Tuesday, January 28, 2020
Evidence Based Healthcare Research Social Work Essay
Evidence Based Healthcare Research Social Work Essay Evidenced Based Healthcare and Research: Appraisal. In the United Kingdom the concept of Independent Living and Self-directed Support has become an established approach for the delivery of health and social care services, that it is currently the preferred residential alternative for people with learning disabilities (Binnie Titchen 1999). Independent living can be defined as enabling independence by receiving the right support how and when it is required (Morris 2004). It has now become a key principle in various government policy documents such as the Valuing People Now Strategy (UK Department of Health, 2009) and the Personalisation through Person-Centred Planning initiative (UK Department of Health, 2010). This assignment aims to present a detailed critique of a qualitative study entitled How adults with learning disabilities view independent living (Bond Hurst 2010). A critique can defined as a balanced evaluation of the strengths and limitations of a research article, in order to determine its credibility and/or applicability to practice (Gamgee 2006). This study is a welcome contribution to the current health and social care research domain because whilst independent living is the preferred residential option, it is not at all clear whether it is suitable for all people with learning disabilities, moreover if there is in fact sufficient empirical evidence to support this notion. It is therefore imperative to establish a sound evidence base that draws upon the lived personal experiences of those with learning disabilities. Using an acknowledged framework A Step by Step guide to critiquing a quantitative study (Coughan et al., 2007) the relative worth of the evidence in support of i ndependent living will be judged systematically. As well as exploring the significance of independent living as an essential nursing intervention and its application to modern clinical practice. Ryan-Wenger (2003) suggests that in analysing published articles it is important to ascertain two fundamental aspects of a critique which can be subdivided into elements that influence the robustness of the research methodology also known as integrity variables and elements which influence the believability of the research such as writing style, author(s), report title and abstract otherwise known as credibility variables. The latter seems to be the most logical place to commence. Evaluation of the Journal Article Polit and Beck (2006) state that writing style should be such that it attracts the reader to read on; this paper is well written, comprehensive and concise. The structure and layout of the paper is well organised with a logical consistency and free from jargon in comparison to some papers where the author(s) can be opaque in their approach. However slight reservation is reserved concerning the level of proof reading as there seems to be some grammatical and typographical errors which can be found on pages 288 and 289. Both authors appear to have a sound background in learning disability from both a social context and educational settings. As indicated in the acknowledgements the authors qualifications indicate that they have a degree of knowledge in this field and this piece of research seems to be a part of a taught component of their masters programme. The report tile seems to be descriptive and succinct, although it lacks specificity of the research methodology used in the study. This can be very useful for others who are searching for this type of paper. Although the term qualitative research is mentioned under keywords the title itself could be more specific. As a result the report title is ambiguous and merely eight words in length. Meehan (1999) states that a title should be between ten to fifteen words long in order to clearly identify the purpose of the study for the reader. This paper presents both an accessible and detailed version of the abstract, but are both helpful? The accessible form includes information on the subject and the number of participants, whereas the detailed form provides an outline of the methodology used, ethical framework, findings and recommendations. On balance the summaries present a clear overview of the study, however it does beg the question in what sense is the accessible form accessible? and to whom? It seems that the authors are trying to be politically correct rather than logical because how many service users actually read the British Journal of Learning Disabilities?. It seems that this is a knee jerk reaction which has been applied incorrectly; it would be more suitable if the document was aimed at informing an audience with learning disabilities such as Valuing People (UK Department of Health, 2001) which caters to a wide range of readers. The easy -read version is aimed at service users whilst the denser version is aimed at professionals and service providers. Having identified and analysed variables that affect the credibility of the research presented, how believable the work appears, the authors qualifications and their ability to undertake and accurately present the study. The robustness of the research methodology and the integrity of the findings will be appraised in order to determine the trustworthiness of the study and its applicability to nursing practice. The authors state the aim of the study is to explore the views of nine people with learning disabilities who have already achieved independence and wish to contribute to the debate of independent living. The authors suggest that this style of living is now viewed as desirable, but what is the reality for people who live with learning disabilities? This concept of desirability is held as problematic by the authors who choose to study and present the reality of living independently as opposed to the notion of general and conventional wisdom. A study conducted by Barlow Kirby (1991) concluded that people in receipt of self-directed support had more life satisfaction than those in residential care. This finding is further supported by the publication of Independent Living (HM Office for Disability Issues, 2007). The decision to suspend judgement about independent living is justifiable and is supported by other researchers in the field of learning disabilities; as there are several impli cations for service users, professionals and service providers. This is for a number of reasons for instance promoting choice and control (OBrien, 2002), health issues (Priest Gibbs, 2004), vulnerability (Cooper, 2002) and the ability for those with learning disabilities to access services (Jansen et al., 2006). The literature review conducted by the authors demonstrates an appropriate depth and breadth of reading around independent living. The majority of studies included are of recent origin being less than five years old; the few historical studies included put the concept of living independently into context. The authors successfully identified conflicts between the literature by comparing and contrasting findings (Burns and Grove., 1997), because although evidence exists to show people who have moved from larger institutions prefer smaller group homes (Forrester-Jones et al., 2002) there is still no accurate data detailing the number of people with learning disabilities living independently (Beadle Brown et al., 2004). However the authors failed to mention how they conducted their search and information on the databases used to gather papers in their review. The authors did however, use primary sources of information as opposed to secondary sources and anecdotal information, which attes ts to the integrity and value of the study presented. Bond Hurst (2010) ascertained the narratives of nine people with learning disabilities via the use of semi-constructed interviews within their methodology. The authors are to be commended for their attention to detail in terms of their ability to design and structure interviews so as to accommodate the needs of the participants. As well as conducting interviews at times and venues convenient to them. The interview structure included open-ended questions to assist understanding as communication emerged to be a key barrier for some people with learning disabilities. The authors report on a number of theoretical issues that have been adapted for the participants in order that they might fully participate in the research process. The structure of the interviews was devised using the Canadian Model of Occupational Performance (Canadian Association of Occupational Therapists, 1997), but is this model applicable to the United Kingdom population and to which care setting? Bond Hurst (2010) adopted thematic analysis within their methodology in assessing the narratives. The data collected was audio taped and later transcribed into coded themes, which is acknowledged in general research literature to be good practice. On balance, the authors adhered to the steps in the research process and it is conveyed between the fluidity of phases. The critique subsequently moves onto considering the ethical framework. This research paper was supported by the local ethics committee and all participants in the study gave informed consent. Although it is not clear whether or not it was an National Health Service (NHS) ethics committee. However, the authors sought to ensure their working methods complied with the Data Protection Act (1998) but not with all government legislation applicable to the study such as the Mental Health Act (1983). Although there is mention about accessibility, the authors failed to ensure the participants had the capacity to make informed decisions as defined in the Mental Health Act (1983). In relation to the number of participants, the sample size is small and therefore may not be reflective or wholly representative for all people with learning difficulties. Small samples are more likely to be at risk of being overly representative of small subgroups within a target population (Coughan et al., 2007). Th erefore slight reservation is held as the authors did not mention whether they sought to remove overall bias by generating a sample that is likely to be representative and generalisable to the target population. Parahoo (2006) states that for a sample to truly reflect of the population it represents the authors must generate a probability sample. The participants in this study were recruited via convenience sampling using a third party (Melton 1998); however several variables could have an affect on the sample which can lead to it being distorted such as the vast age range. The authors are to be commended however, in their efforts to maintain the confidentiality of their participants by offering them the choice to provide their own pseudonyms. In the discussion the authors identified seven themes from their data analysis which reflected the views of all the participants and in turn addressed the aims of the study. Their findings supported the four key principles as stated in the Valuing People policy document, and ways in which people can be supported to achieve this includes increasing social inclusion, increasing autonomy and choice for people and raising awareness of the vulnerability of those with learning disabilities. However the study also highlighted that the majority of participants struggled with the more complex aspect of living independently, such as money management and budgeting. The government has recently introduced Direct Payments as part of a nationwide transformation in social care services, which involves paying money directly to an individual in need to take control of their own support and care services. This initiative will aid finance management as it enables service users to have control over the c are they receive and how they receive it. The majority of participants maintained that when comparing their current lifestyle of independent living to that of their previous lifestyle it was clear that they wanted to remain living independently. Application to Clinical Practice This section will explore the significance of independent living as an essential nursing intervention and its application to modern clinical practice. Gates Atherton (2001) state that there is a need for evidence of effectiveness in health and social care. The most important aspect of being a practitioner regardless of ones vocation, is that collectively we as professionals seek the best evidence available on which to base our practice (Coughan et al., 2007). The evidence in support of independent living is limited and not entirely accurate, therefore when evidence is presented it should not be taken on face value. As Cullum Droogan (1999) put it not all research is of the same quality or high standard therefore as a learning disability nurse and social worker it is important being a care provider that although a paper has been published it can be critically appraised. This paper is of central relevance to our practice in ensuring that the lifestyles of people with learning disabil ities are informed by valid and reliable evidence. This research paper adds value to the current literature available in support of independent living however caution must be expressed as it is not solely about living independently. The concept of independently living cannot be advocated for everyone; each person is different and therefore require different levels of support which will meet their needs. The publication of Valuing People (UK Department of Health, 2001) the key document that prompted a change in the way health and social care services operate. The paper made Person-Centred Planning a central component of service reform, and outlined four key principles namely: Human Rights, Independence, Choice and Social Inclusion (Mansell and Beadle-Brown, 2004). This means that people with learning disabilities should be valued members of society, treated with dignity and respect whilst having the same rights and choices as everybody else (OBrien, 2002). Furthermore, people with le arning disabilities should feel empowered to take control over the care that they receive in order to plan and live their lives independently. Previously, people with learning disabilities were shunned away from the community and susceptible to abuse. The Community Care Act (1990) was introduced as a result of both political and social changes in attitudes towards the treatment of people with mental illnesses. In line with Mental Health Act (1983) the aim was to remove the stigma associated with mentally ill people away from isolation towards social inclusion (Social Role Valorisation, Wolfensberger, 1983). But does independently living mean that you get social inclusion? Currently we are seeing a culture of people who require support being effectively excluded from society, waiting for the next support worker to cook their meals, help with personal hygiene and general cleaning. This is a downward spiral in our society which is putting a demand on our system. As a care provider in line with the General Social Care Council and the Nursing and Midwifery Codes of Conduct (2008), it is our duty to advocate in the best interest of the client at all times but who is actually making the decisions? Bond Hurst (2010) highlighted how closely health was linked to independent living and that many of the participants suffered from chronic conditions such as asthma, diabetes and arthritis. Is it a case of compromising funding for services at the expense of overlooking health issues? It seems that the authors make a plausible case that people with learning disabilities are being seen as not a priority as they carry a disproportionate burden of health inequalities among our population. The reality for people with learning disabilities is far from the projected lifestyle of independence (Emerson UK Literature). It is a challenge to support people with learning disabilities, several factors need to be considered to prevent potential disregard. Jansen et al., (2006) points out the need to adopt integrated care approaches in treating those with learning disabilities. This will involve working with different agencies (interagency team working) and different types of professionals (multidis ciplinary team working) in order to provide an holistic service to meet their needs. Current research shows that a disabled person is likely to be in contact with at least ten different care professionals in their lifetime (UK Department of Education, 2003). Issues can arise through out this time which may lead to lack of continuity and communication. Therefore, a sufficient amount of training and awareness is needed to ensure that all staff are qualified and skilled to ensure equity of service provision. When caring for patients it is essential as a practitioner to adopt the current best practice. To determine what this is one must be able to critically appraise evidence that is presented to them (Basset and Basset., 2003). This paper focused on the lived experiences of nine people with learning disabilities about the reality of living independently. In critiquing this paper, the authors successfully highlighted the importance of independent living as an essential nursing intervention however there were also some limitations, the most important being limited verification of the data. Furthermore the narratives of the participants were highly subjective and findings non-generalisable, thus the notion of independent living is not to be applied to all that have a learning disability, or vulnerable adults with complex needs. As recommended by the authors, further accurate, reliable and valid research is needed that will add value to the evidence-base domain. Total Word Count: 2,452 Excluding Headings and References
Monday, January 20, 2020
Heart of Darkness - Outline :: essays research papers
Marlow stands on the Thames River and remarks that the land he and his      comrades is standing on was once a place of darkness and an uncivilized      wilderness  ·Ã‚     Through nostalgia he remembers an incident from his past when he commanded a      steamboat on the Congo River.  ·Ã‚     He talks about the Company’s chief accountant who first mentions Kurtz to him.  ·Ã‚     The accountant tells him that Kurtz supplies more ivory for the company than      everyone else combined.  ·Ã‚     Marlow’s interests in Kurtz is perked.  ·Ã‚     Marlow discovers that the steamer he is supposed to command has been destroyed      in a wreck.  ·Ã‚     He meets the local manager who mentions Kurtz in conversation.  ·Ã‚     He tells Marlow that Kurtz is ill and he must get to Kurtz swiftly and bring him      back for medical treatment.  ·Ã‚     Marlow speaks with a brick maker who admires and envies Kurtz.  ·Ã‚     Marlow eavesdrops on a conversation between the manager and uncle. He learns      that the manager resents Kurtz.  ·Ã‚     Three months pass. Marlow and a crew set sail towards Kurtz’s location.  ·Ã‚     Fifty miles before Kurtz’s station, they discover a hut bearing wood for the      steamboat and message to proceed with caution.  ·Ã‚     Two days later they awaken to an attack by the savages. The helmsman is killed.      Kurtz blows the steamboat whistle to frighten away the savages. Dumps dead      helmsman’s body overboard so cannibals don’t get any ideas about eating him.  ·Ã‚     They arrive at the Inner Station. Greeted by a Russian that takes care of Kurtz.  ·Ã‚     Through conversation with the Russian, they learn that Kurtz has not been the      most upstanding and moral person. He’s been abusive to the natives.  ·Ã‚     Kurtz appears, carried on a stretcher.  ·Ã‚     They carry Kurtz onboard the steamboat.  ·Ã‚     The manager tells Marlow he disapproves of Kurtz.  ·Ã‚     The Russian makes a visit to Marlow, tells him that Kurtz ordered the attack on      their vessel that killed their helmsman.  ·Ã‚     Kurtz escapes and swims ashore. Marlow goes after him and cuts him off.  ·Ã‚     They make a departure, savages show up, Marlow blows whistle and scares them      away again.
Saturday, January 11, 2020
A Pestle Analysis of Tourism Industry Essay
Using the PESTEL framework, identify and discuss the key factors in the macro environment that influence the tourism industry. Political: A large influence on the tourism industry can be the stability of government. If the government in unstable it can be viewed as dangerous and unpleasant to visit. This can have a huge impact on that countries tourism numbers. Some governments also choose to make shopping tax-free for tourists, as tourists have the right to claim back VAT (Value-Added Tax)/GST (Goods and Services Tax). By making shopping in foreign countries tax free it has attracted tourists to these countries. As stated in case one terrorist attacks in 2001 had a huge impact on the tourism industry. People were worried for their safety so were much more subdued to travel. Therefore it has been important that the government implemented tighter security and immigration laws. Economic: Exchange rates can have an impact on tourism, as when currency strengthens or weakens it can affect spending overseas. For instance when the British pound is strong against the U. S dollar it influences Britons to travel overseas to the US, as they get more for their dollar. However it has a negative effect on UK tourism as the Americans are put off travelling to the UK and instead look to holiday in locations within the US (The Guardian, 2007). With the British Pound still being strong against other currencies this is relevant to the Tourism Industry today. (Rates List, 2012) Interest rates can too have an effect on the tourism industry. If interest rates increase payments to loans also increase, therefore people who have loans consequently have less disposable income. With less disposable income people are less inclined to spend it on luxury items, like holidaying. However, in the current state interest rates in the UK are expected to stay low (0. 5%), due to the on-going recovery from the Eurozone crisis (BBC, 2012). Furthermore with the current economic recession people are still struggling, some even to hold down jobs. Consequently, people have less money and can’t afford such extravagant holidays, like going overseas for long periods of time. Therefore shorter and cheaper holidays look far more appealing, for instance travelling by car just for a weekend. Social: There is an aging population in many countries. With an aging population the needs of the market will change. People who are in a later time of their life have different needs and wants. There are more and more people who are in their later years who want to travel, to cater for this it may mean advertising focused more on comfort and relaxation rather than thrill ridden activities. There is an ever increasing attitude for positivity towards ‘going green’. People are purposely searching to only buy products from companies with sustainable practises in place. Hence, it is important for the tourism industry to take on these attitudes as well, as it is becoming an important part of our society today to have environmental policies incorporated into everyday business practises The Asian population is increasing at a rapid pace. There are 3. 9billion people in Asia, which is 60% of the world’s population. As stated in the 2010/11 ITB World Travel Trends Report, â€Å"By 2020, the number of Chinese outbound travellers could double and the number of Indians travelling abroad could grow fivefold. This would raise both countries within a decade to the top six outbound markets worldwide. This shows just how quick China and India are becoming powerful players in the tourism industry. Technological: In our world today new technologies are forever being made to be faster and more efficient as people want things to take less and less time. Internet has made a huge influence on the tourism industry. There has been a steady incline of online sales. For example in 2005 online bookings for TUI were 15%, which had doubled in 2008 to 30% (Viardot, 2009). Booking online has made it much easier for individuals to book their own holidays. As well that with online bookings it allows for the customers to do their own research of where the best places for them to go is, rather than using a travel agent. Secondly, technologies are so advanced now that communicating with people around the globe is made much easier. For instance, people on opposite sides of the world can chat easily, possibly even to strangers. This leads to the new trend that people can blog and communicate their thoughts to millions of people with a simple click of a button. This new way of communicating can have a huge impact on the tourism industry. People all over the world are sharing their thoughts and feelings about everything they do, whether that’s a new product or an exciting new experience. Environmental: In this current decade environmental concerns have greatly became a huge influence in all business industries. Aviation is a large part of tourism. Sadly it is also a huge contributor to CO2 emissions. An increase in carbon emissions is a major threat to climate conditions. Consequently there have been more taxes placed on air travel. This increase in taxes will raise the prices of flying therefore could discourage people to go abroad. Natural disasters can also affect a country’s tourism. People are less likely to travel somewhere which is viewed as dangerous and secondly the disaster could ruin tourist attractions. Legal: There are a lot of laws and regulations regarding aviation safety (Department of travel, 2009). Following regulations is important as to ensure everything is done to prevent any problems. As if people lose faith in airlines being safe it could have an impact on tourism. Another legal point is that when companies merge or work with companies in different countries they need to be aware of the laws and regulations overseas.
Friday, January 3, 2020
The Problem Of Air Pollution - 1708 Words
Arizona is on the rise as one of the fastest metropolitan areas in the United States of America. In fact, in 2015 Forbes Magazine ranks Phoenix, Arizona as the 11th fastest growing city in the U.S.1 This growth is due the unprecedented resources and growing opportunities in the state of Arizona. With all of these opportunities come more production, which means more emissions from various industries and cars, more fossil fuels burned, and household and farming chemicals added to the sky. All of these are examples of pollution; which is one the sacrifices that comes with being a large city that is emerging. Pollution is defined as the action or process of making land, water, air, etc., dirty and not safe or suitable to use.2 We understand that Phoenix is a rapidly growing city, but they should be able to grow without being a detriment to the environment and health of their citizens. The purpose of my report is to examine the problem of air pollution in Phoenix, Arizona and look at sol utions to fix this problem. Air pollution can harm plants, lakes, and animals. In addition to damaging the natural environment, air pollution also can damage buildings, monuments, and statues. Not only does it reduce your visibility but it also interferes with aviation. In 1970, Congress created the Environmental Protection Agency (EPA) and passed the Clean Air Act, giving the federal government authority to clean up air pollution in this country.3 Ever since then, the EPA, states, tribes,Show MoreRelatedThe Problem Of Air Pollution1142 Words  | 5 Pagesbelieved that the problem of air pollution began with the industrial revolution (circa 1750 -1850) which brought with it the increased burning of coal that fueled the engines upon which the wheels of the industrial revolution were being propelled. 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