Friday, September 6, 2019
Essay on Democracy Essay Example for Free
Essay on Democracy Essay Democracy is the worst form of government except all those other forms that have been tried from time to time Introduction            Even though the concept of democracy form of governance has long been in existence for centuries, it was the emergence of country state government system which gave birth to the rise and flourish of democracy that we enjoy today. In the modern day, almost three quarters of the world countries claim to be democratic. As accepted this form of governance may seem to be, still it has some inherent flaws as a system of governance. Most of the critics of this form of government claim that democracy is morally corrupt, humanly unfair, economically inefficient and humanly unfair. It is because of this view that Winston Churchill said that, â€Å"Democracy is the worst form of government, except for all those that has been tried from time to time. Democracy definition            According to the English oxford Dictionary, democracy is defined as the system of government by all the eligible members of the state or the whole population. One time US president, Abraham Lincoln, summed up the very essence of democracy as it being, the government of the people, by the people and for the people (History Place 2012). This of course was an idealist view and in regard to the current system, we can say that the true democracy was only demonstrated in 1918 when the representation of people act gave women the right to vote or they were declared as eligible voters. Before this act enactment or reform, democracy in Britain was only afforded by the rich and in fact up to the end of the 18th century, only about two percent of the population were entitled to vote. Following a number of vital reforms in the break of the 19th century, voting rights were extended slowly that lead to the culmination of the third Reform Act of 1884 that saw all men acquiring votes. This is the time that we can term as the crucial turn of event that led to the democracy that we all enjoy today.            There are differences to the democratic forms of government that exist today. In UK, we have the centralistic form of government where decisions are made in the capital and the local authorities are demanded to act according to these decisions and rules. In contrast to this, the federal government of Germany gives a lot of power to the federal state and this is the same form of democracy that is practiced in the United States (Dobson, 2012) Other forms of government            As we know, democracy is not the standardised form of government that is practiced all over the world. There are many other alternatives that are apparent in other countries. For example in the republic of Korea, there exists a totalitarian regime. This form of government is solely based on ideology. This ideology claims the general validity for all the life aspects and often tries to replace religion. A totalitarian form of governance does not tolerate any kind of deviation from the known ideology and any person who attempts to oppose this ideology is persecuted. This was of course the form that was adopted by the Nazi Germany that led to the political opponents being persecuted and tortured and also detained in the concentration camps leading to the genocide of the ethnic minorities who were in line with the Nazi policy.            Even though the authoritarian form of governance is linked to the totalitarian regime, they have no distinct state ideology and they also grant some cultural and economic freedoms being careful not to jeopardize their policies. The goal that the authoritarian regime takes as being the most important is the maintenance of power along with personal enrichment on the cost of the population and the country as a whole (democracy-building website, 2005.).            There are other forms of government that are apparent and the one that is of particular interest is the Theocracy form of governance that is practiced by the Republic of Iran. This is known as â€Å"government by God†. This is where the official policy is governed by divine guidance or by people or official regarded as divinely guided, or it is simply pursuant to the doctrine of a specific religion or a religious group (merriam-webster online encyclopaedia 2012).            With regard to the UK’s democratic form of governance that we have in place, its success can be determined by how the government interpret what we as people wants. The recent changes like the Scottish devolution along with the creation of the Welsh assembly sends light that if democracy is for the people, then such constitutional changes can be termed as integral and also successful part of practice of democracy.            As we said earlier, the literal meaning of democracy is the government of the people, for the people and by the people. But when the concept of democracy is mixed up with that of governance, this is really not the case even though we get the supporters of democracy pretending to be so. When the people are told that democracy is the rule by the people, then that’s a fallacy. If there is governance that is over those people, than there exist no government or governance by the people. Owing to this argument, the democracies that are adopted by many countries for instance the western countries are in fact oligarchies in every detail. But the people who are the main subjects believe that there are free and become apathetic of the same and they do not see any further need for revolution. The formation that is surely oligarchy is the one that makes democracy to be termed as the worst form of government like Winston Churchill termed it. Bel ow the arguments that point out the worseness of the democratic form of government are discussed. Among these are democracy and economic instability and Democracy as a vehicle of chaos and anarchy. Also the connection of police violence in Canada and democracy will be discussed in details citing the main features of the issue, the advocates of the issue and also the perspectives of the issue. Democracy breeds Economic instability            The frequent changes of power that follows the democratic concept of carrying a general election after a term period of four or five years is a major source of economic instability for the countries that practice democratic form of government. Prior to election, each political party comes out with their manifesto of how they will govern the nation. A political party that wins the election may not be the one that was previously on power. When a new political party takes power they bring other policies that were not the ones adopted by their successor. This leads to frequent changes of policies with regard to the country’s economy. These changes can not only highly daunt investments but also affects corporate and individual businesses, hence limiting the country’s economic growth. The short and limited duration that a certain political party takes power also leads to short term policies. This comes in because the politicians ha ve the idea that they are in power for a limited time period and so they adopt This leads to frequent changes of policies with regard to the country’s economy. These changes can not only highly daunt investments but also affects corporate and individual businesses, hence limiting the country’s economic growth. The short and limited duration that a certain political party takes power also leads to short term policies. This comes in because the politicians have the idea that they are in power for a limited time period and so they adopt short term policies that will bring immediate gratification for the citizens so that they can win their votes for the next general election. These policies are adopted even though they could be disadvantageous in the long-run. This means that the democratic nations mostly will sacrifice their short term pains for the long run gains. This adversely affects the economy of the country. In most cases, the economies are the ones that suffer because policies are not given that time period to be tested and tried before they are adopted. Only come with a policy that will proof to be effective to the common people even though it could be disastrous in future. The These policies are adopted even though they could be disadvantageous in the long-run. This means that the democratic nations mostly will sacrifice their short term pains for the long run gains. This adversely affects the economy of the country. In most cases, the economies are the ones that suffer because policies are not given that time period to be tested and tried before they are adopted. Only come with a policy that will proof to be effective to the common people even though it could be disastrous in future. The ever rising debt of the UK and Us and many of other democratic countries could be attributed to the economic instability that is brought about by short-termism which is the main flaw of the democratic form of government. These changes can not only highly daunt investments but also affects corporate and individual businesses, hence limiting the country’s economic growth. The short and limited duration that a certain political party takes power also leads to short term policies. This comes in because the politicians have the idea that they are in power for a limited time period and so they adopt short term policies that will bring immediate gratification for the citizens so that they can win their votes for the next general election. These policies are adopted even though they could be disadvantageous in the long-run. This means that the democratic nations mostly will sacrifice their short term pains for the long run gains. This adversely affects the economy of the country. In most cases, the economies are the ones that suffer because policies are not given that time period to be tested and tried before they are adopted. Only come with a policy that will proof to be effective to the common peopl e even though it could be disastrous in future. The ever rising debt of the UK and Us and many of other democratic countries could be attributed to the economic instability that is brought about by short-termism which is the main flaw of the democratic form of government. This means that the democratic nations mostly will sacrifice their short term pains for the long run gains. This adversely affects the economy of the country. In most cases, the economies are the ones that suffer because policies are not given that time period to be tested and tried before they are adopted. Only come with a policy that will proof to be effective to the common people even though it could be disastrous in future. The ever rising debt of the UK and Us and many of other democratic countries could be attributed to the economic instability that is brought about by short-termism which is the main flaw of the democratic form of government.            The free market economists like Milton Friedman believed that democracy produces inefficient economic systems. These economists argue that if the government were to make effective economies, they need to make what is generally regarded as unpopular decisions, for instance mass privatisation; removing the rights of the workers and also deregulation especially a time like this of economic austerity. This example is the one that is termed as ‘governing paradox’ (Flinders, 2010, p. 311). Mostly, this is what is seen as inherent contradiction between capitalism and democracy in that, as economic agents, all individuals are expected to act in their own interest but when it comes to casting their votes, they are expected to act in the interest of the society.            The critics are perhaps rights when they say that democracy can lead to ineffectual government. This can be traced many years ago when Aristotle started establishing typologies and categorising political systems. According to him, democracy was a ‘perverted’ form of governance or rule by many. Democracy as a vehicle of chaos and anarchy            The ancient great thinkers and philosophers like Plat, Machiavelli and Thomas Hobbes were very critical on the flaws that come by with the democracy form of governance. They saw the concept of democracy as an unlimited freedom and liberty for all which is a tool of manipulation that can culminate into chaos and disorder in the society. Despite democracy being the most popular form of governance in today’s world, this form of government is prone to the manipulation of wild politicians and other stakeholders who are out to use it as a tool to acquire power and accumulate the country’s wealth for their selfish interest hence create anarchy and chaos to the society as a whole. For instance, Tomas Hobbes saw democracy as a form of government that permits reckless liberty that will usually undermine the law conservation and the societal order. Most of the politicians usually will exploit the antagonism between the economic classes and the dissimilarity in the ethnic groups to turn them into votes for their political parties. Instead of intervening for good and for the passions of the people, these politicians unruly politicians will obviously fun them so that they can be seen as the heroes. Firstly, they monopolize the media and use it to propagate these courses. This eventually pokes holes into the community and creates differences that eventually results into chaos and riots in these groups. In the year 2006 for instance, two major national wide riots erupted in the country of France. The first was in economic in nature and started in the month of February and the next was both religious and ethnic erupted in November the same year. These riots are among the examples that can be brought about by the diverse opinions within the nation. For instance, Tomas Hobbes saw democracy as a form of government that permits reckless liberty that will usually undermine the law conservation and the societal order. Most of the politicians usually will exploit the antagonism between the economic classes and the dissimilarity in the ethnic groups to turn them into votes for their political parties. Instead of intervening for good and for the passions of the people, these politicians unruly politicians will obviously fun them so that they can be seen as the heroes. Firstly, they monopolize the media and use it to propagate these courses. This eventually pokes holes into the community and creates differences that eventually results into chaos and riots in these groups. In the year 2006 for instance, two major national wide riots erupted in the country of France. The first was in economic in nature and started in the month of February and the next was both religious and ethnic erupted in November the same year. These riots are among t he examples that can be brought about by the diverse opinions within the nation. For instance, Tomas Hobbes saw democracy as a form of government that permits reckless liberty that will usually undermine the law conservation and the societal order. Most of the politicians usually will exploit the antagonism between the economic classes and the dissimilarity in the ethnic groups to turn them into votes for their political parties. Instead of intervening for good and for the passions of the people, these politicians unruly politicians will obviously fun them so that they can be seen as the heroes. Firstly, they monopolize the media and use it to propagate these courses. This eventually pokes holes into the community and creates differences that eventually results into chaos and riots in these groups. In the year 2006 for instance, two major national wide riots erupted in the country of France. The first was in economic in nature and started in the month of February and the next was both religious and ethnic erupted in November the same year. These riots are among t he examples that can be brought about by the diverse opinions within the nation. For instance, Tomas Hobbes saw democracy as a form of government that permits reckless liberty that will usually undermine the law conservation and the societal order. Most of the politicians usually will exploit the antagonism between the economic classes and the dissimilarity in the ethnic groups to turn them into votes for their political parties. Instead of intervening for good and for the passions of the people, these politicians unruly politicians will obviously fun them so that they can be seen as the heroes. Firstly, they monopolize the media and use it to propagate these courses. This eventually pokes holes into the community and creates differences that eventually results into chaos and riots in these groups. In the year 2006 for instance, two major national wide riots erupted in the country of France. The first was in economic in nature and started in the month of February and the next was both religious and ethnic erupted in November the same year. These riots are among t he examples that can be brought about by the diverse opinions within the nation.            Democracy can be said to be a pluralist system of power distribution that is set to distribute power among the many and diverse competing groups even though not equally. Even if democracy can be said to be somehow worse, it achieves a greater level of political equality amongst the citizens than any other form and hence reflects the fundamental belief that all individuals or humans are all born equal and so the consent of governance should originate from the governed (Dahl, 1998). In addition, this form of government allows individuals to protect their self interests. The nature of humans dictates that each and every individual desires some control over their needs and wants and John Stuart Mill said that the ability to protect ones interests protects us from evil in the hands of others. The competition that exists between different groups of people within the society is exactly what differentiates democracy from authoritarianism. As it wa s argued by (Flinders, 2010), â€Å"Difference is good†. The discussion and debate along with the exercise of the right to freedom of speech act as the pillars upon which democracy is formed. Inherently, democracy is a system of rights. By definition, democracy grants both civil and political rights to the citizens so that they can fully participate in the democratic process. The nature of humans dictates that each and every individual desires some control over their needs and wants and John Stuart Mill said that the ability to protect ones interests protects us from evil in the hands of others. The competition that exists between different groups of people within the society is exactly what differentiates democracy from authoritarianism. As it was argued by (Flinders, 2010), â€Å"Difference is good†. The discussion and debate along with the exercise of the right to freedom of speech act as the pillars upon which democracy is formed. Inherently, democracy is a system of rights. By definition, democracy grants both civil and political rights to the citizens so that they can fully participate in the democratic process.            So as for all the citizens to participate and hear the voice of their people, it is then very vital to grant these citizens the right to the freedom of assembly that is not provided for in the totalitarian nor in the authoritative regimes. The belief of equality is also one of the building pillars of democracy and thus enforcing and establishing the rights gives this a greater degree of equality than any other non-democratic form of government. In fact, granting these rights helps shield the minority from persecution and also allow them to also protect their interests. The society that we are in these days is made up of heterogeneous groups, all which represent different and varied interests; all these must be respected and recognized. If we do not observe this, we will obviously be committing ourselves to rule by an elite or selected few who think that their interest are over those of the other people. The police violence and democracy in Canada            In Canada, the use of police force and violence has become one of the greatest concerns to the society. Many civilians and students are becoming more concerned about the force that is applied by the police in most encounters with the citizens in different situation. Following some of the bad encounters the people had with the police officers, many people are now tending to think that police in most of the time act to deprive the people their constitutional rights and hence they are violating the rule of democracy. The critics say that police sometimes employ much power to the civilians by use of violence and force. On the other hand, the advocates of this say that the police are entitled to use any power to stop crimes and also secure the people’s wellbeing.            For years the violence and force that has been used by police officers and the local authority in Canada has been not only of major concern but also a significant issue that has to be addressed for democracy to be realised. It all commences when a police officer abuse the powers that has been delegated to them by the state and constitution. In Canada, it has become obvious that each day in and day out there must be a case where a police officer has employed excessive power to the civilians.            As the literacy levels are increasing all day, people are becoming more aware of their democratic rights and the voices are becoming united daily. The authorities and the officers are in place to protect, help and promote safety in communities. There many people who are filing complaints daily against the police officers who are causing violence and using unnecessary force during arrest. In many instances in the city, we have seen how two or three police officers beat up a defenceless citizen using their batons or how they mistreat women and teenagers. These are all the cases that are act against democracy of whom the people should be enjoying, owing to the fact that this is a rule for the people, for the people and by the people. The heightened technology and the media has promoted the awareness that the police are culminating violence by abusing their powers. This has created fear and mistrust by the people towards the police departments . In accordance to the penal law guidelines, the police are only justified to use force that is only necessary to prevent homicide or a crime. The advocates            The advocates for the police usage of power and force term the police as an armed force for participation and protection. They declare the power of the police by them being armed forces; then, they demonstrate their power by stating protection and express their community connection by stating that they participate. First these officers have the delegated power by their weapon that they carry and the ability that this weapon has to make other people to comply to the law. They argue that, by the fact that police have been given the mandate to protect; they must in any means pursue this goal even if it means use of excessive or unnecessary powers. Finally, the participation concept emphasizes the relationship between the officer and the community. To ensure that the communities are safeguarded effectively, they are free to use any power whether it means to deprive a person his/her constitutional rights or not. How we can improve democracy on this issue            The police officers also being one of the citizens, they should strive to serve the communities they are in with their best interest at heart while safeguarding the democratic rights of the civilians. The police officers are the officials that are mandated to impose the laws while preserving order in the society and they should not act in a manner that may culminate violence or in any case deprive any individual his/her democratic rights. In the cases that the police officers are called into some stressful and dangerous events that may involve violent altercations, that must be controlled. We as the citizens also do not want to see our streets run by criminals who terrorize other people. It is true that in some cases police officers are allowed to use force but not in all the situations or self created situations geared at harassing a civilian or depriving him/her his/her democratic rights. Let us all observe the law. References Abraham Lincoln. The Gettysburg Adddress. Available http://www.historyplace.com/speech/gettysburg.htm. Last assessed 05 June 2012 Dahl, Robert A. On Democracy. New Haven: Yale UP, 1998. Print. Dobson, William J. The Dictators Learning Curve: Inside the Global Battle for Democracy. New York: Doubleday, 2012. Print. Flinders, Matthew V. Democratic Drift: Majoritarian Modification and Democratic Anomie in the United Kingdom. Oxford: Oxford UP, 2010. Print. Johnson, Marilynn S. Johnson, ed. Street Justice: A History of Police Violence in Canada. Beacon Press. p. 365. 2004. Loree, Don Corruption in Policing: Causes and Consequences; A Review of the Literature. Research and Evaluation Community, Contract and Aboriginal Policing Services Directorate. Royal Canadian Mounted Police, 2006 Peterson, Amsterdam.Democracy, Policy and Economic development. Stockholm: Stockholm Press, 2005. Stein Ringen. Three Priorities to Improve UK Democracy,2007 Theocracy. Available: http://www.merriam-webster.com/dictionary/theocracy.Last accessed 05 Jude 2012 Source document
Thursday, September 5, 2019
Total Knee Replacement Post Op Pain Management
Total Knee Replacement Post Op Pain Management To improve the quality and mobility of life, the most frequently used operative procedure is the total knee replacement. But it is necessary to administer the pain relief measures in the post operative period which would allow the ambulation and reduce the post operative complications. It is important to consider the pain relief options provided in the text with reference to the possible adverse affects in each case. Objective The main objective is the identification of the most suited method for the post operative pain control after the Total Knee Replacement Surgery. Methodology The random control trials executed on adult patients with the Total Knee Replacement Surgery was identified by going through the databases of MEDLINE, PUBMED, COCHRANE and CINAHL from the year 2000 to the present year. Results The patients involved in this study had pre operative and post operative osteoarthritis diagnosis. The continuous pain arising due to the arthritis can be eliminated by the total knee arthoplasty treatment. The use of femoral nerve blockade can be used to treat the pain after the total knee arthoplasty. Reduced oral opioid were taken in by the patients with primary, unilateral, noncemented total knee arthoplasty. These patients are also known to take less stool softener as a post operative measure and have increased mobilization. The patients poor health often resulted due to the obesity which led to a modifiable co-morbidity as was shown by the higher classification of the ASA. Conclusion Until now no adequate solution has been found to the pain after the Total Knee Replacement surgery. Although some consideration could be given to the combined femoral nerve block, the author however supports the use of multimodal approach in the control of postoperative pain in the TKR surgery. This method should be administered keeping in mind the clinical status of the individual patient, availability of skilled technicians and adequate equipment.Contents Page 1 Introduction Pain according to the International Association for the Study of Pain, has been described as an unpleasant emotional and a sensory experience that is often connected to an actual or a potential damage or is a sense that may be described in terms of that damage (Merskey, 1986). Although much advancement have been made in the study of mechanisms and their treatment, still they scientists have been unable to find the appropriate solution to postoperative pains (Joshi and Ogunnaike, 2005). If the inadequate methods of relieving pains are administered, then this may cause damage to the physiological and psychological workings and the patient may need more time to recover and return to the daily life (Gottschalk and Smith, 2001; Joshi and Ogunnaike, 2005). The most dreadful consequence can be death itself. In addition patients are complaining about the post operative symptoms such as pain which results due to the anesthesia or any surgical procedure. It is also an established fact that a postoperative pain treated inadequately can inculcate into a chronic pain which may be not diagnosed properly and will lead to its negligence (Joshi, and Ogunnaike, 2005). The health care costs and the resources are required more in these cases (Phillips, 2003). It is important that steps be taken to improve the control of preoperative pain which is a much better option and will lead to the reduction of post operative morbidity. This will therefore increase the standard of health associated quality of life and will also benefit the health sector economically. Theory of Pain The Gate Control Theory was established by Melzack and Wall (1965), to explain the differences in the perceptions of the similar stimuli. These scientists believed in the existence of some sort of a gate in the spinal cord that would open in specific situations and allow the passage of the nerve impulses linked with the pain stimulation which was then read by the brain as a sensation of pain. They also believed that certain psychological factors such as the anxiety would also affect the degree of the opening of the gate. Therefore in order to minimize the pain the theory was based on the idea of closing this gate. According to the Gate Theory, it was possible to control the transmission of the pain impulses through a gating mechanism present along the nervous system. The pulses can move in both the direction both up and down the nervous system. This means that the whole nervous system is involved in the perception of the pain response (Suza, 2007). Physiology of Pain The basic process of the pain transmission is Nociception. According to Loeser and Treede (2008), the Nociception is the neural process of encoding and the process of noxious stimuli. The mechanical, thermal or the chemical changes when surpasses the set limit, then they can be detected by the nociceptors or the pain receptors. The nociceptors transmit a signal along the spinal cord after its stimulation, to the brain which is then perceived by the brain as a sensation of pain (McCaffery and Pasero 1999). Pathophysiology of pain The sympathetic nervous system is activated by the stress responses in which the body is alerted to the existing harm. This denotes that the stress responses are a protective measure by nature. Through the stress responses the damages like blood loss is minimized as well as the perfusion to the vital organs will be maintained, healing will be enhanced and prevention to infections will also be carried out (Singh, 2003). But if the pain is prolonged then harmful consequences may be caused to the multiple systems of the body. A calculated amount of the hormones are released by the endocrine system which are responsible for the conversion process and the utilization of the carbohydrates, proteins and fats. Excessive amounts of these hormones are released by the endocrine system when the person is under stress. These hormones include Cortisol, Growth hormone, Adrenocorticotrophic hormone, Antidiuretic hormone, Catecholamine and Glucagon. Tachcardia, fever, shock, increased rate of respiration and some severe results leading to death may be produced by the combination of the inflammatory process, endocrine and the metabolic changes. The stress responses are prolonged by the pain and physical changes and may severely affect the recovery of the patient from the situation of trauma (McCaffery and Pasero, 1999). The sympathetic nerves system is activated as a response to the stress by the cardiovascular system. A number of affects are caused by the activation of the sympathetic nervous system in the post operative period, such as; increase in the heart rate, hypercoagulation due to the decrease in the fibrinolysis, blood pressure, oxygen demand and a cardiac workload. Major impacts of the hypercoagulation may be seen on the morbidity and the mortality as these may be connected to the infarction, irregular angina and myocardial ischemia. The risks of pulmonary embolism may be increased due to the deep venous thrombosis (DVT) which is generally associated with the surgical procedures and an absence in the movement postoperatively. The respiratory system affects of the severe pain can be calculated in terms of the high inspiratory and expiratory residual capacity, tidal volumes and the alveolar ventilation. If the controlling measures applied to the postoperative pain are not adequate then the adverse respiratory affects can convert to severe pulmonary complications in the form of atelectasis and pneumonia (McCaffery and Pasero, 1999). The urine outputs, electrolyte balance, other fluids are regulated by the hormones in the Genitourinary System. These hormones also control the blood volume and the pressure. These hormones may include ADH, cortisol, angiotensin II, catecholamine, prostaglandins and aldosterone. If the pain is not relieved then it may lead to the excess release of the hormones which can cause the water and the sodium ions to be retained, the functional extracellular fluids are decreased with the fluids being moved to the intracellular compartments and the excess excretion of the potassium ions. Among the harmful effects are: decrease in the urinary output, increase in the cardiac workload, urine retained, hypokalemia, hypertension and the overloading of the fluids (McCaffery and Pasero, 1999). The activity of the sympathetic nervous system is increased due to the stress responses which affect the Gastrointestinal System, increase in the smooth muscle sphincter tone, intestinal secretion and the decrease in the gastric disposal and intestinal motility. These may lead to the gastrointestinal function to be temporarily impaired (McCaffery and Pasero, 1999). The pain in the Musculoskeletal System may lead to the impairment of the muscle function, muscle spasm, immobility and fatigue. The short and the long term recovery can be affected by the inadequate control of the pain after the execution of an orthopedic surgery as this may create interference in the patients performance of the physical therapy exercises (Choy, Bandar, Scott and Dockets, 2010). The hospital stay for the patient may be prolonged as a result. The time duration spent by the patient in the hospital indicates the patients satisfaction level. Patients who had a short stay were found to be more satisfied as compared to those with longer hospital stay. The Immune function can be suppressed by the pain (page 2000) which will make the patient more vulnerable to postoperative infections such as pneumonia, sepsis and the wound infection. The severe acute pain or the pain which is prolonged can affect the Cognitive function which will make the patient to undergo some behavioral changes such as the increased sensitivity to the external stimuli like light and sound. Individuals may react by withdrawing themselves form interpersonal interactions and an increased indulgence in ones self concern (NHMRC, 2005). If the pain is not relieved the patient may experience a loss of control over the environment such as the expression of anger and resentment which may make the patient believe that the treatment is being delayed (Joshi and Ogunnaike, 2005). Postoperative pain control The surgical pain should be appropriately managed owing to the negative effects that it has on the physical and the psychological system of the postoperative patient. The following methods have been applied in the Total Knee Surgery in the practice area of the author in the area of orthopedic surgery: Systemic Opioids The treatment of moderate and acute pain can be done through opioids which is still the main systemic analgesia. Titration is needed to estimate the individual needs as the opioids requirements differs from one patient to another with respect to dosage. The most effective pain relievers are the opioids but they are generally not desired by the patients or the doctors due to the wide ranging adverse effects (NHMRC, 2005). Paracetamol To treat the post operative pain, paracetamol was introduced as an analgesic and antipyretic. The use of opioid was reduced by 20-30% by the usage of paracetamol and the level of patient satisfaction was also increased. The postoperative pains are also affectively dealt with the combination of Non-Steroidal Anti-inflammatory drugs (NSAIDs) and the opioids. The NSAIDs are effective analgesics, anti-inflammatory drugs and antipyretics. The NSAIDs are also helpful in reducing the usage of opioid, but the adverse effects associated with this drug has made the clinicians extra careful when using it. The method in which the patient can administer the analgesics as needed is referred to as the Patient Controlled Analgesia (PCA). Although this term may be more frequently associated with the programmable infusion pumps that administer the dose for the opioid medication intravenously (Morgan, et al. 2006). The cumulative doses of the drugs are decreased in comparison to the continuous epidural infusion by the usage of Patient Controlled Epidural Analgesia which contains Bupivacaine and Fentanyl. This may be done without any difference seen in the side effects or the relief of pain. The duration of the postoperative analgesia is extended beyond the duration which is generally available in a single injection by the help of Continuous Peripheral Nerve Blockade (CFNB). The technique utilized in the nerve location, the typology of the continuous catheter, local anesthesia, equipment and the management is some of the technical issues that are brought under consideration. The CFNB is sometimes referred to as the 3-in-1 due to the triple benefits that it offers as when it the catheter is positioned in the femoral nerve sheath, it will allow the penetration of the local anesthesia to the lateral femoral cutaneous, the obturator nerve and the femoral nerve block (NHMRC, 2005). Total Knee Replacement (TKR) The patient suffering from acute pain and unstable knees, in order to gain a pain relief and a functional movement, requires a total Knee replacement surgery. Prophylaxis and early mobilization can reduce the complications and morbidity caused after the surgical procedures. Prophylaxis According to Palmer (2010), in the absence of prophylaxis there was an occurrence of 40-88% of deep venous thrombosis (DVT) after the TKR. According to Palmer several methods can be applied to reduce these risks such as low dose of warfarin, mechanical compression stockings, heparin of low molecular weight and aspirin. Mobilization A rapid recovery to the normal functions after surgery can be done through postoperative mobilization. If the postoperative pain is not relieved then it will lead to late mobilization which will increase the DVT risks, chest infection and pulmonary embolism. If the chest infection is concurred, then the static secretions will lead to atelectasis and pneumonia (Bone and Joint, 2009). 3 Methods The method of study was primarily based on the extensive literature review of the publications which were related to the management of postoperative pains in adults who have undergone Total Knee Replacement Surgery. The method was more preferred by the author due to limited clinical access to the patients as the author is an international student. This method was also chosen under the light of the statement by Aveyard (2007), who said that the literature review is able to provide a complete picture and helps in forming a systematic approach towards the studys answer. Therefore the study will include as many options available from the literature review as possible. Search strategy The Cardiff Universitys electronic database was used as the source to gain data on the most effective method used in the post operative pain control after the Total Knee Replacement Surgery. The search gave 246 hits with the keywords used such as Pain, Analgesia, Anesthesia, postoperative and Knee. Among these results the author selected the most relevant options with the help of Medline Ovid. The search was limited to the English language due to convenience in understanding this language as compared to the others and included results from the year 2000 to the present. The appendix 1 shows the details of the research strategy. Scope of the study The inclusion of the data in the study was based on adult human beings and total knee replacement surgery. The pediatric and other surgical specialties were not included in the research as was the study involving non human subjects. Data collection The MEDLINE, PUBMED, COCHRANE and CINAHL were the primary source of information. The Critical Appraisal Skills Programme criteria were used in the judging of the key methodological points considered in the Randomised Control Trials (PHRU, 2006). Data analysis In the published materials, broad themes were identified and studied with the most common and frequently used methods of pain relief resulting for the Total Knee Replacement Surgery were compared and analyzed with each other. The adverse effects of these methods were also considered in the analysis. The results were analyzed under the CASP (PHRU, 2006) criteria which was developed by the Center of Evidence based Medicine (CEBM, 2011). The appendix 2 shows the appraisal sheet. 3 Results (Review of the literature) A double blinded Randomized Controlled Trial was conducted by Kardash et al (2007), for the comparative analysis of the obturator with the femoral nerve block used for the analgesia after the Total Knee Replacement surgery. This was done by using at the surgerys end the spinal anesthesia with the femoral, obutrator or the placebo nerve block. The study consisted of 60 patients who were divided in treatment groups of varying sizes. The participants and the collectors were not aware of this allocation at all. All the patients were present in the study except for one patient who was removed from the study due to the confusion of the patient in the recovery room postoperatively. The patients were given a follow up after 48 hours of post surgery. The pain scores were found to be lowered after the femoral nerve block as compared to the obturator nerve block. But no difference was found in the groups after 48 hours related to pain or baseline among the groups. There was an absence of a sign ificant difference between the groups with the pain score of p=0.03 as an option. This would favor mobilization of the femoral block over the obturator block. The data is widely represented as shown by the demographics of the total knee replacement population. The findings could not be generalized owing to the small size of the groups. A prospective randomized placebo controlled single blind study was executed by Macalou (2004). The assigning of the patients into three groups was done randomly through envelops given to the patients. A femoral nerve block (FNB) was given to group 1 while combined and selective obturator nerve block, FNB=33 was given to the group 2. The group 3 was given the placebo FNB (n=28) with a total of 90 patients enrolled in the study. The three groups demonstrated no significant demographic differences. All the participants were present in the study without any dropouts and there was no failure of the block experienced which makes the study even more valid. In the first 6 hours the patients were monitored postoperative. The administration of the Patient Controlled Analgesia was initiated post anesthesia without the recording of any symptoms of pain in the first 6 hours. The study follow ups are from 24 to 48hours which means that the duration of the study of 6 hours is not sufficient to obtain any conclusions. 3 tables and 1 graph presented the study. The results obtained in the first 6 hours after the surgery showed the morphine boluses given through the PCA were consumed in a lesser number in group 2 as compared to the group 1 and 3 (P0.05). The ITM group showed an increase in the occurrence of nausea, pruritus and vomiting. About 20% of the patients in the ITM group in the follow up satisfactory survey rated their anesthetic experience as not satisfactory. These were considered in comparison with none in the FNB group (P=0.035). The validity and reliability of the study was enhanced by the reporting of the P value and the confidence interval. Equal amounts of the postoperative analgesia were experienced but the fewer side effects were seen in the FNB group such as nausea, itching and vomiting. Less level of satisfaction was observed among patients receiving T morphine. However the interventions were not sufficient to provide the completed postoperative analgesia. A randomized controlled trial was conducted by Davies in 2004, in which the 60 patients who underwent unilateral primary total knee replacement surgery were included in one of the two study groups. The continuous epidural analgesia was given to the group 1 until a single shot combined with sciatic plus femoral which is available in 3 in 1 combined block. The research used a random number generator, Arcus Quickstat version 1.0, to divide the participants in groups in which a third party would store the codes in sealed and opaque envelopes which would reduce the chances of bias (Parahoo, 2006). The exclusion of the patients was done on the following basis: local anesthesia, ASA>3, neuraxial blockage or the use of tourniquet, contraindications to use the non steroidal anti inflammatory drugs, pain poly analgesia. The criteria used for the exclusion seemed to be correct. All the participants were present in the study and in the conclusion. The failure to locate the epidural space led to the exclusion of one patient. After the exclusion the analysis was done but no difference in the results were seen in the analysis on an intention to treat the basis. The data collection was done in a similar manner and the follow up was carried out. A performance bias was created by the inconsistencies. The analysis of the patients was done for the pain assessment after 48 hours postoperatively with the use of a visual analog VAS. The power analysis was used to determine the sample size, obtained from a lower limb neural block study which showed the 10mm VAS difference. A risk of 0.05 was obtained in group A and a risk of 0.2 was obtained in group B. a minimum of 24 patients would be sufficient for the study. In each group 30 patients were however recruited to make up for the incomplete data collected and to make sure that the validity was ensured. 3 tables and 3 graphs were used to demonstrate the results. An absence of a statistical difference between the two groups was seen in the two groups for the block insertion time (P=0.92). The dose given for the fentanyl was to be same. In both the groups the score for the pain was higher than 24 and 48 hours. A greater number of the patients were found in the epidural group with the completed recovery of the analgesia. There was no pain reported in the 0.23 of 39 patients when a movement was attempted as compared to the 16 out of 30 patients form the block group. The scores of the level of satisfaction were found to be high in both the groups with an increased tendency of the statistical significance which was found to favor the block group at 48 hours. The validity of the study was increased with the discussion of the P value and the confidence interval. A practical alternative to the epidural analgesia was offered by the combined block for the total knee replacements. The results can be applied to the clinical setting.
Effect Of Tailor Made Technique Nursing Essay
Effect Of Tailor Made Technique Nursing Essay Children are members of families, communities, populations and overall society, which shape the context, experiences, and opportunities of their lives. Thus, their wellbeing is inextricably linked to the well-being of their families, communities and the society in which they live. Hospitalization of children is for acute or chronic conditions. Many factors contribute to the distress of young children during hospitalization, and existing fears and emotions may be intensified with prolonged hospitalization. Children become anxious and normal fears are exacerbated when they think about being in pain, harmed, or mutilated in some way or being separated from parents (Nicki and Barbara, 2007). Cannulation causes moderate or severe pain and fear in a substantial number of children and adults. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage (Merskey and Bogduk, 1994). Pain relief is a human right, yet pain in children is an under-recognized problem around the world. Children not only have pain from injuries, surgery, burns, infections, and the effects of war, terrorism, and violence, but also undergo pain from many procedures and investigations used by doctors and nurses to investigate and treat disease. Fear can be explained as a state of dread, apprehension or trepidation related to the future. Fear is a major stressor among hospitalized children. According to children, insertion of needle is one of the most fearful experiences. For many people, the needle can only be a source of fear to the extent that a needle is a necessary part of the procedure that initiates a terrifying involuntary reaction of ones body. For some the fear may extend up to needle phobia, who has thought about the nature and origin of their condition, they actually have no fear of needles at all, but may have an extreme fear of suffering the physical effects of a needle phobia reaction. Thus, these problems of a hospitalized child can be alleviated by the nurse who is directly responsible for their protection and guidance. Nurses are at high risk for liability with regard to the under treatment of pain and fear. Of all the members of the health care team, nurses spend most of the time with patients and are recognized as the patients primary pain managers. The nurse is concerned not only with providing nursing interventions to children, but also with obtaining cooperation of children to the procedures to them. This is possible for a nurse with the skill in wide variety of interventions such as therapeutic play and the use of the arts and humanities as music, drama, television etc. Some institutions have procedures for minimizing the predictable pain and fear of cannulation, especially in children. Current advances are being made to control pain by integrating both the science of pain medications and the science of the human mind. According to Brunner and Suddharth (2004), distraction is thought to reduce the perception of pain by stimulating the descending control system, resulting in fewer painful stimuli being transmitted to brain. Distraction techniques may range from simple activities, such as watching TV or listening to music, to highly complex physical and mental exercises. Topical analgesics have been one important tool in reducing and preventing pain during minor procedures. As elicited by Potter and Perry (2005), the anesthetic cream which is thickly applied is placed on the skin 15 minutes before local anesthetic infiltration or minor procedures, e.g., IV start. The Lidocaine patch is a topical analgesic effective in cutaneous pain. Three patches are placed on and around the pain site using a 12-hour on, 12-hour off schedule to avoid Lidocaine toxicity. According to Sr. Nancy (2005), hot applications can be dry heat applications or moist heat applications which may be applied either locally or generally. Hot applications have many local physiological effects on the body. One among the many local physiological effects of hot application is vasodilatation. Dilatation of vein aids in reducing the number of phlebotomy attempts. Also, the chief therapeutic use of local hot application is that it decreases pain due to ischemia, local congestion and muscle spasm. Injections of any kind can hurt! Children know this pain is predictable. How they respond to an injection depends in part of their developmental age and their previous experience. Intravenous and intramuscular injections should be given in such a manner that the children do not have time to build up their anxiety about the procedure. Tailor-made means, it has been specially designed for a particular purpose. Thus the researcher uses tailor-made technique for preschool and school-aged children who enjoy active play, during the injection the nurse can suggest distraction activities along with local analgesics agent and hot application. NEED FOR THE STUDY The leading health indicators, the healthy people 2010 provides a framework for identifying essential components of child health promotion programs, designed to prevent future health problems in our nations children (Department of health and human service, 2007). The present total population of children in the world is 2.2 billion where in India, 13.1 percent of the population that is 15, 87, 89,287 are children (Census, 2011). The Paediatric ward of Sri Ramakrishna hospital receives an average of 1414 admissions per year. Almost all of them ought to have venipuncture since it is an integral part of performing diagnostic procedures and administering therapy during a patients hospitalization. Each hospitalized child has to undergo at least a single venipuncture within every three days of hospital life. Thus, attention in relieving such pain and fear is a must. Pain is the primary complaint for which people seek medical treatments. Sr. Callista Roy (1991), defined pain within the psychological mode, as a sensory experience of acute and chronic nature, coded into the somatosensory pain pathways. Acute pain, according to Sr Callista Roy, refers to Discomfort which is intense but relatively short and reversible. Using principles from neuropsychology; Roy stated that a sensory experience such as pain involves the transmission of information from sensory pathways to the cerebral cortex. The theoretical explanation for the effectiveness of distraction lies in its ability to divert attention away from the painful stimulus. McCaul and Malott (1984) hypothesize that the brain has a limited capacity to focus attention on stimuli. Therefore, using up attentional resources while engaging in a distracting task leaves little capacity for attending to painful stimuli. The Gate Control Theory of Pain proposed by Melzack and Wall (1965, 1995) offers a physiological explanation of the effectiveness of attention diversion. In brief, the Gate Control Theory explains that pain perception can be affected by factors other than the stimulus itself. This theory suggests that pain perception is controlled by a neural mechanism or gate in the spinal cord. Depending on how the mechanism is activated, the gate can be opened or closed. When the gate is open, 8 pain signals are transmitted to the brain, and when the gate is closed, they are not. Melzack originally proposed this theory to exp lain why physically stimulating an area can lead to reduced pain perception, but later modified his theory to suggest that cognitive factors can also open or close the gate. Cognitive and behavioral processes, such as distraction, Lamaze, and self hypnosis, cartoons can close the gate to subsequent pain perception by diverting attention away from the painful stimulus and toward focal points. Neglected pain erodes a patients trust in the health care system. In 1995, the American pain society challenged all health care systems to make pain as the fifth vital sign. James Campbell, the societys President noted that, if pain were assessed with the same zeal as other vital signs, there would be a much better chance of its being treated properly .Failure to appropriately assess and treat pain is a liability issue for facilities and members of the health care team . Pain is always a source of anxiety, as well as a constant companion. Furthermore about 10% of adults in the United States have needle phobia, as intense fear of needle that triggers immediate anxiety in the most severe cases, vasovagal response can lead to shock. The phobia may intensify for most people with the minimal pain of venipuncture. The fear usually begins in childhood and it may lead to avoidance of medical care. According to Journal of Anxiety Disorders (2006), the tendency to experience pain, disgust, and fear of fainting during injections was associated with anxious responding to the venipuncture and a probable diagnosis of needle phobia. A local anesthetic, Lidocaine blocks the conduction of pain impulses and stabilizes the neuronal membranes, thereby relieving pain. The drug penetrates the skin to act locally on the damaged or dysfunctional nerves and soft tissues, underlying the site. The benefit of local mechanism of action is that, with appropriate use, there is minimal systemic absorption of Lidocaine and adverse effects such as central nervous system depression or excitation are averted .Local absorption, also results in fewer drug interactions , an important consideration ,because many people with chronic pain requires opioids, nonopioids or adjuvant analgesics. A study was conducted by C V Bellieni et al., in 2006 conducted to the children, the results of is reported in the November 28 issue of the Archives of Disease in Childhood.In this study, 69 children aged 7 to 12 years undergoing medical procedure were randomized to receive no distraction procedure (controls), active distraction by their mother, or passive distraction by a television cartoon. Both the mothers and childrens rating scores suggested that procedures performed during television watching were perceived as being less painful than procedures performed during active or no distraction. Many studies have tested the effectiveness of Eutectic Mixture of Local Analgesics (EMLA) and Lidocaine gel .Since the application of Lidocaine is one quarter the cost of EMLA cream, significant saving can be obtained if it is proven to be effective as a topical anesthetic agent. It was seen in earlier studies that, IV cannulation was easier with Lidocaine gel as compared to EMLA cream. A randomized, double-blinded, placebo-controlled study by J.B.Rose et al., (2002) of Lidocaine Iontophoresis for Paediatric venipuncture among 59 children aged 6-17 years suggested that lidocaine iontophoresis is safe in children, reduces discomfort associated with venipuncture, and increases satisfaction when compared with the placebo. Hot applications promote vasodilation. A study was conducted on effect of EMLA Cream and Application of Heat to Facilitate Peripheral Venous Cannulation in Children by Lori Huff et al., (2009). There was a significant increase in vein visualization from pre-application of heat to post application of heat with a success rate of 80% with the first time attempt of IV insertion. Therefore, application of heat counteracts the adverse effect of vasoconstriction that occurs with EMLA cream application, potentially increasing peripheral venous cannulation success rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO, 2003) has approved revised standards for pain assessment and management in hospital ambulatory and home care settings .The American pain Societys Quality improvement recommendation provides excellent foundations for meeting JCAHOs expectations which includes recognizing and treating pain properly and promising patients attentive analgesic care. On the investigators personal experience, it is observed that children are having increased pain and fear during needle-related procedures performing in Paediatric ward. This motivated the researcher to conduct a study to make venipuncture a total painless procedure. Hence Tailor-made technique was selected for the research. 1.2 STATEMENT OF THE PROBLEM EFFECT OF TAILOR-MADE TECHNIQUE ON PAIN PERCEPTION AND FEAR AMONG CHILDREN UNDERGOING VENIPUNCTURE AT SRI RAMAKRISHNA HOSPITAL, COIMBATORE. 1.3. OBJECTIVES To administer Tailor-made technique among children before venipuncture. To assess the pain perception among children after administering Tailor-made technique in experimental and control group. To assess the fear among children after administering Tailor-made technique in experimental and control group. 1.4. OPERATIONAL DEFINITION 1.4.1. Effect Effect refers to the change in the level of pain perception and fear during venipuncture among children after Tailor-made technique. 1.4.2. Tailor-made Technique Tailor-made technique refers to the combination of three interventions, such as exposure of the child to cartoon animations, application of 2 % Xylocaine gel for 10 to 15 minutes and application of local heat for 2 minutes over the planned site, before venipuncture. 1.4.3. Pain Perception Pain perception means the level of pain experienced by a child during venipuncture, expressed in terms of behavioral responses in face, legs, activity, cry and consolability. 1.4.4. Fear Fear is an unpleasant feeling due to frightened situation during venipuncture among children expressed as responses in face. 1.4.5. Children Children refer to those who are between the age group of 4-12 years, who need to undergo venipuncture at the Paediatric ward of Sri Ramakrishna hospital. 1.4.6. Venipuncture Venipuncture is a needle-related procedure, in which a vein is punctured for medication administration, fluid infusion or blood sampling among children between 4 to 12 years of age at Sri Ramakrishna hospital. 1.5. CONCEPTUAL FRAME WORK Modified Weidenbachs Helping Art of Clinical Nursing Theory Modified Weidenbachs Helping Art of Clinical Nursing Theory (1964) was adopted for developing conceptual framework. The theory views nursing as an act, based on goal oriented care and closely parallels the assessment, implementation and evaluation steps of nursing process. This theory is composed of three basic elements: Identification. Ministration. Validation. 1.5.1. Identification. It involves individualization of the patient, his experiences and recognition of the patients perception of his condition. The researcher identifies the children who need to undergo venipuncture from the medical records, collects the demographic data and then plans for Tailor-made technique. 1.5.2. Ministration. It is providing the needed help. It requires the identification of the need-for-help, the selection of a helping measure appropriate to the need, and the acceptability of the help to the patient. In this study, the researcher administers the Tailor-made technique before venipuncture to the experimental group, whereas no intervention is given to the control group. 1.5.3. Validation. It is the evidence that the patients functional ability was restored as a result of the help given. In post test, the researcher assesses the level of pain and fear after the administration of Tailor-made technique and compares the effect of Tailor-made technique on pain perception and fear during venipuncture in experimental group with the level of pain perception and fear during venipuncture without Tailor-made technique in control group. 1.6. PROJECTED OUTCOME Application of Tailor-made technique reduces the pain perception and fear among children undergoing venipuncture. Review of literature Literature review refers to the activities involved in identifying or searching for information on the topic (Polit and Hungler, 1999). Literature review is an essential component to the researcher for the greater understanding of the research problem and its aspects. It provides the researcher with an opportunity to evaluate many different approaches to the problem. Thus the literature review has organised and presented under three headings. 2.1. Literature related to pain and fear during venipuncture. Cavender et al., (2004) done a study to determine the effectiveness of parental positioning and distraction on the pain, fear, and distress of pediatric patients undergoing venipuncture. An experimental-comparison group design was used to evaluate 43 patients (20 experimental and 23 comparisons) who were 4 to 11 years old. Experimental participants used parental positioning and distraction. All participants rated their pain and fear; parents and child life specialists (CLS) rated the childs fear, and CLS rated the childs distress. Self-reported pain and fear were highly correlated (p Anil Agarwal et al., (2005) conducted a study to evaluate the efficacy of the valsalva maneuver on pain during venous cannulation among children. In this study 75 samples were randomly assigned to 3 groups respectively. Group I was control group without intervention, group II was instructed to blow into a sphygmomanometer tubing and raise the mercury column up to 30 mm of Hg for 20 seconds and group III was instructed to press a rubber ball. After 20 seconds peripheral venous cannulation was performed. Venous cannulation pain was graded by a 4 point scale. Results showed a significant reduction in the incidence of pain in group II (72 %), whereas other two groups experienced 100 % pain. Researcher concluded that, the valsalva maneuver performed at the time of venous cannulation greatly decreases venipuncture pain. Gupta et al., (2005) carried out a prospective, randomized controlled study to evaluate the efficacy of balloon inflation on venous cannulation pain among children by Devendra. The study was conducted among 75 children aged 6-12 years who were randomly divided into three equal groups. Group I was control group with no intervention, group II was provided with distraction like pressing a ball and group III with balloon inflation. Visual analogue scale was used to assess the venipuncture pain and there was a significant reduction observed in group II and group III, when compared with group I. Visual analogue score in group III was decreased when compared with group II (p Farion et al., (2006) conducted a randomized control study to determine the effect of vapocoolant spray on pain during intravenous cannulation by among 80 children between 6-12 years. The children received either vapocoolant spray or placebo before cannulation. Children rated their pain using a 100-mm colour visual analogue scale. Parents (p = 0.04), nurses (p = 0.01) and child life specialists (p Movahedi et al., (2006) conducted a study to examine the effect of local refrigeration prior to venipuncture on pain related responses among school age children. 80 children aged 6-12 years were selected by purposive sampling. In experimental group the injection site was refrigerated for three minutes using an ice bag before venipuncture and in control group venipuncture was performed according to routine procedure. Physiological responses, behavioral responses, and subjective responses were assessed in both groups. Results showed no significant difference between two groups for physiological responses, whereas behavioral responses (p = 0.0011) and subjective responses (p = 0.0097) showed that, the test group had lower score in behavioral and subjective responses compared to the control group. The researcher concluded that the use of local refrigeration prior to venipuncture can be considered as an easy and effective intervention for reducing pain related to venipuncture. Kennedy et al., (2008) reported in an article that pain during venipuncture and intravenous cannulation is an important source of paediatric pain and has a lasting impact. Older children have reported greater pain during follow-up and cancer-related procedures, if the pain of the initial procedure was poorly controlled. Fortunately, both pharmacologic and non pharmacologic techniques have been found to reduce childrens acute pain and distress and subsequent negative behaviours during venipuncture. This review gives the evidence for the importance of managing paediatric procedural pain and methods for reducing venous access pain. Nilsson et al., (2008) evaluated the concurrent and construct validity and the interrater reliability of the Face, Legs, Activity, Cry and Consolability (FLACC) scale during procedural pain among 80 children of 5-16 years age. Children scheduled for peripheral venous cannulation of a venous port were included in this study. In 40 cases, two nurses simultaneously and independently assessed pain by using the FLACC scale and in 40 cases one of these nurses assessed the child. All children scored the intensity of pain by using the Coloured Analogue Scale (CAS) and distress by the Facial Affective Scale (FAS). Concurrent validity was supported by the correlation between FLACC scores and the childrens self-reported CAS scores during the procedure (r = 0.59, P Hess and Hall (2009) conducted a prospective study to evaluate the effect of a near-infrared light vein viewing device on the success rate of venipuncture performed by staff nurses on a paediatric surgical unit. The number of attempts, age of the patient, and time required to establish successful vascular access were recorded for 91 children and this data was compared to baseline data (n=150) previously collected on the same unit prior to the implementation of the device. The first attempt success rate for the control group was 49.3%, and for the experimental group 80.2% (p Harrison et al., (2011) conducted a randomized controlled study to assess the efficacy of sweet tasting solutions or substances for reducing needle-related procedural pain in children beyond one year of age. A sweet tasting solution or substance was given to 330 children between 1 to 16 years of age randomly in experimental group. Control conditions included water, non-sweet tasting substances, pacifier, distraction, no treatment, positioning or breastfeeding. Results for the toddlers or pre-school children show that in the sucrose group in one study had significantly lower cry duration and behavioral pain scores, compared with the no intervention group, while crying time did not differ between the sucrose and the no intervention group in the other study. For school-aged children, chewing sweet gum either before, or during the procedure, did not significantly reduce pain scores. 2.2 Literature related to distraction strategy, local anesthetics and local heat. Halperin et al., (1989) conducted a double-blind, placebo-controlled study was conducted by to evaluate the effect of topical skin anesthesia (EMLA, eutectic mixture of prilocaine and lidocaine) for venous, subcutaneous drug reservoir and lumbar punctures in children. Venipunctures were performed on 18 children (6.1 to 12.2 years of age) equally divided in the study and control groups. . Pain intensity was scored by the children themselves, using a visual analogue scale. EMLA cream was associated with lesser pain scores than those with placebo (means +/- SD: 2.8 +/- 2.4 versus 6.8 +/- 2.1, P less than .01). A crossover trial was used in the studies of subcutaneous drug reservoir and lumbar punctures, eight children (6.1 to 15.1 years of age) were tested for subcutaneous drug reservoir punctures. Pain induced by this procedure was rated at 3.9 +/- 2.2 with placebo compared with 1.2 +/- 1.8 with EMLA cream (P Peretz et al., (2002) conducted a random crossover study to assess childrens reactions while receiving a warmed local anesthetic solution for dental procedures (37o C; W) and to compare with one at room temperature (21o C; RT). 44 children between the ages of 6 to 11 years were randomly assigned to receive either a W or a RT local anesthesia on the first visit and the alternate local anesthesia on the second visit. The modified Behavioral Pain Scale (BPS) was used during the injection. For subjective evaluation, the Wong-Baker FACES Pain Rating Scale (FPS) was used. Using the FPS, 19 boys ranked the experience of local anesthesia as a positive experience , 4 boys and all 21 girls ranked it as negative for both types (W and RT). No significant difference was found in the mean VAS scores between the room-temperature group and the warm group (23.4 +/- 21.8 and 20.8 +/- 18.9, respectively). Thus there is no advantage to warming local anesthetic solu tion prior to injection. Biswas, D. (2005) conducted a study on effectiveness of four modalities (hot fomentation, glycerine Magnesium Sulphate application, and Ichthamol Magnesium Sulphate and Ichthamol Belladonna) of nursing interventions on phlebitis pain was evaluated. Ichthamol Belladonna along with hot fomentation was effective in reducing pain, erythema, swelling, induration, palpable venous cord at 0.01 as compared to Ichthamol Belladonna dressing, glycerine Magnesium Sulphate dressing and glycerine Magnesium dressing with hot fomentation. Tools included the demographic data to know the sample characteristics, phlebitis measurement chart, observation check list and visual analogue scale. The pre test mean pain score related to peripheral IV infiltration were 61.23 and post test mean pain scores were 13.27 in treatment with Ichthamol Belladonna dressing with fomentation which was found to be the most effective out of all the 4 interventions. Thus the study concluded that Ichthamol Belladonna dressing with fomentation was effective. Vangoli et al., (2005) conducted a study to investigate the presence of clown doctors on a childs preoperative anxiety during the induction of anaesthesia and on the parent who accompanies them until he/she is asleep. There were 40 samples of 5-12 years of age who were assigned randomly to the clown group in which the children were accompanied in the preoperative room with the clown doctors and a parent and to the control group in which the children were accompanied by only 1 of his/her parents. The anxiety of the children in the preoperative period was measured through the Modified Yale Preoperative Anxiety Scale instrument and the anxiety of the parents was measured using State-Trait Anxiety Inventory. Also, a questionnaire was developed for health professionals to obtain their opinion about the presence of clowns and a self-evaluation form was developed to be filled out by the clowns themselves about their interactions with the child. This study shows that the presence of clowns during the induction of anaesthesia with the childs parents was an effective intervention for managing childrens and parents anxiety during the preoperative period. Anjum. S (2007) conducted a study on hot fomentation versus cold compress, to reveal that the pre-treatment mean score of degree of infiltration was 7.1667 and it was decreased to 0.7071 on the third day of treatment with hot fomentation. In cold compress group, pre-treatment mean score of degree of infiltration was reduced from 6.9333 to 0.7571 on the third day of cold compress treatment. The intensity of pain was reduced from severe [56.66%] to no pain [93.4%] in hot fomentation group. In cold compress group, the intensity of pain was reduced from moderate [60.0%] to no pain [86.6%]. The mean score of hot fomentation group was 6.5067 in reducing the degree of infiltration while cold compress the mean score was 6.6. The study concluded that hot fomentation better than that of cold compress. Lee (2008) done a randomized cross-over study to determine the effect of heat and duration of stretching on the extensibility of hamstring muscles and their electromyographic responses to passive stretch in children with hypertonia and severe mental retardation. There were 29 participants with ages from 4 to 13 years who randomly received 4 treatment sessions as (A)10-second stretching, (B)30-second stretching, (C) hot pack followed by 10-second stretching, and (D) hot pack followed by 30-second stretching each consisting of 5 repetitions of stretching and successive treatments were separated by at least 24 hours. The distance between greater trochanter and lateral malleolus and hamstring electromyographic (EMG) activity during passive knee extension stretching were measured. Two-way ANOVA showed a larger increase in hamstring extensibility in conditions C and D (1.3 +/- 1.1 cm) than conditions A and B (0.7 +/- 0.9 cm) (P Warming local anesthetics has been proposed as a cost-free intervention that reduces injection pain. Hogan et al., (2011) conducted a study to determine the effectiveness of warming local anesthetics to reduce pain in adults and children undergoing local anesthetic infiltration into intradermal or subcutaneous tissue. 29 studies were retrieved for close examination and 19 studies met inclusion criteria. A total of 18 studies with 831 patients were included in a meta-analysis. 17 studies had
Wednesday, September 4, 2019
Essay --
Social networking has become increasingly popular over the past few years, especially with many new media sites and apps being released. Facebook, Twitter, Instagram, and Linkedln are perfect examples of social media sites where people can post what they are doing and where they are at with pictures for the general public to see. Different companies and establishments are using social networking to check on their employees and to see how they carry themselves out side of work. Outside of our work and jobs, we represent the companies and establishments that we work for. Major companies and establishments want their employees to be responsible and act maturely when they are inside and outside of work. Employees are expected to hold the integrity of the company and their image. Sharron Smalls was a principal at the Jane Addams High School in Chicago, Illinois when a photo of her and another man drizzling chocolate upon themselves surfaced. Much controversy circulated over this case whether Sharron should be fired or still be able to keep her job. Margie Feinberg who is a spokeswoman fo...
Tuesday, September 3, 2019
Holocaust 6 Essay -- essays research papers
The Holocaust      Throughout history the Jewish people have been scapegoats; whenever something was not going right they were the ones to blame. From Biblical times through to the Shakespearean Era, all the way to the Middle East Crisis and the creation of Israel, the Jews have been persecuted and blamed for the problems of the world. The most horrifying account of Jewish persecution is the holocaust, which took place in Europe from 1933 to 1945 when Adolf Hitler tried to eliminate all the people that he thought were inferior to the Germans, namely the Jews, because he wanted a pure Aryan State.      In January of 1933, Adolf Hitler, who was part of the Right Wing National Socialist German Workers Party or Nazis, became Chancellor of Germany. Chancellor was the highest and most powerful position in all of Germany, and this gave Hitler the control of everything and everyone in Germany, after that nothing would ever be the same. Hitler wanted a pure Aryan State, a country that had a superior race to the rest of the world. This meant that he would have to kill all of the people who stood in the way of his purification. This was called a cleansing of Germany. Hitler had most of the Jews, Romani (Gypsies), Poles, Slavs, homosexuals, the anti-social, communists, socialists, trade unionists, Jehovah Witnesses, and the mentally and physically handicapped people whom were holding back the advancement of the Aryan’s executed, this was called â€Å"Aryanization†.      Knowing who was and who was not a Jew was one of the problems that faced the Germans at beginning of the Holocaust. You were considered a Jew if you had three or four Jewish grandparents who were Jews, even if you weren’t a part of the Jewish community. You were known as a Mishlinge or half-breed if you had one Jewish grandparent, and you were considered a half-Jew if you were part of the Jewish community or married to a Jew. All these people were known collectively as â€Å"non-Aryans.†     People often wonder why no one put a stop to the elimination of the Jewish people; but most people did not know what happened in Germany and the rest of Europe until the end of the war. If they did know about it they chose not to believe that it existed and thought that it was only a bunch of lies. Aryan’s knew that if the... ...d because he did not like a group of people he felt that he was superior to them. It is also scary to think that so many people believed that he was right and that they truly could get rid of all the Jews and non-Aryans. In my opinion it is disgusting that people could actually have thoughts like that, it just proves that he are not as great as we think we are and maybe we are not the smartest and most intelligent creature on the earth. We have to stop blaming others for something that we are not or for something that we did, it’s just not right. During the Holocaust six million Jews died whether from the extermination camps, malnutrition, disease, being executed or by medical experimentation. In 1933, before WW II there were approximately nine million Jews living in twenty-one European countries, which Germany would soon occupy. At the end of WW II six million Jews had died. A jolting sixty six percent of all Jews died that means two out of every three Jews died because of Adolf Hitler and his followers. Jews were not the only ones to be persecuted hundreds of Gypsies, Poles, Slavs and other ethnic groups, along with homosexuals and other â€Å"insuperior†races were also persecuted.
Monday, September 2, 2019
Education reforms Essay
Education reforms are procedures that bring systematic changes in the education sector in a society or community. Education reforms date back in the time of the Roman Empire during Christianity due to the need to teach the roman about Christianity. The modern reforms were preceded by the neo classical education that was similar to the classical education in m any way. The need for modern reforms is backed by many reasons, which include the economic reasons, different philosophies in the education, different aims of education and the essence of educating all the people unlike in the past when education was meant to be for the well up families. Reforms in the modern education have been of paramount importance, this is because the classical education system answered the question about when where, what, who, and how, and leaving the questions of which and why, more so, the classical education preferred the use of the ancient languages like the Latin and Greek thereby deprecating the local languages and this produced odd effects in the social arena. The child study program that was introduced by Jacques Rousseau that meant to educate the children as they developed to adult hood was very important though it was rarely implemented but enabled the later thinkers. He advocated for the removal of the children from the society and utilize their potential and curiosity by teaching them through experience instead of intellectually. In countries like Prussia, Spain, Soviet Union, Germany and France, the education reforms were of great important since education is used to install a symbol of national unity, culture and maintain a national language. This resulted to many children being taught the national language in their early childhood and the immigrants were also forced to learn these language so that they would be easily be assimilated into these nations. Education reforms have been carried out to attain many different objectives, but in general most reforms are directed to address the problems within the society, this general view has enabled these reforms to be implemented, some of the societal problems being addressed are problems of poverty, class and gender. These changes are proposed by thinkers and are then implemented through the society change institutions like the education of certain class of individuals in the society; ruling class, immigrant class or the ruling class. Education reforms have been seen as an avenue to achieve democracy. This is because when the general public is educated, it is likely to make wise informed decisions in all aspects in life (economic and social aspects) and therefore guarantee high levels of democratic governance that can only be achieved through education. Educational reforms for democratization have been recorded in Plato and US during the reign of Thomas Jefferson. Social economic problems have been associated with lack of proper education therefore resulting to the need for education reforms. It has been observed that education reforms have had good yields of creation of wealth and improving the social welfare. In 1950 in Kerala, India, the improvement in the health standards of the women was associated with the increase in the education levels of women due to the educational reforms. In Iran the increase in level of income and efficiency in farming methods had a correlation with the education reforms. Good educational reforms such as the libertarian that allowed the parents or guardians to select the best schools for their children has enabled the children to excel in their academic performance due to the increased competition among the schools. The competition has compelled the schools to offer better education and improve the standards in schools. The increased demand for parents to take the responsibility of their children learning through home education has been accepted in many countries since the parents can monitor their children closely rather than taking them to the public schools whose performance is questionable. There has also been the introduction of online learning where by a student can study online ether at home or at the office. These reforms have yielded good results since students is able to monitor himself and plan his/ her work after considering the tasks he / she should accomplish. The introduction of the adult education has earned better fruits than offering the adults with opportunities. This is usually implemented better by having a public library fully equipped with academic resources for use. Other reforms that have had good results include the involvement of the students in the learning activities through participation in classrooms. The students are used by the board of governors and the school authorities to know the changes that are essence. Some of the problems that have resulted due to the education reforms is the introduction of the public schools, these schools are supported by the locals through the levies they pay. This means that the schools have different learning facilities depending with the financial endowment of the locals and the ability to pay the taxes. The schools within the poverty ridden areas are likely to be failing. This has resulted to division in the performance of schools in different states when weighed on a common scale. This is a great mistake since their should be equality in funding of all schools in all states so that all the children have equal opportunities. Another problem is the no child left behind policy; this ensures that all children pass the federal exams without which the schools will lose its federal funding. This further forces the teaching staff to teach the students the exams, what is likely to be tested, and the students are left with the purpose of memorizing rather than understating what is taught. This action goes against all the fundamental principles of teaching. Another problem with the public education program is that the teachers only teach what they know, and since the teaching fraternity is dominated by the white with rare cases of colored that found their way to America through the illegal immigration, slave trade or brain drain, this means that the teachers cannot teach or answer question about the non white cultures or traditions The education reforms have had very positive impact to the student from the disadvantage families, those living below the poverty line and may be have single parent’s whiles others have emotional, physical or mental disabilities. These kinds of children have diminished expectation and were given less attention in classrooms, but with the reforms, they have experienced different kind of classrooms whereby they interact with others and compete in performing complex tasks The reforms have been characterized with clear cut goal and objectives to be achieved that are communicated to the parents, teachers, and the students who must come to an agreement on how viable and sustainable is the reform. The reforms must provide a school culture that provides an atmosphere for learning whilst linking all the cultures of all students and backgrounds. Proper management of the reforms is essential, this involves considering all the internal and external environment, the expected results should be listed and control measures put in place in case the objectives are not attained. The kind oaf reforms that should be encouraged are the once that have been evaluated keenly and found to have a positive net effect, this is because some reforms are likely not to meet the expectation. Formal procedure for reforms should begin by identification, formulation, appraisal, implementation, completion and the evaluation.
Sunday, September 1, 2019
Brand Community Analysis
Brand Community Analysis As the development of communication technology and global market, the concept of Brand Community was fist defined as ‘a specialized, non-geographically bound community, based on a structured set of social relationships among admirers of a brand’ by two social scientists, Albert M. Muniz, JR and Thomas C. O’Guinn (2001). This essay will firstly give a brief overview of brand community, and then point out three main characteristics and further discuss these features of brand community based on the article by Muniz and O’Guinn (2001) using the supporters of Manchester United Football Club as an example.Brand community is a customer-customer-brand triad. It reflects on a collection of brand-centric social group stressing the use of brand and the relationship formed by emotion between consumers (Muniz and O’Guinn, 2001). Furthermore, McAlexander, Schouten and Koenig (2002) have extended this model to the extent that brand communit y is actually a customer-centric network and aim to provide customer special brand-related consumption experience. They have also emphasized the concept of brand experience in a community.Any brand experience comes from the interaction among members, and at the same time customers also construct the meaning of the brand in the process of interaction and experience. Subsequently, by the research in the abandoned Apple Newton, Muniz and Schau (2005) found brand community can be regarded to a kind of religious affiliation. Manchester United Football Club (MUFC) is a famous professional football team founded in 1878 in England. It is the best supported in Europe (Rice, 2009) and probably the most popular football club in the world.According to the article by Cass (2007) from Daily Mail, the number of worldwide MUFC supporters was closed to 333 million in 2007. In this case, I assume the fans of MUFC all are the members of the club community and they principally consume match tickets and club-related products. Muniz and O’Guinn (2001) raised 3 basic characteristics for brand community, like other traditional communities, which respectively were a shared consciousness, rituals and traditions and a sense of moral responsibility. The most important shared consciousness is group awareness.It means there is an implicit relationship between community members and members can be distinct from others. Rituals and traditions is a vital social process. Brand and the meaning of brand community with their history, culture and consciousness can be duplicated and passed on through ritual and traditions. Moral responsibility indicates that community members are responsible for each other. These 3 characteristics show the nature of brand community. For the sense of consciousness, members feel a great relation toward one another is more important than the connection to the brand (Muniz and O’Guinn, 2001).That is why two main organisations for MUFC supporters in the UK, Independent Manchester United Supporters Association (IMUSA) and Manchester United Supporters Trust (MUST), were established to let like-minded people join together and formed local communities. IMUSA has even set up a committee to better represent the interest and voice of supports. Supporters from all around the world can also just easily use web-based communication tools such as Twitter, Facebook, and forums like MUFC fansforum (http://community. manutd. com/forums/) to share updated news and maintain connections.On the other hand, members, ‘also set them apart from others and makes them similar to one another’ Muniz and O’Guinn (2001) claimed, especially try to distinct them from the main competitive brand in the market. This regards to oppositional brand loyalty. In this MUFC case, the oppositional brand is its main rivalry in the Premier league located in the same city – Manchester City Football Club (MCFC). Fans from MUFC always differentiate them against MCFC supporters. Members usually said MCFC is built by money, just an upstart and a noisy neighbour.Most of the community members despise this kind of team because they think MUFC has the glories that MCFC lack of and embodies the passion and excitement of the world's most popular sport (Hill and Vincent, 2006). Muniz and O’Guinn (2001) indicated rituals and traditions focus on sharing consumption experience with the brand. Supporters sing several specific songs during the match regarding to different circumstances to encourage and cheer the team. Those songs have already become a kind of spiritual symbol of the MUFC brand, and therefore will be passed on each time they are sung in matches.Celebrating the history of the brand is crucial for maintaining community and reproducing culture (Muniz and O’Guinn, 2001). For the MUFC community, the most vital history is the trophies they gained. After MUFC won their 19th English top league title last season, the Barclay s Premiership Trophy Cup was being demonstrated around the world for the whole summer in 2011. This tour is not only presenting the precious trophy cup to supporters but also a promotion of the great history of MUFC to further raise reputation and attract new members.Sharing brand stories is another important means of maintaining and creating community (Muniz and O’Guinn, 2001). MUFC fans always mention either face to face or on internet about the classic victory of the champion league final in 1999 in Munich. This can be related to viral marketing by which positive image and consciousness of the brand and community can be delivered through word of mouth or improved by the internet network effects. ‘The sense of moral responsibility is what produces collective action and contributes to group cohesion’ Muniz and O’Guinn (2001) said.There are two traditional shared missions: intergrading and retaining members and assisting members in the proper use of the br and. Firstly, it is crucial to retain existing members and obtain new ones. The fundamental way for MUFC to save and fascinate supporters is to keep winning. Getting consistent good record and reputation will really help the brand to attract and retain members. MUFC also gives discount to the existing official members to renew their membership and buy season tickets in the following year. Thus members can gain benefit from their loyalty.Secondly, moral responsibility also provides assistant normally in problem solving and shares brand-related information. For instance, members share transport information in away games on fansforum. In conclusion, the notion of brand community has been extended in recent years and become a usual marketing phenomenon. The three key characteristics represent the essence of brand community and each of them has its own manifestation. Due to the improvement of communication way, members of brand community are more convenient to communicate and the brand i s also easier to build connection with customers and create brand communities.Looking to the future, I believe brand community will become a crucial and staple marketing strategy. Reference: Cass, Bob (2007). â€Å"United moving down south as fanbase reaches 333 million†. Daily Mail (London: Associated Newspapers); 15 December 2007. Manchester United official fansforum: http://community. manutd. com/forums/t/84281. aspx Manchester United Membership benefit: http://www. manutd. com/en/One-United/Member-Benefits. aspx McAlexander, J H, Schouten , J W, and Koenig , H F. Building brand community[J ] . Journal of Marketing; Jan 2002; 66, 1; ABI/INFORM Global p. 8 Muniz Albert M. Jr. and Thomas C. O’Guinn (2001), Brand Community, Journal of Consumer Research; March 2001; 27, 4; ABI/INFORM Global p. 412 Muniz Albert M. Jr. and Schau, H J. (2005), Religiosity in the Abandoned Apple Newton Brand Community, Journal of Consumer Research; Mar 2005; 31, 4; ABI/INFORM Global p. 737 Rice, Simon (6 November 2009). â€Å"Manchester United top of the 25 best supported clubs in Europe†. The Independent (London: Independent Print). Vincent, John, Hill, John S. (2006) Globalisation and sports branding: the case of Manchester United.
Subscribe to:
Posts (Atom)