Saturday, August 31, 2019

The Effects of Working Overseas of Filipino Parents

THE EFFECTS OF WORKING OVERSEAS OF FILIPINO PARENTS ON THE ACADEMIC PERFORMANCE OF THEIR CHILDREN by Pascual, Kristelle D. March 21, 2012 Introduction As experienced by many Filipino children like me nowadays, separation from one of our parents results to a very great impact in our lives. Unlike any other children with both parents present at home, raising us up needs more effort and careful attention since that there is only one attending parent.The temporary single parent at home must have the ability to handle things very well—from raising children up to the accomplishing of household chores, and even to the budgeting of resources, like money and time. Fortunately, as for me who have witnessed such, I can say that my mother did very well in handling these tasks, considering there are three of us she had to take care of. The academic performance of children is affected when one of their parents, especially when both, are working overseas. These effects are just the manifesta tions of the situation families have when one parent or the parents, is/are not present at home.This paper aims to provide the effects that are observable and some of their psychological factors. The Filipino Family Setting â€Å"Families provide social and emotional supports that help family members cope with crises†¦But perhaps the most widely recognized and universal functions of the family are the care giving and training that parents and other family members provide for their young. † (Shaffer, 1999, 558) Filipino families have great values, which up to now are still present. They are known to putting a great importance to family, because one of the most weighty and intimate relationships among humans is that between parent and child.It is important especially for the child because it makes him feel secure about life and molds his future (Bigner, 1989). This is the reason why in the Philippines, they have extended families. Since that family members become really cl ose to one another, they have a hard time letting go of a family member when he needs to leave home during the time he decides to build his own family. Furthermore, in the Spanish colonial period, only men were sent to school to learn, and women were to stay at home to do domestic things, like household chores.It is in the history that women do not have the right to learn because they are probably â€Å"designed† to be housewives, and they need to focus on that. Men, on the other hand, study so that in the future, they could earn a living for their family. As a very influential culture imposed by the Spaniards, this, until now, has been an ideal Filipino family tradition—men are to work, women are to stay at home. Labor Migration Nevertheless, today, because of the financial instabilities Filipino families face today, they are forced to send an able-bodied member to work and earn a living for them.In addition, with a great number of Filipinos sent everyday to different countries around the world, a single Filipino family also suffers from temporary loss of a family member each day (Parrenas, 2006). Labor migration has always been the first choice of families in need of more financial support; so as a result, separation normally happens every day in the Philippines, which leads to various effects in the behavior of family members, especially to children. One example is its effect to their academic performance.In the modern nuclear family, usually, fathers work abroad—which proves that the tradition above is somewhat still alive. They fulfill their duty as the â€Å"good providers† of the family; while as for the mothers, they do the traditional household responsibilities by putting all of their energy into meeting the daily needs of the family. However, because of this work division of parents, children crave for emotional guidance coming from their father. However, since a gap develops through the course of time (â€Å"embarrassmen t†), it prevents them from expressing this desire.This is according to Rhazel S. Parrenas who wrote the book, Children of Global Migration (2006). Mothers rarely go outside of the country to look for work opportunities without being driven by the deep necessity of the family financially, or else, the children are more likely to question their motives (Parrenas, 2006). The only time that mothers pursue working overseas must be when they badly need money to support the family that both of the parents must go, the father is incapable of working, or the mother is a single parent.The Situation of Family Members after Separation As an effect of the economic problem, parents, mostly fathers, choose to work abroad to support the needs of their family. Therefore, in every decision made, there is always separation afterwards, and it always, has an effect on the family members: †¢ On the Migrant parent: The decision is the first hard thing to do. Leaving the family means missing imp ortant events and giving up being in the actual growing up of his/her children. It requires absence to meeting the daily emotional needs of the family.Furthermore, the hardest is when this parent encounters problems—may it be in health, financial, or work—he/she has to face them alone. The person has to be strong emotionally especially when feeling homesick. The parent should focus also on the goal of meeting the needs of his/her family, so that his/her convictions will not sway when distractions come on his /her family. †¢ On the Non-migrant parent: The pressure of raising the children alone is passed on to the non-migrant parent. Fulfilling both duties of a mother and father is difficult and strenuous at the same time.In addition, the parent suffers from emotional struggle from being separated with his/her spouse. Like the other parent, he/she experiences distractions. However, the weight is doubled, because this parent needs to show a strong personality and fir m stance on the situation while at the same time, doing all of his/her duties at home, and/or sometimes working part time to support the family more. †¢ On the Children: Children growing without one of the parents or both of them can result in different responses from children. They can respond positively or negatively.The necessity of having the parents present is one big factor on how well they will turn out in the future. Therefore, it depends on how the parents handle the situation in the family that the children will be able to bear it and respond to it properly. As I have said earlier, the parents have to keep their stance firm in these kinds of situations. They need to have trust and confidence in each other. They, also, need to have constant communication to address to each other their needs to build a strong relationship within the family despite the absence of one family member. More than anything in the world today, children need strong parents with strong conviction s, a set of values and principles by which they live. Without such strength of convictions and principles, our children stand a good chance of simply being gobbled up by the social pressure in the world. † (Dacayanan & Isaac, 1974) The Effect of Labor Migration Childhood is a very crucial stage for children. It is the time when children get the values that will found their behavior when they grow up. Therefore, parents’ role is very essential.According to Guthrie and Jacobs (1967), during the earliest childhood years, child gets the attention of older people. However, as he grows, people expect him to become conscious of the things he ought to do and not to do. Not only that these things vary with the time and mood of people older than he does, he is compelled to obey them and to predict what pleases or displeases them. About the things they encounter, children wonder and try to ask unending questions to their parents believing their parents can answer them. If the chil dren receive responsive answers to their questions, they will be encouraged to find out more answers.On the other hand, when children receive unresponsive answers, or worse, are ignored, they will just try to figure things out on their own, and thus, starting lack of communication between the parent and child. This is according to Felicidad Dacayanan and Josefina Isaac in their book, Towards Building the Filipino Family Today (1974). Childhood is the time when children need the presence of their parents the most. Nevertheless, how about those children with parents separated because of working overseas? How well will they turn when they grow up?On the Behavior of Children When children experience separation, there is a sudden change in their behavior. Children are immature. When they are given an entirely new situation, their behaviors that are manifested will be decided according to it, forgetting the previous one (Dacayanan & Isaac, 1974). Therefore, when children experience separa tion, they are quick to respond. According to Ortigas (1996), there are stages of attachment/detachment. First, the child denies the situation. He chooses to be blind to reality in order to cope with the situation.Second, when he feels that he cannot really cope with it, he becomes depressed. In this period, the child lacks interest in doing things—playing, studying, eating and the like. He pities himself about the situation and feels helpless and hopeless. After that, different thoughts will start dwelling inside his mind. One of these is fear of abandonment. The child clings to other parent fearing that the parent left may also leave him since the absent parent was able to leave him. As a result, the child becomes submissive to the parent, or acts unacceptably to get attention from the parent.Another thought that will enter his mind is that he may be the cause of separation of the parents, making him feel guilty eventually. Hence, it will start the self-blame of the child. Because of this, he starts acting out behaviors that will lead to punishment. Lastly, he develops low self-esteem. In this period, he feels worthless and unlovable, maybe because of the punishments received from acting certain behaviors. The child thinks that this is the reason why the absent parent left him, and develops helplessness especially when he does not see much concern from the absent parent.These effects lead to certain manifestations in the actions of the children. To be particular, the situation compromises their academic performance. On the Academic Performance of Children Students belonging to a family with a migrant parent sometimes have bad images, like being â€Å"pasaway† in school, back then. It was an issue for people to have single parent families—because it was not still the first in mind when it comes to finding a high-paying job, assuming that children belonging in an â€Å"imperfect nuclear family structure† connote poor academic perfor mance. Different studies produced different hypotheses about the topic.Nevertheless, the presence of both of the parents, the mother only, the father only, or none of them has different outcomes: Children with two parent migrant families are more likely to suffer from poor guardianship. In fact, many children, according to an interview, who dropped out of school, had all been members of those types of family who experience separation from their parents for a long time (Parrenas, 2006). Another piece of information is in agreement with the earlier: Children in single parent families are at a greater risk than children in other types of family.Even though they have the same level of intelligence with other children, they are three or more times to drop out of school. (Adoption. com) Furthermore, according to Hoffman (1967), daughters of employed mother are academic achievers, are successful in their careers, and are more independent. On the other hand, children in poverty, in both two -parent or single families with employed mothers, have higher cognitive and socio-emotional indices scores. In addition, sons from the middle class with employed mothers have lower school performance and lower I. Q scores in the early years in school than those with mothers at home.One finding from the 1970's from the blue-collar class said that sons of employed mothers did well academically; however, there was a strain in the father-son relationship. It is true that life in single parent family structure can be very difficult. Children, as said earlier, are more prone to suffer emotional struggles. As a result, they have greater chances to act inappropriately, especially if the parent left is busy working too. This can result in lack of time in disciplining and controlling their children, which often lead to lower school performance or misinterpretations—that the parents left does not love them.Some researchers suggest that family has great impact on the academic performance of children. It is a factor in the involvement of parents in their education. Income is a pressure that can limit parents’ effort from supporting them. (Adoption. com) Nevertheless, this is not true in all situations; some children coming from the single parent families perform well in school. This may be credited to how well the family coped with the situation, and how firm the parent left stood firm on the situation.As I have pointed on the first part of this research, â€Å"Families provide social and emotional supports that help family members cope with crises†¦But perhaps the most widely recognized and universal functions of the family are the care giving and training that parents and other family members provide for their young. † (Shaffer, 1999, 558) Socialization and Time as factors to Prevention of the bad effects Children become what they are today through interaction and exposure—getting values from people surrounding them and using everything h ey acquired from the environment. This process of becoming self is fastest and crucial in the formative years because parents leave a mark on children, which schools will have a hard time correcting. This must not be taken for granted by Filipino parents who consider that all children in tender years can be ignored because they are still unaware (Dacayanan & Isaac, 1974). Studies about the topic may differ from one to another, may they agree or not, the performance of children in school is not dependent upon their situation.It is dependent on how the family handles it, starting from the responses of the parents, to their orientation of it to children, and to how children would respond to it. According to Shaffer (1999), in his book, Developmental Psychology: Childhood & Adolscence, Socialization is a process by which children gain the beliefs, values, and behaviors considered fit by elders in the society which serves it through controlling children’s behavior, promoting growt h in order to function well within their communities, and imparting what they have learned as social adults to their children.However, time spent with the children is also a factor in building a good relationship in the family. Therefore, it is possible for children with parents working overseas to perform well in school, because parents can control their responses to situations. Generalizations â€Å"Time together, mutual efforts for more open communication and greater understanding could alleviate the gap in father-away families. † (Parrenas, 2006, 78) Indeed, working overseas of Filipino parents affects the academic performance of their children, may it be in good or in bad.However, we can minimize the bad effects, and only reap good effects of it, by simply applying what has been said above. The family is not built to function individually; it is sector in the society built to function as a whole. Hence, the solution to the problem cannot be solved by anyone else, but our selves. Reference List: Adoption. com (n. d. ). Single parenting and children’s academic achievement. Retrieved January 31, 2012, from http://library. adoption. com/articles/single-parenting-and-childrens-academic-achievement. tml Bigner, J. J. (1989). Parent-Child Relations. (Third Ed. ). New York: Macmillan Publishing Company Dacayanan, F. M. , & Isaac, J. D. R. (1974). Towards building the Filipino family today. Quezon City: Bustamante Press Guthrie, G. M. & Jacobs, P. J. (1967). Child rearing and personality development in the Philippines. Manila: The Bookmark, Inc. Hoffman, L. W. (1967). The effects of the mother’s employment on the family and the child. Retrieved January 31, 2012, from parenthood. ibrary. wisc. edu/Hoffman/Hoffman. html Ortigas, C. D. (1996). The Solo-parent experience: A growing social phenomenom. Quezon City: Office of the Research and Publications Ateneo de Manila University Parrenas, R. S. (2006). Children of global migration: Transnational f amilies and gendered woes. Quezon City: Ateneo de Manila University Press Shaffer, D. R. (1999). Developmental Psychology: Chilhood and Adolescence. (Fifth Ed). USA: Brooks/Cole Publishing Company

The Challenge of Starting Up A New Internet Venture

Lui and Wong had made a good choice in choosing music as there online start up business, because of the nature of music itself is information rich, easy to distribute, consumption experience are indifferent between digital or physical product, also, without the space limitation of a physical store, MusicJuice. net can provide a large amount of selection for user to choose. In addition, internet landscape empowers the business model of Crowd-Sourcing, where millions of vertical interest group can form their own communities, share and support each other on the internet.And such business model has proven to be very successful in Europe, theoretically, MusicJuice. net should also be successful in North America where the potential market size was approximately 240,000 musicians. However, the company has been losing money month after month since launched in April 2008, only 70 artistes has signed up in July 2008 and none of them had reached the fundraising goal, and of course, no premium m embers at all. The two co-founders have to decide what could be done to save MusicJuice. et or whether they should close the business for good. Before jumping into conclusion, let’s examine the situation with the 5 Forces analysis. First of all, the threats of new entrants are too high, just like their competitor – Slicethepie. com was launched one month after MusicJuice. net began its development. Forming such music portal requires relatively low capital investment, and there is no customer or brand loyalty at all, because the users will only loyalty to the musicians. The threats of substitute products for MusicJuice. et is also very high, as people will enjoy and obtain the music they like in many different sources, CD Store, radio, youtube, iTunes, sharing between friends, or even download from piracy websites! Not only facing the threats of new entrants and substitute, what really bothers MusicJuice. net is the high bargaining power of supplier, i. e. the musicians . The business of MusicJuice. net is bet on the quality of their signed musicians, but what musicians really cares is to expand their fans network, but not to build any relationship with a particular platform.Even though the bargaining power of customers is comparatively low when the user addicted into any single musician, but such advantage is not sustainable once the musician switch to other platform. And the biggest force affecting MusicJuice. net is the high intensity of competitive rivalry, many companies including those major music labels and big IT corporations e. g. Microsoft also attempted to use MySpace to slice the pie of the profitable music industry, not to mention those giants like iTunes and Amazon.Even thought in such unfavorable situation, MusicJuice. net can still do something to rescue their business, not just working on marketing campaign or functional enhancement, but to focus on building the pure music community by forming strategic partners with indie band and independent music labels, line up with quality musicians to build few showcases of successful stories, aforementioned, their business is bet on the quality of their suppliers, they should provide a reason for the musicians to sign up on their platform.After all, people are looking for music as an enjoyment, not an investment, MusicJuice. net should provide more interesting free content for the user to enjoy music, but not just invest on music. (end)

Friday, August 30, 2019

Self Realization Through Education

Self-Realization through Education Over the past 32 years of my life, I have been both directly and indirectly impacted by numerous social institutions. Without question, education has been the most influential by creating a positive change in my life. There are many benefits to pursuing an education. First, embarking on a rewarding career path has its own rewards such as a generous salary and social prestige. In addition, an individual’s relationships within the institutions of family and marriage are also affected by the presence of an educated head of household.Lastly, the impact of a good education on mental well-being is tremendous since most people feel a sense of accomplishment after earning a college degree. Above all, I believe that education, as a social institution, has helped to shape my mental attitudes towards society as well as mold my sense of identity. Beforehand, I would like to define the term social institution followed by my own interpretation. According t o Merriam-Webster’s dictionary, an institution is defined as â€Å"a significant practice, relationship, or organization in a society or culture† (Institution, 2010).I feel that social institutions in particular are systems which  require society to form social groups; these social groups work towards  their collective goal of attaining desired statuses  and roles within said society. Simply put, a social institution is a system that can be used to attain certain social goals that are predefined by its respective social group, governed by a set of social norms. By adhering to social norms of academia, I have been able to earn an Associate’s degree which aided me in securing a new career.By depending on the institution of education, I have been able to meet one of my social goals and achieve Federal employment status. Social institutions are necessary components within our society in order to maintain and provide individual stability based on institutional dependence. Social institutions such as economy and education can directly correlate with one another. Common sense in today’s society tells us that the more educated a person is, the greater the likelihood that person will acquire high salaried employment.This so-called common sense also entails that a measure of normative isomorphism, or organizational standard, exists in the form of a college degree in order to establish a common â€Å"best practice† (Carter & Clegg, 2007, para 3). Individuals who do not possess the established minimum qualifications for employment are unlikely candidates due to an accepted social perception that said individuals lack the desired aptitude.In effect, being financially secure and having a  successful career that requires a college degree grants a sense of stability in the household. Family is considered to be another social institution and is affected by other social institutions, specifically economy and education. The involvement of the two latter social institutions has a great impact on the quality of life and stability of any given household. Herbert Spencer referred to institutions by using the analogy of society as if it were an â€Å"organism† (Henning, 2007, para 3).Basically, institutions are compared to the organs of the body since they too properly function only with effective interdependence. With respect to family, I believe that children are likely to grow up to become responsible members of society if they are raised in a household with educated parents. Seeking higher learning only strengthens the institution of family through both tangible and intangible benefits. Stability in the household, both emotional and financial, is directly affected by the level of education held by the working person.Indeed, family members traditionally benefit from the financial rewards which are bestowed upon the college-educated provider within the household. However, there are a multitude of intangible be nefits conferred upon graduation from a college or university. Social prestige, self-confidence, time management skills, and the ability to think critically are the most notable benefits. Abraham Maslow, a noted psychologist and theorist, developed a theory on human motivation that is widely known as a hierarchy of needs.After a person meets their esteem needs, he or she will seek to fulfill their potential through a process of self-actualization (Myers, 2010, pp 446-47, 564-65). Throughout this process, I feel that education is a key component towards self-actualization. In conclusion, by utilizing the institution of education, I am learning valuable life skills necessary to become a productive and successful member of society, as well as realize my true potential. References Carter, C. & Clegg, S. 2007). New institutional theory. The Blackwell Encyclopedia of Sociology. G. Ritzer (Ed. ). Retrieved from http://www. blackwellreference. com Henning, C. (2007). Institution. The Blackw ell Encyclopedia of Sociology. G. Ritzer (Ed. ). Retrieved from http://www. blackwellreference. com Institution. (2010). In Merriam-Webster Online Dictionary. Retrieved June 13, 2010 from http://www. merriam-webster. com/dictionary/institution Myers, D. G. (2010). Psychology (9th ed. ). New York, NY: Worth.

Thursday, August 29, 2019

Sustainable Electrical Construction Research Paper

Sustainable Electrical Construction - Research Paper Example e industrial process whereby the various processes that go on in manufacturing and production will be treated with a sense of urgency for the conservation of the environment (ZinCo Worldwide, 2011). Detailed reason why this is so will be discussed later but it would be noticed that the rate of industrialization has left us all with very few options other than manufacturing as many of the goods and products we need as possible. In the present paper, the electrical construction industry shall be used as a case study whereby a critical analysis of the industrial process that takes place during electrical construction shall be undertaken to understand the options of sustainability available for industry players and how best they have played their roles in ensuring that these roles are well played. Why Industrial Process is a focus for Sustainability The United States and other countries commonly referred to as the power houses of industrialization continue to depend on massive industrial development for the running of their economies. Interestingly, it is when some of these powerhouses survive in their economic dealings that the global economic climate becomes stable and sound (Diadem USA, Inc., 2011). But as much as it is important to embrace industrialization, it is equally important to understand the risks and challenges that industrialization carries so that when these challenges and risks are known, the needed risk management interventions would be developed towards them. Indeed, industrialization is highly associated with industrial processes whereby manufacturing and production takes the larger part of industries. Meanwhile, the means or source of energy in powering most of these industries in the industrial processes demand the use of energy sources that have long been known to be very threatening to the environment (Ludwick, 2011). Apart from the source of energy, the waste produced in the course of industrial processes such as smoke has also been identifi ed to be highly harmful to the environment. Even more, the byproducts of most of the industrial processes have been suspected to be ill-treated and wrongfully disposed (Intelligent Design Group, 2011). Usability among end users also accounts for some instances of industrial process’ risk against the environment. This is because most end users have very limited knowledge on the best ways to handle the products they buy such that the products will not end up becoming a threat to the environment. It is against the backdrops listed above that it has become so necessary that industrial process becomes a focus for sustainability in the current research paper. Electrical Construction and the Environment Electrical construction is mainly concerned with the production of electricity and electricity products (Glavinich, 2007). This is often than by electricity construction companies. Lately, oil and gas companies have also been highly involved in this process. Depending on the locality and resources available to an electrical construc

Wednesday, August 28, 2019

RELIGION Essay Example | Topics and Well Written Essays - 250 words

RELIGION - Essay Example As a result, he was able to perform miracles that proved that he was a supernatural being as the miracles work against the natural laws of science and human beliefs. Such include walking on water which violated the law of floatation, calming the storm which confirmed that he had power over nature, healing the sick which proved his abilities beyond those of man and multiplication of two fish and five loaves of bread which proved that matter can indeed be created. At the same time, being man, he felt pain, hunger and rejection from his close associates which makes it easy for Christians to identify closely with him knowing that he understands their afflictions very well since he personally went through them. The identity of Jesus as God makes Christians to be aware that the one whom they are following and believed in, has power over everything and they only need to strengthen their faith in him so as to experience him in their

Tuesday, August 27, 2019

Analyze the ways in which controversy over the extension of slavery Research Paper

Analyze the ways in which controversy over the extension of slavery into western territories contributed to the coming of the Ci - Research Paper Example In fact, slavery was already in rapid decline in the Border States and cities, because they could not compete with free labor. In the 1850s, tensions between revived by the same problem that produced dating back to the Missouri Compromise of 1820: slavery in the territories. Northerners and southerners in fact came to define "Manifest Destiny" in different ways, undermining nationalism as a unifying force. The Compromise of 1850 relating to the acquisition of territory after the Mexican-American War. It includes a provision for the execution of fugitive slave who led a series of small local events in the North, which has expressed concern about slavery. Most people think of the compromise amendment was finished as a regional problem, but Stephen A. Douglas again in 1854, and the name of democracy. Douglas proposed the Kansas-Nebraska Bill aims to open a huge new range of high quality, clearing and settlement. As an American of Chicago, Chicago was particularly interested in the track link in Kansas and Nebraska, but it was a moot point. More importantly, Douglas was a firm believer in democracy at the grassroots level that the actual settlers have the right to decide on slavery, not politicians from other states. Finally, the popular reaction has come, but the leaders had the spark. Chase Appeal of Independent Democrats "did much to educate the public. In New York, William H. Seward finally took charge of organizing a demonstration against the Nebraska bill, since none had arisen spontaneously. Press as National period, the New York Tribune, and local magazines free of soil, condemned the bill. Convinced that Northern society was better than the south and more convinced than ever a threat to the efforts of the South to expand the slave power of its current borders, the north has been a global approach, which has a risk of conflict, but conflict required power of the Republican Party. Republican Party - a people's campaign, emotional release of "free country" is the border - took over the White House after only six years of existence. The Republican Party was born of the controversy over the Kansas-Nebraska Act. Once the Northern reaction against the Kansas-Nebraska Act took place, its leaders have acted to promote a different political reorganization. Henry Wilson said the death Whig Party and vowed to oppose any attempt to revive it. Horace Greeley Tribune has called for the formation of a new party of the North, and Benjamin Wade, Chase, Charles Sumner and others have talked about the union of all opponents of the law of Nebraska. Tribune Gamaliel Bailey was involved in calling a caucus of anti-slavery Whig and Democratic Party members of Congress in May. Meeting in a church in Ripon, Wisconsin, congregations, February 28, 1854 some thirty opponents of the law of Nebraska called for organizing a new political party and suggested that "Republican" would be the most appropriate name ( to link their cause with the Declaration of Independen ce). rights activists, the mind has played a leading role in creating the Republican Party in most northern states during the summer of the 1854th While conservatives and moderates were content to call for the restoration of the Compromise Missouri or prohibition of slavery extension,

Monday, August 26, 2019

Answer the questions in Bold Essay Example | Topics and Well Written Essays - 500 words - 3

Answer the questions in Bold - Essay Example Clinicians can gain recognition for quality care knowledge of conditions like diabetes, heart disease, and stroke. They may also take obtain acknowledgement of quality in other aspects of the profession, such as providing patient-centered, up-to-date practice. Employers can receive accreditation for quality health plan coverage, and a variety of care organizations (HMOs, diabetes care, promotion) can received extensive evaluations that are tailored to the quality standards associated with each area of the medical industry (Pawlson, & Lee, 2010). Patients/consumers are necessarily impacted by virtually every service provided by the NCQA, being the end users of the entire profession. While there are understandably no accreditation or recognition programs available for the public, there are materials and projects that are directly aimed at the general population. The NCQA works directly with the government at both state and federal levels to work toward providing the highest quality of health services throughout the country. In addition, there are a variety of educational resources available through the association that serves to inform the public of the many challenges and improvements associated with the delivery of health care. As should be expected from any organization concerned with quality, the NCQA is regularly and repeatedly evaluated. They use a standard formula of measurement, analysis, improvement, and continual repetition. This system is important for both regulation within the organization, and in the development of quality assurance programs. The measurements used to judge their own performance comes from a variety of national health care indicators. Given the scope of the NCQA, data from throughout the nation is valuable in the assessment process, and may come from a number of sources. The organization conducts its own

Sunday, August 25, 2019

Managed health care future for the disabled and poor Essay

Managed health care future for the disabled and poor - Essay Example Center of discussion in this paper is managed health care as delivering health care in an integrated system and in an organized manner. The main goals of managed health care are to enhance the clinical quality of the medical services, to enhance the client and social service element of health care, and to minimize the costs of distributing quality health care. Managed care is a structured approach to purchasing and getting the right service for a particular health need. Health maintenance organizations (HMOs), preferred provider organizations (PPOs), and physician hospital organizations (PHOs) are forms of managed care. Managed care and in particular, the health maintenance organizations became popular as a way of enhancing care and minimizing unnecessary services. However, towards the end of 1990s, the consumer backlash resulted in the abandonment of the firmly controlled care management systems. Quality is â€Å"now the watchword for 21st century healthcare as the institutions and individuals who pay for services begin to focus on what they are getting for their money†. In other words, individuals demand for quality health care because they are paying for it. There is still no consensus as to who should be accountable for the provision and financing of the health care services in the United States. This has resulted in a patchwork system in which the individuals, employers, and the government all assist in covering up the expenses. For a while, the government has assumed the mandate of providing health insurance to particular deserving populations (such as some poor people, children, disabled, and other older persons) but it has generally shunned financing care for the working adults (Earp, French, and Gilkey, 2008). Instead, majority of the working adults get insurance either through buying coverage on their own or through their employers, or they go without the cover. It is important to note that there is no single unifying system offering the system s. The health services are offered directly by private providers, organizations supported by state or federal funding, and governmental organizations (like the public health). Health care services are provided by both not-for-profit and for-profit organizations (Earp, French, and Gilkey, 2008). Managed care imposes quality measurement, accountability, controls, and organization in the delivery of health care to attain the buyer’s aims for access to cost of care, effectiveness of care, care, and quality of care. The introduction and growth of managed care strategies have influenced the general health care organization. They have begun to alter the delivery of publicly and privately health care (National Research Council, 1997). Provider Contracting The aim of a managed care organization is to offer or organize for the health care services provision. Majority of the managed care organizations like the preferred provider organizations (PPOs) and the health maintenance organizati ons (HMOs) offer their services through agreements with medical groups, individual physicians, hospitals, individual practice associations (IPAs) and other kinds of health care facilities and

Saturday, August 24, 2019

British Film Research Paper Example | Topics and Well Written Essays - 2500 words

British Film - Research Paper Example This determination was fueled by his strong-minded mother, an out-and-out teacher, as well as his own courage and determination to overcome his physical disability. The History of the Film The Irish culture and its local setting is shown and is depicted in the conduct and actions of different characters. Apart from the physical struggle of Christy, the story also appeals to the audience emotionally, physically and psychologically. The film appeals to audiences in a way show how one can overcome a serious handicap to achieve life goals. It reveals the complexity of man, able to overcome physical disability and severe speech impediment. Christy displays a fighting spirit and intelligence throughout the film in all situations despite his lack of ability to communicate. The film begins with a setting in which Christy has been invited to a home of a wealthy sponsor, and he is given a nurse to look after him until he appears on stage. The nurse sees him with a book and is fascinated with i ts title My Left Foot, and she begins to go through it chapter by chapter. As she reads it, she discovers the life story of Christy in a flashback. The nurse however discovers that Christy is humorous, despite his background that is affected by poverty. Christy mumbles inarticulate comebacks to his father’s dinner table in a pestering manner. Christy appears not interested in many things around him but he in happy when his brothers and sisters laugh, however his father appears confused. Christy was unable be concerned with anything at all in his life and is he developed a keen interest in painting as he prefers to listen to his mother. The doctor is seen physically outside his locked bedroom and is closely whispering about Christy. However, even further than the humor Sheridan permits the hard won joy in Christy’s story. The unusual scene is where the family watches as the young at the age of five hold a piece of chalk with his toes and makes letter A. At this stage, C hristy is discovering a way of expressing himself to others, as he could not speak as a normal child. Christy later writes the word mother on the floor with a piece of chalk. This is observed quietly and sensitively as the scene reveals a real sense of completion at the end of such a pleasing surprise. In the film, the local Irish society in which Christy is born is depicted as poor and somehow genuinely religious but at times considers the handicapped as something serious. Throughout his early days, Christy played with local children and his brothers and sisters. The neighbors at times make attempts to play with Christy openly although he has not learned to speak or how to express himself. The family and the whole community of Christy is seen having deep ties to one another and are final extremely proud of Christy. His father’s is seen as a good father in his family. However, the father is at times harsh and often quarrels his children, despite himself being truly devoted to his family and their needs. The connection between mother and son runs throughout the story from its very beginning. The heavily pregnant demonstrate her love to Christy although she is alone in the small house; she struggles to carry the disabled son upstairs to his sleeping-room. She later agrees with him to keep the money meant to buy him a good

Friday, August 23, 2019

How Can We Fix K-12 Education Essay Example | Topics and Well Written Essays - 500 words

How Can We Fix K-12 Education - Essay Example Darwinian evolution advocates for evolution of current creatures from simple organisms million of years ago. Scholars argue that, teaching of creationism discourages students from applying scientific knowledge learned in class. Furthermore, the students are unable to conduct experiments, come up with logical results and make conclusions on experiments (National Academy Press 17). Another challenge is the inability to embrace new technology. This denies the system the ability to use new ideas effectively. This problem is caused by failure to recruit and retain qualified teachers (National Academy Press 21). Another challenge is legitimizing K-12 education. Regardless of the effort by environmentalists on the importance of K-12 education as means of conserving the environment, the government has not legitimized K-12 education or made it part of the curricula within public schools. The government has failed to adhere to warnings that make learning convenient and effective. Lastly, the system does not get any funding from the government leading to seclusion of public schools from K-12 education. It is regrettable that only children from affluent families can learn using K-12 education system (National Academy Press 57). Despite all the challenges experienced by K-12 education system, scholars argue that there are some positive efforts. Consequently, K-12 education should be accessible to students. The concerned stakeholders should train and recruit qualified teachers. Tutoring program found at Haas Center for Public Service, Stanford Teacher Education Program and the Teach for America program should be used for training any members that would like to learn more about K-12 education system (National Academy Press 69). K-12 education system should have specific teachers who can be able to guide students on-line as they learn. Teachers who are responsible for K-12 education

MBA BUSINESS ANALYSIS, portfolio 1 sub Essay Example | Topics and Well Written Essays - 1000 words

MBA BUSINESS ANALYSIS, portfolio 1 sub - Essay Example Business analytics is the key for the company to run its business activities. As Vijayan (2011, p. 1) states, â€Å"predictive analytics approaches are focused on helping companies glean actionable intelligence based on historical data†. For working on the data provided by the clients and checking its operational feasibility through predictive models, the use of business analytics seems essential. Moreover, the company also uses management information system to manage information in a logical manner. The management information system helps the company in storing and processing of information into useful data which can be used for decision making purposes. Let us take a real life example of the use of business analytics in Front Guide investment Solutions. A client goes to the company to know whether he/she should make investment in the telecom sector of any particular country or not. Now, the company will gather data related to the telecom sector of that country which may incl ude annual revenue, growth potential, GDP deflator, and other important data and will perform statistical analysis of the data to know whether investment in that sector will be a feasible option for the client or not. Looking at this example, it is obvious that the company is a data driven organization and has adopted the use of business analytics to a great extent. How is it benefiting from doing so? The company is getting a number of considerable benefits from the use of business analytics. For example, the company is able to provide accurate details about the feasibility of investment to the clients. Clients come to the company to know what the investment will yield for them in future. The company provides the clients with information based on statistical analysis of data which in not only accurate but also very close to reality as the analysis is done using predictive models. As Stubbs (2011, p. 1) states, â€Å"the value of analytics lies in its ability to deliver better outco mes†. The more the employees will be skilled in using business analytics, more accurate and consistent will be the results of analysis. The well organized business analytics system also provides many other benefits for the company. For example, one of the main benefits of using business analytics appears when the company applies re-apply existing competencies to get real life data regarding investment scenarios. The company also applies modeling skills to increase the revenue, improve customer retention, and maintain the business image. Along with improving the business efficiency, business analytics helps the company in avoiding the risk of miscommunication by communicating the value of business analytics clients in such a way that become able to build support and gain traction. Business analytics does not just relate to statistics, it also plays a key role in organizational change processes (Stubbs 2011). Do analytics contribute to business performance and profitability? The business analytics definitely contribute to improved business performance and profitability. It helps the company maintain its competitive advantage that comes from the firm’s ability to capitalize on uniqueness. Front Guide investment Solutions has the potential to make use of that exact uniqueness in a unique and matchless way. The company takes advantage critical data, which is the biggest

Thursday, August 22, 2019

Outdoor Essay Example for Free

Outdoor Essay 1. What are some of the benefits of using outdoor space in early childhood? Using outdoor space in early childhood provide children with health, cognitive, and social benefits. Health benefits: It gives children the opportunity to exercise their large muscles group much more than when they are indoors, because they have more space to run, skip, climb, swing, and jump. Playing outside also allow children to burn more calories than when they are inside. Cognitive benefits: When children play outside they often will make up their own games, by doing this they are exercising their problem solving skills. When children make the rules for the games and practice using them with friends, they are developing organizational abilities, and leadership qualities. Their creativity is enhanced and their imaginations are nourished. Social benefits: being outside promotes cooperative play which leads to the development of social skills. When children wait to take turns while playing a game, or when they work together with others to build something, these are ways children can enhance their social abilities outdoors. 2. Describe the role of the teacher in supporting outdoor space, including children with special needs. The teacher can be supportive by interacting with the children when they are outside, the teacher can do this by talking with the children about what and how they are going to play. The teacher can assist the children in different activities, for example: hopping, skipping, and climbing, and the teacher can also make sure that the children are safe while playing outdoors. The teacher must also plan activities that encourage children with special needs to participate while outdoors, but he/she should not use the same activities when they are outdoors with the special needs children. Creating different activities will provide the children with special needs the opportunity to use their bodies in new ways. 3. What problems can there be with static playground equipment and their traditional uses? Static playground equipment doesn’t stimulate children’s physical, cognitive, or creative development. Children need to experience new physical challenges; static playground equipment won’t allow the children to use the equipment in a new way because it doesn’t change. Static playground equipment can make children feel limited in their play. 4. Describe three ways teachers can use traditional equipment in creative ways. Then create one idea of your own for using traditional equipment in a creative way. Teachers can use traditional equipment to engage children in group activities, by doing this he/she can enhance the children’s social skills. The teacher can play a game like follow the leader; he/she can walk around the swing, slide, jungle gym, and sand box while playing the game. Teachers can use the monkey bars to have the children pretend they are monkeys swinging and climbing their way through the jungle. While the children is doing the activity, the teacher can ask the children questions to challenge them, for example: how fast can you climb through the jungle, or how far do you think you can swing, Teachers can create a obstacle course using the traditional equipment, teachers can challenge the children to crawl through tires, climb over the monkey bars, swing on a swing, or try to balance themselves steady while standing on the outside of the sand box. The children must do all these things while traveling through the obstacle course. An activity I would do with the children in my class while outdoors, that involves using traditional equipment, would be to have the children pretend that they was at a water park. I would have the children to slide down the slide on the playground pretending that they are about to slide down into a pool.

Wednesday, August 21, 2019

Case study of fostering team in nuneaton

Case study of fostering team in nuneaton The background to your involvement I am currently on placement with the fostering team in Nuneaton which has in excess of seventy five carers in and around the Nuneaton/Bedworth area. The fostering team consists of 4 full time social workers, whose role encompasses assessment work along with supervisory responsibility of foster carers in line with the Department for Children, Schools and Families Working Together to Safeguard Children March 2010 which sets out how organisations and individuals should work together to save and promote the welfare of children and young people in accordance with the Children Act 1989 and the Children Act 2004 ( (DCSF, March 2010) and to identify placements for children being accommodated under various sections of the Children Act 1989. While on placement I shadowed a social worker involved in supporting 14 yr old Philips foster carers to deal with particular behavioural issues that had led to his placement breaking down. The foster carers have 3 foster children currently in their care, Phillip 14, James 15 and David 16. The 2 foster carers Mike 49 and Jane 46 live in a 4 bedroom house in Hinckley. Philip had left the house and was refusing to return, stating that his foster carers did not like him and that he wanted to live on his own. Bed and breakfast accommodation was arranged for him for a few days while the situation was re-assessed and a meeting with the foster carers arranged. Fundamental to all relationships and particularly the interaction between Philip and his mother, Philip and his foster carers and social worker and foster carers, communication is a central component. Analysing how effective communication plays a vital part in this clients circumstances will form the basis of this discussion. Good communication skills are a principle component of effective social work practice. They include active, attentive and empathetic listening, recognition of verbal and non verbal communication and general formal and informal interview techniques, as Payne has suggested, the application of communication theory gives practical help in controlling and understanding relationships and interactions with clients and a technology of interviewing and interpersonal skills (Payne, 2005, pg 178). Over recent year the children looked after by foster carers have included an increasing proportion of distressed adolescences along with the disruption rate for these placements as being high (Farmer et al 2003). One of the aims of the fostering social worker is to conduct detailed assessments of parenting approaches and strategies used by the foster carers looking after a teenager in a long term placement and how these strategies can change and develop during the course of the placement. Research has been conducted into fostering task with adolescents by Farmer et al (2004), found that they were concerns about the behaviour and well being of children when they move into a new placements. The findings in this case study highlighted a number of factors that contributed to the breakdown in the relationship with the foster carers and Philip and finally the placement. In this situation I had found out the Philips social worker had not communicated the nature and context of behavioural issues associated with him to the foster carers social worker so that foster carers could have been better informed. Following the placement breakdown the foster carers had reflected on their own lack of knowledge and experience at dealing with young people with behavioural problems had highlighted the need for specific training in this area for foster carers. Part 2 Using the material from part 1, critically analyse the challenges in ensuring good practice in communicating with this service user/s or carer/s What theory underpins your interaction? Modern social work theory incorporates social psychology and social construction theory to understand the way groups in society relate to each other and create and maintain social identities. Social psychology has influenced social work practice specifically with concepts from role theory and communication theory. Role theory offers a viewpoint in sociology and also within social psychology that includes most of everyday activities to be the acted out of socially defined categories such as mother, supervisor, and lecturer. Each defining social role comes with a set of rights, duties, expectations, norms and behaviour a person has to be able to fulfill. Communication theory uses a range of concepts from the scientific to the humanistic, to help us understand how people conduct themselves in creating, exchanging and interpreting messages (Farrell, 1987). These concepts help us to understand patterns of language and identify how people construct their social world.helping them to recon struct the world by using language differently to identify possibilities for change (Payne, 2005, pg 161). Communication theory is concerned with a range of ideas that can explain how individuals, groups and organisations communicate with each other. Linguistically, in the form of the spoken and written word and other mediums, and non verbal forms, such as body language and the way we speak, including tone, pitch, intonation and speed. Communication is more than the mere transmission of facts, as has been suggested information might be facts, or other things that might be learned, such as emotions, memories, bodily sensations or an idea about how someone feels about you (Payne, 2005, pg 171 or 178) and furthermore that language informs the way we think, the way we experience, and the way we interact with each other. Language provides the basis of community, but also the grounds for division (Thompson 2003:36) This suggests that communication networks are inextricably linked to social identity, ethnicity, culture and class. As Payne suggests, networks of communication build up and how we communicate and with whom, becomes part of our culture and social relations, for example, ethnic and class division are marked by separation in communication networks and patterns of communication often express power, domination and subordination. Communication may, therefore, help us to identify oppression and inequality (Payne, 2005, pg 171). If we use language, along with the capacity to communicate, to form our lives and to relate to others, then social workers need to be sensitively aware how their choice of words and mode of communication in intensely personal and emotional charged situations, can increase and decrease oppression in their interactions with young people. For example, use of professional jargon without explanation may alienate a client by creating a language barrier between social work er and the service user or carer. Where a child is suspected of being in need of protection the social worker must balance the needs of the young persons safety along with the potential of breaking up the family. The social worker that I shadowed believed that the needs of young people in foster care could be met through meaningful, consistent and positive relationships with the foster carer whilst on the other hand you have child care policy which is primarily about safeguarding, outcomes and accountability. A crucial time for young people spans 12-19 years, this is when they ask themselves: Who am I? Where do I want to be? During this period they are also concerned with how they appear to others and what groups and networks they identify with. Erikson terms this psychosocial stage as the Identity versus Role Confusion period (Beckett, 2002 ). Attachment theory Attachment theory offers an understanding of personality development and behaviour in close relationships and provides an account of the difference in peoples emotional and relationship styles. (Howe, 2000).  John Bowlby is considered to the psychiatrist that developed the attachment theory. Bolwby suggests that when children are separated from their parents or care giver they suffer loss because of the attachment between them. I can see how Philip may have felt when he thought the he had to leave his home for a second time having already lost the home of his birth mother, it is thought by the social worker and the foster carers that one of the reason that Philip does not want to return is because he does not want to suffer loss again. This has had an obvious affect of Philips behaviour, the tenets of this theory is that close relationships or attachments have a direct effect on the emotional and social development across a lifespan (Howe 2000). Avoidant Attachments Howe (2009) describes avoidant attachments as children and young people whom display avoidant attachments as having parent(s) that are either indifferent whom have their own trauma going on or are emotionally rigid or completely rejecting of their childs needs. Although parents will react well when their child is happy and content that soon changes when the child needs change for instance when their child is in distress and is need of comfort. Howe suggest that attempts at intimacy only seem to increase parental distance, even rebuff, this communicating to the child that they are not wanted. Attachment to home and a safe place is a primary ways in which people preserve self-identity. the way in which people identify and become attached to places, buildings, objects, and how this attachment can contribute to personal well-being or how we feel about ourselves (Low et al 1992). To look at why these places, building and objects become important provides us with insight into what happens when people have to move and the dilemmas that they may face. Attachment is an emotional relationship that provides reliability, continuity, care and comfort. John Bowlby writes in his research relating to the concept of attachment, describing it as a lasting psychological connectedness between human beings (Bowlby, 1969, p. 194). Bowlby held the psychoanalytic view that early years experiences of a child has an important propensity toward development and behaviour later in life, most attachment styles are formed in the early years of childhood developed through the relationship with the care -giver. Mary Ainsworth during the 1970s built on the work of Bowlbys work in her study called Strange situations which looked at children where they were left alone for a short period of time then quickly comforted by the care giver/mother (Ainsworth, 1978). These help her to formulate the attachment classification system, which examine specific differences in a childs use of attachment figures as a constant and reliable base from which they can then explore the environment. Change requires personal adjustment, and some change can be more stressful than others. When facing a move fears of adjustment and a change in familiar environment and living conditions can be seen as a major problem for young people. Philip was reluctant to move out of the area that he lived at with his foster carers, he felt that if he had to move to supported lodging that it would be in an are where he has had problems in the past. Care Management involves assessing needs and keeping a watchful eye over a number of services that are provided by workers other than the social worker, the role of care manager is not new to social work and has existed for many years, historically the social worker would arrange a package of care, seek the views of the service user, engage with other professionals when collecting information relevant to the care package following that there would be an assessment then the social worker would engage appropriate services that met the need of the service user. Discrimination ,Inequality and oppression, Separation and Loss Solution focused (brief) theory Solution-Focused Brief Therapy (SFBT)is based on solution-building rather than problem-solving. SFBT explores the here and now and planned aspirations opposed to solving the current problems this method of working with young people can be practiced as well as other interventions. The theoretical underpinnings of solution-focused brief therapy have been developed out of philosophy as well as an appreciation of communicating positive outcomes through a creative process. Primary because the focus of this intervention is on future goals set by the young person, more importantly because with this method of intervention shows that problems are not limited by boundaries therefore neither the social worker (and other professionals) cannot be wrong the tends to lead to agreements being forged. This had been found to help build the relationship with David so that he felt that he was being heard through his verbal and non verbal communication. However whilst there is not a grounded understanding that identify the nature of the problem SFBT it creates problems in being able to measure efficacy. In this instance SFBT was used to build confidence, trust and capacity with David so that he would be prepared for his future with the current foster carers. Task centred practice Task Centred social work provides a clear framework for professional intervention, it deal with current (here and now) problems. It focuses on the problem and tries to negotiate and agree a method of dealing with the problem by identifying goals and setting timescales. There are 2 primary components of this approach which are Task Crisis intervention theories Outcomes Led Approach Child development Children do not have the same language skills or the emotional development of adults and therefore their attachment anxieties are triggered stopping them expressing themselves verbally and producing dysfunctional or attachment behaviours. Attachment behaviours can include minimising expressions of distress, that is the child knows that when their parent is shouting at them and the child is distressed this results in further parental rejection, so the child learns to minimise expressions of distress. The child acts happy even when frighten. In contrast the child express graet distress, especially when a parent is about to leave a type of attention seeking behaviour is communicating but not saying verbally show me you love me. Parenting a teenager in foster care can be vastly different from the ordinary parenting a birth child that is now a teenager. With the foster child there need to be a recognition and understanding of the young person background along with any previous placement breakdowns whether there are any disturbed and difficult behaviours. Foster carers must assist in adjusting the young persons defence mechanisms, developing attachments with the foster family whilst wherever possible maintaining links with the birth family. The foster carers felt that due to a recent argument with Philips birth mother he felt that no one liked him as his birth mother had chastised him for his language toward her. What skills are necessary? Report writing in accordance to the BAAF standards, work load and time management. Correspondence and record keeping Empathy is a dominant concept within social work. Recieving empathy enhances a clients feeling of self worth by communicating to them that they are understandable and are worth understanding. A social workers verbal and non verbal responses are crucial to communicating to the client they are being understood and entails skills to filter out and feedback themes and core messages in the client communication( ) Communications skills are essential in effectictive social work practice throughout the stages of assessment, planning, intervention and review. Questioning skills need to be employed to gain greater clarification concerning extremely personal issues and to constructively challemge client to recognised their responsibilities. For example, in the assessment process the accuracy of information is vital. However, the nature of this information is often sensitive and loaded with emotion and feeling from the past. If foster carers and young people are able to share this type of information they need to be convinced that there are being understood. What knowledge is required? In my interaction with service users and specifically in this case service providers (foster carers) human development theory influences my approach and form of communication. What techniques are appropriate? Interview formal and informal Assessment Reflection From my learning perspective, this case study highlights the complexities associated with working with children with behavioural issues. It was an opportunity to examine how social work can and does address thiese issues through the legislative and policy frameworks, along with our own knowledge and experience as well as the values and ethics set out in the National Occupational Standards. Your analysis should also include reflection on your skills and learning needs (500 words including 500 word description of an interaction with a service user) References Department of Children, Schools and Families (2010) Working Together to Safeguard Children: A Guide to Interagency Working ToSafeguard and Promote the Welfare of Children Nottingham: DCSF Publications. Thompson, N. (2003) Communication and Language: A Handbook of Theory and Practice. Basingstoke: Palgrave Macmillan. Low, S, Altman, I. (1992) Place attachment: a conceptual inquiry in Altman, I. and Low, S.M. (eds) Place Attachment, New York: Plenum Press. Thompson, N. (2005) Understanding Social Work, Preparation for Practice- Second edition. Basingstoke: Palgrave Macmillan. Department of Health (1991). Care Management and Assessment: a Practioners Guide. London: HMSO. Howe, D. (2000) Attachment Theory. In Davies, M. (ed). The Blackwell Encyclopaedia of Social Work. Oxford: Blackwell (pp 25-27). Howe, D. (1995) Attachment Theory for Social Work Practice. New York: Palgrave. Farmer,E.,Moyes,S.,Lipscombe,J, (2004) Fostering Adolescents Jessica Kingsley: London Farmer,E,. Moyers,M,(2003) Parenting skills adolescents: Skills and starategies, London School for policy Studies, University of Bristol: Bristol Care Management Care management is gathering information and seeking out how needs can be best met whilst enabling the service user to access services required, it also monitors service delivery ensuring that their services are continuing to meet the identified needs. The relationship between social worker and carer is a continually developing one whereby the negotiating with other professionals and giving and receiving information, this is all done in a non judgemental way enabling the carer to also develop their own skills of negotiating. I this case the carer was concerned with achieving a form of agreement or understanding as to the amount of foster children she could have at her home. It is important not to make the carer feel that care management is all about ticking boxes and ensuring that the correct piece of paper have been completed, if this where the case then there would not be the need for social work skills when manage care packages. Characteristics of Attachment Bowlby held that there were four characteristics of attachment: Proximity Maintenance The desire to be near the people we are attached to. Safe Haven Returning to the attachment figure for comfort and safety in the face of a fear or threat. Secure Base The attachment figure acts as a base of security from which the child can explore the surrounding environment. Separation Distress Anxiety that occurs in the absence of the attachment figure. (Bowlby, 1969). Care Management, involves overseeing the provision of a package of care services geared toward maintaining someone in the community who would otherwise need to rely on institutional provision (Thompson 2005 p69). Good care management encompasses a macro overview when completing the assessment, it should be completed in partnership with the service user and family paying regard to the strength and weaknesses as well as their ability to look at their life history and communicate the reason they find themselves in the current situation. Care Management is defined in government guidance as the process of tailoring services to individual needs (DOH, 1991:b).

Tuesday, August 20, 2019

Chronic Obstructive Pulmonary Disease Case Study

Chronic Obstructive Pulmonary Disease Case Study CASE STUDY : COPD This piece of work will explore the comprehensively physical examination, differential diagnosis and various diagnostic tests to confirm the disease condition that is CHRONIC OBSTRUCTIVE PULMONARY DISEASE. It will then move further to discover the comprehensive treatment plan and present a argument on an excellent method to treat the disease condition on the basis of current evidenced based studies. The actual name of the patient is replaced with another name so as to retain confidentiality (Dimond, 2002). Mr.X is a 58 year retired office manager came to the emergency ward with his son. He had chief complaints of difficulty in breathing, severe cough, weakness and was feeling discomfort. Patient general appearance shows that he is weak, sitting in high fowlers position, respiring through pursed lips. Suggest that this type of breathing is the indication of emphysema. Pursed lip breathing helps in emitting the air which is trapped in the lungs and limits the force for taking breath (Rik Gosselink, 2003). History taking and proper investigations are the two main components for confirming the disease condition. Complete history is essential to determine the exact etiology of shortness of breath that includes past history of asthmatic attack, family history of asthma, occupational history, present history of smoking, alcohol intake, medication history, episodes of cough whether it is productive or not, presence of any heart problems (Walsh, 2008). COPD develops due to the lack of alpha one antitrypsin hereditary factor. Furthermore the occupational hazards along with genetic factor deteriorate the condition. So detail history collection including all the aspects is significant (Yohannes and Hardy, 2003). History of patient reveals that patient was a chronic smoker from the past 20 years and consume near about twenty cigarettes every day, although patient left smoking 6 months ago his smoking history provides estimation of 20 packs a year. Moreover COPD is more prevalent in patient who consume 20 packs of cigarettes in one year (Georgios et al, 2004). However there are various other diseases that occur due to cigarette smoking such as cancer, heart diseases, pulmonary diseases, influenza, pneumococcal, meningococcal, tuberculosis etc (Arcavi and Benowitz, 2004). Also patient is not able to perform daily activities due to shortness of breath and cough with sputum production. These symptoms are quite common in carcinoma of bronchus, however difficulty in breathing, cough and sputum production are also main clinical symptom of COPD (Pauwels and Rabe, 2004). Moreover, history of the client indicates that plentiful production of sputum for more than three months for two years which shows t he presence of chronic bronchitis (GOLD, 2008). Patient is also not able to sleep during night. Awakening during night which occurs by shortness of breath reveal presence of congestive heart failure or asthma (Price, 2010). Complaints of patient we loss of weight, fatigue, chest tightness due to severe episodes of cough, disturbance in sleep. Dietary history shows that patient is non vegetarian, family history does not provide any significant data. Client having age more than 40 and have sign and symptom such as formation of sputum, difficulty in breathing, history of cigarette smoking and any inhalation of noxious fumes and chances of occurrence of COPD is more at the age above 40 ,therefore patient is believed to have COPD (Vestbo, 2010). Although all the sign and symptom of the client signify that patient is suffering from COPD still functional diagnosis is necessary to confirm the exact diagnosis and proper physical assessment is necessary to confirm the diagnosis (Ferrara, 2011). In high risk cases of COPD proper cardinal sign, body mass index, height and weight of the patient is to be notified as component of assessment (Stockle, 2007). The vital sign of patient are blood pressure:124/76mmHg, height: 174cm, rate of respiration: 20/minute, temperature: 98.2F, Weight: 56kg and body mass index is 19kg/m2. During inspection it is observed that shape of chest of patient is barrel and patient respire with the help of accessory muscle which indicates presence of emphysema (Smeltzer et al, 2009). This less amount of air in the lungs causes disturbance in breathing pattern (Celli, 2007). This alteration in shape of chest shape occur due to the decrease in flexibility of lungs muscles and therefore extra energy is required for this forceful type of breathing as a result client is not able to eat in adequate manner and loosen the weight (Smeltzer et al, 2009). Percussion indicate presence of tympanic resonance that occur because of less motion of diaphragm and presence of wheezing sounds indicating COPD (Celli, 2007). Auscultation indicate that there is extended forced expiratory pattern due to the decrease in air in the lungs. Congestive heart failure or lung fibrosis is differentiated from COPD on the basis of wheezing sound and presence of ronchi. Club shape finger of patient may indicate the presence of other disease condition such as cancer of lungs, bronchiectasis, and pulmonary fibrosis. The skin mucosa of the client is bluish which signify that less of oxygen in blood (American thoracic society, 2004) . Physical assessment of respiratory system does not provide the relevant and valid information for the detection of disease condition but related co morbid state and differential diagnosis are well judged with the help of thorough examination (Mcivor et al, 2004). However the decrease in flow of air in lungs is not predicted with the help of history collection and general assessment. Therefore pulmonary functional test such as spirometry is useful in diagnosing COPD (Travers et al, 2007). Furthermore for identification and confirmation of the COPD and its progress level can be easily identify with the help of spirometry (Stoloff, 2011). COPD is well detected with the help of satandarized device that is spirometry however this device is inconsistent in clinical area (Gold, 2008). Spirometry reading of patient reveals that FEV1/FVC is 56% , this value is less than 70% and it is categorize as stage two that is moderate. However spirometry is not believed to be valid tool for the evaluati on of broad category of airflow obstruction diseases (Borg, 2010, American Thoracic Society, 2004, GOLD, 2008). But provision of bronchodilators are beneficial in diagnosis of asthma and COPD and determine the limit of flow of air that is not reversible fully. Still the exact value of reversibility that helps in judging the patient asthmatic or COPD pdiseases is not known. However differential diagnosis of COPD can be clinically evaluated and also can determine by various non invasive procedures (Vestbo, 2010). Chest radiography is useful technique in excluding various differential diagnosis such as pneumothorax, chronic heart disease, pneumonia (Man et al, 2004). Therefore, to clear out the differential diagnosis, a proper clinical examination and simple investigations including chest radiography could resolve uncertainty if any (Vestbo, 2010). Radiography of chest mostly exhibit clear interstitial markings in patient with chronic bronchitis however there is no particular outcomes that provide evidence that radiography is beneficial for the diagnosis of COPD or Chronic bronchitis (Kane Graham, 2004). In the patient, chest radiography reveals that lung field is hyper distensded, diaphragms are flattened and retrosternal space is more which is the sign of emphysema. Moreover determination of various changes in lungs in case of emphysema can be determined with the help of superior type of chest film (Vestbo, 2010). However with the help of chest x ray it is not possible to detect initial stages of COPD (Gold, 2008). Therefore high resolution Computed tomography is used for identifying emphysema in the initial stages. Moreover the lesions in the lungs can be identifying with the help of high resolution computed tomography (HRCT) without any trouble (Gold, 2008). There are various other diagnostic test which are helpful in COPD confirmation with more accuracy such as arterial blood gas analysis, cardio pulmonary exercise test (GOLD, 2008). The presence of pulmonary emphysema and various other alternative diseases such as asthma and other minor airway diseases can be determined by the value of total lung capacity and diffusing capacity for carbon monoxide(Vandevoorde, 2006) suggest that through examination of blood gas, saturation of oxygen in blood, blood perfusion is determined (Smeltzer et al, 2009). (also supported that arterial blood analysis in moderate and severe cases of COPD should be performed (Vestbo, 2010). However this test is not is not a reliable test to confirm COPD but in high risk cases of emphysema this test is helpful to know hypoxemia (Travers et al, 2010). Value of ABG analysis of patient was PH-7.30, Pao2-84mmHg, Paco2-48mmHg, HCO3-25mg/dl and Sao2 94% Haemoglobin level of patient was 13.4 mg/dl . Chronic Obstructive Pulmonary Disease is the disease of respiratory system that causes non reversible and progressive decrease in pulmonary function (Higginson, 2010). The air flow is not proper in lungs due to this reduction of lung function. The diseases it includes are bronchitis, asthma and emphysema. It effect more than three million people in England. (Jones, 2001) In the Western World, the main cause of COPD is smoking, smoking is related with over 90% of this disease, however COPD occurs in merely 10% to 20% of chronic chain smokers. (Beyer et al, 2008)Respiratory illness is also occurred by passive smoking. (Higginson, 2010) Genetic factor is also responsible for yhe occurrence of COPD however there is only one genetic factor alpha antitrypsin that involes in causing this disease. The lack of this genetic factor is the single major risk factor for the occurrence of this disease. Though determine in only one percemt cases of COPD. Contact with noxious substances is the most c ommon cause of COPD. (Yohannes and Hardy, 2003) There are various diseases in childhood such as pneumonia and whooping cough prior to the age of 12 year are considered to be the risk factor of bronchiectasis and bronchiolitis. Females are at high risk of COPD than man however argues that there is no difference in occurrence of COPD in male and females (Lindberg, 2006). The progress of the disease inside body is mostly described by the inflammation that involve central and peripheral airways. By the inhalation of the noxious substances or irritants , inflammation occurs in the central airway. Due to this soreness , there is more secretion of mucus that damage the ciliary clearance. As a result the glands of the mucus turn into large size and therefore more production of mucus take place due to more amount of goblet cells. This increase production of mucus provides an brilliant medium for the growth of microorganism cause the impairment of airway. Repeated infection causes damage to cilliary body and further inflammation. This progression leads to constriction of airway . Following obstruction trapping of air inside lungs occurs that result in hyperinflation, difficulty in breathing and less tolerance to exercise. The chronic obstruction diseases are chronic bronchitis, emphysema (Higginson, 2010). For the appropriate management of COPD, holistic approach must be taken in account (Paul, 2004). Individually management plan must be made that covers the essential components such as termination of smoking, dietary management and function of lungs should be maintained by medication therapy. Instant treatment in emergency unit is started with the provision of oxygen and sometime bronchodilator may be beneficial to find out reaction to the treatment (Gold, 2008). Moreover administration of oxygen helps in treating hypoxemia and hence improves breathing problem (Downs Appel, 2007). However excess utilization of oxygen may lead to withholding of carbon dioxide level in lungs. So it should be provided with cautious (Kevin, 2007). Patient was provided with oxygen therapy for short duration, the partial pressure of oxygen of the patient is 74% so there is no requirement of oxgen for long term (Gold, 2008). Drug therapy is beneficial for the treatment of COPD and it is provided according to the seriousness level of disease condition (Incalzi et al, 2006). In mild COPD cases, short acting beta 2 adrenoceptor agonists is advised whereas in moderate and severe cases long acting beta 2 adrenoreceptor agonist are recommended. Moreover anti cholinergic is beneficial and easily bearable in older people. Pharmacotherapy is essential in relieving the various symptoms however there is no medication that reveals long lasting improvement of lung function (Gold, 2004). Suggest that with the combination of different drug therapy can give better result and reduce the harmful effects as compared to large amount of single dosage. The preference of different bronchodilators depends upon, accomplishment of desired reaction and ill effects (Downs Appel, 2007). Suggest that due to very few harmful effects and less dosage requirement, inhalation route is chosen for treatment (American thoracic society, 2004) . The widely used short acting beta agonist are salbutamol, terbutaline, pirbut erol and salmeterol, formoterol are the long acting beta agonist also methylxanthines such as theophylline , antichollinergic and inhaled corticosteroid are commonly used that are beneficial in reducing m mucus secretion in airway (Nazir and Erbland, 2009). Pharmacotherapy in the patient was begin with the administration of combined therapy of salbutamol of dose 50Â µg with ipratropium 20Â µg. these are the bronchodilators which is provided with the help of inhaled and injection of theophyllin also administered through intra muscular route. There are some other drugs that are beneficial in severe stage such as antioxidants and immunoregulators (Gold, 2008) Improper nutrition in COPD patient is quite general and it has harmful influence on the pulmonary functioning. So helping the client in maintenance of adequate nutrition level is important and beneficial in improving the respiratory functioning (Shepherd, 2010). Moreover the client whose BMI is less than 21 kg/m2 should be given supplementary diet in order to improve condition of client further (Vermeeren et al, 2001). However age associated alteration in structure, height, muscular changes and if value of BMI is more than also malnutrition cannot be identified (Shepherd, 2010). In patient BMI is in normal category instead patient is advised to take adequate calories, carbhohydrate and proteins in diet. Patient is also advised to avoid caffeine, restrict sodium and taking more milk. The other preventive measure is vaccination of influenza. It has much influence in prevention of various acute respiratory illnesses along with COPD. This type of vaccination must be advised to each patient suffering from COPD (Wongsurakiat, 2004) . Patient who is moderate or severe deterioration of lung function then pulmonary rehabilitation is beneficial to gain maximum functioning to manage with disease condition. Patients are motivated to do different types of exercise to keep body healty Such as steps up, walking , various arm exercises, self handling of various activites such as taking medication, that helps in keeping the function of different system appropriately. Also exercise for decreasing hyperinflation and manage dyspnoea such as deep breathing and pursed lip is advised to the patient (Barnett, 2008). Moreover advantages of rehabilitation of lung fuction maintain for numerous months even after the end of this program (O` Donell, 2007) . COPD is the most prevalent problem that effect mostly elderly people. The mai symptom of COPD is shortness of breath, production of cough with sputum. The main cause of occurrence of this disease is cigarette smoking. History taking and physical examination is beneficial in excluding all the differential diagnosis. Through spirometry diagnosis of COPD can be made. Pharmacology is helpful in controlling the further spread of disease but medication does not provide efficient result in long term care. CASE STUDY ON SPINAL CORD INJURY This case study will throw light on the complete physical examination and diagnostic test and a range of laboratory investigation to confirm the diagnosis. It will then undergo detail treatment plan along with differential diagnosis to explain the appropriate intervention on the basis of present evidence sources. Also it will explore the recent issues regarding care of spinal cord injured patent. The actual name of the patient is changed in the study so that data cannot be recognized (Dimond, 2002). Mr. Malik Aggarwal is a 21 year old student studying in University of Greenwich doing mastering in marketing. During summer break in France, Malik was struck with an motorbike accident. During accident he fall harshly on the footpath from his bike and was lying towards his abdomen . This accident was witnessed by the policeman and he quickly gave call for first aid management. Ambulance was arrived soon and emergency staff identify the severity of Malik injury, they protect the neck of the victim with the help of strong board and immobilize the part before transferring him to the emergency department of the closest hospital. Patient was awake and also familiarized with current date, day and location. He was also replying in well manner. After reaching hospital, he complained of loss of feeling on his both legs, severe pain in neck, mild pain on his back and all extremities, patient was not able to move his neck and lower extremities properly. The assessment was carried out by the eme rgency specialist staff, and found that there were contusions and lesions present on his trunk and lower extremities, the restriction of the neck was rapidly maintained by the staff with the help of firm cervical collar. In order to limit further deterioration of condition, patient was supported with cervical traction and head was also supported with motion restricted devices that are helpful in maintaining proper alignment (Grubb, 2006) . The cardinal signs were checked and indicate that patient has Blood pressure of 100/70, pulse rate: 90/minute, respiration: 20/mt, temperature: 98.4 F and oxygen saturation was 90%. During history collection main emphasis should be given on complete mechanism that how the injury took place, this data is confirmed from the witness and also who is present at the time of accident to so as to proceed accurately towards confirmation of diagnosis (Schreiber, 2009). Other physical and social factors should be noticed that may interfere with the proper assessment of pain (Cruz-Almeida, 2007). Moreover complete history plays an important role in knowing possible etiology of different symptoms and also helps in excluding differential diagnosis. Proper pharmacological history , family history and dietary history should be taken because it might be beneficial in knowing the disease (Cox, 2008) . History collection of patient reveals that patient was anxious and had complaint of pain at the site of neck. The constant pain occur due to the contraction of muscles of neck muscls. There were presence of mild lesions on the trunk and extremities. Therefore it might be the case of injury on cervical cord because continual pain is the indication of spinal cord injury (Lee and Ostrander, 2003) . The exact cause of injury is the extreme flexion of head towards the chest that is due to hyperflexion. Moreover if the main reason of spinal cord injury is hyperflexion or hyperextension then it might be the case of spinal cord injury (ElFaramawy, 2009). Client gave appropriate reaction to each question during history taking , this shows that patient has good level of consciousness. As patient vital sign indicate that patient has hypotension, low respiratory rate and decrease in temperature. The one reason for the occurrence of hypotension might be the interference of vagal and symphathetic vascular tone (Karlet 2001). The client symptoms of hypotension, bradycardia indicates that it might be due to neurogenic shock (McLeod, 2004). After the collection of data it is essential to carry out physical assessment by covering all the aspects. Adequate Physical assessment is the basis in determining the injury related to spinal cord (Bono and Lee, 2004). Moreover physical examination especially of neurological system is beneficial in gathering the baseline data. The main section in neurological examination include will be cranial nerves, sensory and motor function and also reflexes (Noah, 2004). Assessment take place by mkaintaing proper interpersonal relationship with patient. While doing inspection assess for the mental condition, intellectual and cognitive response of the patient (Crimlisk, Grande 2004). Assess for the posture of the patient, if posture maintained by patient is decerebrate thenit may indicate trauma in the midbrain. With the help of Glasgow coma scale, level of consciousness should be assessed and also this scale is beneficial in determining the sensory, motor and verbal response. However the response through this scale is not satisfactory in determing the verbal function (Iyer, 2009). Assess for the extremities for spasticity, presence of weakness, flaccidity as these are the significant mark of damage to neurologic system and also assess for the pronator drift which signify hemiparesis (Crimlisk and Grande, 2004). In the patient, level of consciousness through Glasgow coma is assessed and it is found to be 13 which is normal(Iyer, 2009). Inspection of the patient indicates that there is presence of abrasions on the body and he has difficulty in breathing which is indicated from the use of accessory muscles. This data may be crucial in determine that damage occur in between C3 and C5 vertebrae (Walker, 2009). Neck and trunk should be properly palpated as it is helpful in determine any kind of defect in the neurological system. Palpation should be done in an appropriate manner starting from the cranium and regularly descending along the vertebral disc. On palpation of patient there is feeling of rigidity of muscles of cervical and tenderness. So there are chances of cervical injury (Noah, 2004). Diagnosis of spinal cord injury is based not just on history collection and examination infact complete neurological examination and radiographic studies are essential for the confirmation of diagnosis (Berney, et al 2011) . Spinal nerve assessment should be done with the help of hammer that should be strike beneath the knee. Striking causing sending of nerve impulse and thigh muscles contracted due to this flow of nerve impulse. If there is no contraction of muscles then it indicates there is distruption in the pathway and some sensory or motor deficit. In patient there was mild contraction of muscle fibre indicate neurological deficit(Cox, 2008). After that cranial nerves should be assessed by various method such as recognization of smell, assessment of the vision through snellen chart, assess for speech ,facial expression, assess for optic fundi with the help of opthalmoscope, if there is presence of papilloedema it may be the case of increase intracranial pressure. In patient all the cranial nerves are intact and also no papilloedema is present which exclude the diagnosis of increased intracranial pressure (Cox, 2008) . Patient motor and sensory function is determined by the American Spinal Injury Association (AISA) impairment scale. In this scale sensory deficit and motor impairment is recognized with the help of broad categorization. In the patient the strength of elbows, wrist was normal, the stretch of the biceps and triceps was also normal. The response of the patient towards light touch and pin prick was normal up to the inguinal area however due to weakness of lower limbs, the response of lower extremities was not adequate indicate sensory deficit due to spinal cord trauma (Dodwell, 2010) . However the proper alignment of the vertebrae and recognizing of fracture cannot be possible with such scale so for that radiography is essential (Sheerin, 2005). The radiography is beneficial in determine the fracture of thoracic vertebrae, it gives reliable information but it is not useful in case of cervical vertebrae as these vertebrae are to small to be visible appropriately in radiography (Jorge, 2009). Radiography of the patient provide inadequate data as the film was not properly clear. The deep examination of displacement of bone segments and fractures is possible with the help of computed tomography. The CT scan is beneficial in visualization of the image in different cross section (Jorge, 2009). It is possible to get exact information regarding injury of bone with the help of CT scan and radiography films however the injury to the soft tissue on the cord, intervertebral disc then these diagnostic test does not provide complete information regarding soft tissues (Sheerin, 2005). The CT scan of patient exhibit that injury take place at the level of C5 spine. Magnetic Resonance Imaging is helpful in visualization of injury that occurs on soft tissues by providing well clarify image. The further deterioration and injury that occur due to soft tissues is clearly recognized with the help of MRI (Sheerin, 2005). The MRI of patient shows that there is no soft tissue injury. Functional studies such as positron emission tomography, electromyograms are not of use in case of conscious client. They are only essential in patients who are not cooperative (McDonald and Sadowsky, 2002). From the above history collection, physical assessment, various diagnostic test it is clear that client has cervical injury at the level of 5 intercostals vertebra. Spinal cord is the basic part of central nervous system. It consists of thirty one segments. However due to the fusion of coccygeal bones there are 30 segments in vertebral column (Sheerin, 2004). Spinal cord has two region that is cervical and lumber and it is consist of grey matter (Sheerin, 2004). Approximation of 500 to 700 people each year suffers from traumatic spinal cord injury in UK. The main aetiology of spinal cord injury is straight mechanical injury and injury develops due to the compression on cord (Pellatt, 2010). This compression develops from traumatic and non traumatic reason (McDonald Sandusky, 2002). Due to this overstress of cord, intense flexion, extension or rotation develops. If injury develops due to direct force then within little duration discharge of enzymes from cells and vasoactive substance take place. After that neutrophills and macrophages infilterate in that region. The amount of potassium in extracellular fluid boost up and cells become depolarized and result in hypoxic conditions. Where as in case of indirect cause, vascular system compromised causing lack of blood supply in tissues. Which further leads to development of various haemorrhages, due to this haemorrhages the endothelium of blood vessels become disrupted. Further development of aneurysms occurs causing thrombi development in blood vessels. Due to stimulation of vagus nerve, imbalance thermoregulation develops and because of dermal blood vessel dilatation various life threatening sign and symptoms are developed such as neurogenic shock due to vasodilatation (McDonald and Sadowsky, 2002). There are also development of various syndrome such as anterior cord syndrome which occurs due to the injury to the two third of spinal cord in the anterior side, and next is the posterior cord syndrome that occurs due to the injury to the two third of spinal cord in the posterior side (Bailes et al, 200) . Central cord syndrome mainly occupies the cervical part of spinal cord. This syndrome usually influence elderly people and develop cervical spondylosis due to hyperextension. This spondylosis and hyperextension injury together put compression on the anterior and posterior side of cord. Due to which ligament turn towards inner side and put force on the anterior horn cells. This will further causes development of oedema (Bailes et al, 200) . Management of the patient begins from the site of the accident. First priority of the management is the maintenance of the airway, breathing and circulation. Oxygen therapy helps to prevent hypoxic conditions along with that oxygen therapy stop secondary injury that occurs due to the hypoxic conditions. For maintain airway jaw thrust method should be used chin lift method should be avoided as this may deteriorate the neck by extension (Pellatt, 2010). Immediately stabilization of spine must be maintain with the help of stiff cervical colour. The client must be positioned on hard board so as to maintain proper alignment. If there is requirement of intubation then it should be maintained with the help of three people without mobilizing the patient. However immobilization is not as important as the oxygen therapy because death of the patient may take place due to development of encephalopathy in hypoxic condition (Sheerin, 2005). After the confirmation of diagnosis, drug therapy should be started without any delay. Currently this drug therapy is recognized as basic treatment and helps in limiting secondary damage due to hypoxic condition. Steroid treatment must be started immediately. Methylprednisolone is more preferable. The amount needed for this drug is 30mg/kg in 15minutes, subsequently 5.44mg/kg/hr within 24 hours. Steroid treatment helps in improving neurologic deficit through blood flow toward central nervous system. However this drug is helps in only protection of neurological function and also use of elevated amount this drug result in side effects such as gastric bleeding and infection of wound (Weant, 2008). Further supporting, this drug is usually beneficial within 8 hours of injury. Also in the study organized by the researcher in random controlled trial to see the impact of nimodipine and methylprednisolone on patient with spinal cord injury in acute phase is that both the drugs produce side e ffects and these drugs are not of much beneficial (Pointillart, 2000). Also respiratory and cardiovascular function should be adequately maintained in spinal cord injury. Excessive damage if occur by spinal cord injury has remarkable effect on respiratory system. Mostly colloidal solutions maintain pulmonary wedge pressure. (Nockels, 2001) Moreover due to spinal cord injury the tidal volume generated by accessory muscles is not adequate and result in further damage to pulmonary function so there is need of maintainence of respiratory function. Also hypotension may develop in patient as a result of neurogenic shock. Therefore it is essential to check blood pressure and average arterial pressure should be more than 85mmHg. However if blood pressure is too low than it can be managed with the help of vasopressin agent such as dopamine (Sheerin, 2005). Mr. Malik was provided oxygen about 2 litres/min so as to maintain proper perfusion. Pulse oxymetry was continued and part