Introduction: A COPD exacerbation can be defined as “an event in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum, that is beyond normal day-to-day variations, is acute in onset and may warrant a change in medication in a patient with underlying COPD,” according to the Global Initiative for Obstructive Lung Disease (GOLD). COPD exacerbations are debilitating, in and of themselves. The toll they take on patient’s body can lead to disability and even death. Paying attention to signs and symptoms, taking better care of themselves and taking steps towards prevention may ultimately help patients to avoid a COPD exacerbation.

Clinical Focus: Effective education to increase early rehabilitation for over 20y/o both female and male adult who diagnosed COPD with acute respiratory failure in ICU.

Overall Project Goal:

Overall goal is to be able to propose improvement early rehabilitation to achieve optimal health as well as to promote knowledgeable and effective self management for chronic disease.

Nursing Theory: Roy’s adaptation model of nursing and Orem’s self care mode

Inclusion population

Patient older than 18 years of age

Chronic obstructive pulmonary disease

Patients without sedation or catecholamine

Conscious and cooperative state

Ability for the patient to sit in a armchair

Exclusion population

Non chronic obstructive pulmonary disease

Lack of patient involvement

Patients under guardianship

Unconscious and non cooperative state

Patients unable to ride in a wheelchair

Patients under justice safeguard

Date

Objectives

Strategies

Time frame

Outcomes

10/5/10

Using Orem’s self care model the student will establish needs assessment tool based on the protocols of the institution and information gathered from the health care team of Montefiore Hospital.

Introduce myself to Mr. Villarente. Discuss with overall project goal

1hour

Student explains overall project goal and a plan for assessment tool.

10/11/10

Using Orem’s self care model the student will establish needs assessment tool based on the protocols of the institution and information gathered from the health care team of Montefiore Hospital.

Generalized all information gathered from patient’s chart with COPD, as well as the overview of patient’s education sources.

An insight form the Nurse Manager, unit nurses, allied team members such as Doctor of the unit, social worker and clerk.

Introduce master plan to Mr. Villarente. Discuss about overall project of this object. Unit orientation, discuss about project concept, theory application.

Review current project of the unit and objectives.

2hours

2hours

2hours

1hour

1hour

*Overall outcome: The student reports knowledge on COPD and project of concept using nursing theory which is Orem’s self care model. Student also reports teaching guidelines and support rendered for COPD for Montefiore Hospital.

The student visited Montefiore ICU and Med-Surg unit on the 5th floor with the preceptor and the clinical practicum project was presented to the all available staffs by the student and the preceptor.

No specific and realistic education guideline was unearthed by the student.

The preceptor introduced ongoing project of the unit. The concept is ‘decrease the rate of unscheduled extubation.’ The student was able to merge her own view of the master plan with the ongoing project in Montefiore Hospital.

10/15/10

Using Orem’s self care model and Roy’s adaptation model Student will identify what the barriers are to using COPD guidelines for montefiore hospital patients.

Interview with 3patients and 3 unit nurses at Montefiore Hospital about (lack of) Awareness & knowledge-of what needs to change & why, (lack of) Motivation-drive & desire to improve care, priorities, (lack of) Acceptance & beliefs-perceptions of benefits vs costs of proposed change, (lack of) Skills Practicalities-(lack of ) availability of resources, personnel External environment-financial, political, and organizational.

Review literature

9hours

(1.5hrs for each pt)

(1.5hrs for each nurse)

1hour

*Overall outcome: Student presents what the barriers are with COPD patients and what COPC guidelines needs to change at Montefiore hospital.

The student interviewed 3 patients and 3 nurses to learn good interview skills as well to get their ideas or answers regarding COPD education.

The student found that there is no nursing specialist to teach about how to manage themselves for COPD to prevent exacerbation.

The nursing staffs are able to access KRAMS which is patient education hand out via internet.

During interviewing with patients, the student found that thick hard hand out materials is not able to motivate pt to read all of them.

10/18/10

Using Orem’s self care model and Roy’s adaptation model Student will identify what the barriers are to using COPD guidelines for Montefiore hospital ICU patient.

Review 3patient’s charts to gather information.

Interview with 3 patients about considering respiratory isolation to reduce risk of outbreak or epidemic.

Observe patient care with primary nurses

Review literature

3hours

3hours

(1hrs for each pt)

3hours

1hour

*Overall outcome: Student presents what the barriers are with COPD patients and what COPC guidelines needs to change at Montefiore hospital.

The student reviewed 2charts and observe patient care with primary nurse to gather data regarding medical hx, status, medication, treatment, s/s, family hx, allergies, cigarette or drug uses, etc.

The patients were admitted for asthma and COPD exacerbation with complicated diagnosis such as diabetes, bipolar disorder, CHF. All these diagnosis seemed to be related COPD exacerbation.

One of the interviewee who is 65y/o male stated “I know how to use inhaler to reduce my symptoms but I don’t want to do that myself.”

The student found that we, nurses need greater awareness of and familiarity with COPD diagnosis and monitoring guidelines and an understanding of their practice compared to guidelines

Summary: Patients with stable COPD should be directed at improving quality of life by preventing acute exacerbations, relieving symptoms and slowing the progressive deterioration of lung function. The clinical course of COPD is characterized by chronic disability, with intermittent acute exacerbations that occur more often during the winter months. When exacerbations occur, they typically manifest as increased sputum production, more purulent sputum and worsening of dyspnea. Although infectious etiologies account for most exacerbations, exposure to allergens, pollutants or inhaled irritants may also play a role

Background of COPD Self Assessment

Today, COPD is a widely-spread disease that threatens to the life and health of many patients. The development of the effective treatment and prevention technique for COPD becomes of the utmost importance, taking into consideration the fact that COPD is a chronic disease. In this regard, Orem’s self assessment model can be very effective taking into consideration the necessity of conducting the self assessment by patients on the regular basis to control their health and any changes that occur to them.

Importance and relevance of COPD Self Assessment for nursing

The COPT self assessment is particularly important for nursing because it opens large opportunities for the development of effective approaches to nursing care. To put it more precisely, patients can reveal the deterioration of their health due to the use of the self assessment model, whereas nurses can provide patients with the essential medical aid immediately and, if necessary, the in-patient treatment starts. At this point, it is worth mentioning the fact that nurses often suffer from the lack of the lack of the close cooperation with patients because they fail to identify health problems and deterioration of their health in time. As a result, the in-patient treatment may be needed and nurses will have to work hard to help patients, whereas the positive effects of such treatment may be at risk, whereas the deterioration of health identified early facilitates the work of nurses and increases the efficiency of their work.

Literature review

In actuality, specialists () recommend using Orem’s self assessment model and Roy’s adaptation model as effective tools that allow patients to conduct self assessment and monitor their health on the regular basis. The use of these models is simple for patients just need to fill in the form and, depending on the result, they can take action and appeal for a doctor or carry on the regular treatment (See App). Many specialists argue that Orem’s model is effective due to the simplicity of its use. On the other hand, patients should remember that they do need the regular supervision and control from the part of health care professionals to avoid consistent deterioration of their health.

Roy’s adaptation model and Orem’s self assessment model

In actuality, Roy’s adaptation model and Orem’s self assessment model is very effective and helpful to nursing. In this respect, it is important to place emphasis on the fact that the self assessment is very important because nurses can get the detailed information from patients concerning their health and provide nursing services just in time, in case of the deterioration of patients’ health under the impact of the development of COPD. In actuality, Orem’s self assessment is a reliable technique and nurses can rely on outcomes of such self-assessment, whereas the use of other less reliable models can raise difficulties in immediate diagnosing and provision proper nursing services for patients.

Relationships between COPD self assessment and other factors

At the same time, COPD self assessment is very important in regard to the development of the adequate treatment and can minimize the risk of the development of other diseases. In actuality, Orem’s model of self assessment can help prevent the development of complications that may lead to the consistent deterioration of health in patients with COPD.

Assessment plan development

In such a situation, nurses should assist patients to develop the assessment plan. In this regard, nurses should provide patients with detailed information on the process of self assessment. To do this, nurses can conduct the questionnaire to assess the educational level of patients. In actuality, training courses may be the next step in the assessment plan development because they will help to educate patients. After that nurses should introduce the control system to evaluate the effectiveness of self assessment and introduce changes in the self assessment model, if necessary.

Effective Interprofessional Collaboration is key to providing good quality patient centred care

This essay will discuss the principles of patient centred care and their relationship to multi-disciplinary team working and identify and explain key concepts of individual and team communication within the practice setting. Reference will also be made to experiences in practice and the effect of these experiences on the patient. My personal experiences of multi-disciplinary team working will be reflected upon, as will my strengths and weaknesses in relation to my skills as a collaborative team member. Patient confidentiality will be protected at all times when reflecting on personal experiences in placement in accordance with the NMC code of professional conduct (NMC 2004).

The term patient-centred care refers to the participation and involvement of the patient in the decisions taken concerning their care and treating the person as an individual, recognising the differing needs amongst individual patients (Barrett, Sellman and Thomas 2005). The importance of involving the patient in their own care has become increasingly important over the last half of the 20

^th

century, with more people living into older age than ever before, and with this increase of life expectancy has come an increase of those living with chronic or long-term illness (Department of Health 2001). This has led to a heightened number of people becoming, in many instances, more knowledgeable of their condition than the healthcare professionals that are involved in their care and treatment, and therefore, rather than being merely recipients of this care they are increasingly taking responsibility for the management of their illness by making informed decisions concerning their treatment, alongside those of healthcare professionals (Department of Health 2001). As the significance of patient centred care has been identified it also important to understand the relationship between patient centred care and multi-disciplinary team work, which is that to enable the provision of patient-centred care a number of different professions will need to be involved, as it is not possible for one profession to have all the knowledge required to provide effective care, therefore the multi-disciplinary team must work collaboratively to be effective, with effective communication between professions making this collaboration possible (Barrett, Sellman and Thomas 2005).

Furthermore, as healthcare teams are not comprised solely as a solitary department a patient may need to attend clinics in many of the different hospital departments in order to gain the desired treatment. In order to provide the patient with the best quality treatment and care, it is essential that there is high level of effective Interprofessional collaboration between all members of the healthcare team. Ensuring efficient communication between healthcare professionals will not only increase the quality of the service, but it could also help reduce hospital waiting lists for treatments and ultimately, increase patient satisfaction. For example, when considering a department such as radiology it is becomes clear why effective communication between all members if the team is essential. A radiology team is composed of many different interdisciplinary professionals not only doctors, radiologists and nurses working within the radiology department, but it also comprises the individuals with whom these members of staff interact within their different, complementary departments. For example, a patient will have been referred to a radiologist from a different department e.g. gynaecology. The patient will also go to meet the staff at the admissions desk, outpatients staff, perhaps ward staff if they are to be admitted. Thus, the coordination of this team of practitioners is vital in order to ensure that the patient is treat efficiently and that their care needs are met.

When there is a lack of communication between professions the quality of care will inevitably suffer. There are many examples, and consequences, of good and poor communication and one example is that of a scenario my colleagues and I were asked to consider as part of our online learning for the Collaboration in Professional Practice (CIPP) module, which was of a student nurse attending a ward round with a doctor. In the scenario the student nurse had concerns as to the patient having little opportunity to ask the doctor any questions or allay any concerns that he had, which the student nurse perceived to be due to a number of reasons, including the lack of privacy on the ward and the doctor making it apparent that he was short of time. When she reflected on this incident she felt that she had not communicated with the doctor efficiently and acted as advocate for her patient, therefore, the consequences are that he was possibly left with many unanswered concerns. There were many opinions relating to this scenario put forward on the group discussion board (see appendix 1) and many of us felt that this emphasised the importance of having a mixed number of professions on ward rounds, including a nurse whose responsibility it is to act as advocate for the patient. The student nurse in the scenario pointed out that she felt she had let her patient down in favour of showing the doctor that she was efficient and good at her job and it could be argued that this need to impress the doctor was due to the hierarchical structure within which hospitals tend to operate, with doctors being at the top of this structure, which could affect communication between doctors and nursing staff.

One of the objectives of a study which was carried out by Kinley et al (2001) was the investigation of ‘the quality of communication between senior medical staff and ATN’ (Kinley et al 2001: 2) (The ATN are appropriately trained nurses) and the study was conducted in retrospect of the plans to implement nurse-run clinics and to give nurses some duties which were previously considered to be that of a doctor. This is of importance and relevance to the provision of patient centred care, as the ability of members of a healthcare team to effectively communicate and articulate any problems, concerns or even advice which one may have in order to help another member of the healthcare team to treat a patient is one of the keys to effective collaboration within the multidisciplinary environment of a hospital (Barrett, Sellman and Thomas 2005). The conclusion made by the research team was that there is ‘no reason to inhibit the development of fully trained nurse-led pre-operative assessment, provided that the nurses are appropriately trained and maintain sufficient workload to retain skills’ (Kinley et al, 2001: 3). However, the qualitative counterpart of the study indicated that the use of ATN ‘for pre-operative assessment was agreeable to patients but there was no indication that there was any improvement in the ‘communication between senior medical staff and those carrying out the pre-operative assessments’ (Kinley et al 2001: 3). Hence, this study could be viewed to be indicative of the fact that if interdisciplinary communication and collaboration was to be improved within the healthcare team and hospital settings, perhaps the abilities of nursing staff to fulfil roles and complete duties previously associated with a doctor, such as completing pre-operative assessments and taking medical histories would be enhanced.

I myself have witnessed examples of both good and poor interprofessional collaboration and communication whilst out in practice. For example, whilst caring for an elderly lady in hospital who was recovering from surgery it became apparent that she was suffering from acute constipation. Numerous healthcare professionals worked collaboratively to eliminate her constipation, including doctors, nurses, a dietician and physiotherapist and in the end a satisfactory result was achieved. On reflection of this incident I felt that although there was clearly excellent communication and collaboration between professions, once they were working together in the treatment of this problem, there was also an unnecessary delay in the nurses involving these other professions in her treatment for this particular problem, which led to unnecessary suffering and pain for the patient. I referred to this incident on the CIPP group discussion board (see appendix 2) and found that this concern as to the length of time it can sometimes take to involve other professions was shared. Therefore, it is worth noting that even when communication is good between professions the quality of patient care will still suffer if there are delays in bringing about their collaboration.

The ability to reflect on incidents such as these is an essential component of nursing as it enables us to analyse what we did, if we did it well or if it we could have done it better, and then how we can develop our skills further to do better in the future (Brooker and Nicol 2003). When considering that nurses are expected to make certain decisions as to the care of a patient the benefits of reflective practice become apparent, reflecting on past mistakes can help greatly when deciding what action should be taken in the care of patient, particularly when it is a situation that one has previously experienced and thus gained knowledge from (Brooker and Nicol 2003). I feel that although I have made significant progress in my ability to reflect over the last year there is still much room for improvement, something which I have referred to in my action plan for the formative assignment (see appendix 3). I listed the priority of this ‘action point’ as being medium to high as although it is to be achieved throughout my career, as part of my lifelong learning, I feel that it is also an essential skill whilst being a student as it will my greatly aide my learning at present as well as in the future when qualified.

Being self-aware is vital to the reflective process as it is through our knowledge of ourselves that we are able to recognise our strengths and weaknesses and identify areas where more learning is required (Burns and Bulman 2000). Self-awareness is to be conscious of who we are, to be aware of our own values, beliefs and strengths and weaknesses (Burns and Bulman 2000). Being self-aware is essential to nursing as not only does it form the basis upon which reflection is built but it also contributes to how we communicate with others and aides our interpersonal development with our colleagues, as well as enabling us to build and maintain positive relationships with our patients (Bulman and Schutz 2004).

When reflecting upon my own strengths and weaknesses, in relation to my collaborative skills, I feel that whilst I am beginning to acquire an in depth understanding of the role of the nurse in the care of the patient I feel that I lack substantial knowledge of the roles of the other healthcare professionals that I work alongside in the care of these same patients. This point is also referred to in my action plan for the formative assessment (see appendix 3) and I listed the priority of this as being medium to high as I feel that it is not possible to become an effective collaborative healthcare professional without having an understanding of the roles of others with whom you are working alongside. If there is a lack of understanding of the roles of others I feel that it would be difficult to see why they are involved in the care of my patient, or even when it is appropriate to involve other healthcare professionals, inevitably leading to the quality of the care for the patient to suffer.

As we have identified the importance of Interprofessional collaboration in the provision of effective patient centred care and satisfaction within the hospital environment it is important to look at methodologies which can be utilised in order to improve the interactions and communication between members of each multidisciplinary team within the healthcare setting. Buchan and May (2007) describe how the process of ‘skill mix’; can be used to as a method of organisational change within a healthcare team and it has a role to play in improving the effectiveness of the organisation and quality of care. The four stages of a skill mix cycle are ‘the evaluation of the need for change, the identification of opportunities and barriers for change, the planning for change and finally making the change happen’ (Buchanan and May 2007: 1) Therefore, we can see that the methodology of skill mix is one option available to healthcare managers when they are aiming to improve the Interprofessional collaboration between members of their healthcare teams, the method does however require careful planning. Furthermore, it is important to realise that skill mix is more than just a technical exercise, as it is also ‘a method of achieving organisational change which requires careful planning, communication, implementation and evaluation if it is to achieve its main objectives’ (Buchanan and O’May 2007: 1).

Sibbald, Shen and McBride (2004) value the strategy of changing the skill mix of the healthcare workforce and highlight that factors promoting success in the improvement of the patient care service and the interactions and collaborations of members of the healthcare interdisciplinary teams include: ‘introducing ‘treatments of proven efficacy, appropriate staff education and training; removal of unhelpful boundary demarcations between staff or service sectors; appropriate pay and reward systems; and good strategic planning and human resource management’ (Sibbald, Shen and McBride, 2004 : 28). It is important to identify the areas which can help to improve staff communication because this will help with the planning and implementation of change and improvements within the healthcare setting. Education and training opportunities appear to be beneficial in two ways, firstly they provide a method for improving the staff morale and self-respect as they feel more satisfied and qualified to help others and thus communicate with other members of the healthcare team and additionally the training will provide opportunities for members of staff to become acquainted with other employees and to interact (Sibbald, Shen and McBride 2004). This may then help in the collaboration in the work place. Education and training strategies which could train doctors and nurses simultaneously would be beneficial in reducing the hierarchical boundaries between these disciplines (Freeth, 2005 and Dominelli, 2002).

The subject of this essay is increasingly significant at present due to the recent changes observed within the structure and function of the National Health Service (NHS) and the demands placed upon it to reduce the waiting times of patients and increase patient centred care, whilst at the same time cutting the costs and expenditure within the NHS (The Department of Health 2000). This puts pressure on medical staff, not only to increase their efficiency of treatment, but also to cope with and adapt to changes which are being made within their departments (The department of Health 2000). One of these changes which may be difficult for medical staff to adapt to in particular is the replacement of doctors with nursing staff in the carrying out of some of the duties and roles which were previously associated solely with the doctor. As the primary aim of the NHS is to provide the best healthcare possible for each patient, it is important that the staff employed to take over some of the duties and responsibilities previously associated with the doctors we must ensure that the nursing staff are fully trained and able to perform the tasks to the required standard and in order to do this it is important that there is an effective level of collaboration between the doctors and nursing staff and that the doctors provide a support network, to which members of the nursing team can turn to and ask advice when and wherever appropriate. However, as there may be negative feelings towards this change, perhaps felt more so by the doctors, this may prove to be difficult. Hence, it is necessary to enhance the levels of cooperation and team spirit in order to work more efficiently and make the most of the skills of all the professionals in the NHS workforce (The Department of Health 2000).

In conclusion, it is clearly apparent that the effective collaboration and consequentially the communication between members of a healthcare team is of vital importance when considering the accuracy and efficiency in which care can be provided to patients in a patient focused manner, and as this is an important aim of the NHS plan to reform, plans must be put into action to ensure that the levels of communication between members of the healthcare team are achieved to enable the goals made by government bodies to be reached and to aid staff moral in the workplace.

Reference List

Barrett, G, Sellman, D and Thomas, J (2005)

Interprofessional working in health and social care

. Basingstoke, Palgrave Macmillan

Brooker, C., Nicol, M (2003)

Nursing Adults, the Practice of Caring

. London, Mosby

Buchan. J, O’May. F (2007)

Determining Skill Mix: Practical Guidelines for

Managers and Health Professionals

[online] last accessed on 16

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December 2007 at: http://www.who.int/hrh/en/HRDJ_4_2_07.pdf

Bulman, C., Schutz, S (2004)

Reflective Practice in Nursing

. Oxford, Blackwell Publishing

Burns, S and Bulman, C (2000)

Reflective practice in nursing: the growth of the reflective practitioner

(2

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Edition) Oxford, Blackwell Science

Department of Health (2000)

The NHS Plan: a plan for investment, a plan for reform

[online] last accessed 16

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December 2007 at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002960

Department of Health (2001)

The expert patient: a new approach to chronic disease management for the 21st century

[online] last accessed on 15 December 2007 at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006801

Dominelli, L (2002)

Anti-oppressive social work theory and practice.

Basingstoke, Palgrave Macmillan

Freeth, D (2005)

Effective interprofessional education: development, delivery and evaluation.

Oxford, Blackwell Publishing

Kinley et al (2001) Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery

Health Technology Assessment

. Vol 5: No 20

Nursing and Midwifery Council (2004)

The NMC code of professional conduct: standards for conduct, performance and ethics,

London, Nursing and Midwifery Council

Sibbald,B, Shen, J and McBride, A (2004). Changing the skill-mix of the health care workforce.

Journal of Health Service Research and Policy

9(1), 28-38.

The Disability Discrimination Act (DDA) defines a disabled person as someone who has a physical or mental impairment that has a considerable and long- term adverse effect on their ability to perform every day tasks. (DDA, 2005). Access and inclusion into sport and physical activity is difficult for many people with a disabiltiy therefor changes must be made to ensure that every person wishing to take part can do so. This could be changing the facilities so that access is better for disabled people as well as modifying equipment and training programs so that everybody can access the facilities.

There are many schemes in place to help give disabled people the opportunity to participate in sporting activities. The Federation of Disability Sport Wales (FDSW) is a pan-disability National Governing Body of Sport. The aim of the FDSW project is to expand and enforce excellent sporting opportunities for people with disabilities (Disability Sports Wales, 2004). Many studies have been carried out in an increased effort to find connections between disability and physical activity but despite this increased effort problems still remain.

Many young disabled people would like to be included in sporting activities and in a study the majority of people surveyed expressed a preference to participate in a sporting environment if it was organised within a disability sports. (EFDS, 2005). Sports for the disabled still remain an understudied area and should be improved greatly if it is to develop. A development for disability in sport is needed because there are people who cannot participate in sport because of reasons beyond their own control. For most disabled people, their disability is not the barrier and therefore more should be done to overcome barriers that could be easily eradicated (Barton, 1989)

Many health and social benefits have been linked with a physical lifestyle. This is also true for those individuals who have a disability or long term health condition. Physical activity can not only decrease the danger of secondary health problems but can also improve all levels of functioning (Hidde et al. 2004).

The Disability Discrimination Act (DDA) defines a disabled person as someone who has a physical or mental impairment that has a considerable and long- term adverse effect on their ability to perform every day tasks. (DDA, 2005).

For people with a disability, accessing sporting activities can be difficult as there may not be many facilities to provide for them. Also the sports that they are able to access may not be suitable for them to be included therefore adaptations must be made to the sports to give them the opportunity to participate (Jette, 2003). This should include participation with able bodied participants also. There are schemes which run to organize safe and enjoyable sporting activities for disable people, as well as schemes that look to give access, inclusion and participation in sport for disabled and able bodied people alike (Finch et al, 2001).

The Federation of Disability Sport Wales (FDSW) is a pan-disability National Governing Body of Sport. The aim of the FDSW project is to expand and enforce excellent sporting opportunities for disabled people (Disability Sports Wales, 2004)

This scheme is set in Wales but there are other schemes that work towards promoting and developing disability sport throughout the UK.

This report will look at disability in sport. The main issues that will be looked at are access to take part in sports as well as the inclusion for disability in the sports. With these factors being identified, participation levels for disability in sport will be examined to see what areas of the UK are working towards giving equal opportunities for disabled children and adults.

Rimmer et al, (2006) reported that an investigation was carried out into the accessibility of health clubs and leisure centre for disable people. The investigation studied thirty-five health clubs and fitness services in a nationalized field test in which a new piece of equipment was used. The Accessibility Instruments Measuring Fitness and Recreation Environments (AIMFREE), was used for measuring the ease of access of fitness amenities in the built environment, the available equipment and swimming pools. In addition the information available to the service users was measured along with the facility guidelines, and the professional behaviour of the staff working within the facilities. All the facilities that the test was carried out on confirmed low to moderate levels of accessibility. Some of the deficiencies showed a cause for concern with the Disability Act guidelines regarding the built setting; other problems related to parts of the facility such as the equipment, information, policies, and professional staff (Davies, 2002).

Many studies have been carried out in an increased effort to find connections between disability and physical activity but despite this increased effort problems still remain (Fitzgerald, 2008).

Hezkiah (2005) stated that young disabled people demonstrated low levels of physical activity and perceptual motor difficulties compared to young people without a disability. This low level of activity and motor learning affects their ability to learn. Major barriers to young disabled people include language conception which is vital for following commands, and physical disabilities, which have an effect on their capability to carry out motor skills (Gatward and Burrell, 2002; Gordon and Williams, 2003).

These limits can have an effect on their motivation and add to restricted opportunities for regular involvement in movement, physical activity and sports, which consecutively affects their capability to develop and progress in life.

Finch et al (2001) set out to perceive the consequences of the barriers linked with disability and how it affects their levels of exercise. During the study many questions were asked to the participants were and asked to answer for a range of information, and were then asked to specify which physical activities they participate in. The subjects were asked to provide the reasons preventing their contribution to exercise. No clear inclusion or exclusion instructions were given therefore the reasons would be their own personal feelings.

Findings of the study have shown that 20% of the participants acknowledged that their disability was one of the barriers preventing them from additional physical activity, with half of the participants expressing it as the most important grounds as to why they do not take part in more physical activities.

Current injury or disability was a barrier to physical activity in older people more often than younger participants.

Injury or disability was the main difficulty to participate in physical activity for people who are overweight or obese based upon their body mass index (BMI). This reason was stated more frequently than for those who were underweight or standard weight. Another finding during the study suggested that current injury or disability was a major barrier for people who were inactive compared to people with high levels of physical activity.

The findings suggested the importance to target the support of physical activity available to overweight and older adults particularly to get them active by giving them access to facilities along with the inclusion to the activities. They go on to identify the problems that can occur with disability. They state that a person would stop exercising because of a disability rather than just becoming overweight and not exercise because of the weight problem.

Rimmer et al (2004) recognized a variety of barriers and facilitators that were associated with participation levels in health and leisure programs and amenities amongst persons with disabilities. The results showed that the participants reported 178 barriers and 130 facilitators. The problems identified were barriers and facilitators connected to the built and natural environment along with economic issues. Emotional and psychological barriers were also identified as a problem. The amount of involvement in activities among disabled people is a problem due to a set of barriers and facilitators. Future research could utilize information conducted by Rimmer et al (2004) to develop participation schemes that have a superior probability of accomplishment.

A report from the EFDS, (2005) showed that whilst young disabled people valued sport and recreation opportunities, they do not access their chances for physical activity on a regular basis. Disability is not a barrier to participation in sport and leisure. Regardless of rising guidelines and legislation encouraging improved participation in sports and physical exercise by young disabled people, only a restricted quantity of young disabled people do take part in physical activity. Only a small number of young disabled people can access sporting activities and opportunities outside the activities obtainable inside curricular time which includes after-school clubs, community opportunities, and general play.

The person’s impairment was the most significant factor to be found to have an effect on physical activity involvement. Those with multiple impairments were far less probable to take part than those with a single impairment (Maloney et al, 1993).

The most frequent curriculum sports linked with disability and exercise was Athletics, Ball Games, Boccia, Cricket, Football and Swimming. There are many barriers to participation which included access to facilities and equipment. Improvements in facilities and access to equipment would improve access to sports and recreation opportunities (Williams, 2005)

In studies, young disabled people have expressed a fondness for taking part in physical activity when participating in a sporting environment particularly if it was organised within a sports club specifically for other people with comparable disabilities. With consideration to the type of activity, results showed that young disabled people would like to join in physical activities that young disabled people already participating in (EFDS, 2005).

There are many initiatives set up to give disabled people a chance to take part in sport and physical actvity (Norwich, 2007).

The Inclusive Fitness Initiative (IFI) is a proposal that supports the fitness production to develop into a more inclusive plan that can cater for the needs of both disabled and non-disabled people alike. Through a variety of developments, the initiative has maintained facilities across England to produce a comprehensive service which results in increasing participation levels by disabled people.

Parasport is a combined proposal set up in a joint initiative invloving the British Paralympic Association (BPA) and the services services firm Deloitte. Their aim is to amplify participation levels in competitive sporting events. Parasport aims to improve the identification of sports people and aims to support them at a community level. They set out to provide bursaries to assist talented and potentially top class athletes through a joint venture with SportsAid. Parasport is ran by the BPA. The BPA is the body responsible for the elite side of disability sport, although the Parasport scheme is availiable for all abilities to take part.

Another initiative in place is “The Talented Athlete Scholarship Scheme” (TASS). This scheme is set up in England and aims to help young athletes committed to improving their potenital by sport and education. Currently there are 50 sports eligible for TASS, of which 16 are disability sports. This scheme is open to people aged between 16 and 25, with an upper age limit of 35 for people with a disablity. The scheme can provide a package of sporting activities to athletes and give them the ability to access high quality training facilities.

An athletics initiative has been launched in by the Sports Council Wales to encourage more children with disabilities to participate in sport. Combined with the Federation of Disability Sport Wales, athletics sessions have been introduced where children can join in with fun sessions delivered by skilled volunteers from Welsh Athletics.

The Disability Sport Wales National Community Development Programme is an initiative set up in conjunction with the Sports Council for Wales, the Federation of Disability Sport Wales and 22 local authorities across Wales. The proposal aims to develop excellent community based sporting and leisure opportunities for disabled people throughout Wales (Hughes, 2009)

Arthur and Finch (1999) said that people with a disability might recognise the physical and social benefits resulting from participating in physical activity generally. However, a failure to recognise specific guidelines on the necessary frequency and extent of physical activity in order to achieve such benefits, particularly amongst older people, contributes to low participation levels.

External barriers that have resulted in a lack of opportunity to contribute in physical activity among people with a disability have been widely discussed in literature (Arthur and Finch, 1999;; Doll-Tepper, 1999; DePauw and Gavron, 2005). Research has shown a range of issues, which include a lack of confidence. With the opportunity to participate, the confidence would grow and give the people a chance to be active.

A Lack of physical and emotional support was also a factor that caused people with a disability not to take part in sport and physical activity. Not having someone to go with to the gym or sporting facility is another barrier (DePauw and Gavron, 2005). According to Arthur and Finch (1999), this poses a greater problem for those people with a disability who need some kind of physical, oral or visual assistance or moral support.

Lack of information was a big factor in reasons to why they did not participate in sport. Arthur and Finch (1999) found that a lack of information held by people with a disability led to low awareness of the sorts of possible sporting activities and appropriate sport facilities. According to the English Federation of disability sport (2000), the lack of access to information has worsened.

Lockwood and Lockwood (1997) and Doll-Tepper (1999) both said that the subsistence of poorly trained service providers, unsuitable activities and inflexible programmes as areas of particular concern. Both Arthur and Finch (1999) and DePauw and Gavron (1995) raise the issue of a lack of available facilities and say that the blame for this is due to cuts in funding. Arthur and Finch (1999) found that poor physical access at existing facilities could present a barrier to the participation of people with a disability in sporting activities, in terms of the inappropriate design of buildings, lack of aids and adaptations to equipment.

Negative attitudes towards disability include those of other facility users. DePauw and Gavron (1995) found that college students held negative and stereotypical attitudes towards the inclusion of individuals with a disability in physical education and sport. Arthur and Finch (1999) found a correlation between the negative and conventional attitudes of other sport centre users. This then produced a lack of confidence and motivation for people with a disability.

National statistics show the lowest participation rates for disabled people. They produced a Taking part and active people survey which showed that 8.8 – 9.5% disabled adults participated in regular moderate activity (Sport England, 2006; DCMS, 2007). It also found that 44% of disabled young people did not take part in regular physical activity (Sport England, 2001)

Research has shown that disabled young people do participate in sport both in and out of school (Finch et al, 2001). However, both the overall rate of participation and the frequency with which disabled young people take part in sport is lower than for young people in general.

There are also important differences between participation in school compared with out of school participation. In school young disabled people participated in sport more frequently than they did out of school. However, this pattern was the reverse for all young people (Corneliben and Pfeifer, 2007)

An initiative set up in Ireland is called “Disability Sport Donegal”. This scheme aims to give children an opportunity to participate in sporting activities. They aim to offer a wide range of activities that include Boccia and martial arts. They develop the programme for inclusion into sports for disabled people. They also look to form a relationship with local schools to include children in sporting activities. With the inclusion within schools they can then develop programmes out side of school and give opportunities to disabled children and adults to take part in sports clubs that provide the safe, fun environment and facilities that are needed to give a wider range of activities to disabled people (Donegal Sports 2007)

Research has shown that many people with a disability do not take part in sport because they don’t have access to the facilities or equipment they needed (Paciorek and Jones, 2001). In addition travel was shown to be a barrier as they were unable to get to and from any accessible venues. Lack of information was a problem for the many of the participants and parents because they were unaware of facilities or clubs offering activities for disability. Organisations were identified during the questioning, including Viva project and RCT Tigers. Viva is a registered Charity that was established in November 1992 to work with young people with a disability aged between 11 and 25 with who live in Rhondda Cynon Taff.

The ethos of the Viva project is to facilitate and support all the youth service members to become fully involved in community activities. Viva believes that this ethos can encourage young people to develop better liberty and make more choices for themselves. The main aim of Viva is to challenge their service members to raise their ambitions while they broaden their experiences and abilities. They try to give confidence to the members to develop greater independence and make more knowledgeable choices for themselves. At the same time they aim to elevate community awareness in accepting disabled people as valued members of the community (Sports Council Wales, 2006)

Viva’s aim is to create equal and respected relationships between disabled young people and their non disabled peers. They look for disabled young people to participate in active community amenities, which they may have been conventionally excluded from because of the stigma and separation that is related with disability. Viva believe that by giving young people the same chances as their peers, people can learn and work together to meet the challenges we face in life.

RCT Tigers FC is a pan disability football club for young children in the Rhondda Cynon Taff Area which was set up in January 2008. It was founded to improve opportunities for disability sports in Rhondda Cynon Taff.

With these organisations set up it is important that extra work is conducted to make them successful. It is imperative because without these organisations people with a disability would not be able to take part in any sport or physical activity. It is also important to develop new initiatives as well as making the existing organisations more accessible by better information and promotion.

With the development of initiatives, disability in sport can develop and give opportunity to people where participation would be difficult and inaccessible (Yuen et al, 2007).

In conclusion I feel that physical activity and sports participation can improve a disabled persons health and well-being. Regular exercise and inclusion in sports by disabled people is as important as it is for their active counterparts. Professionals working with people with disabilities should enthusiastically encourage participation in sports and recreation activities. The relationship of sports for the disabled is difficult. Sports are a rehabilitating tool for integration into society and a way for them to remain active. In addition, sports and disability as portrayed by the media often still broadcast existing stereotypes that erect social barriers for the disabled, in the area of social perception (Barton, 2001)

Sports for the disabled still remain an understudied area and should be improved greatly if it is to develop. A development for disability in sport is needed because there are people who cannot participate in sport because of reasons beyond their own control. For most disabled people, their disability is not the barrier and therefore more should be done to overcome barriers that could be easily eradicated (Barton, 1989)