (Oliver, 1990)

This model approaches the matter of “disability” in a way that other minority groups are stigmatized. The “disabled” are also a minority group, within these social and political structures in place. These structures restrict and limit opportunities for the individual as a result of the institutional values and legal constraints that exist within our modern day society. This restricts and almost victimises the individual, limiting their opportunities to live a “normal” life. The problem exists within the socio-political framework and how people with impairments are seen. This model brings a new found attentiveness on the deeper issues that are seen in what disability is. Foucault’s idea on governmentality has been related directly to these factors within disability. He speaks of the social constructs in place within society and their affect on it. How this minority group, “disabled” have suffered from the medical model protocol and how their “subjectification” has been the ramifications of this. These are a direct result of his ideas of governmentality, through what he calls “bio-power” or “bio-medicine”. Perhaps it is important to point out that Foucault didn’t write specifically about disability. His first major work did explore what he called madness and that could be construed to what disability is, however I’m more interested in his ideas of governmentality and how it relates to the idea of what disability is today. He was not directly talking about disability. But these ideas heavily influence the evolution within the subject disability and equality.

Focault

Foucault’s works helped in the shift from the medical to the social model, and are influential in how we evolve even further to our understanding of what disability is.

So how do we relate Foucault in relation to evaluating the differences between the medical and social models?

Shelly Tremain says in her article,” politicized conceptions of disability and the increasing consolidation and visibility of the social movement, that spawn have predicated significant social change.” (Tremain, 2005)

By this she means the “normalisation” of what disability is, and how Foucault’s idea of governmantality, especially to do with bio power has led to this new found understanding of what disability is.

I will focus on Foucault’s ideas as they now can be used as critical reflections on existing practices in regards to how disability is perceived. Foucault speaks of subjectivication and how human beings are been made subjects of, by the very institutional practices that exist in our society. By this I mean his object is to create a history of different modes by which our culture have been made into subjects. It can be said that it is like objectivication, which is a process of turning people into subjects by a process of domination, like those of the institutional practices we have today. There are three ways of doing so according to Foucault; dividing practices, scientific classification and self formation.

Foucault is interested in the relationship between knowledge and power. There is no distinguishing element between them, because as he sees it, they are two sides of the same coin.

“Power must be analysed as something which circulates, or rather as something which only functions in the form of a chain. It is never localised here or there, never in anybody’s hands, never appropriated as a commodity or piece of wealth. Power is employed and exercised through a net-like organisation. And not only do individuals circulate between its threads; they are always in the position of simultaneously undergoing and exercising this power”. (Foucault, 1980).

Disciplinary power or bio-power as he more commonly phrases it has a huge relationship as to how we see the relationship between disability and society. It is operated through surveillance and this is the key factor to managing people’s behaviour, which focuses on the human body. This surveillance permits knowledge and thus power in the management of these groups. It creates a sort of ranking order as to where people exist within the “norm”.  This circulating power can be seen in our schools, hospitals and many other institutions that exist within western society. But the surveillance Foucault talks off has become softer, in the sense that we now cannot see who is doing the surveillance. It has now taken a somewhat invisible form through modern technology in the use of CCTV, smart-phones, credit cards etc. So the subject is visible at all times through these mechanisms. You are unaware that you are been incorporated in power, within this mode of disciplinary power, like keeping to timetables at work or schools. It creates a kind of docile body and in doing so regulates the subjects in question. Those who are incarcerated within different types of institutions are more subject to these practices through power and knowledge. It is easier to gather information on them. These institutions support these practices. The purpose of this disciplinary power is to produce these efficient docile bodies, because the more docile they become, the more use they have for them within society.

The dividing practices that exist within these practices of power and knowledge are fundamental in linking how disability is perceived and how it leads to inequality. Those individuals who are earmarked as been problematic are then segregated from the “normal” society. Many examples are still seen today like hospitals or prisons. But there are also less direct ways incorporated. Through what Foucault calls, scientific classification, or with the use of the, “psy’s” . He notes that medicine operates on two strands; one focusing on the individual (disciplinary power) and one focussing on the population as a whole or groups of the population (Bio-power). These scientific disciplines emerged and developed their own individual classifications based on the knowledge of each of the disciplines involved. Along with these institutions, they developed a “panoptic practice”, something which Foucault says guarantees order. The use of the word panoptic is a metaphor for the relationship of these institutions in social control and the power/knowledge concept, and how through this invisible surveillance people became subject to what the social norm is. These people were ignorant of what constituted their best interests, especially in relation to mental health and so these institutions were designed to relieve people of these flaws.

A leading example is that of our primary school system. These were set up to defuse flaws that existed with its subjects. Impaired ambition, impaired in ways with loyalty to the state could be some examples. This regulation of people through disciplinary power is the governmentality that Foucault speaks of. It is a process of identification, then institutions are created in order to set up surveillance, then social order than be controlled. This incites a reflection on the role of the human sciences in organising and identifying and then justifying a response to these perceived impairments. There is a knock on effect in this type of regulation, as the policies and services that are provided and created are more about the regulation and management of these potentially troublesome populations, rather than providing equal access to services, to the population as a whole.

Foucault’s work has been used as a critical reflection on the medical model, and how disability is not what it is portrayed in it; as an individual problem. Rather the stepping stone of the social-political model is a result of this critical thinking in regards to how we view disability and to what is a perceived impairment. These questions need to be asked in regards to social policy making and decision making in the field of disability. The findings have been crucial in the progress of disability studies, and the formation of the social model is proof of this.  I will take a look now at works from both French and Cameron in their critique of the social model and how perhaps a newer model would lessen the gap of inequalities within the field of disability.

The Affirmation Model and beyond

The social model has had many people criticising it. Mike Oliver who was its founding father, in his defence does claim that it is not the absolute answer to lessening the gap of the inequalities we see.

“I have never seen the social model as anything more than to improve peoples lives, and I am happy to agree that it does not do many of the things it opponents criticise it for not doing”.(Oliver 2013).

I would like to look at the idea of the affirmation model proposed by swain and French and how it can help lessen the gap between disability and the inequalities which exists in our culture. They claim that if a more personal experience was incorporated in non catastrophic way, a better understanding may be pooled.

“It is essentially a non-tragic view of disability and impairment which encompasses positive social identities, both individual and collective, for disabled people grounded in the benefits of lifestyle and life experience of being impaired and disabled”.(Swain and French 2000).

The proposal of the affirmation model is not a complete critique on the social model, rather it is a stepping stone to “normalise” what it is to be disabled or to have impairment.  The main critique is however that the social model disassociates impairment from disability. It states to claim that having a perceived impairment is not a tragedy and that there are benefits from having impairments too. Also it points out that certain “impairments” are not addressed in the social model. They say that pain and chronic illness have not been addressed by the social model. These are not only restricted to disabled people, as non-disabled people experience both of these things too. Jenny Morris also criticises the social model in so far as it predominantly looks at the social barriers in society and it fails to take a look at personal experiences of disability. “There is a tendency in the social model theory to deny the experiences of our own bodies”. She argues that because disability is seen as mainly a social and political issue, a barrier has been placed to the acknowledgment of the effects that having a perceived impairment can have on an individual.

The affirmation models main progression from the social model is that it brings to light personal experiences to those individuals with “impairments”. These experiences have shed some light on how they feel; that their “impairment” has actually made their lives better and less complicated than if they didn’t have. Examples given are for women in society to form relationships, have kids etc. Those with perceived impairments are not under the scrutiny and pressure of society’s norms. They are left to their own devices, and to actually live a life which they want to live, not under the watch of our society’s invisible protocol of behaviour. Swain and French also discuss how being born with an impairment can give a clarity or perspective on life that one would not have being non-disabled. I think there is a lot of power within this statement. In its essence it means that whatever way you enter the world, maybe its through poverty, having an impairment or having no family or support network; all these things

can

present a problem in how we view what normal is in our society. It is up to the individual to live the way they want to live. Whatever social structures or barriers that might be in place, having perspective can always make you overcome any obstacle. I feel this is the main thought of disabled people. Life to them is normal. Their impairment is just part of their existence and who they are. Just like those who came from poverty. It is part of your identity and nothing can change that; being true to who you are and proud of it is the key to a life of fulfilment. The problem lies again in what Foucault says about regulation or defining the norm. And once this exists, there will always be barriers in place in society and hinder the prospect of collectively embracing every person as unique. This is why the affirmation model is fundamental to breaking down these societal “norms” through shared experiences of those with impairments, both collectively and individually. It will only help unify the disabled world with the non disabled world. Also with the development of the affirmative model, it signifies an ownership with impairment. This will help bring us further away from the medical model,  with new awareness of what medical intervention is actually doing to our bodies, and if we choose to accept it.

Cameron builds on the affirmation in his paper by suggesting that impairment is not a problem for those with impairments, but rather it is manufactured by those around them. They only become aware of their impairment when in a social situation, i.e. someone else’s awkwardness in their company. This social awkwardness makes impairment more relevant to those who have it. They become negatively aware of their own bodies because of these types of situations. He feels that because of these barriers that exist, that those who don’t have impairments struggle to deal with situations like this. They almost have a pitiful remorse in these types of situations. This is not that persons fault however; it is just another element of the difficulties faced with breaking down the barriers that exist between the disabled and the non disabled world. Because of the governmentalty that Foucault speaks of, we have been alienated into different groups, and this divide has created a social tension which exists in these types of situations.

“When he became aware of the gaze of the waiter standing behind him however his mode of awareness changed. He became an object for the other, and aware of himself as an object of scrutiny, fascination and perplexity. In other words he became aware of himself as a disabled person”. (Cameron, 2015)

Cameron relays on Foucault’s ideas when he talks of industrialisation and that before it was introduced, people with perceived impairments were included within community life. However post industrialisation, a divide made it self present as to what normal behaviour was, in relation to the factory setting. This element of capitalism cast aside those who were not fit to keep up with these production norms, and so the normal standard of behaviour was redefined by this movement. This was the catalyst for them to be” medicalised”. I find this point he makes very interesting. We have seen a transcending plot through how institutionalisation has been the founding father of what defining the norm is. However at the root of all this is the capitalist society in which we all partake in. Money breeds power. Almost like what Foucault resonates, that knowledge and power are two sides of the same coin. The element of money is a contributory factor to power, and holds a big grip on society today. Social structures today are set up in allegiance with how capitalism operates. It casts aside those who they feel cannot maintain a normal input to its mode.

The affirmation model is the next step into breaking down the social relationship that exists in the field of disability. Education and awareness within the population as a whole is the only way these barriers can be removed.

I have hoped to show that with the evolution of these models, steps are being made toward a greater understanding to what disability is and how it is portrayed in the world today. The stare of the medical model still lies in the root of the division and social awkwardness and constraints that still exists. Oliver’s social model is the stepping stone in a new found awareness of what disability actually is. It is a social construct of Foucault’s work on governmentality or more specifically bio-power.  The social-political model brings light to the structural barriers that must be overcome to lessen the divide between disability and inequality. These barriers are the foundations of the oppression that exists within the disability world. With this new found understanding, Swain and French’s Affirmative model came about. It sheds more light on what it is to have a perceived impairment. Its main critique of the social model is that it disassociates impairment from disability. Its main objective is to get into the nuances of what living with a perceived impairment is like, looking at personal experiences. It takes into account what is like to live with a perceived impairment and not simply shove the issue to one side. Taking these accounts into consideration can only bring about a more non tragic notion to what disability is. Cameron builds on this again and that the non-disabled world are guilty of making disabled person more aware of their impairments through socially awkward behaviour.  So it must be a collective movement in order to eliminate this crazy divide in our population in which social and political structures have put in place.  The regulation that Foucault spoke of is at the epicentre of this inequality that exists. We are all living and breathing human beings, sharing a space on this planet, in order to live. What is it to be normal or abnormal? How can we express our true feelings in a society which is set up to repress that? New found awareness and open conversation is vital to breaking down these social constraints of which society employs. I think it only right to let Foucault have the last word.

“Maybe the target nowadays is not to discover what we are, but to refuse what we are…the conclusion or would be that the political, ethical, social, philosophical problems of our day is not to try and liberate the individual from the state, and from the state’s institutions, but to liberate us birth from the state and type of individualization which is linked to the state”. ( Foucault,1982)

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Whose Prescription Pad Is It? Direct-to-Consumer Pharmaceutical Advertising Explained

Introduction

Direct-to-consumer pharmaceutical advertising (DTCPA) is the industry that advertises directly to patients by pharmaceutical companies. Over the past few decades, this form of health communication has taken off and is now labeled to be the utmost prominent form of advertisement. These companies claim their goal is to educate patients and motivate them to take responsibility for their health. With the help of the media, pharmaceutical companies are able to infiltrate the homes of the average American and suggest a prescription medicine.

This report will touch on five main topics: policies in foreign countries regarding DTCPA, the rules and regulations applied in America, the link to the opioid crisis, the annual cost of advertising, and the potential effects on the public.

Data Section

Policies in Foreign Countries

DTCPA is forbidden in Europe. The European Union argues that bypassing qualified healthcare professionals and communicating directly to patients is an unethical practice for pharmaceutical companies to partake in. In the European Community, abolishing the ban is a controversial issue as the pharmaceutical industry continues to grow. Those in support of abolishing the ban argue that DTCPA is an exceedingly effective marketing strategy (PMC). The European Parliament last met to discuss modifying the prohibition in 2007 but stuck with their decision that direct advertisement is not appropriate.

Currently, DTCPA is accepted as a legal form of advertising in only two countries, New Zealand and the United States. In New Zealand, however, general practitioners have recently come forward and demand they be banned, as they “are particularly upset by the misleading content of many of the advertisements and the commercial pressure this puts them under to prescribe advertised drugs, even when they’re no better than existing alternatives or are not suitable for the patient” (PubMed).

Canada allows advertisements that either address a medical condition and encourage people to talk to their doctor regarding possible treatments, or they can name the product, include details on strength, dose, and cost, but cannot guarantee effectiveness. They can do simply one or the other, but not both (Open Medicine).

Rules and Regulations in America

Direct to consumer advertising is regulated by the Food and Drug Administration (FDA). In 1938, the Federal Food, Drug, and Cosmetic Act was passed, authorizing the FDA to approve pharmaceutical products for advertisement in the U.S. Later, the FDA was granted the power to regulate the labeling and marketing of prescription drugs by Congress. After a discussion in 1969, the final regulations placed on these advertisements included: must not be false or misleading, must present an equal balance of information explaining both the benefits and risks, must provide relevant details, and include a brief summary of every risk present on the medication’s label (NEJM).

In 1997, the FDA issued a regulation stating that advertisements could include just the major risks to meet the requirement of a summary and direct viewers to obtain a full summary elsewhere, such as a toll-free number, their healthcare provider, or from the internet. In 2004, the FDA eased the rules a little more and stated companies just needed to provide a simplified brief summary, this change allowed companies to just touch on the major risks in simpler terms that would be easier for the average viewer to understand (PubMed). Today, Americans argue that the regulations placed on these ads are too relaxed, resulting in the amount of pharmaceutical advertisements on television (Journal of Ethics).

Link to the Opioid Crisis

The opioid crisis is a term used to group the mass increase and abuse of prescription drugs and Opium derived substances. The number of deaths caused by opioid abuse in America tripled between the years 1990-2007. Ensuing around the time DTCPA began to skyrocket, most looked to prescription drug ads as the cause.

Evidence points to this being a cause of increased population drug-use rates, as the advertisement of a pain reducing medicine appealed to consumers (OpenMedicine). These advertisements for medications that claimed to be anti-inflammatories and reduce pain were being seen everywhere and patients began requesting the prescriptions by their name. This was demonstrated in a recent survey in which more than one-third of respondents reported requesting information from their physicians about a drug they had seen or heard advertised, and nearly three quarters of patients directly requested the drug by brand name (Emerald).

The Annual Cost of Advertising

Direct-to-consumer advertisements have shown the fastest growth from 1996 to 2016 in terms of medical marketing. The expenses of DTCA were reported to be at $2.1 billion in 1997, representing 11.9 percent of the nation’s spending. In 2016, $9.6 billion was invested in DTCA, reflecting 32 percent of total spending (JAMA). Before 2005, DTCPA was estimated to be growing by 20 percent per year, raising the price of every dollar spent on DTCPA by an approximated $2.20 to $4.20 (PubMed).

It was reported in 2018 that pharmaceutical companies spent over $64 billion on advertising, a 4.8% increase from the year before. The well-known anti-inflammatory Humira, came out on top with having spent $487 million on media advertisements, a 13 percent increase from 2017. In second place was Lyrica, at $272 million. Following Lyrica was Xeljanz, spending $257 million. Spending for Lyrica is expected to decrease dramatically in the next year, as it lost patent protection. Since being approved by the FDA in 2004, Lyrica was deemed to be a best-selling product, bringing in sales of $3.46 billion (Kantar).

Effects on the Public

While DTCPA is a controversial issue in America, there are well-balanced arguments for the benefits and risks. Those who support DTCA claim these advertisements educate consumers and encourage them to take responsibility for their wellbeing and become aware of possible treatments (PubMed). Supporters also argue that it urges patients to contact their physician.

A 2004 FDA survey revealed that 27 percent of Americans had made an appointment with their doctor to discuss a condition they had not previously mentioned after seeing a drug advertisement (Annals of Family Medicine). Those against DTCPA claim that patients are often misinformed by these advertisements. A point often made debates that important information is omitted from the ads.

In one report, 82 percent of DTCPA advertisements made factual claims for the marketed drug; however, only 26 percent of ads identified the risks or causes of the disease (PubMed). Another argument is that the ads over emphasize the benefits. A study conducted in 2007 proved that television commercials promoting a drug spend more time on the benefits that the risks (ProQuest).

New Zealand associate professor at the Christchurch School of Medicine and Health Sciences, Dr. Dee Mangin, is a critic of DTCPA and argues that, “The truth is direct-to-consumer advertising is used to drive choice rather than inform it,” most commonly seen in expensive name-brand companies. In addition, these big pharma companies are enticing doctors to prescribe their product.  Surveys carried out in New Zealand and in the USA show that when a patient asks for a specific drug by name they receive it more often than not, as the doctors reported feeling pressured to prescribe the drug (World Health Organization).

Conclusion

While the exposure of DTCPA to the public remains a topic of great debate, existing evidence suggests that the influence direct drug advertising has on consumers is an equal balance of beneficial and damaging. Nonetheless, there is no doubt that improving current knowledge of the effects will produce significant results for the public of New Zealand and the United States, whether it be constructive or destructive and result in the abolishment of these ads. The opioid crisis in America is a problem still being resolved, but new evidence could potentially aid in understanding the roots of this epidemic.

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