The Dynamics of Inter-professional Relationships and how They Impact Essay

The Dynamics of Inter-professional Relationships and how They Impact on Inter-professional Working and the Quality of Care - Essay Example Examples of this would include professions such as interior designing or perhaps construction work. In these types of professions, there is a strictly one-on-one relationship. That is to say, one consumer is dealt with by one professional, and that consumer is not directly concerned with the other professionals in that particular workplace. Another example of professions however is one where an entire setting is expected to cater to the needs of one person, as a collective and collaborative team effort. The most prime example of this is any profession related to the medical sector, be it a doctor, a physiotherapist, or most importantly a nurse. In these sort of professions, inter-professional relationships are extremely important to consider and in fact can be the key to successful collaboration and would therefore have a direct impact on the comfort and satisfaction of the patient. This begs the questions of what exactly inter-professional working is. Loosely defined, the concept of various professionals working together towards the care of one particular patient is referred to as inter-professional working. More specifically, the definition of inter-professional working, as defined by Waddingtion (2007) is '†¦care which involves professionals from different disciplinary backgrounds (e.g. nursing, social work, medicine and physiotherapy) working together more effectively, often in teams, to improve the quality of care provided to individuals, families and communities'. In other words, inter-professional working involves professionals collaborating to work together more effectively to improve the quality of patient care. Although the practice is age old in specialized fields such as the medical field, official recognition of the term and a deeper study into the development of these inter-professional relationships began after an NHS developed research study in 2000. Official education being imparted to develop inter-professional relationships and the effec t on a patient's care were examined and methods were researched on making these relationships more effective towards a patient's benefit. Inter-professional relationships, as mentioned, is basically emphasis on a collaborative collective effort rather than an individual one. Which means, that instead of having each professional only concerned with his own area of interest, each would have a fairly sound level of knowledge about each area of interest, thereby enabling them to have greater confidence in their own area and work in harmony with other professionals working towards the care of a patient. As stated by Mahmood-Yousuf (2008) this also means that it encourages a team of professionals to share knowledge and therefore to have more sound knowledge and understanding of the medical issues at hand, which in turn enables them to take improved decisions in regard to the patient's health, not only in accordance to their own area of expertise, but rather in a general light. Sherwin (20 09) reiterates this view and in addition says that it provides more confidence to the professional as well, since they have a fair amount of trust on the fact that their decision will not conflict with any other decision in regard to the patient. In the long run, this would increase job satisfaction and reduce situations where conflict arises between two professionals wor

Research paper Example | Topics and Well Written Essays - 2000 words - 1

Research Paper Example Generally, for along time product design has been the concern of most scholars in all fields and more so in the development of computer information products. Product design involves aspects of making and coming up with products, events processes as well as services based on the user experience and add quality to the user. It also takes into consideration the immediate environment in order to identify and solve certain problems. It is with this view that emotional appreciation of an event process or product goes along way in improving the quality as well as the usage of the same (Norman, 2004). In my opinion, when people are more enthusiastic about a product designed they are likely to appreciate the product and in the event talk good about it. Through such those developing the product also look at ways of improving it. Through appreciation of the aesthetic and visceral aspects of products it creates emotional satisfaction as well as encourages association with the product (Kausler, a nd Trapp, 1960). In the market this aesthetic appreciation helps in marketing as more of the product is sold more and more. Emotional appreciation during product design has been also argued that it encourages integration of theories and concepts that are vital in the final development of product. In the companies this has also been seen to result to hard work and dedication as people become more attached to the designs they produce and emotionally feel good about their work. So anyone who has an experience of the products either directly or through the website appreciate this aspects of product design and become emotionally attached to it which therefore spreads to family members ,professionals as well as the media in general. Therefore it becomes very important to look at these aspects of aesthetics in the design of any product. Q2. The philosopher's tool kit II (Wittkower) In his attempt to examine the philosophical aspects of iPod mobile audio player, Wittkower (2008) uses 19 cha pters written by different authors and philosophers on how iPod is changing the lives of individuals and their sense of community. The philosopher’s toolkit is a comic philosophical thought and methods book as well as a novel. This novel have several chapters with latest revision of philosophical writing making this book further good for the readers understanding of its concepts. This book has six chapters and presents instances of certain kind of philosophical tool in each of them. Chapter one of these books jerks mouldy aptly by unfolding the position of influences in viewpoint. This chapter goes on and discuses several peripheral philosophies example of these being the difference between explanation and reasoning. This seems to be confusing and irrelevant to some extent. This chapter points out how inappropriate logically valid advices might seem to the layman. Finally the chapter explains that the structure of fight regulates its validity and resolutions the pressure by f amiliarizing the position of truth for the discussion. In chapter two, the hypothetical-deductive technique is categorized though it looks to be perplexing. It says that the result of the trial may in the sturdiest case prove or criticize the thesis. In feebler cases the outcome might offer proof for or against this thesis as well. With HD technique one can prove the truth of a concept; this is even well elucidated in the next chapter. In another contrasting example, the pass of reduction to some

Essay about Walmart Example | Topics and Well Written Essays - 1000 words

About Walmart - Essay Example imary advantage is to over come barriers that are related to Multi-tier distribution which has at all times been the common approach of doing business in Japan. Over time, Wal-Mart will alter that. By approaching the suppliers directly, Wal-Mart will establish a more well-organized distributional system. Retailers will have to set up a similar system to stay competitive. Wal-Mart will approach the strong suppliers, mainly those that might already have globally established relationship for aid in building this innovative and extremely different distributional system. The most important advantage is that the benefits of that enhancement in distributional efficiency will be enjoyed by both i.e. Wal-Mart as well as their suppliers. Wal-Mart does uneventfully gain success in superseding the wholesaler segment, they will be in a lot better of if they are in a position to distribute goods at less expensive costs, which will allow them to pass along a little of the price savings to customers. The degree of success that Wal-Mart will encompass in Japan depends on the degree to which Wal-Mart can adjust Retail Link to Japan’s distribution system. Also, Wal-Mart will have to obtain a handsome amount of real estate to get the economies of scale required to be successful, at the same time keeping local management content. And finally they must be patient, as the Expansion into Japan maybe takes a lot of time. I believe that Wal-Mart is successful by circumvent the current Japanese distribution system by reflecting activities of manufacturers as well as retailers to circumvent the wholesalers, share knowledge, and incorporate decision making. Wal-Mart recently decided to gain 66.7 percent of Seiyu, Japans fourth largest retail group. Ten years ago Wal-Mart had attempted to sell its private label cookies in Japanese stores, and customers emptied out all the shelves. But the Japanese buyers did not buy them again as they were too sweet, a part from this most of them

The two pairs of lovers in Much Ado about Nothing Essay Example for Free

The two pairs of lovers in Much Ado about Nothing Essay Much Ado About Nothing, written in 1598 and set in Messina (Sicily) is one of Shakespeares comedies which addresses some very serious social and cultural issues inherent in Renaissance (Elizabethan) society. The play focuses on the relationships and attitudes to marriage of two couples; the mature Beatrice and Benedick and the much younger Hero and Claudio. The couples are of noble rank. Benedick and Claudio are brother officers and noblemen, Lords of Padua and Florence respectively. Benedick is a mature and experienced man in his thirties whilst Claudio is barely out of his teenage years. Hero is the young and innocent daughter of Leonato the Governor of Messina, in whose villa the play is set, whilst Beatrice, his ward and niece is much older. Both couples are in search of love, for Hero and Claudio Shakespeare makes this very explicit whilst that of Beatrice and Benedick is rather more implicit. Firstly, the relationship between Claudio and Hero, both young, naà ¯Ã‚ ¿Ã‚ ½ve and impressionable individuals. Claudio is so infatuated with Hero at first sight that he immediately falls in love and wants to marry her. However he is shy and unsure of his own desires, he constantly seeks praise and reassurance from others and trusts Don Pedro to act as a kind of go between to help him secure Heros love. Hero a beautiful and demure young heroine is portrayed as a faithful and dutiful daughter obedient to her fathers wishes and lacking in independence; indeed she is on the receiving end of Claudios romantic speeches during Act 1 and says absolutely nothing in return. Claudio speaks convincingly of his love in verse. Their attitudes to marriage are somewhat different. For Claudio marriage is a financial matter as wealthy young women came with substantial dowries thus enabling a gentleman to provide a suitable lifestyle for his future family. A man was required to marry a woman of equal social standing. As Hero was the only child of Leonato, Claudio was also desirous of an additional sum by way of an added inheritance. Hero like most young noblewomen at that time was eager to please and simply wanted to secure a husband of equal or better social standing than themselves. Claudio being a Lord of Florence fitted the bill perfectly, being handsome and dashing was just a bonus. A womans job was primarily to run the household and produce male heirs to inherit their husbands title and fortune. As a conventional and dutiful daughter she was prepared to accept her fathers choice of partner. Here Shakespeare is alluding to the stereotypical young noble woman of the time when arranged marriages were accepted as the norm in upper class society. This scenario would appeal to contemporary audiences composed largely of working people who had paid a small sum to be entertained each afternoon. They would have enjoyed watching such upper class antics as a kind of the escapism from their rather dull and dreary lives. Indeed traditional love stories such as this had proved popular with audiences before in plays such as Romeo and Juliet. A modern audience maybe frustrated by Heros actions because today the sanctity of marriage is not as well respected and most people embrace the notion of sexual equality. Despite their apparent naivety, both Hero and Claudio have more complex sides to their characters which are reflected in their actions during the play. Claudio shows extreme jealousy when informed of Heros treachary in Act four. He is vengeful, jealous and impetuous as he immediately rejects Hero, refusing to marry her without even discussing the matter and calling her a rotten orange. Hero does nothing to defend herself when accused of this infidelity and accepts the scorn of others including her own father Leonato who rejects her immediately without question. Such actions illustrate the double standard regarding sexual relationships that existed in Renaissance times. Women were expected to maintain their purity and enter marriage as virgins, not to be so was regarded as a cardinal sin and would bring utter disgrace not only to herself but to her entire family who ran the risk of being permanently outcast from upper class society. This illustrates how vulnerable women in Renaissance times were to accusations of bad treatment. Claudio had to shun Hero in order to maintain his honour as an officer and a gentleman, being engaged to a loose woman would bring nothing but shame. Confidence is shown in Act four when Claudio willingly agrees to participate in a plot to bring Beatrice and Benedick together. However later in the play he is remorceful as he agrees without question to marry Leonatos niece. Depite her innocence and vulnerability Hero is sexually aware as she plots with Ursula to convince Beatrice that Benedick loves her. Nevertheless Hero often responds to a situations initiated by others; when she agrees with the Friars plan to win back Claudio and pretends to die, the deceitful nature of her character is revealed. Whilst Hero and Claudio represent the Elizabethan norm in marriage, the relationship between Beatrice and Benedick is more profound and less conventional for the time. At the start they play down and are cynical about the subject of love and marriage. Both characters are talkative, outspoken and full of wit; they hide their feelings for one another by engaging in a merry war (1. i. 56 ) of verbal sparring. This is illustrated in the first scene when Benedick says of Beatrice: Benedick: Well, you are a rare parrot-teacher. Beatrice: A bird of my tongue is better than a beast of yours. Benedick : I would my horse have the speed of your tongue, (1. i. 128-130) Benedick a mature and worldly wise character cannot make up his mind about marriage and privately believes he is unsuitable. His words are whilst witty are often shallow and destructive illustrated in the final line of the quote above Beatrice on the other hand a very clever, independent, strong and feisty female who is suspicious of men, scorns the institution of marriage, rejects men and rebels against the unequal status of women. In Act 4 she says O that I were a man for his sake! Or that I had any friend would be a man for my sake! I cannot be a man with wishing, therefore I die a woman with grieving(1V. i. 321-31) She defends at all costs her spinsterhood, being jealous of Hero she is afraid of becoming an old maid and remaining the dependent niece of Leonato. Beatrice is clearly unhappy with her current status in society. Whilst a modern emancipated audience would easily be able to identify with Beatrices complaints, a Shakespearean one would find her character both fascinating and outrageous. Nevertheless this controversial story line would add spice to the play and foster discussion and audience participation, thus making it an enjoyable and entertaining experience. In vowing never to marry, Benedick sets himself up for a fall, openly he is full of bravado for example when he opens up to Don Pedro; he constantly performs to the audience and other characters, by exaggerating everything. In Act 2 Scene he begs Don Pedro to send him away when Beatrice enters Will your grace command me any service to the worlds end ? I will go on the slightest errand now to the Antipodes. I will fetch a toothpicker now from the furthest inch of Asia; bring you the length of Prester Johns foot; fetch you a hair off the Great Chams beard; .. rather than hold three words conference with this harpy. ( 11. i. 246-254) When he hears that Beatrice is in love with him he promises to love her better, however he hides his deeper emotions until the latter stages of the play when he falls victim to a deception. He is totally unaware of the plot by Claudio and Don Pedro to bring Beatrice and himself together and believes every word he overhears in the garden during the second act. Similarly Beatrice is also unaware of Hero and Ursulas deception indicating the couples general gullibility. Like Claudio Benedick has a deeper side to his character such as when he agrees to Beatrices request to kill Claudio after he jilted Hero. As far as language is concerned Shakespeare uses both verse and prose. He uses verse to characterise Claudio and Hero and express deep emotion to make it sound convincing, a regular and rhythmic pattern is used. This is illustrated in the last scene when Claudio finally marries Hero: Claudio: Give me your hand before this holy friar. I am your husband if you like of me. Hero : And when I Livd , I was you other wife; And when you lovd , you were my other husband. ( V, iv, 58-61) Prose is chosen to represent the more serious interaction between Beatrice and Benedick. It is also more accessible to a largely uneducated audience who might have difficulty understanding the more complicated verse. Shakespeare also uses language to differentiate between the social classes. Noble well to do characters speak in flamboyant fancy language indicative of their importance and education whilst common barely educated characters such as Dogberry and Borachio speak in plane and simple and often inaccurate terms. For example Dogberry often gets his words completely wrong and makes ridiculous mistakes. In Act 3 Scene 3 he says Why, then, depart in peace, and let the child wake her with crying; for ewe that will not hear her lamb when it baes will never answer a calf when he bleats. (3.3.74 76). In conclusion the play illustrates a kind or irony. The young passionate relationship between Hero and Claudio based on shallow first appearances deepens. As Claudio matures he begins to appreciate Hero as a real person when he realises her innocence and finally marries her. Beatrice and Benedicks innate love is cemented, when in the final scene, they begin to realise the game they have been playing and see each other for who they really are. Benedick finally silences Beatrice with a kiss, and thus like all Shakespeares comedies the play ends in marriage between the two couples, allowing his audience to return home satisfied and in good spirit. BIBILOGRAPHY 1. Much Ado About Nothing William Shakespeare Arden (2001) 2. Much Ado About Nothing Film starring Emma Thompson and Kenneth Brannagh. 3. Much Ado About Nothing York Notes (1980) 4. Much Ado About Nothing Spark Notes 5. Internet www.gcseguide.co.uk

Role Of Nurse Promoting Health

Role Of Nurse Promoting Health This essay will look at the role of the nurse in promoting health of female adults (25-45) in terms of sexual health and behaviour. It will give definitions of Sexual health and promotion, which will also cover areas such as health models in relation to sexual health and behaviour. It will give an overview of what the role of the sexual health nurse is and throughout the essay relate the nurse and their importance to promoting sexual health. The essay provides government initiatives that are being set in place to highlight the issues surrounding this age group and that show how these affect this specific age group. With this particular client group, which is the female adult, will look at Sexually Transmitted Infections (STIs) and what control measures and interventions are being put in place to lower the rate in Scotland. The Royal College of Nursing (Royal College of Nursing. 2000) defines sexual health as the physical, emotional, psychological, social and cultural well-being of a persons sexual identity and the capacity and freedom to enjoy and express sexuality without exploitation, oppression, physical or emotional harm. Sexual health is also a term used to associate sexually transmitted diseases such as HIV or AIDS. Whereas an individuals sexuality is shaped by their environment, self-concept, health or disability. This in the role of nursing means that sexual health nurses must take a holistic view of the individual when assessing the clients needs. To focus solely on the sexual behaviour of the individual , ignores the influence of the wider social context we live in. Each society is structured by dominant gender roles, ideologies and power inequalities that appear to prescribe certain expectations and assumptions about what is Normal or Natural sexual expression for men and women (Dallos et al. 1997). In society today with this specific age group there are large differences than that of a generation ago. There are more individuals marrying later and substantially more marriages ending in divorce. This for an older population means more individuals possibly being with more partners than what was deemed as respectable a generation ago and seeking new relationships with different partners after ending marriages. These changes to society bring an increased number of individuals with sexual health issues and a growing number of sexually transmitted diseases. Mace (1974) defines sexual health as being a combination of the somatic, emotional, intellectual and social aspects of sexuality which enhances personality, communication and wellbeing, giving the individual an enriching positive experience. There are three basic elements of sexual health, which are, the capacity to enjoy sexual and reproductive behaviour in accordance with a social and personal ethic. Freedom from fear, shame, guilt, false beliefs and other psychological responses, freedom from impaired sexual relationships and freedom from organic disorders, disease and deficiencies that interfere with sexual and reproductive functions. All individuals consider sexual health and wellbeing differently, this is usually determined by their own sexual experiences and /or by their interactions within the healthcare system. Within the healthcare system there are nurse led sexual health clinics. These clinics are run by specialist nurses in sexual health and are available to any individual seeking advice or guidance in relation to their sexual health needs. These clinics provide patients/clients with one stop specialist sexual health screening, family planning advice, sexual transmitted infection tests which when results are given can also provide prescribed medication that can be given free of charge. They can also use a referral system for counselling and hospital admission. Sexual health is a sensitive area, set in a rapidly changing society and health care system. Providing sexuality and sexual health care can be an intimate process. Scotland has a history of poor sexual health with rising incidents of STIs, which include HIV. The sexual health nurse practitioner must have the skills to give the client the best informed care available. There is an abundance of research studies available to the sexual health nurse in improving their knowledge and the latest changes to policy and procedures within the NHS healthcare system. Taking a holistic view approach to the individual sexual wellbeing but at the same time recognising the individuals diversity of moral, cultural and ethical view of their sexual health. The skills involved in this area are, being able to identify the needs and priorities of the individual. Being able to set aims and objectives that are acceptable and which are seen as a reachable target by the individual. The sexual health nurse must always include the client in all decision making, consulting and negotiation of the client needs and care. This cannot be obtained unless the practitioner has up to date knowledge of policies and available resources within the clients graphical area. Being ab le to plan, act and evaluate the care and treatment of the individual, is vital in the aim of empowering the individual to gain control of their sexual health. But of the most vital skills required, is a skill that is used across all areas of nursing, which is communication, without this the client will not feel trust and care, thus will not improve their health. There are staff training and development programmes in all services that address sexual health issues as appropriate to the needs of the client group. This includes services for which sexual health is not a main priority. Staff should be expected to be knowledgeable, supportive and non-judgmental in their approach to clients. Using evidence-based knowledge which is available through a varied means of learning, gives the sexual health nurse up to date insights on changes and recommendations of daily practices within the sexual health area of healthcare. With Scotland having the highest rate of unwanted pregnancies in Europe. Many sexual health statistics show the higher amounts of recorded STIs are in areas of the poorest population. Sexual health services in Scotland treat large numbers of young female adults with low cost interventions, but this has proved to be poorly developed due to under-investment, lack of strategic leadership and low prioritisation. These factors have resulted in a variance in accessibility and quality of services available to this clientele. With sexual health being a personal and sensitive area of health. There is still a stigma attached to the use of these services, that can result in the lack of public involvement and proves difficult to obtain a public voice. Scotland issued a national sexual health and relationship strategy. This was published as the Respect and Responsibility: strategy and action plan for improving sexual health in Scotland. This strategy was launched in January 2005, with the aim to enhance sexual health promotion, education and services provisions, which is now in its second phase (2008-2011). This is to address the wider societal issues related to sexual health with shifting cultural and behavioural change. The strategy has nine standards, that set out the initiative. The developments of the second stage includes a publication of an HIV Action Plan, that has prevention as its main core and commitment in providing treatment and care for all those who need it. All sexual health services performance will be monitored in each of the NHS Boards areas by the NHS Quality Improvement Scotland (NHS QIS). The government standards are not a set of rules but a guidelines for all NHS Boards to develop and improve sexual health services. The standards are set out as follows: Standard One A comprehensive range of specialist sexual health services is provided locally and that individuals with the greater need are treated as a priority. This means that each NHS board must provide a full range of sexual health services that will identify the needs of the local population and to prevent inequality within the area. These services must ensure a high quality of care within these services to reduce individual morbidity and maintain public health. Standard Two The public has access to accurate and consistent information about sexual health relevant to the clients needs. Access to accurate and unbiased information, this can only assist if the client attends the service facility or if information is made available within all doctors waiting rooms. Standard Three NHS boards ensure the development and delivery of integrated approaches to sexual health improvement, particularly in relation to young people. This standard is in relation to the role of the parent or carer and the positive influence that they assume there is between parent and child, but this is not always the case in most families and certainly not in the case of young adults over the age of twenty-five. Standard Four Individuals who are diagnosed with a STI, see an appropriately trained member of staff to organise partner notification (contact tracing). This would be an ideal strategy in the prevention of increased rates of STIs but we do not live in a society that is so open and understanding with each other. Standard Five Individuals attending for ongoing HIV care are offered high quality sexual and reproductive healthcare to improve personal wellbeing and to minimise the risk of transmitting infection to others. This will raise the quality of sexual and reproductive healthcare provided for this clientele. Standard Six Women receive safe termination of pregnancy with minimal delay, followed by contraceptive advice and psychological support. The Sexual health nurses role in this situation is to provide information on all contraceptive interventions and arrange for counselling if the client needs it. Standard Seven Men who have sex with men who are at risk of sexually transmitted hepatitis B are offered vaccination. Statistics show that homosexual men are 54% more likely to seek sexual health advice than a heterosexual male. Standard Eight All individuals have access to intrauterine and implantable contraception. These are more effective and the individual is not required to have continuous routine follow-ups until the expiry of the contraception. This can reduce the rate of unwanted pregnancies but eludes the need for education of the individuals sexual behaviour. Standard Nine All staff who deliver sexual health are adequately and appropriately trained. Sexual Health care like any other area of healthcare requires a high standard of competency, with a non-judgemental and sensitive approach towards the individual. The staff must also be aware of legal and local policies to protect the individual and their care. Sexual health is not just about clinical services. These services must make a contribution to the vast effort of promoting sexual health rather than just that of sexual behaviour. This may result in, these services only being beneficial to this client group, if they attend. But for those that are not fully aware of these confidential services, the only other means of finding out about these services is through the power of literature provided within doctors surgery waiting rooms or through advice and instruction from relationships with peers and family. This has a follow on effect to the quality and amount of sexual health and relationship education reaching Scotlands young female adults. Sexual health services such as Specialist Family Planning Clinics, Genito-Urinary Clinics, GPs, Chemists and Nurse Practitioners can provide sexual health services that the individual can use to access advice, information, contraception such as condoms, morning after pill to longer lasting contraception such as implant (Implanon), Contraception Injection or the IUD (Coil). These are measures to stop unwanted pregnancies but these services also provide screening for STIs with follow up assistance and guidance. Within these services, the sexual health nurse will provide the instruments for avoiding STIs, unwanted pregnancies and all screening and testing but they must also provide the individual with holistic health education. An individuals emotional, social and spiritual aspects of their health are just as important as the physical aspects. People learn best when they feel secure, the relevant and appropriate needs are met, they are actively involved and know and understand what has to be done to reach their goals set but most importantly they are respected as individuals in their own right. (Daines et al 1992) For the sexual health nurse, there are several models of nursing that can be used with the nursing practice of sexual health and behaviour. Beatties Model of health promotion offers a structural analysis of Health Promotion. Beattie suggests that there are four strategies of health promotion which are 1. Health persuasion. This is aimed at the individuals and is co-ordinated by the sexual health nurse and other members of the multidisciplinary team, to be persuaded and encouraged the individual to change to a healthier lifestyle. The sexual health nurses role is to be the expert or prescriber. Activities include advice and information. 2.Legislative action. This strategy protects the population by making healthier choices available. The sexual health nurse is the role of Custodian knowing what will aid the improvement of the individuals health. Activities could include policy work and lobbying. 3.Personal Counselling. The Sexual health nurse use their skills to empower the individual to have the confidence to take more control of their health. This intervention is client led with a focus on personal development. 4.Community Development. This strategy is similar to personal counselling, with the aim of seeking to empower or enhance the skills of the community with their sexual health with further education. Beatties model is a useful tool for the sexual health nurse because it can identify a clear framework for deciding a strategy but remind them that the choice of interventions can be influence by social and political aspects. (Beattie, 1991) Tannahills model of health promotion is extensively accepted by health care workers. Tannahills model takes a holistic view, showing that all three spheres of activities are entwined. The three spheres of Tannahills model are Health education, which emphasises on communication to enhance well-being and prevention of ill health through knowledge and attitudes. Prevention, by reducing or avoiding risk of disease or ill health through medical interventions. Health Protection, using legislative, fiscal or social measures in the bid to safeguard the populations health. This model suggests that all aspects are interrelated but they also reflect distinctive ways of looking at health issues and is descriptive of what goes on in practice but does not show why the sexual health nurse may chose one approach over another. (Downie et al 1996) There is also the Empowerment model by Tones, which its main principle is to enable individuals take and gain control over their own sexual health. Healthy Public policy + Health Education = Health Promotion, health promotion involves improving a populations health through improvement of their lifestyle (or behaviour), environment, and health policy. It prioritises empowerment as the core value and strategy underpinning and defining the practice of health promotion. The support of the individuals is also vital for implementing change. Tones model of empowerment enhances individual autonomy and enables individuals, groups and communities to take control of their sexual health. (Tones Tilford 2001) All the above models aid the sexual health nurse to think through the aims, implications of different strategies and their own role as the practitioner with a successful outcome. Health promotion has a full range of modifiable determinants of health which are not just concerned with only individual behaviours and lifestyles but other societal factors such as income, social status, education, employment, work conditions and also factors such as access to health services and their physical environment. These effect everyone throughout their lives and health. This is a ongoing challenge within health promotion for sexual health nurses. Using data collected from GUM clinic setting, between 2004-2008, it was observed that diagnosis of STIs, as an example Gonorrhoea infection had raised 77% within young adult females group. Even though this seems to be a large percentage of reported cases, Scotland is ranked ninth (for Gonorrhoea infection) in comparison to thirteen areas of the United Kingdom. Within Scotland, the Scottish Government are diligent in obtaining the national statistics in regards to sexual health as this give them a clearer insight on how to update and promote better health services available to the population. Scotlands statistics for STIs with young adult females (25-45). In the past five years (2004-2008) of data collection, there has been on average 3,388 reported cases and this covers eleven NHS Boards covering Scotland. Although data show that STIs, unintended pregnancy and abortion are more prevalent in those aged less than 25, these issues also affect older age groups. In 2008, individuals aged 25-44 comprised 40% of the workload in GUM clinics. While one third of all acute STI diagnoses made in the GUM clinic setting are attributed to this age group, over half of acute STIs among those aged over 25 are being diagnosed in the 25-29 year age group. (ISD 2009) There are many people in Scotland that experience positive sexual relationships and good sexual health but looking at the statistics, they show that there is a growing concern within the promotion of sexual health. The media has an impact on society and their choices. Sexual imagery is used in todays society as a tool to entice the consumer to spend money. It uses sex and relationships to emphasise stereotypes about different beliefs in activities and behaviours, usually in a way that ignores the risks associated with sexual behaviours, and has contributed to the casual attitudes to sexual issues are risk free and acceptable. But, the media can be a powerful tool in regards to getting the important messages of sexual health out to the public and can also be an incentive tool in recruiting individuals to help with government campaigns to change the attitudes of the younger generations view of sexual health. In conclusion, the sexual health nurse is a varied role in society, with the ongoing challenge of assisting the younger female adult obtain a good sexual health attitude and showing them how to promote good sexual health as peers. The government is working hard to raise Scotlands standards of sexual health for the individual and communities, which can aid the struggle of reducing the numbers of STIs reported across Scotland. All individuals have their own views of sexual health and healthcare services are there to give them more information, support and guidance on their sexual health needs. This, if nurtured can reduce statistics and for the next generation of Scotland be sexually healthier. Scotlands sexual health issues cannot be remedy overnight but with continuous improvement and availability of sexual health nurses and services, Scotland can look forward to a positive sexually healthier Scotland.

Evidence Based Public Health Health And Social Care Essay

Evidence Based Public Health Health And Social Care Essay Public programmes have absorbed huge amount of money for health improvement, social welfare, education, and justice. However, the result of the programmes are still unkown whether improve peoples lives or not and experts knowledge is not used in policy decisions (Oxman, et al. 2010). Gaps between research of effectiveness and policy implementation are also clearly seen (Brownson, Chriqui, Stamatakis 2009). These gaps occur because policy makers have different priorities. Black (cited in Wallace 2006) argued that ideological blinders, economic pressures (both in governmental budgets and their own campaign coffers), electoral realities, bureaucratic inertia, and a host of other factors that can make good data irrelevant, influence policy maker in decisions making. Wallace (2006) also stated that political concerns lead to immune to facts in policy makers. Brownson, Chriqui, Stamatakis (2009) stated that the process of making public policies can be complex and messy and the policies are not only technically sound, but also politically and administratively feasible. The first step of health-policy making-process is problem identification and agenda setting. In this stage, public problems will be political agenda if the problems are converted into political issue (Palmer Short 2000). Evidence-based public health enable to influence policy makers in public health decisions because evidence-based practice use a particular type of evidence and focus on clear reasoning in the process of appraising and evidence interpretation (Rychetnik et al 2004). Evidence-based practice rises evidence from research which encompass a wide variety of public health research. Rychetnik et al (2004) also mentioned several type of studies which used in evidence-based public health such as decriptive, taxonomic, analytic, interpretive, explanatory and evaluative. Prinja (2010) asserted that evidence and information contribute to policy making process through research and consultative process or published documents or reports. Moreover, Rychetnik et al., expanding on earl ier Brownsons argument (cited in Fielding Briss 2006) argued that evidence-based public health decisions can be supported by three types of scientific evidence. Type 1 evidence is that something should be done is determined by causes and magnitude of disease, severity and preventibility. Type 2 evidence shows that which intervention or policies should be done may effective in specific intervention to promote health. Type 3 evidence describe how something should be done that how and under what circumstances interventions were implemented and how they were received. Those type of evidence are useful in public health decision because they may improve the quality and availability of the evidence (Rychetnik et al 2004). Evidence for evidence-based policy can be determined into two categories, quantitative evidence and qualitative evidence. Both of them are important for policy relevant evidence (Brownson, Chriqui, Stamatakis 2009). Quantitative evidence for policy making, which provides data in numerical quantities, is collected from many sources, such as scientific information in peer-reviewed journals, public health surveillance systems, or evaluations of individual programs or policies (Brownson, Chriqui, Stamatakis 2009). Quantitative evidence, for example prevalence, incidence and cumulative incidence, may express the magnitude and severity of public health problems through frequency or proportion and rates measurments (Rychetnik et al 2004) but this type of evidence presents little understanding of why some relationships exists (Brownson, Fielding, Maylahn 2009). On the other hand, qualitative evidence or non numerical data may be taken from methods such as participants, group interviews, or f ocus group. Qualitative evidence may influence policy deliberations, setting priorities and proposing policy solutions by telling persuasive stories (Brownson, Chriqui, Stamatakis 2009). However, according to Rychetnik et al (2004) one of qualitative evidence that is expert opinion is positioned at the lowest level in levels of evidence hierarchies and identified as the least reliable form of evidence on the effectiveness of interventions. Nevertheless, the combination between two type of evidence leads to a stronger persuasive impact in policy making process than using only one type of evidence (Brownson, Chriqui, Stamatakis 2009). Evidence-based practitioner shoul build strong evidence to convince public health policy makers. Brownson, Fielding, Maylahn (2009) proposed three concept to achieve a more evidence-based approach to public health policy. First, scientific information on the programs and policies is required to make more effective in health promotion. Second, combination between information on evidence-based interventions from the peer-reviewed literature and the realities of a specific real-world environment is required to translate science to practice. Third, the prove of effectiveness of interventions must be informed in wide-scale consistently at state and local levels. Brownson, Chriqui, Stamatakis (2009) also recommended that evidence should show public health burden, identify priority of an issue over many others, present relevance at the local level, show benefits and harm from intervention, explain the issue by how many peoples lives are affected, and estimate the cost of intervention. In the article example (LeePark 2010) which is about HBV immunisation policy in the US, it is clear that the policy was based on convincing evidence, in this case was epidemiological data. According to these data which taken from different sources, such as American Cancer Society (ACS) and Centers for Disease Control and Prevention (CDC) showed that chronic HBV infection is responsible for the majority HBV-related morbidity and mortality. Some quantitative evidence was provided such as 1.4-2 million (0.4%) people had chronic HBV invection. The policy also relied on other successful policy intervention which might produce similar result if the HBV immunisation was implemented in population. The CDC reported that the incidence of acute HBV infection decreased 80% which was largely due to universal vacination programs for children. Characteristic of the HBV infected population was also identified such as 2.7-11% among injecting drug users, 1.1%-2.3% in homosexual, 1.5% among pregnant wo men. The data convincingly showed that there was corelation between HBV and HIV infection. The natural history of the disease also clearly identified led to assumption that HBV vaccination was important for community. The next stage of the health policy making process is policy formation. In this stage, policies are formulated or changed to a new policies. The formation stage, which is also referred to policy design or development, specific attention will be provided when policies are examined relating to the issues (Palmer Short 2000). According to Brownson, Chriqui, Stamatakis (2009) that formulation of health policies in public health practice is complex and depends on variety of scientific, economic, social, and political forces. However, huge number of people want policy and practice to be relied on the best scientific evidence. Maximising policy effectiveness and efficiency depend on evidence base (Wallace 2006). On the other hand, policy makers require a reasonable and justifiable policy solution. Hence, health public practice should develop a convincing message based on research evidence to explain policy makers how the intervention may solve the public health problems (Goldstein 2009). To develop policy formulation, research evidence should be reviewed and evaluated before being proposed to policy makers. The aim of the research evaluation is to determine the degree of credibility (validity and reliability) of information and usefulness (relevance and generality) in a different context (Rychetnik et al 2004). Systematic Reviews and Critical Appraisal are required in evidence review processes as a guide to understand the research methods (Rychetnik et al 2004). Systematic review implementation leads to practitioners and policymaker to understand all of relevant information, how the evidence was collected and assembled, and how the conclusions and recommendations relate to the information (Fielding Briss 2006). Then, the result of evidence review will be integrated with social consideration which obtained from practitioners, policy makers and consumer to produce evidence based recommendations (Rychetnik et al 2004). Through systematic appraisal of research, public h ealth practice enable to demonstrate the effectiveness of interventions based on available evidence (McMichael, Waters, Volmink 2005). In other words, the evidence-based recommendations are based on the nature and strenghth of the evidence. Furthermore, the recommendations should be evaluated with respect to the balance of advantages and disadvantages (Rychetnik et al 2004) or the benefits of interventions must be weighed against the costs (Cookson 2005). However, systematic review tend to have narrow and regressive interpretation of the nature of evidence which leads to exclude a wide range of research-based information and professional experience that may be important to policy development (Nutbeam 2001). Therefore, combination between systematic review and narrative review may bring convincing evidence rather than systematic review alone. Iit is obvious in the article example that the recommendation of HBV immunisation in the US was based on previous research evidence. For example, in June 1982, the CDC Advisory Committee on Immunization Practices (ACIP) released the first inactivated HBV vaccines for individuals at a high risk for HBV infection (Lee Park 2010). The reason why the first HBV vaccine recommendation only for high risk community because epidemiological data showed that the distribution of hepatitis B cases was not uniform across populations. Large and urban immigrant-dense areas had higher prevalence of chronic HBV infection. The CDC concluded that high morbidity and mortality from chronic HBV infection in the US would be unavoidable if those high risk populations were not interfered by immunisation programs. In 1989, the recommendation of HBV vaccine were expanded to health care workers after obtaining surveillance data of the HBV infection prevalence and input from health professionals through public a nd private requests (Lee Park 2010). The third stage of the health-policy-making process is adoption. In this stage the policy formulation is enacted and brought into force, such as state legislation (Palmer Short 2000). Public health practice requires advocacy and lobbying to influence policies, change practice and achieve public health action. Nevertheless, the process of achieving influence is often difficult rather than appraising evidence and formulating recommendations because the process requires more complex social and political negotiations and often detrmined by social, political and commercial factors (Rychetnik et al 2004). Brownson, Fielding Maylahn also argued that translation from research to community applications may require many years. Moreover, evidence-based policy and practice inform the policy maker through evidence consideration whereas policy making will depend on prevailing values and priorities. Therefore, it is challenging for public health practice to close the gap between research and pract ice (Rychetnik et al 2004). According to Nutbeam (2001), policy development is a political process rather than scientific-based process. Hence, evidence-based public health requires a strong public health voice and advocacy supports within political system in which may be obtained from public and mass media. Another support may come from public servants who have skill in critical appraisal of evidence to use research evidence in the policy development. The article example of HBV immunisation programs in the US shows that several groups influenced the US government decisions in HBV immunisation programs. From inside of the government, such as National Health and Nutrition Examination Surveys (NHANES), American Cancer Society (ACS), Centers for Disease Control and Prevention (CDC), the CDC Advisory Committe on Immunization Practices (ACIP), supported the HBV immunisation proposals by providing convincing data to the government. WHO, as an outside of government institution, might influence the US government to consider the spread of the disease by presenting international data of HBV prevalence. Health professional also forced the government to expand the HBV immunisation program not only for infant and high risk groups but also children and all adolescents. The next step of the health-policy-making process is implementation of the policy. In this stage, policy document is changed into reality (Palmer Short 2000). Evidence-based public health is challenged to translate research evidence to practice among organisations, practitioner groups, or general public. Evidence-based practitioners enable to identify the most important component of an intervention to bring effective actions to the community (Brownson, Fielding, Maylahn 2009). Interventions in public health should focus on the benefit of communities or populations rather than individuals, although many intervention bring secondary advantages to individuals (Frommer Rychetnik 2003). Rychetnik et al (2004) stated that public health interventions include policies of governments and non-government organisations; laws and regulations; organisational development; community development; education of individuals and communities; engineering and technical developments; service development a nd delivery; and communication, including social marketing. In the example article, the recommendation of HBV immunisation in the US was implemented by ACIP whereas the federal provided vaccine for health care workers and children. The final step of the health-policy-making process is evaluation which include monitoring, analysis, criticism and assessment of existing or proposed policies. The result of the evaluation is used as data sources in agenda setting and policy formation. The goal of the evaluation is to bring policy implementation in effective and efficient ways (Palmer Short 2000). Evidence-based policy requires documenting the effect of implemented policies to undertand the impact of interventions on community and individual which may change peoples behaviour (Brownson, Chriqui, Stamatakis 2009). McMichael, Waters, Volmink (2005) believed that evidence around intervention effectiveness plays important role to address health priorities for the next policies particularly in developing countries or resource-poor areas. Evidence-based practice use evidence as valuable sources in evaluation to maximise the benefits and limits the harms of public health policy and practice. The evidence enable to inform e valuation planning to improve the quality and relevancew of new research (Rychetnik 2004). Evaluation may also be useful to explain failures in policy implementation, unintended side effects, and monitoring the policy application towards achieving the policy goal (Wallace 2006). Evidence-based practice also evaluate public health policy in economic perspective because it can provide information about the association between economic investment on public health programs and policies and health impacts, such the prevelance of prevented disease or years of life saved. This method, named cost-effectiveness analysis (CEA), can explain the relative value of alternative interventions on public health programs and policies (Brownson, Fielding, Maylahn 2009). Another important evaluation of evidence-based policy is health impact assessment (HIA) that enables to estimate the possibility impacts of policies or interventions in out side of health perspective, such as agriculture, transportation, and economic development, on population health. HIA also analyse the envolvement of stakeholders in the policy interventions. Evidence-based practitioner use this method because there is much evidence that population health and health disparities are influenced by many determinants such as social and physical environments (Brownson, Fielding, Maylahn 2009). Therefore, it is essential to evaluate health policy implementation in different ways. In the article of HBV immunisation in the US, CDC always conducted evaluation and found that the incidence of HBV infection had declined after releasing recommendation of HBV vaccination. The CDC also identified that education of health care providers was clearly important to make the program successful (Lee Park 2010). The result of CDCs evaluation, which formulated into epidemiological data, can help to build new strategies to eliminate HBV infection, such as expansion of HBV immunisation recommendation for other groups and routine screening for HBV positive persons. In conclusion, evidence-based public health is important in public health policy making because evidence-based approach enables to provide policy suggestion based on convincing evidence generated from rigorous research. Since many determinants influence public health, analysis of quality and quantity evidence is essential to convince policy makers in identification of policy priorities and the best public health interventions. This essay also suggest that faster and better scientific information may influence public assumption in public health which leads to support evidence-based policy making in public health interventions.

Understanding The Moon is Down :: Moon is Down Essays

War affects everyone involved - the conquerors and those being conquered. War is a struggle that is internal and external. Man can be a dedicated and loyal soldier for only so much at a time. He then longs for laughter, music, girls, a good meal and more. In The Moon is Down, the soldiers feel the need to return home. They begin to doubt what they are doing and if they are being told the truth. They become uneasy when the enemy doesn't talk to them. The townspeople's hatred is growing. They remained indoors and stared from behind curtains while the patrol walked through the town. Lieutenant Tonder was a romantic naive poet who felt the enemy should love him. Steinbeck presented Tonder as "a bitter poet who dreamed of perfect, ideal love of elevated young men for poor girls" (25). When Lieutenant Tonder first arrived in town he thought that it was a nice country with nice people. Tonder says, "There are some beautiful farms here. If four or five of them were thrown together, it would be a nice place to settle, I think" (34). The war was not ending as quickly as Tonder expected. The townspeople had become the silent enemies of the soldiers or the townspeople became silent waiting for revenge. "Now it was the conqueror was surrounded, the men of the battalion alone among silent enemies, and no man might relax his guard for even a moment" (65). The soldiers now have only each other to talk to and Tonder longed to go home. "The men of the battalion came to detest the place they had conquered,...and gradually a little fear began to grow in the conquerors, a fear that it would never be over" (65-66). In war, as time goes on fear begins to settle on soldiers. "Thus it came about that the conquerors grew afraid of the conquered and their nerves wore thin and they shot at shadows in the night" (66-67). Tonder starts to doubt the honesty of his fellow Germans Tonder says, "If anything happened- at home, I mean - do you think they would let us know...well, I would like to get out of this god-forsaken hole!" (70-71). Tonder felt at first that this town had nice, pleasant people but as time moved on, he changed his views. "These people! These horrible people! These cold people! They never look at you.