Public Health Reflective Journal Health And Social Care Essay

Our discussion last Thursday and Friday focused on the Impact of Disease on Health Care Delivery System and Health & Social Care. During that time our tutor Kate gave us an activity which we will cite examples have disease affected those areas of health.
Things like Financial Issues, Supply and Demands, Lack of Awareness and Knowledge, Skills Shortage and Poor compliance are the cited problems in all groups that occur in a community who are affected with any kinds of disease. We come up this idea of some reasons. Why Financial Issues? Because medicines and manpower are not free which means it needs funding to cope this problem especially when a large portion of individuals who are needed to be rendered with health services. Supply and Demands, still related to financial issues. Lack of Awareness and Knowledge, this contributes the problem because if a community is lack of awareness or knowledge about it health they are very vulnerable to illnesses or diseases. Skills Shortage this pertains to the members of health care system, it talks about how effective are they in rendering their services, are they professional and skilled to give services in an efficient and effective way??
Another topic we also considered last week was about case study of Philip, that study is very meaningful to us because its talks about Philips health and family problem. That case study gives us information that Health awareness is vital to a human life and we should take care of ourselves. It also
gives ideas to health practitioner on how to manage a case that has crucial situation and needs immediate attention.
Has this new knowledge changed my understanding? ( have I developed a whole new way of seeing things):
Knowing about the topic we tackled last week enlightened my mind on the importance of caring ourselves and a community as a health practitioner. Hearing those facts make me think that we should take care ourselves in many ways like having enough knowledge in health promotion and disease prevention, regular check up to assess our health status whether we are having illness or not, having healthy habit, diet and lifestyle.

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On the other hand also as a health care provider it is our responsibility to provide health teaching on those individuals we know that needs it or even not because doing this promotes health and gives knowledge to them on avoiding any disease problems. In addition, we should be a role model of health to them because this is one of the effective way were they will believe our health teachings and apply it to their selves.
How will I apply this knowledge and understanding in my work situation?
In my situation, there are many cases where I can apply this facts and knowledge I gathered in our last week’s discussion. As we know, we can encounter different case of diseases in care homes both communicable and non-communicable disease and we are aware that we’re susceptible to have that diseases if we are not aware of it. Due to this point, precautions necessary to prevent getting and spread of one disease to another and we can do it by applying the things we discussed about public health in our workplace. In order to avoid ourselves and others from getting any disease we must maintain doing the basic things like hand washing after toileting/diapering, before preparing or eating food, after covering a sneeze or cough, after blowing the nose, before and after treating a sore or wound. Using of proper protective clothing as a first line of defence.
2.) Submitted: 28th of Jan. 2010
Learning a new topic leads to changes in our knowledge and understanding and should also lead to changes in ways of working.
Identify any new knowledge, facts or theories that I have learnt from this week’s teaching:
Last week, We discussed all the things that are related about public health and itself. I found out that public health is a very broad topic and correlates many components such as health sector, health organisations, etc.
I learned that Public Health is vital in helping people to be aware about their health because it promotes good health, prolongs life and prevents society in getting any kind of diseases. It is also a gathered deed for the health of the certain population.
In dissemination of all the information related to health, there are agencies that are responsible in data distribution. This agencies and sectors are the one who takes the promotion, prevention, planning, action, and implementation of all the goals in regarding health information dissemination.
One of the most common agencies here in United Kingdom is the National Health Service or commonly called NHS. This agency acts as a framework of local organisations responsible for the healthcare of the community and to work with the local community to improve our populations health and well being. There are more agencies that acts or has a role like the NHS in relation to Public Health.
On the other hand Health Organisation has a big role in terms of promoting people in health awareness of the community because they are the one who distribute the health information globally such as World Health Organisation. WHO is the organisation that coordinates and directs for health within the United Nations. WHO leads in providing information about global health matters. Every time there is a new case of disease they are the one that conducts the studies on it and share the information all over the globe. For example, last week we had disserted the topic about the different infectious disease ( Swine Flu, Salmonella, HIV/AIDS, Measles, Meningitis, Tuberculosis , and MRSA ) and Non-infectious Disease ( Cancer, Coronary Heart Disease, Cerebro-Vascular Accident, Obesity, Asthma ) which are the products of the studios of WHO. Without WHO we cant gain access or unknowledgeable about these diseases.
Match
criteria
Has this new knowledge changed my understanding? (have I
developed a whole new way of seeing things)
The topic we discussed doesn’t change my understanding about Public Health. The lesson we take up last week adds information about what I know in public health and it makes me understand that it is very important in building healthy community not only in a certain place but globally.
It also reminds me that as a health practitioner, we have also the responsibility to share what we have learned about promoting health and preventing diseases. Through this way we can help achieved one of the Public Health goal, which is the Health Awareness.
How will I apply this new knowledge and understanding in my work situation?
Like what I have said before, we can apply this knowledge by sharing the information about public health and telling them how to prevent diseases.
In my situation as an Health Care Assistant in a Care Home, I can share what I have learned by telling to all my colleague’s the importance of using protective clothes whilst giving care to a service user and explaining them how to make care a service user who has infectious and non-infectious disease.
INTRODUCTION
In this assignment, for Part 1, I am going to cite two agencies and named their roles in Public Health in terms of identifying level of health and disease in communities. I will name also epidemiology of two diseases and investigate a chart or graphical form of its incident rate. On other hand I will show the Statistical Data of the two diseases and interpret it base on facts and my understanding.
In every agency I will choose two different approaches and strategies in controlling disease and investigate its effectiveness and after that I will make surveillance on how it improves Public Health. In this activity too I need to inspect current priorities to the provision of one disease and gives example on how it relates between prevalence rate, its causes and the requirements for health and social care services. Explore
In Part 2, I will do a case study on a given data or on a workplace experience. Analyse its critical factors that affects individual’s health then after I am going to put its priorities and evaluate its effectiveness to individuals well being. I will proposed as well changes that can improve its health and set it in action like having implementing campaigns to encourage maximize their health.
In this part, I will explain the role of 2 different agencies in identifying levels of health and disease in communities
PUBLIC HEALTH
It is improving and safeguarding well-being. Public Health is in charge for health safety, health enhancement and health inequalities issues in England. It is responsible moreover for shaping policy, allocating resources, co-ordinating actions and supervising progress. Diagnose and investigate health hazards and health problems in the society. Assess accessibility, effectiveness, and quality of personal and population-based health services. In addition they are the one organised community efforts in aiming prevention of disease and promotion of health. In relation of this, I select two agencies that will partake the goals of public health.
There are many agencies that have important roles in the society. I chose two agencies which helps contribute health awareness and protection for any kind of diseases; it is the Department of Health (DOH) and National Health Services (NHS).
I will precisely relate this two agency to the two diseases I chose which is the Meningitis and Cerebrovascular Accident.
Department of Health has many roles for the society. This agency focuses on issues related to the general health of the citizenry. It also compiles statistics about health issues of their area. It assesses and assures risk management to human health from the environment properly. Promote and protect the health and wellness of the people within the society and community. Promote and protects the public health to prevent disease and illness. Provides research and information for the detection, reporting, prevention, and control of any diseases or health hazard that the department considers to be dangerous that likely affects the public health. Establish a uniform public health program throughout the community which includes continuous service, employment of qualified employees, and a basic program of disease control, vital and health statistics, sanitation, public health nursing, and other preventive heath programs necessary or desirable for the protection of public health. Gather and disseminate information on causes of injury, sickness, death, and disability and the risk factors that contribute to the causes of injury, sickness, death, and disability within the society for their awareness. Implement programs and campaigns necessary or desirable for the promotion or protection of the public health to reduce and control the disease. DOH develops strategic approaches for current health risks. Establish risk analysis framework and maintenance of risk standards.
http://www.le.utah.gov/interim/2005/pdf/00000306
National Health Services is a publicly funded healthcare systems in United Kingdom, this agency focus on maintaining people’s health and well-being. This agency is responsible for delivering quality and effective health service to humanity. They also contribute fair access to everyone in relation to people’s need. They are responsible for making payments to independent primary care contractors such as GPs, dentists, opticians and pharmacists in rendering their services to all people who needs it. It provides different caring services such as Emergency Respite Care, where care is provided if an individual; are unable to fulfil your caring responsibilities due to unforeseen circumstances, such as illness. Domiciliary Care, where somebody comes into your home and takes over some of your responsibilities for a few hours. Day care centre, where the person you care for spends time at a centre whilst you have a few spare hours to yourself. There are more services rendered by the NHS which develop societies health
http://www.health.gov.au/internet/main/publishing.nsf/Content/36D1CF8D85714DBECA25720D001F6860/$File/quaat3.pdf
http://www.archive.official-documents.co.uk/document/doh/newnhs/wpaper8.htm
In this part, I will investigate the epidemiology of two diseases in graph format and show my understanding and interpretation of the given data:
Meningitis is an infection of the meninges, protective membranes that surround the brain and spinal cord. Infection can cause the meninges to become inflamed and swell, which can damage the nerves and brain. This can cause symptoms such as a severe headache, vomiting, high fever, stiff neck and sensitivity to light. Many people (but not all) also develop a distinctive skin rash.
Symptoms can differ in young children and babies. See the “symptoms” section for more information.
Meningitis can be caused by:
bacteria, such as streptococcus pneumoniae, the bacteria also responsible for pneumonia, which usually live harmlessly in your mouth and throat, and
viruses, such as the herpes simplex virus.
Viral meningitis
Viral meningitis is the most common and less serious type of meningitis. There are approximately 3,000 cases of viral meningitis reported in England and Wales every year, but experts believe the true number is much higher. This is because in many cases of viral meningitis the symptoms are so mild that they can often be mistaken for flu.
Viral meningitis is most common in young children and babies, especially in babies less than one year old.
Viral meningitis usually gets better by itself within a couple of weeks, without the need for specific treatment.
Bacterial meningitis
Bacterial meningitis is extremely serious and should be treated as a medical emergency.
If the bacterial infection is left untreated, it can cause severe damage to the brain and infect the blood (septicaemia), leading to death.
Treatment requires a transfer to an intensive care unit so the body’s functions can be supported whilst antibiotics are used to fight the infection.
There are approximately 2,000 cases of bacterial meningitis in England and Wales every year. The number of cases has dropped sharply in recent years due to a successful vaccination programme that protects against many of the bacteria that can cause meningitis.
The treatment for bacterial meningitis has improved greatly. Several decades ago, almost all people with bacterial meningitis would die, even if they received prompt treatment. Now deaths occur in one in 10 cases, usually as a result of a delay in treatment.
Bacterial meningitis is most common in children and babies under the age of three, and in teenagers and young people aged 15-24.
The best way to prevent meningitis is to ensure that your family’s vaccinations are up to date.
Stroke (cerebrovascular accident)
A stroke happens when the blood supply to the brain is disturbed in some way. As a result, brain cells are starved of oxygen. This causes some cells to die and leaves other cells damaged.
Types of stroke
Most strokes happen when a blood clot blocks one of the arteries (blood vessels) that carries blood to the brain. This type of stroke is called an ischaemic stroke.
Transient ischemic attack (TIA) or ‘mini-stroke’ is a short-term stroke that lasts for less than 24 hours. The oxygen supply to the brain is quickly restored and symptoms disappear. A transient stroke needs prompt medical attention because it indicates a serious risk of a major stroke.
Cerebral thrombosis is when a blood clot (thrombus) forms in an artery that supplies blood to the brain. Blood vessels that are furred up with fatty deposits (atheroma) make a blockage more likely. The clot prevents blood flowing to the brain and cells are starved of oxygen.
Cerebral embolism is a blood clot that forms elsewhere in the body before travelling through the blood vessels and lodging in the brain. In the brain, it starve cells of oxygen. An irregular heartbeat or recent heart attack may make you prone to forming blood clots.
Cerebral haemorrhage is when a blood vessel bursts inside the brain and bleeds (haemorrhages). With a haemorrhage, blood seeps into the brain tissue and causes extra damage.
(2009) (Meningitis). Available from http://www.nhs.uk/conditions/Meningitis/Pages/Introduction.aspx. [Accessed Feb. 24, 2010]
These are the graphs showing the rates of Meningitis and Cardiovascular Accident here in United Kingdom.
Source: PHLS Meningococcal Reference Unit
Disease Trends
Group B- unvaccinated Meningococcal serogroup C
Group C- vaccinated with Meningococcal serogroup C conjugate vaccine (MCC)
Others
Ungroup
This graph table shows the effectiveness of meningococcal conjugate vaccine from 1998 – 2007. As we have seen in the figure, the case reduces every year especially to those who have taken the vaccine. It also shows the successful phased introduction of the meningococcal serogroup C conjugate vaccine (MCC) in 1999 into the National Immunisation Programme in the UK. This graph tells also that the immunity to Meningitis C has been identified in age groups who have not been vaccinated, as bacterium carriage rates are reduced across the population. We can see also in this table that those who didn’t take meningococcal vaccine were greatly affective by Meningitis.
Source: NOIDS England & Wales Final Midi Report for 2005 (Table 3 – Final totals for 2005 by sex and age-group)
Prevalence of Bacterial Meningitis and Septicaemia by Age Group
In this table, we could conclude that ages under 1-4 years old was greatly affected by meningitis as we have seen in the peaks of the graph and 0-11 months was greatly affected by the Pneumococcal and Meningococcal disease. And the same ‘peaks’ in the number of notifications for the ‘under 4 years’ and ’15-24′ age groups can also be seen with meningococcal septicaemia.
Source: NOIDS England & Wales Final Midi Report for 2005 (Table 3 – Final totals for 2005 by sex and age-group)
Prevalence of Bacterial Meningitis (without Septicaemia) by Age Group
This graph shows the high number of notifications of meningococcal and pneumococcal meningitis (without septicaemia) in England and Wales. Observing this graph will note us that the cases in 2005, age group that is 1 year of age are greatly affected with Meningococcal Meningitis and Pneumococcal Meningitis and 15 to 24 years of age were averagely affected with the certain disease. It also illustrates us that among the group cases ‘under 1 year of age’ gets the highest peak in having Pneumococcal disease. It is also interesting to note that the pneumococcal meningitis peaks again in the older age groups (45-64 and 65+).
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This graph shows all the percentages of all six categories are experiencing stroke. Figures for males are in dark gray bars and data for females are in light gray bars, with the number of patients in each age category shown above each bar. All data are patients who are experiencing stroke or CVA. As we observed in the graph the age group from 30 to

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This illustration shows the Incidence Rate of stroke in United States and United Kingdom. Details are articulated as person per year having stroke in 7 age categories. Individual experiencing strokes, person-years of follow-up was defined as the number of years from birth to the date for first recorded stroke. For individual without strokes, person-years of follow-up were defined as the last available follow-up date during the natural history period. Stroke incidence rates are revealed in data chart beneath the graph. As you see the data it’s very clear that a UK male has the highest incidence rates. UK Females, US Males and US Females are mostly like has the same incidence rate in occurrence of CVA.
In this part, I will choose at least two approaches and strategies that control the incidence of one disease and analyse its effectiveness:
As prevention of these diseases and to decrease its rate Department of Health and National Health Services make strategies and campaign to attain their goals. Department of Health formulate the ” Meningitis C Campaign ” the purpose of the this campaign was to immunise as many as possible of the country’s 15 million young people and children aged under the age of 18 years in as short a time as possible, immunising those most at risk of disease first.
Carrying out of the programme was made according to the risk of disease-those at utmost risk being immunised first. In November 1999, National Childhood Programme introduces the routine immunisation of vaccine at the ages of two, three and four months – alongside the DTP, Hib and polio vaccines and in December 1999 adolescent that ages 15 and 17 was also immunised.
As a result of the campaign there are around 13 million children have immunised during the first year through the help of general practitioners, nurses, immunisation coordinators and many other health professional.
This was pursuing by a widespread draw alongside programme to immunise all other children and adolescents up to the age of 18 years in 2000/2001.  After that the vaccine was made accessible to anyone up to 25 years.
National Health Services contributed also a meningitis prevention program here in United Kingdom. The ” Campaign to promote new Vaccine against Meningitis”, this program encouraged all parents to immunised their children against pneumococcal disease which is the causative agent of meningitis. General Practitioners has the big role of this campaign because they are the who will catch-up the campaign for the children ages 0 – 2 years who is starting their immunisations. This program was imposed by Health Minister Dr. Brian Gibbons. He states that: “Immunisation is the best way to protect children from serious disease and the routine childhood programme has been extremely effective in achieving this. The changes will further improve the programme and benefit children. This new vaccine will help save lives and prevent hundreds more cases of serious illness such as meningitis and pneumonia.”
To maximise the defence against Meningitis C and Hib disease NHS made two changes in the routine program. The present three doses of Meningitis C vaccine will be respaced at three and four months of age with a booster shot at 12 months.
Most up-to-date proof shows that the protection offered by this vaccine declines one year after vaccination. To maximise the protection in the first two years of life when the risk of infection is high, we will recommend doses at three and four months of age and a booster dose at 12 months. A booster shot of Hib vaccine will be given at 12 months.
In 1992 Hib vaccine was introduced and is presently given to children at two, three and four months of age. Since 1999, there was a small but slow increase in the number of cases in older children being reported. Again, because of this Meningitis prevention program, the disease declined over time. There was a Hib booster campaign happened in 2003. This dose was given to older children to maximise their immunity. This upturned the small increase in infections that had started to occur. A booster dose of Hib vaccine is being added to the childhood immunisation programme as a routine at 12 months to extend protection against Hib disease.
The new routine vaccination schedule is as follows:
2 months DTaP/IPV/Hib + pneumococcal vaccine
3 months DTaP/IPV/Hib + MenC vaccine
4 months DTaP/IPV/Hib + MenC + pneumococcal vaccine
12 months Hib/Men C
13 months MMR + pneumococcal vaccine
DTaP/IPV/Hib is a single injection that protects against diphtheria, tetanus, pertussis, polio and Hib.
MenC protects against meningitis C
Hib/ MenC is a combined vaccine protecting against Hib and Meningitis C
(2009)( Campaign to promote new Vaccine against Meningitis ) available from www.immunisation.nhs.uk. [Accessed at February 24, 2010]
Due to this campaign the rate of meningococcal infection has fallen every year since, and the cases of laboratory-confirmed group C meningococcal disease across all age groups immunised has go down by 90% since the vaccine was implemented. In 2003/04, there were only 65 cases reported and 8 deaths.
There was even a good effect in those who were not immunised with a reduction of about 70%, recommending that the vaccine has had a community protection effect.
In fact the campaign has been so successful that meningitis C disease now accounts for less than 10% of meningococcal meningitis cases. Even though the campaign made a great success still the health officials and medical professionals need to remain cautious.
(2010) ( Meningitis C Campaign) available from http://webarchive.nationalarchives.gov.uk. [Accessed at February 24, 2010]
. For Cardiovascular Accident prevention, Department of Health formulated new strategies to fall its rate. They formulated the Stroke: Act F.A.S.T. awareness campaign; F.A.S.T means Face, Arm, Speech, and Time.
The Stroke: Act F.A.S.T. awareness campaign aims to teach all health related professionals and the community on the signs of stroke and that prompt emergency treatment can reduce the risk of death and disability.
The campaign will notify the community about F.A.S.T. to call 999. F.A.S.T is a simple examination to help people to identify the signs of stroke and be aware of the importance of fast emergency management.
Campaign adverts, on Television, radio, internet and flyers, illustrate stroke ‘spreading like fire in the brain’ to demonstrate that fast emergency action can limit damage and radically raise a person’s probability of surviving and of avoiding long-term disability.
(2010)( Stroke: Act F.A.S.T. awareness campaign ) available from http://www.dh.gov.uk/en/Publicationsandstatistics. [Accessed at February 24, 2010]
If Department of Health has its campaign towards CVA, National Health Services provide also a program to lessen its incidence rate; The National Stroke Awareness Campaign. This campaign is related to F.A.S.T were NHS implemented that all paramedics should know how to assess a person using F.A.S.T before sending them to hospital.
They also made a Stroke Association who will support this campaign. This kind of charity is exclusively concerned with fighting stroke towards people in all ages. The charity resources research into prevention, treatment, better methods of rehabilitation and facilitates stroke patients and their families directly through its Rehabilitation and Support Services which include Communication Support, Family and Carer Support, information services, welfare grants, publications and leaflets.
In this part, I will investigate current priorities and approaches to the provision of heath services for people with one disease:
Treating Meningitis is not easy thing to do because this disease has various types, viral and bacterial meningitis. There is no treatment for Viral Meningitis. The immune system, will create antibodies to annihilate the virus. Until it is known that a child has viral, not bacterial meningitis, he or she will be admitted to the hospital. But once the finding of viral meningitis is complete, antibiotics are stopped, and a child who is recuperating satisfactorily will be sent home.
Simply acetaminophen must be given to lessen fevers. Clear fluids and a bland diet including preferred foods should be offered. During recovery, a child desires rest in a gloomy, quiet room. Bright lights, noise and guests may irritate a child with meningitis. Increased anxiety on the brain from build-up of fluid in the meninges is a severe problem.
(2010)(Viral Meningitis) available from: http://www.healthscout.com. [Accessed at February 24, 2010)
For Bacterial Meningitis may prove fatal within hours. Patients with suspected acute bacterial meningitis should be immediately admitted to the hospital and assessed for whether LP (lichen planus) is clinically safe. Antimicrobials should be given quickly. If LP is late because a CT scan is essential, antibiotic action should be started before the scan and after blood samples have been attained for culture. When the exact organism is recognized and results of susceptibilities are known, treatment can be customized accordingly. After the diagnosis has been confirmed (generally within 12-48 hours of admission to the hospital), the patient’s antimicrobial therapy can be modified according to the causative organism and its susceptibilities. Supportive therapy, such as fluid replacement, should be continued. Dexamethasone should be continued for Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides.
S pneumoniae (duration of therapy 10-14 days)
Penicillin susceptible (minimum inhibitory concentration [MIC] Penicillin intermediate (MIC = 0.1-1.0 microgram/mL): cefotaxime or ceftriaxone
Penicillin resistant (MIC ≥2.0 microgram/mL) or cephalosporin-resistant (MIC ≥1.0 microgram/mL): vancomycin AND cefotaxime or ceftriaxone.
H influenzae (duration of therapy 10-14 days)
Beta-lactamase-negative: ampicillin
Beta-lactamase-positive: cefotaxime or ceftriaxone.
Streptococcus agalactiae (group B streptococci) (duration of therapy 14-21 days)
Gentamicin AND ampicillin or benzylpenicillin.
Escherichia coli and other gram-negative Enterobacteriaceae: (duration of therapy 21-28 days)
Gentamicin AND cefotaxime or ceftriaxone.
Listeria monocytogenes (duration of therapy 21-28 days)
Gentamicin AND ampicillin or benzylpenicillin.
Staphylococcus aureus (duration of therapy depends on microbiological response of CSF and underlying illness of the patient)
Methicillin susceptible: nafcillin or oxacillin
Methicillin resistant: vancomycin.
Staphylococcus epidermidis (duration of therapy depends on microbiological response of CSF and underlying illness of the patient)
Vancomycin.
Pseudomonas aeruginosa (duration of therapy 21 days)
Ceftazidime and gentamicin.
Enterococcus species (duration of therapy 21 days)
Ampicillin and gentamicin.
Acinetobacter species (duration of therapy 21 days)
Gentamicin and meropenem.
N meningitides (duration of therapy 5-7 days)
Penicillin susceptible (MIC Penicillin intermediate (MIC = 0.1-1.0 microgram/mL): cefotaxime or ceftriaxone.
(2010) (Bacterial Meningitis) available from: http://bestpractice.bmj.com. [Accessed February 24, 2010]
In this part, I will explain by giving examples, the relationship between the prevalence of one disease, its causes and the requirements for health and social care services:
Nowadays United Kingdom is still cautious about Meningitis even though the incidence rate is already decreasing radically. To be safe, health organisation are prioritising women and children’s health. They develop a guideline which suggest about ma
 

Collaborative Working Reflective Essay

Throughout this whole assignment I am going to critically appraise others and my own practice as a collaborative worker via personal reflections and experiences of collaborative working, through experience in professional practice. I aim to link service user improvement and collaboration defining the importance of them both. Furthermore, explaining the various leadership models clarifying why they are important and needed throughout a health care team. I will plan to explain and critically evaluate an experience with the intention to promote positive outcomes for the service environment. Additionally then identifying a service improvement plan, in this case designing a 15minute time management nutritional chart for patients with dementia.
Service improvement
The BW Quality & Safety (2007) defines service improvement, stating it is a combined and constant effort from everyone, including healthcare professionals, patients and their families, researchers, payers, etc. The changes need to lead to better patient outcomes, better quality care and better professional development (see appendix 2). The aim of all health care systems strive to provide safe and good quality health care, improve patient experiences, tackle effectiveness and update practice in the light of evidence from research (RCN 2015).

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Critical analysis of own performance from the Interprofessional capability framework (2009) section OC3/L2, I identified myself as level 2 (see appendix 1). During my district nursing placement, collaborative working is a key when being a nurse in the community. During my placement I interacted with various health professionals across various organisations. I ensured I was knowledgeable about the information I was passing over and I always opted in to interacting with the other professionals to build my confidence.
Collaborative working
The King Fund (2014) recently released a new policy document about “time for change’ bringing ideas together from all sectors to help change the health care and improve collaborative working. The Royal College of Nursing (2004) states collaboration is diverse, ranging from intra-disciplinary teams on an individual setting to multi-agency working practices. Collaboration covers the process of researching, assessing, planning, implementing and evaluation (Thomas 2014).
Critical analysis of my own performance from the Interprofessional Capability Framework (2009) section R2/L2, I identified myself as level 2 (see appendix 1). In multi-disciplinary meetings (MDT), I was co-operative, keen and knowledgeable about the patients. I was eager and asked questions throughout the MDT. I asked question when not understanding and I felt as though the health care professionals valued me as a student because I showed an interested instead of doubting my own knowledge. Weaknesses showed as I felt more nervous to question a doctor if I didn’t feel the statement was correct. Nevertheless, opportunities to share and discuss actions with area for improvements are valued within the health care system (RCN 1995). Additionally, critically analysing another Interprofessional Capability (2009) section CAEP1/L2. I identified myself as level 2 (see appendix 1). Through collaborative working I was able to achieve this capability by engaging myself in discussions about cultural beliefs and awareness, during MDT meetings and general discussion between different sectors, therefore enabling to gain knowledge about the issues within communities of practice.
Service user and collaboration
The Journal of Nursing Management (2010) cited by Francis (2010, p400) dedication, compassion and effective teamwork contribute to the welfare of patients and should be valued. Both nursing and medical staff are entitled to effective collaboration, one of the core values of Interprofessional working should be about respecting the individuals within the team (Barnes 2012). Collaborative practice between disciplines, patients and family result in the highest quality of care and strengthens health care systems, proposing that Interprofessional education is the way forward to producing a “collaborative-practice” ready workforce (Goodman 2010). Reflecting on my first placement, collaborative practice was shown poorly within the team and there was little discussion made throughout the team. This made it difficult for crucial information to be passed on effectively.
Critically analysing my own performance from the Interprofessional Capability Framework (2009) section CW/L2, I identified myself as level 2 (see appendix 1). Effective communication is one of the primary barriers when working to ensure safe, consistent and excellent patient care (Baird 2012). An area of weakness when I communicate with patients is posture, from self-analysis I have noticed that on some occasions I become awkward and am unsure where to stand or how to sit in front of a patient. Hopefully, through self-realisation I will be able to improve in this area on my future placement.
Leadership
The NHS health care system is subject to a pressure of change, throughout these changes the health care industrial requires nursing leaders with special attributes, therefore identifying leaders who are able to guide the profession into a positive future (Sofarelli 1998).
The frameworks that will be critically analysed are The NHS Leadership framework (2011) and NHS Change Model (2013). The NHS Leadership framework (2011) to bring together leadership principles and best practice guidance. The framework delivers a reliable approach to leadership development for staff in health and care throughout the NHS. The NHS Leadership framework is made up of nine leadership styles (see appendix 3). The leadership behaviours are shown on a four-part scale which range from “essential” through “proficient’ and “strong” to “exemplary’.
The NHS Change Model (2013) has a similar aspect about leadership with slight differences as it has been released more recently (see appendix 4). The leadership framework also encourages staff members at all levels across the NHS to become a leader and the main aim for this framework is to encourage everyone working in the NHS to become a leader of change, pushing for everyone’s opinions to gather a general scope of the main issues in the healthcare. So how do leaders inspire staff to participate? Staff members need to be able to be independent, ensuring they can widen their choice of skills (West & Dawson 2012). This will allow greater job satisfaction.
Leadership is important when influencing a group of individuals to achieve a specific and obtainable goal. The style of the leader is essential when influencing change and aiming to achieve a high quality of care. Within leadership there are various types of leadership styles which, depending on your personality, determine which style you will obtain. Collective leadership is known as the most popular leadership style used within NHS healthcare. This style is based upon building relationships with the other health service users, the individual is strong and has passion to support and grow the team (Jackson 2007). This type of style influences and motivates other members, facilitating the development of robust, vibrant and reproductive research cultures (Russell & Stone 2004).The decisions are made within the whole team based on the organisations values and ideals. Additionally, authoritarian leadership is where all the decisions are made without consenting any of the other staff members, negative reinforcement and punishment is often used to enforce rules. This type of style is used when the individual feels power and generally withdraws from the team. The positive aspect about this style is that in an emergency situation little discussion is made and this then enables tasks to be completed promptly. I felt that during first placement authoritarian leadership style was used mainly. This was due to a lack of staff and high demand from the patients. This style seers to be the best for this kind of situation but it also entails negative points.
Critically analysing my own performance throughout placement, I personally feel that I am heading towards becoming a transformational leader, which is very similar to the collective leader. During my first third year placement, I had the chance to lead a small group of team members that were caring for the patients I was in charge of. I needed to make sure I had charisma and confidence, ensuring I motivated the other staff members and allowing me to build relationships with the team. At first I felt embarrassed and unconfident because of my experience compared to others, although after getting to know the team and showing commitment and knowledge, it allowed taking charge easier because I had more respect from the team.
SECOND SECTION
During placement periods as student nurses, we all experience different experiences and various routines dependant on the ward allocated to us. Throughout this section of the assignment, I am going to discuss a placement ward in which I felt there should be an area of change. The reflective model I have chosen to use is Bortons model (Barton 1970). Bortons model simply puts three simple questions to be asked of the experience to be reflected on; What?, So what?, Now what? The model will be incorporated into the reflection to facilitate critical thoughts, relating theory to practice.
In my first year of becoming a nursing student, I was placed on a care of the elderly ward for dementia specialising in Parkinson’s, with around roughly 26 medical beds. This ward was very fast paced and constantly hectic. Throughout the placement, I noticed the patients suffering from severe dementia had various nutritional needs. Weight loss is common in individuals suffering from dementia, caused by poor appetite. This could be due to a variety of problems including communication, depression and pain (Alzheimer’s society, 2013). I noticed that occasionally some patients would not have eaten throughout the whole day or even barely drank fluids due to refusing at meal times; this therefore becomes the patient’s routine because food isn’t incorporated into their daily activity. The main issue with this ward was time management due to the high demand of patients and care needed. This sometimes showed to have a damaging effect on various patients that needed more care and time. PDSA cycle plan is to design a time chart which specifies that a minimum of 15 minutes one-to-one time, needs to be spent with a particular patient. This will then hopefully enable the patient to become familiar with you as the care giver during their meal time.
It occurred to me when on a dementia ward that the patients often go by familiarity despite their memory. For example, some patients would only consume diet and fluids when their relative was around despite not knowing who they are. Therefore, hopefully with my change of plan being put in place, if a member of staff is allocated specific patients for the day and every meal time the care-giver spends 15 minutes with the patient during the period, the likelihood of the patient consuming even a small amount of food is higher than when the patient was not receiving enough quality time.
Additionally to help implement the service improvement, structures known as process mapping and the PDSA cycle (plan, so, study, act) are used. Process mapping enables health professionals to capture the certainty of the patient experiences, following their whole journey to help identify the main problem areas for change. An example of a process map performed is shown in (appendix 5), designing a process map helps to identify the specific problem, which provides clear evidence that a service improvement plan is needed. In this case, a process map was not needed for this service improvement plan. On the other hand the PDSA cycle is used to provisionally trail a change in practice, allowing the team members and patients to assess the impact of the change before implementing it into practice.
Plan
To firstly initiate my plan of change I introduced it into the multi-disciplinary team meeting. This allowed me to help steer and co-ordinate the intervention as well as review my process with the team. Therefore bringing all of the health care professionals together can then be given a stake in the outcome and we can all work to achieve the goal. Clarke (2008) believes that teams without nurses are guaranteed to fail. Additionally tears led by nurses and therapists, however successful, often lack control; therefore doctors must also be a part of the team. This change of plan has been designed purely through observation during my first year placement. Speaking to various service users and family members I gathered together a concern for the patient’s nutritional needs. As well as noticing a strain on the staff I thought assembling a change of plan will relieve the team and prevent stress, hopefully bringing collaborative practice together.
Additionally when implementing a plan of change there will be controversy. Lewin (1951) designed a force field analysis, a strategic tool used to understand what is needed for change in both corporate and personal environments. For example Kurt Lewin (1951) states directly ” An issue is health in balance by the interaction of two opposing sets of forces – those seeking to promote change, known as the driving forces and those attempting to maintain the status quo (restraining forces). Throughout change there will always be individuals willing to contribute to make a change happen, nevertheless there will be restraining forces that resist.
To help with the leadership section for my plan of change, the approach I will use is the transformational style. This will allow me to bring everyone together creating a discussion on everyone’s thoughts and feelings about the plan. It is crucial that the idea set out is agreed by the majority of the individuals, because the plan of change will cost a small amount from the NHS budget, therefore the change needs to be beneficial to the NHS. The Institute for Innovation and Improvement (2013) states currently in the NHS we are facing an unpredictable challenge to improve quality and reduce the cost. Collecting the correct data both quantitative and qualitative at frequent intervals over extended periods allows the health professionals to make an uniformed decision about whether the change is moving the NHS in the correct direction. To enable my plan of change to happen/work I am going to need to ensure I have the involvement of various team members. Therefore allowing the patients to get the specified 15minutes one-to-one time, obviously nurses and health care assistants are going to be my main priority.
Do
To test whether this change of plan is a good idea I am going to perform a pilot study. A pilot study is a methodological introduction, the aim is to develop, adapt and check the possibility of the methods functioning for my service improvement plan (Foster 2013). To test this idea firstly, I discussed the service improvement with members of staff from other wards and family members to gain a general scope of ideas about plan. I performed this because the ward used for my service improvement plan, staff did not work collaboratively therefore I didn’t feel as though I would gain a positive outcome. Nevertheless I decided to use questionnaires with the whole team on the ward. This allowed me to collect the positives and negatives together and analyse whether I have achieved the service improvement. Additionally collecting the information will allow me to predict how long the process will take due to the amount of staff members that are ‘for” my service improvement. Main source of data has come from surveys and questionnaires using a qualitative research approach. Qualitative research is performed in a realistic setting, generally used from research that is collected through interviews and observation (Cleary 2014). Reflecting on this I am able to look back at the data collected and weigh out the pros and cons of my service improvement. I gained feedback from the patient’s family members as well as staff on the ward and on other wards. I feel that I have used a variety of sources to gain an accurate and reliable result.
Study
Merging all of my information/evidence together my main priority was to achieve a summary of the results. I used a matrix framework to bring themes together from the data I collected. This way I could set out the data in various categories to make the research basic. Furthermore with the information, I shared this verbally during multi-disciplinary meetings to put the service improvement plan across a variety of health professionals, gaining a professional feedback. Also discussing the service improvement with family relatives, gaining more of an outside view from individuals that don’t work in the health care. This type of study allowed me to gain precision and feedback from different sectors.
Act
Unfortunately as I am unable to actually perform this service improvement, therefore I need to look at this service improvement plan hypothetically. Reviewing changes of my service improvement plan I am fully aware that this service improvement plan will only work if the ward works collaboratively. Consequently the ward chosen for this, need to aim to improve their leadership skills and their collaboration between the other sectors. To help implement this plan effectively I am going to firstly introduce this plan into breakfast meal times, allowing me to improve small areas more effectively and then eventually open this plan out to all meals. Overall I believe that allowing 15 minutes one-to-one time, whether that is during all meal times or just breakfast will improve patient’s nutritional needs, especially for dementia patients it allows time for familiarity for the patients.
Conclusion
Concluding the whole assignment together prioritising the main issues in this assignment, I feel collaborative practice needs to be used as daily activities within the health care system. It has been clearly shown how essential it is to collaborate in a team and ensure leadership is prioritised. Designing a service improvement plan was a great experience and I now feel confident critiquing services and planning a change, it has helped me realise how much you actually notice during practice placement and the improvements that I, as an individual, can actually make. Overall, l I now hold a greater knowledge about team dynamics, areas of good and bad practice and service user involvement.
 

Completing Thesis: A Reflective Statement

Normally I set date to start my assignments am not a person who starts things earlier and finish it earlier, I set a time to start up things but anyway I finish my work on time. But after the last day of my dissertation advice session I start working on my thesis from that day. In the dissertation advice session the information given to complete the reflective analysis was major cause which helped me in to make my reflective report successfully. That daily dairy idea not only helps me in this project but also for normal activities of my life I started noting some important things.
To complete the thesis I worked practically by talking to lot of people and I did studied lot of books, journals and internet materials and some thesis which is written by some one relates to topic.
t took me almost 2 months to finish this thesis with all my hard work involved in it. When I started doing a thesis I found it difficult as I never did research like this as my previous education is based on exams and question and answer session. But this is the first time I am doing a project with lot of field work and lot of time I spend for understand the logistics management and the challenges faced by them. When I started doing this project I was not guided by any one and I was blank. Because I don’t know what to write and how to start. Then I felt like going slowly to understand the topic first. What the topic says and what are the challenges faced by the apparel industry in logistics market. As one of my friends directed me what thesis is and what is the solution we should find for the topic. Which is set by the university.

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Before working for project I started collecting information’s like articles, journals, websites and books related to supply chain management and logistics. Group discussion held after the advice session was useful that I come to know about the opinions and ideas of my group mates which was different from one another and was very useful. Every day colleagues came with several ideas which were followed by all the members of the group.
But after meeting several people and after getting lot of information about the topic and different answer from different people and different book and journal says different things about the logistics world. It was bit confusing to start with but by setting a time limit to myself to write what I learned every three days. At the end of the month I saw what I wrote after 3 days. Then I consolidate it as a report. These are my basic step I took to start a thesis.
But I find difficult in finding the information practically which is meeting the apparel industry managers and staff. As I find hard to get appointments to get information and the information they provide is not fulfilled my questions. But still I did not lose the hope. I did lot of try at last in few stores like Zara in Croydon high street and M & S in Guildford had a good response to my entire question. I would like to state few of the answers provided by the managers in Zara, M&S and few more stores.
As I had several question relating to the topic. I went to Zara, Next and M&S apparel stores to find out their logistics performance. First one I went is Zara in Croydon high street surrey. Were I found good information about their logistics strategy and the manager of the store started out by saying the apparel manufacturers’ and retailers’ mantra for the new millennium? “Speed to market.” It’s the last leg of the “right product, right market, right time” race – and it’s all about logistics. And he told the companies started concentrating and started investing heavily on investing on logistics as it is the back bone of the fashion industry. If I say you my personal opinion Zara logistics performance is excellent as it is vertical integration to ensure control over supply chain, and proximity.
Zara’s centralized distribution facility gives the chain a competitive advantage by minimizing the lead-time of their goods. Zara’s internally or externally produced merchandise goes to the distribution centre. This is cost-effective due to the close proximities of the distribution centre in Arteixo and their factories in Coruña. In the distribution centre, products are inspected and immediately shipped, since Zara’s distribution centre is a place where merchandise is moved rather than stored. Then, to increase delivery speed, the shipments are scheduled by time zones and shipped by way of air, and land. The typical delivery time within and outside Europe is between 24 to 48 hours.
It was an informative session I had in the Zara store and I was amazed with their logistics performance and the lead time to the shelf is best than all other brand. Like M & S and Next lead time is longer than Zara lead time and these brands are horizontally integrated. But I found there is a disadvantage in vertical integration which I asked this question to a M & S store in Guildford, Surrey. Zara’s strategy also creates some weaknesses. Their vertical integration has more Advantages than drawbacks but it is important to recognize its limitations. Vertical integration often leads to the inability to acquire economies of scale, which means they cannot gain the advantages of producing large quantities of goods for a discounted rate. Higher costs are then incurred for the Inditex Corporation. Inditex also has to support their own high capital investments for their chains and be able to financially back their
“Technology and skills beyond those currently available within the organization”. Zara’s speedy and recurrent introduction of new products incurs increased costs as well. They have higher research and development costs. They also have elevated costs due to the constant changeover of production techniques to create their different apparel lines. That also means that employees must be trained in order to use the new manufacturing techniques, which again leads to increased costs. Traditional retailers do not experience higher costs in all of these areas.
I found lot of information from local shopper till the managers about the logistics performance of lot of the apparel market like TK Maxx, Self Fridge, John Lewis and more. The outcome all are finishing at the end is right product at the right time and reducing the lead time to the shelf is always challenging to the logistics market.
During my collection of information I came across some problem, I shifted from Luton to London in the beginning instance I find difficult in searching books and other related journals, but by the advice given by one of my friend I came to know libraries nearby it helped me in collecting information. I made a timetable for myself every week and worked according to it. Mostly I go to libraries and collect information’s during day and after I return home I took rest for myself for some hours and then go through the information collected by me on that day and will take notes for my thesis.
Once unfortunately I got a call from one of my elder cousin who is working in dubai and when he asked me about my studies I told him that am working for my project and by saying him the topic he gave me phone numbers of some persons who working in logistics sector. The information which was collected by me through phone from logistics managers who are working for ETA groups in middle east countries gave me a detail idea about the challenges which their company face and it was useful for me to research on the basis what exactly affecting apparels. From the day I started working whoever I meet I just put them my dissertation question and take note of the points given by them. For getting additional information and opinions of people I questioned them and comment their ideas and opinion in between which makes them to give answer and which helps me in theoretical argument.
This is where the stage I taught myself how to approach people in collecting information and getting ideas. Each person tell their views what challenges their company face and I came to know that some challenges which are major in some countries are not a big problems in other countries. So then I started my work focus on different countries challenges in port and other clearing process. Then I realised that my ability to research on a issue was improving and I felt much confident. Previously while working for my assignments I compromise if I didn’t get certain information. But I felt that compromise doesn’t wins an argument, so I was very much strict in what I want and I didn’t used any substituent if I couldn’t get information related . I tried and kept pressure on myself to finding things what is needed for me in completing successful thesis.
I find some difficulty in working during weekends after returning from my work. So entirely in the first month I couldn’t able to work for my project during week days. Later I realised that am wasting time and even started working on weekends. This two and half month I heard many people saying even the person who talks with me in phone says your quite reserved than before. This is because my minds always think about the project that i need to submit and most of my words I had with my friends were about my project. Normally I am a talkative guy in nature but this time span made me and showed me a person who listens more than speak. I believe that this field work made me to think and act rather than before. Now I do started following the quote plan and implement. I even feel my patience was more than before.
I even watched some short videos in Google and YouTube and some of the interview posted by people related to logistics and supply chain management as it was in a visualisation mode It helps me more in understanding the concepts and I made it as my hobby whenever I feel bored i use to watch songs but after starting my project I started watching videos related to logistics. It also took me in interesting way and motivated to watch more videos of such type.
After collecting information from different ways like media, books, magazine, newspaper, journals, internet and meeting several professional and non-professional people I came to a understand a change in supply chain strategy and the current supply chain strategy in rapidly developing market.
I couldn’t able to be in contact with my group members often as am far from them so most of my time with them were in phone and I too asked suggestions and gave them suggestions in finding information. And there was a huge difference in the way of working for project among my group mates and the incidents and experience which we shared was useful for us in going to find more information.
To make my work more easier in finding resources I even spoke with some seniors colleagues who finished their masters successfully they told about their time span spend for finishing the thesis and problems faced by them this made me aware to get rid of some problems which I may face in finding and working for data collection.
I even quote a line for myself while going through data collection. That suggestion can be asked from everyone but decision should be decided only by my own.
I felt there was one mistake which I made in this project work is I collected and take notes not in unique order that I should do my project .i mixed notes and it was quite difficult for me to arrange and make it. I get tensed several times because I was not confident and proper and was in a dilemma in making paragraph. I doubt myself which I need to mention first and follow other things. But quietly I came on it and did that accordingly in my best way.
When I finished my theses I felt much happy that I haven’t felt happy like this when I finish my normal assignments. I believe that the effort I insert for this project in double the time which I work for assignments.
After collecting information from different ways like media, books, magazine, news paper, journals, internet and meeting several professional and non- profession people. I come to a understand a change in supply chain strategy and the current supply chain strategy in rapidly developing market.
But after collectively found some information about the topic I put myself in the place of a logistics manager and what will I do if I face this problem. I put myself in lot of question. This I thought because I felt like after my studies I have to face all the challenges and question I am thinking currently. I thought I will inter relate my questions and the challenges faced in my thesis which I did and more over this thesis made me think as a manager for a logistics apparel firm and it put me in a confident that I am capable of taking decision and I am capable of managing a logistics firm and I come to know what are the challenges and what are the disadvantage currently facing by the logistics operation.
 

Reflective Analysis of Contemporary Punishment in the Canadian Society

The Reflective Analysis of Contemporary Punishment in the Canadian Society

Punishment derives from the support of social collective goal that intends to remove criminals and incarcerate dangerous people for their actions. The punitive enforcement of social norms in contemporary western capitalist society have developed strategies to control individuals who are judged and punish them by indeterminate prison sentences (Pratt, 2000, p.35). To what extent is it legitimate in Western societies to punish an offender for the kind of person they are judged to be and to detain an offender on the assumption that they might commit a crime in the future (Pratt, 2000, p.35). The authority that punishes comes from judicial discretion and political discretion which implement authoritative power dynamics and shared values which enforce ideas of punishment over others. Canada has systematically given up its legal right and moral obligation to control the dangerous economic elites. The strengthened state power has criminalized those at the bottom of the increasingly unequal class hierarchy. Crime committed by powerless individuals are seen as threatening to the public but corporate crime is formed to be seen as normal, rationalized and untruthful (Snider, 2001, p.127). Judicial punishment is built on the premise that an individual must maintain the rights to a fair trial and political punishment are enforced by the political mandate which typically enforces coercive punishments (Pratt, 2000, p.40).

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Punishment is important to society and the state because it functions to incorporate forms of suffering, deprivation, and public humiliation as a spectacle of sovereign power. Many forms of punishment do not provide individuals to the right to a fair trial and the nature of punishment is formed by the role of justification that creates different forms of coercion.The infliction of harsh treatment is justified because of punishment and justifications manifest through economic, cultural, and racial inequalities. Corporate abuse of power and its disappearance in law has transformed business, politics and society and has shifted perceptions of punishment which has allowed corporations to abuse their power (Snider, 2001, p.112). As a result, external social constructions influence the implications on the form of a individuals punishment and people are punished for who they are rather than for what they did (Snider, 2001, p.113). The neo-liberal rationality of punishment argues that punishment applies to those who exploit the capital system through criminality. However, Snider argues that, “in law, other formerly criminal activities have been completely deregulated, had their legal sanctions removed and are not inherently wrong” (Snider, 2001, p.112). In the contemporary Canadian society, the shrinking of crime control and the government has meant that people are held responsible for their actions even if they do not have the financial needs to sustain themselves. Neo-liberal views now promote free state rationality and this enforces the idea that individuals will not be punished if they responsible citizens of the state (Snider, 2001, p.113). Punishment then serves to target the unequal more harshly than the authoritative powers of the state which promotes the idea that criminals are negligent and do not uphold the rules and regulations of the law.

Punishment has transformed and incorporated race, class, and gender into the framework of the legal system. Pre trial detention, bail, and plea bargains target specific minority groups and crime is formed through the sanctions formed by the federal, provincial, and municipal laws which shift societies perceptions on the criminal identity. The risks posed by dangerous offenders not only seem to grow but seem to be beyond the capabilities of the modern state to manage. In these respects, the increasing reliance on dangerousness laws illustrate the way in which it has become a much more general form of penal power and of the way in which the boundaries of modern penalty are now being breached in these latest bids to govern the dangerous (Pratt, 2000, p.47). The government adopt punishment from the principles of direct social action, moral sense making, and symbolism of penalty which shape the uses and meaning for punishment. Punishment is presented by culture and punishment acts as a generator for cultural relationships which helps to distinguish the moral from the abnormal (Garland, 1990, p. 249). The communication of penalty is generated through the media and creates symbolism and meaning to the public. The role of media in punishment is to manifest different forms of public opinion and as a result the implications for government policy transform. The expression of punishment is formed on the premise of the deterrence of offenders and as a justification of punishment to the public (Garland, 1990, p. 250).

The criminal justice system and the penal institutions have created importance and the spectacle of punishment has influenced how we understand court drama, architectural symbolism, and social authority that influences the criminal system. The expression of punishment has formed through the political approach to target people through emotional and targetive rhetoric which appeals and persuades people. As a result, political parties use tactics to reassure government power and uphold authority and legitimacy in society. Canadians have recently seen signs of the politicization of crime, the reduction in reliance on expert advice as an informed and moderating voice and growing promotion of prison as an effective solution to crime. The Conservative government has introduced harsh criminal justice legislation characterized by greater use of imprisonment, increased reduction in judicial discretion and a more punitive philosophy of corrections (Webster & Doob, 2015, p. 300).

Parties appeal to the people only when they want to promote their own personal values and be tough on particular crimes. Public attitudes towards offenders and appropriate state responses to crime tend to follow the lead of politicians. The discourse of policy-makers is rendered especially salient in influencing public views (Webster & Doob, 2015, p.301). Senior government officials, politicians and political staff are responsible for criminal justice policies which shape how we delepop, think and implement punishment (Webster & Doob, 2015, p. 303). Cultural values form through discourse and the politicization of crime creates system of punishment which is more punivitive on crime and forms a perception that the offender embodies a permanent criminal identity (Garland, 1990, p. 253). Criminal justice policies for harsh punishment were once believed to be a effective method in reduction of crime. Incarceration was a strategic platform for the government to make the public believe that it would increase public safety against potential offenders. As a result, the public understood the prison system as a viable plan of action in reducing overall crime and reoffending (Webster & Doob, 2015, p.311-312). Crime is now viewed as the result of rational decision making by immoral or ‘bad’ individuals who are considered not only beyond hope or redemption but also unworthy of compassion or even tolerance. Consequently, appropriate punishment must be severe enough to deter others and protect law-abiding citizens (Webster & Doob 2015, p.314).

References

Garland, D. (1990). Punishment as a cultural agent. Punishment and modern society (pp. 249- 276). Chicago: University of Chicago Press.

Pratt, J. (2000). Dangerousness and modern society. In M. Brown & J. Pratt (Eds) Dangerous offenders: Punishment and social order (pp. 35-48). London: Routledge

Snider, L. (2001). Abusing corporate power: The death of a concept. In S. C. Boyd, D. E. Chunn,& R. Menzies (Eds.), (Ab)using power: .The Canadian experience (pp. 112-129), Winnipeg: Fernwood Publishing

Webster, C. M., & Doob, A. N. (2015). US punitiveness ‘Canadian style’? Cultural values and Canadian punishment policy. Punishment & Society, 17(3), 299-321.

Directions:-This assignment is an analytical and reflective essay about why we punish, and why punishmentis important to us. The importance and meaning of punishment in contemporary Canadian society.-Explain your chosen theoretical tool(s) and/or concept(s) by illustrating them throughcontemporary rationales and/or justifications for, approaches to, as well as examples of,punishment.

-You may also include relevant historical considerations (i.e., that are linked to or influencecontemporary practices and/or perspectives).

Tips:In the first paragraph, clearly identify the following:1. The texts you will be drawing on to formulate your argument/critique. (The articlesshould be purposefully chosen.)2. The thesis/main argument of your reflection.3. Main, key ideas/arguments that will be made in the remainder of the paper.In the following paragraphs, provide:1. A critical analysis of the texts. DIG DEEP.2. Connections to key concepts in the course.3. Your voice. Based on our discussions to date, discuss what you think about theimportance and meaning of punishment in contemporary Canadian society.4. You should be responding to, and integrating in, the course literature you have chosen.[What are the arguments/contributions of the texts? Do you have any questions orconcerns? Are there gaps in the arguments or analysis? What were the things you foundinteresting, unsettling, questionable, significant, insignificant…?]

Reflective Journal And Case Study Health And Social Care Essay

Our discussion last Thursday and Friday focused on the Impact of Disease on Health Care Delivery System and Health & Social Care. During that time our tutor Kate gave us an activity which we will cite examples have disease affected those areas of health.
Due to our disserted topic I learned that once a disease happen get through in a community many problems will appear and needs to be solve immediately before it will get worst. To prevent it to happen, many organisation like WHO, DOH, UNICEF etc. made actions to control it but unfortunately still many problems coming up which was all explained by the groups.

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Things like Financial Issues, Supply and Demands, Lack of Awareness and Knowledge, Skills Shortage and Poor compliance are the cited problems in all groups that occur in a community who are affected with any kinds of disease. We come up this idea of some reasons. Why Financial Issues? Because medicines and manpower are not free which means it needs funding to cope this problem especially when a large portion of individuals who are needed to be rendered with health services. Supply and Demands, still related to financial issues. Lack of Awareness and Knowledge, this contributes the problem because if a community is lack of awareness or knowledge about it health they are very vulnerable to illnesses or diseases. Skills Shortage this pertains to the members of health care system, it talks about how effective are they in rendering their services, are they professional and skilled to give services in an efficient and effective way??
Another topic we also considered last week was about case study of Philip, that study is very meaningful to us because its talks about Philips health and family problem. That case study gives us information that Health awareness is vital to a human life and we should take care of ourselves. It also
gives ideas to health practitioner on how to manage a case that has crucial situation and needs immediate attention.
Has this new knowledge changed my understanding? ( have I developed a whole new way of seeing things):
Knowing about the topic we tackled last week enlightened my mind on the importance of caring ourselves and a community as a health practitioner. Hearing those facts make me think that we should take care ourselves in many ways like having enough knowledge in health promotion and disease prevention, regular check up to assess our health status whether we are having illness or not, having healthy habit, diet and lifestyle.
On the other hand also as a health care provider it is our responsibility to provide health teaching on those individuals we know that needs it or even not because doing this promotes health and gives knowledge to them on avoiding any disease problems. In addition, we should be a role model of health to them because this is one of the effective way were they will believe our health teachings and apply it to their selves.
How will I apply this knowledge and understanding in my work situation?
In my situation, there are many cases where I can apply this facts and knowledge I gathered in our last week’s discussion. As we know, we can encounter different case of diseases in care homes both communicable and non-communicable disease and we are aware that we’re susceptible to have that diseases if we are not aware of it. Due to this point, precautions necessary to prevent getting and spread of one disease to another and we can do it by applying the things we discussed about public health in our workplace. In order to avoid ourselves and others from getting any disease we must maintain doing the basic things like hand washing after toileting/diapering, before preparing or eating food, after covering a sneeze or cough, after blowing the nose, before and after treating a sore or wound. Using of proper protective clothing as a first line of defence.
Learning a new topic leads to changes in our knowledge and understanding and should also lead to changes in ways of working.
Identify any new knowledge, facts or theories that I have learnt from this week’s teaching:
Last week, We discussed all the things that are related about public health and itself. I found out that public health is a very broad topic and correlates many components such as health sector, health organisations, etc.
I learned that Public Health is vital in helping people to be aware about their health because it promotes good health, prolongs life and prevents society in getting any kind of diseases. It is also a gathered deed for the health of the certain population.
In dissemination of all the information related to health, there are agencies that are responsible in data distribution. This agencies and sectors are the one who takes the promotion, prevention, planning, action, and implementation of all the goals in regarding health information dissemination.
One of the most common agencies here in United Kingdom is the National Health Service or commonly called NHS. This agency acts as a framework of local organisations responsible for the healthcare of the community and to work with the local community to improve our populations health and well being. There are more agencies that acts or has a role like the NHS in relation to Public Health.
On the other hand Health Organisation has a big role in terms of promoting people in health awareness of the community because they are the one who distribute the health information globally such as World Health Organisation. WHO is the organisation that coordinates and directs for health within the United Nations. WHO leads in providing information about global health matters. Every time there is a new case of disease they are the one that conducts the studies on it and share the information all over the globe. For example, last week we had disserted the topic about the different infectious disease ( Swine Flu, Salmonella, HIV/AIDS, Measles, Meningitis, Tuberculosis , and MRSA ) and Non-infectious Disease ( Cancer, Coronary Heart Disease, Cerebro-Vascular Accident, Obesity, Asthma ) which are the products of the studios of WHO. Without WHO we cant gain access or unknowledgeable about these diseases.
Match
criteria
Has this new knowledge changed my understanding? (have I
developed a whole new way of seeing things)
The topic we discussed doesn’t change my understanding about Public Health. The lesson we take up last week adds information about what I know in public health and it makes me understand that it is very important in building healthy community not only in a certain place but globally.
It also reminds me that as a health practitioner, we have also the responsibility to share what we have learned about promoting health and preventing diseases. Through this way we can help achieved one of the Public Health goal, which is the Health Awareness.
How will I apply this new knowledge and understanding in my work situation?
Like what I have said before, we can apply this knowledge by sharing the information about public health and telling them how to prevent diseases.
In my situation as an Health Care Assistant in a Care Home, I can share what I have learned by telling to all my colleague’s the importance of using protective clothes whilst giving care to a service user and explaining them how to make care a service user who has infectious and non-infectious disease.
INTRODUCTION
In this assignment, for Part 1, I am going to cite two agencies and named their roles in Public Health in terms of identifying level of health and disease in communities. I will name also epidemiology of two diseases and investigate a chart or graphical form of its incident rate. On other hand I will show the Statistical Data of the two diseases and interpret it base on facts and my understanding.
In every agency I will choose two different approaches and strategies in controlling disease and investigate its effectiveness and after that I will make surveillance on how it improves Public Health. In this activity too I need to inspect current priorities to the provision of one disease and gives example on how it relates between prevalence rate, its causes and the requirements for health and social care services. Explore
In Part 2, I will do a case study on a given data or on a workplace experience. Analyse its critical factors that affects individual’s health then after I am going to put its priorities and evaluate its effectiveness to individuals well being. I will proposed as well changes that can improve its health and set it in action like having implementing campaigns to encourage maximize their health.
In this part, I will explain the role of 2 different agencies in identifying levels of health and disease in communities
PUBLIC HEALTH
It is improving and safeguarding well-being. Public Health is in charge for health safety, health enhancement and health inequalities issues in England. It is responsible moreover for shaping policy, allocating resources, co-ordinating actions and supervising progress. Diagnose and investigate health hazards and health problems in the society. Assess accessibility, effectiveness, and quality of personal and population-based health services. In addition they are the one organised community efforts in aiming prevention of disease and promotion of health. In relation of this, I select two agencies that will partake the goals of public health.
There are many agencies that have important roles in the society. I chose two agencies which helps contribute health awareness and protection for any kind of diseases; it is the Department of Health (DOH) and National Health Services (NHS).
I will precisely relate this two agency to the two diseases I chose which is the Meningitis and Cerebrovascular Accident.
Department of Health has many roles for the society. This agency focuses on issues related to the general health of the citizenry. It also compiles statistics about health issues of their area. It assesses and assures risk management to human health from the environment properly. Promote and protect the health and wellness of the people within the society and community. Promote and protects the public health to prevent disease and illness. Provides research and information for the detection, reporting, prevention, and control of any diseases or health hazard that the department considers to be dangerous that likely affects the public health. Establish a uniform public health program throughout the community which includes continuous service, employment of qualified employees, and a basic program of disease control, vital and health statistics, sanitation, public health nursing, and other preventive heath programs necessary or desirable for the protection of public health. Gather and disseminate information on causes of injury, sickness, death, and disability and the risk factors that contribute to the causes of injury, sickness, death, and disability within the society for their awareness. Implement programs and campaigns necessary or desirable for the promotion or protection of the public health to reduce and control the disease. DOH develops strategic approaches for current health risks. Establish risk analysis framework and maintenance of risk standards.
http://www.le.utah.gov/interim/2005/pdf/00000306
National Health Services is a publicly funded healthcare systems in United Kingdom, this agency focus on maintaining people’s health and well-being. This agency is responsible for delivering quality and effective health service to humanity. They also contribute fair access to everyone in relation to people’s need. They are responsible for making payments to independent primary care contractors such as GPs, dentists, opticians and pharmacists in rendering their services to all people who needs it. It provides different caring services such as Emergency Respite Care, where care is provided if an individual; are unable to fulfil your caring responsibilities due to unforeseen circumstances, such as illness. Domiciliary Care, where somebody comes into your home and takes over some of your responsibilities for a few hours. Day care centre, where the person you care for spends time at a centre whilst you have a few spare hours to yourself. There are more services rendered by the NHS which develop societies health
http://www.health.gov.au/internet/main/publishing.nsf/Content/36D1CF8D85714DBECA25720D001F6860/$File/quaat3.pdf
http://www.archive.official-documents.co.uk/document/doh/newnhs/wpaper8.htm
In this part, I will investigate the epidemiology of two diseases in graph format and show my understanding and interpretation of the given data:
Meningitis is an infection of the meninges, protective membranes that surround the brain and spinal cord. Infection can cause the meninges to become inflamed and swell, which can damage the nerves and brain. This can cause symptoms such as a severe headache, vomiting, high fever, stiff neck and sensitivity to light. Many people (but not all) also develop a distinctive skin rash.
Symptoms can differ in young children and babies. See the “symptoms” section for more information.
Meningitis can be caused by:
bacteria, such as streptococcus pneumoniae, the bacteria also responsible for pneumonia, which usually live harmlessly in your mouth and throat, and
viruses, such as the herpes simplex virus.
Viral meningitis
Viral meningitis is the most common and less serious type of meningitis. There are approximately 3,000 cases of viral meningitis reported in England and Wales every year, but experts believe the true number is much higher. This is because in many cases of viral meningitis the symptoms are so mild that they can often be mistaken for flu.
Viral meningitis is most common in young children and babies, especially in babies less than one year old.
Viral meningitis usually gets better by itself within a couple of weeks, without the need for specific treatment.
Bacterial meningitis
Bacterial meningitis is extremely serious and should be treated as a medical emergency.
If the bacterial infection is left untreated, it can cause severe damage to the brain and infect the blood (septicaemia), leading to death.
Treatment requires a transfer to an intensive care unit so the body’s functions can be supported whilst antibiotics are used to fight the infection.
There are approximately 2,000 cases of bacterial meningitis in England and Wales every year. The number of cases has dropped sharply in recent years due to a successful vaccination programme that protects against many of the bacteria that can cause meningitis.
The treatment for bacterial meningitis has improved greatly. Several decades ago, almost all people with bacterial meningitis would die, even if they received prompt treatment. Now deaths occur in one in 10 cases, usually as a result of a delay in treatment.
Bacterial meningitis is most common in children and babies under the age of three, and in teenagers and young people aged 15-24.
The best way to prevent meningitis is to ensure that your family’s vaccinations are up to date.
Stroke (cerebrovascular accident)
A stroke happens when the blood supply to the brain is disturbed in some way. As a result, brain cells are starved of oxygen. This causes some cells to die and leaves other cells damaged.
Types of stroke
Most strokes happen when a blood clot blocks one of the arteries (blood vessels) that carries blood to the brain. This type of stroke is called an ischaemic stroke.
Transient ischemic attack (TIA) or ‘mini-stroke’ is a short-term stroke that lasts for less than 24 hours. The oxygen supply to the brain is quickly restored and symptoms disappear. A transient stroke needs prompt medical attention because it indicates a serious risk of a major stroke.
Cerebral thrombosis is when a blood clot (thrombus) forms in an artery that supplies blood to the brain. Blood vessels that are furred up with fatty deposits (atheroma) make a blockage more likely. The clot prevents blood flowing to the brain and cells are starved of oxygen.
Cerebral embolism is a blood clot that forms elsewhere in the body before travelling through the blood vessels and lodging in the brain. In the brain, it starve cells of oxygen. An irregular heartbeat or recent heart attack may make you prone to forming blood clots.
Cerebral haemorrhage is when a blood vessel bursts inside the brain and bleeds (haemorrhages). With a haemorrhage, blood seeps into the brain tissue and causes extra damage.
(2009) (Meningitis). Available from http://www.nhs.uk/conditions/Meningitis/Pages/Introduction.aspx. [Accessed Feb. 24, 2010]
These are the graphs showing the rates of Meningitis and Cardiovascular Accident here in United Kingdom.
Source: PHLS Meningococcal Reference Unit
Disease Trends
Group B- unvaccinated Meningococcal serogroup C
Group C- vaccinated with Meningococcal serogroup C conjugate vaccine (MCC)
Others
Ungroup
This graph table shows the effectiveness of meningococcal conjugate vaccine from 1998 – 2007. As we have seen in the figure, the case reduces every year especially to those who have taken the vaccine. It also shows the successful phased introduction of the meningococcal serogroup C conjugate vaccine (MCC) in 1999 into the National Immunisation Programme in the UK. This graph tells also that the immunity to Meningitis C has been identified in age groups who have not been vaccinated, as bacterium carriage rates are reduced across the population. We can see also in this table that those who didn’t take meningococcal vaccine were greatly affective by Meningitis.
Source: NOIDS England & Wales Final Midi Report for 2005 (Table 3 – Final totals for 2005 by sex and age-group)
Prevalence of Bacterial Meningitis and Septicaemia by Age Group
In this table, we could conclude that ages under 1-4 years old was greatly affected by meningitis as we have seen in the peaks of the graph and 0-11 months was greatly affected by the Pneumococcal and Meningococcal disease. And the same ‘peaks’ in the number of notifications for the ‘under 4 years’ and ’15-24′ age groups can also be seen with meningococcal septicaemia.
Source: NOIDS England & Wales Final Midi Report for 2005 (Table 3 – Final totals for 2005 by sex and age-group)
Prevalence of Bacterial Meningitis (without Septicaemia) by Age Group
This graph shows the high number of notifications of meningococcal and pneumococcal meningitis (without septicaemia) in England and Wales. Observing this graph will note us that the cases in 2005, age group that is 1 year of age are greatly affected with Meningococcal Meningitis and Pneumococcal Meningitis and 15 to 24 years of age were averagely affected with the certain disease. It also illustrates us that among the group cases ‘under 1 year of age’ gets the highest peak in having Pneumococcal disease. It is also interesting to note that the pneumococcal meningitis peaks again in the older age groups (45-64 and 65+).
Top of Form
Bottom of Form
This graph shows all the percentages of all six categories are experiencing stroke. Figures for males are in dark gray bars and data for females are in light gray bars, with the number of patients in each age category shown above each bar. All data are patients who are experiencing stroke or CVA. As we observed in the graph the age group from 30 to

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This illustration shows the Incidence Rate of stroke in United States and United Kingdom. Details are articulated as person per year having stroke in 7 age categories. Individual experiencing strokes, person-years of follow-up was defined as the number of years from birth to the date for first recorded stroke. For individual without strokes, person-years of follow-up were defined as the last available follow-up date during the natural history period. Stroke incidence rates are revealed in data chart beneath the graph. As you see the data it’s very clear that a UK male has the highest incidence rates. UK Females, US Males and US Females are mostly like has the same incidence rate in occurrence of CVA.
In this part, I will choose at least two approaches and strategies that control the incidence of one disease and analyse its effectiveness:
As prevention of these diseases and to decrease its rate Department of Health and National Health Services make strategies and campaign to attain their goals. Department of Health formulate the ” Meningitis C Campaign ” the purpose of the this campaign was to immunise as many as possible of the country’s 15 million young people and children aged under the age of 18 years in as short a time as possible, immunising those most at risk of disease first.
Carrying out of the programme was made according to the risk of disease-those at utmost risk being immunised first. In November 1999, National Childhood Programme introduces the routine immunisation of vaccine at the ages of two, three and four months – alongside the DTP, Hib and polio vaccines and in December 1999 adolescent that ages 15 and 17 was also immunised.
As a result of the campaign there are around 13 million children have immunised during the first year through the help of general practitioners, nurses, immunisation coordinators and many other health professional.
This was pursuing by a widespread draw alongside programme to immunise all other children and adolescents up to the age of 18 years in 2000/2001.  After that the vaccine was made accessible to anyone up to 25 years.
National Health Services contributed also a meningitis prevention program here in United Kingdom. The ” Campaign to promote new Vaccine against Meningitis”, this program encouraged all parents to immunised their children against pneumococcal disease which is the causative agent of meningitis. General Practitioners has the big role of this campaign because they are the who will catch-up the campaign for the children ages 0 – 2 years who is starting their immunisations. This program was imposed by Health Minister Dr. Brian Gibbons. He states that: “Immunisation is the best way to protect children from serious disease and the routine childhood programme has been extremely effective in achieving this. The changes will further improve the programme and benefit children. This new vaccine will help save lives and prevent hundreds more cases of serious illness such as meningitis and pneumonia.”
To maximise the defence against Meningitis C and Hib disease NHS made two changes in the routine program. The present three doses of Meningitis C vaccine will be respaced at three and four months of age with a booster shot at 12 months.
Most up-to-date proof shows that the protection offered by this vaccine declines one year after vaccination. To maximise the protection in the first two years of life when the risk of infection is high, we will recommend doses at three and four months of age and a booster dose at 12 months. A booster shot of Hib vaccine will be given at 12 months.
In 1992 Hib vaccine was introduced and is presently given to children at two, three and four months of age. Since 1999, there was a small but slow increase in the number of cases in older children being reported. Again, because of this Meningitis prevention program, the disease declined over time. There was a Hib booster campaign happened in 2003. This dose was given to older children to maximise their immunity. This upturned the small increase in infections that had started to occur. A booster dose of Hib vaccine is being added to the childhood immunisation programme as a routine at 12 months to extend protection against Hib disease.
The new routine vaccination schedule is as follows:
2 months DTaP/IPV/Hib + pneumococcal vaccine
3 months DTaP/IPV/Hib + MenC vaccine
4 months DTaP/IPV/Hib + MenC + pneumococcal vaccine
12 months Hib/Men C
13 months MMR + pneumococcal vaccine
DTaP/IPV/Hib is a single injection that protects against diphtheria, tetanus, pertussis, polio and Hib.
MenC protects against meningitis C
Hib/ MenC is a combined vaccine protecting against Hib and Meningitis C
(2009)( Campaign to promote new Vaccine against Meningitis ) available from www.immunisation.nhs.uk. [Accessed at February 24, 2010]
Due to this campaign the rate of meningococcal infection has fallen every year since, and the cases of laboratory-confirmed group C meningococcal disease across all age groups immunised has go down by 90% since the vaccine was implemented. In 2003/04, there were only 65 cases reported and 8 deaths.
There was even a good effect in those who were not immunised with a reduction of about 70%, recommending that the vaccine has had a community protection effect.
In fact the campaign has been so successful that meningitis C disease now accounts for less than 10% of meningococcal meningitis cases. Even though the campaign made a great success still the health officials and medical professionals need to remain cautious.
(2010) ( Meningitis C Campaign) available from http://webarchive.nationalarchives.gov.uk. [Accessed at February 24, 2010]
. For Cardiovascular Accident prevention, Department of Health formulated new strategies to fall its rate. They formulated the Stroke: Act F.A.S.T. awareness campaign; F.A.S.T means Face, Arm, Speech, and Time.
The Stroke: Act F.A.S.T. awareness campaign aims to teach all health related professionals and the community on the signs of stroke and that prompt emergency treatment can reduce the risk of death and disability.
The campaign will notify the community about F.A.S.T. to call 999. F.A.S.T is a simple examination to help people to identify the signs of stroke and be aware of the importance of fast emergency management.
Campaign adverts, on Television, radio, internet and flyers, illustrate stroke ‘spreading like fire in the brain’ to demonstrate that fast emergency action can limit damage and radically raise a person’s probability of surviving and of avoiding long-term disability.
(2010)( Stroke: Act F.A.S.T. awareness campaign ) available from http://www.dh.gov.uk/en/Publicationsandstatistics. [Accessed at February 24, 2010]
If Department of Health has its campaign towards CVA, National Health Services provide also a program to lessen its incidence rate; The National Stroke Awareness Campaign. This campaign is related to F.A.S.T were NHS implemented that all paramedics should know how to assess a person using F.A.S.T before sending them to hospital.
They also made a Stroke Association who will support this campaign. This kind of charity is exclusively concerned with fighting stroke towards people in all ages. The charity resources research into prevention, treatment, better methods of rehabilitation and facilitates stroke patients and their families directly through its Rehabilitation and Support Services which include Communication Support, Family and Carer Support, information services, welfare grants, publications and leaflets.
In this part, I will investigate current priorities and approaches to the provision of heath services for people with one disease:
Treating Meningitis is not easy thing to do because this disease has various types, viral and bacterial meningitis. There is no treatment for Viral Meningitis. The immune system, will create antibodies to annihilate the virus. Until it is known that a child has viral, not bacterial meningitis, he or she will be admitted to the hospital. But once the finding of viral meningitis is complete, antibiotics are stopped, and a child who is recuperating satisfactorily will be sent home.
Simply acetaminophen must be given to lessen fevers. Clear fluids and a bland diet including preferred foods should be offered. During recovery, a child desires rest in a gloomy, quiet room. Bright lights, noise and guests may irritate a child with meningitis. Increased anxiety on the brain from build-up of fluid in the meninges is a severe problem.
(2010)(Viral Meningitis) available from: http://www.healthscout.com. [Accessed at February 24, 2010)
For Bacterial Meningitis may prove fatal within hours. Patients with suspected acute bacterial meningitis should be immediately admitted to the hospital and assessed for whether LP (lichen planus) is clinically safe. Antimicrobials should be given quickly. If LP is late because a CT scan is essential, antibiotic action should be started before the scan and after blood samples have been attained for culture. When the exact organism is recognized and results of susceptibilities are known, treatment can be customized accordingly. After the diagnosis has been confirmed (generally within 12-48 hours of admission to the hospital), the patient’s antimicrobial therapy can be modified according to the causative organism and its susceptibilities. Supportive therapy, such as fluid replacement, should be continued. Dexamethasone should be continued for Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides.
S pneumoniae (duration of therapy 10-14 days)
Penicillin susceptible (minimum inhibitory concentration [MIC] Penicillin intermediate (MIC = 0.1-1.0 microgram/mL): cefotaxime or ceftriaxone
Penicillin resistant (MIC ≥2.0 microgram/mL) or cephalosporin-resistant (MIC ≥1.0 microgram/mL): vancomycin AND cefotaxime or ceftriaxone.
H influenzae (duration of therapy 10-14 days)
Beta-lactamase-negative: ampicillin
Beta-lactamase-positive: cefotaxime or ceftriaxone.
Streptococcus agalactiae (group B streptococci) (duration of therapy 14-21 days)
Gentamicin AND ampicillin or benzylpenicillin.
Escherichia coli and other gram-negative Enterobacteriaceae: (duration of therapy 21-28 days)
Gentamicin AND cefotaxime or ceftriaxone.
Listeria monocytogenes (duration of therapy 21-28 days)
Gentamicin AND ampicillin or benzylpenicillin.
Staphylococcus aureus (duration of therapy depends on microbiological response of CSF and underlying illness of the patient)
Methicillin susceptible: nafcillin or oxacillin
Methicillin resistant: vancomycin.
Staphylococcus epidermidis (duration of therapy depends on microbiological response of CSF and underlying illness of the patient)
Vancomycin.
Pseudomonas aeruginosa (duration of therapy 21 days)
Ceftazidime and gentamicin.
Enterococcus species (duration of therapy 21 days)
Ampicillin and gentamicin.
Acinetobacter species (duration of therapy 21 days)
Gentamicin and meropenem.
N meningitides (duration of therapy 5-7 days)
Penicillin susceptible (MIC Penicillin intermediate (MIC = 0.1-1.0 microgram/mL): cefotaxime or ceftriaxone.
(2010) (Bacterial Meningitis) available from: http://bestpractice.bmj.com. [Accessed February 24, 2010]
In this part, I will explain by giving examples, the relationship between the prevalence of one disease, its causes and the requirements fo
 

Reflective Account Examples Childcare

Reflective account- Conferencing
In taking part of the conferencing it has improved my academic skills and has broadened my knowledge and understanding of different aspects of life. When we first got given the task and were told to start posting comments and forming discussions I didn’t see a big discussion going on within my group but once people were getting the hang of it, then more discussions were made. At first I found it very challenging and I was thinking that people in my group will judge me for what I say and go against everything that I posted. I started to build up my confidence in posting my first comment under social class where I talked about the different social classes that me and my family lived amongst. Also making reference back to some reading and research that I made.

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Looking back at my childhood I was aware of all the different stages of social class from a very young age and this does not only apply to what my family was going though but others around us as well. This is because there were times where I get everything I desired from my father and times were I couldn’t have anything. And as a child this had a big effective on me as it would for other children in not getting what they want. I still think that social class is affecting me and my family in having a lot of financial crisis to overcome. Therefore this makes me became less sociable, in going out with my friends and started to keep my self to my self.
Both of my parents do not work for medical reasons and are on income support therefore at times I feel like I am not getting everything that others are but having traveled aboard and seeing how people were living in absolute poverty it makes me come back and realise how thankful I should be as people are not getting half of what am getting. According to Julian Glover she states that “the poorest people in society are most aware of its impact; with 55% of them saying class, not ability, greatly affects the way they are seen.” This is a clear statement that in today’s society people are judging each other according to their social class/ wealth and not according to a person as an individual.
Being in a low social class can have a great impact within the family. By this I mean the parents can have bad tempers most of the times and can take this out on their children and abuse them, also can cause the parents to have suffer depression. What we see is the lower class areas have been most affected by drugs and crime and it is those aspects that seem to be given more focus than education also this has an impact on the family unit. The family is pivotal in the upbringing of children and if the family unit is unstable then that will no doubt have a domino effect on the children and their future. Also the children may suffer from this be not getting fed healthy, in order for them to have a strong immune system so they don’t become ill and they continue to grow.
In my childhood in Saudi Arabia I was aware of different ethnicities according to different races and cultures but not religions. This is because we had a maid in our house to help my mother with the house work and to look after me, my sister and my brother. She was from Malaysia but has the same religion as us which is Islam. But once I came into the Untied Kingdom I was more aware of different cultures, races and beliefs and especially in the city of Sheffield where it is a multicultural society and a large number of Muslims, Christians, Hindus and many other beliefs.
When I started attending my first primary school I found children from all different ethnic minorities. This was something different to what I was used to seeing in Saudi Arabia as everyone there were from the same race and had the same culture and belief. Once I got into secondary school I started having lessons on religious education in these lessons we covered all different cultures and beliefs. I found it really interesting to learn about other cultures then my own such as Indian, Chinese, Catholic and many more. We were also being able to compare the similarities and differences in marriage ceremonies etc within the different cultures. I decided to take it as a chosen subject in my GCSE’s. This then made me become more aware of ethnicity.
During my childhood I never wearied a head scarf as it is apart of the Islamic religion that a woman should wear it to cover to from any strange men. I wasn’t forced my parents to wear it but in secondary school I had a lot of friends that did wear the head scarf. Is was in year 10 when my friends persuaded me to wear the scarf and I found it as a big step to take but I agreed at the end and started wearing it and never took it off. I felt like I had to overcome a lot of racism because I had chosen to wear the scarf. I was getting racist comments from the boys in my school who were black and used to talk to me before and didn’t like the fact that I covered my hair. Even though my secondary school had 75% of children who were Muslims from different ethnic minorities. Not all the racist comments that I was getting from school but I was getting them from the public as well for example bus drivers just drive past me as am standing in the bus stop with my hand out and the bus is not even full. At first I used to let these things get to me but I realised that some people are not aware of other religions and cultures so therefore they decided to be racist because they went everyone to follow their beliefs. I felt that it was vital that children should be introduced to different ethnic minorities; they should be taught that every religion and belief should be respected.
As I was growing up I was aware of different genders within my family. I have a brother that is seven years older than me and a sister that is three years older than me. When we were young in Saudi Arabia we all shared one big room. I used to see what different roles we got by our parents. For example my brother would be asked to go to the shop and get things that are missing for the house and my sister and I were just ask to tidy our rooms up and little jobs as such. As part of the Islamic religion a women’s role in life is to care for her family and men’s must take on the role of supporter, protector, provider, custodian and servant to the family. This does not mean that a woman should be forced to clean, cook and stay at home no that’s part of their care for their family put a man should no aspect a woman to be doing that all the time. If a woman shows to carry on with her education to gain more knowledge then there is nothing that can stop her from doing so. But this as well goes back to the time where woman were seen to be as house wife’s and can’t even vote etc.
I have come across in many placements that I have worked in children having a firm understanding of gender for example in the games in which girls can play but boys can’t and the opposite. This now where woman and man seem to be equal and settings do tend to follow the anti- discrimination and anti- bias set policies and proceeds.
When I was in Saudi Arabia the schools don’t allow to have mixed genders. Therefore when my sister and I went to school it was girls only. We both enjoyed that and the way that we are all girls and have the same mentality and were able to discuses issues freely.
The final dimension that we had to discuss in our conferencing was disability. In my childhood I was aware of disabled people by seeing them in the media. My siblings and I were looked after by aunty sometimes and she has a speech and language disorders where she couldn’t speak fluently. Another thing was that she would have tantrums and knowing that she is having them. I have also realised that she has the mentality of a child that’s like ten years old even though she is a lot older.
Starting my secondary school I was finding my reading and writing to be very poor. Therefore I seemed to be struggling in my studies but I was fighting myself to do well all the time and to let it but me down. I got to college and during my final year I felt like I was under a lot of pressure and left like I might have a learning difficulty. So I went to the learning support base in college and I asked if I can have a test taken and so I did. The results showed that I was dyslexic and I so therefore I was given extra time in handing my coursework and for my exams. As I started university I tried to apply for disabled students allowance and I sent my college report but the said they don’t accept it. So they offered me to take a test with the university it self so I did and the results turned out to be that am not dyslexic and that I wasn’t eligible to any extra support. Therefore am finding it hard being at university and trying to cope with all the assignments that are been given to me without any additional support.  

Reflective Account of Child GSA

Recently in our house in the month of May this year a young boy has joined as a day student. I will refer to him as Jake in this reflective account (this is not his real name and all relevant information/personal data regarding exact time of the movement has been changed in order to comply with the CSA Confidentiality Policy).

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When Jake first came to the house he of course came as a trial period and he has been accompanied by two other care workers from his former placement/school who knew him very well. This was a transition for him and also for us. His placement with our house was a two day a week. These two days were spread apart into Mondays and Fridays.
In order to assess his needs I believe it is required intensive observation. The information provided from his previous school, parents and care workers/social worker it is very important but I believe that working hands on with him will allow a better understanding and I could make a proper evaluation of his needs according to the new environment and settings that he is currently surrounded by.
When a new student enters our house, everyone’s vigilance/attention and my own it is much higher in order to understand his needs, to assess him and fully understand him as an individual. I believe that everyone it is unique in their own way and to fully assess someone it takes a lot of care, understanding and information in order to take the right decisions for that person and provide the best care /therapeutic program so that they can grow and develop furthermore.
Jake is a very outspoken young man, knows what he wants and has grown a lot in the last months in independence and is more able to deal with changes than when he has first arrived to our house.
As an initial assessment it has been taking into consideration all the information gathered from his previous care plans, statements from care workers, discussion with his parents and most importantly by talking to Jake and finding out what he thinks and wants to do.
CSA uses a series of therapies and therapeutic activities and they are as follows: therapeutic art, music, speech, movement, riding, play, massage, foot bath and counselling. Every child and young adult that is attending school or it is part of a placement with CSA has the available support to benefit from all these activities. These therapeutic activities happen as a one to one situation unless stated otherwise in the child or young person’s care plan. CSA has also a range of workshops available to every student that is in the community. They are as follows: metal, pottery, candle, weaver, felting, green woodwork and garden workshop. These workshops help with the increase of creativity, independence and self esteem which gives the students an incredible sense of achieving once they hold their creations into their own hands and not only also during the creative process.
Discussing with Jake, I quickly found out that he likes video games and that he is very technological. Jake is also a very good communicator which helped me understand quicker what and how I should approach a development care plan and properly assess his needs. Also by reading and asking about him from multiple sources provided but not only, especially through daily observation and working with Jake has been equally important.
At the beginning like I said his trial period consisted in showing him around the house, estate, programmes and workshops. He got to know everyone else from the house residents, day students and co-workers. He has been accompanied for the first month by other two staff members from his previous school and by me. The input from his parents, the information from his school, reading his previous care plan and the information from previous staff who has worked with Jake has helped me assess and better understand Jake’s needs. Jake though has been the one who helped the most in order for us to provide the best care plan and fulfil his needs.
After each day that Jake spends with us it has been recorded in a diary which has helped me make his care plan and his individual risk assessment. They are all kept in the office in his personal file. After his arrival to the house there are 28 days in which I have to provide his care plan and the intended approach. Working with my colleagues, the craft masters, parents, former care workers from his previous school and with Jake’s input I was able to make his care plan. Speaking with everyone involved gives me a better understanding of the whole situation and gives me the opportunity to take the best decisions. After doing so I made sure that everyone from the house who was involved in his care was aware, read, understood and that we all stand together on a common ground and take the same approach. These have been done through multiple meetings regarding Jake with all the personal that was involved in his care.
All observations, assessments and reviews are recorded in his personal file and it is kept in the office of the house and the main office of CSA. Each time he was with us has been documented and recorded his progress in his personal diary which is up to date. His personal file also includes a few incident reports.
The first few times that Jake was with us, actually the first two he was outgoing and very communicative.
In order to asses a child’s needs according to the Children (Scotland) Act 1995 under section 24 it is primordial that it is looked upon at the child needs and it is equally important that it is looked at also at the ability of the carer in order to provide the care. Both parties are actually being assessed by the Council in order to provide the best care and the most relevant support that it is needed.
Meeting this need for Jake, gives us great responsibility in order to bring his development further. When his transition started with the CSA and the house for Jake it has been done through the proper channels.
For example:
Permission from his family in order to gather information that will allow us to understand and create a plan in order to meet up his needs, the discussions in the meetings regarding the assessment and most importantly a one to one get to know the child in a safe environment and space are the basic approach that gave us an insight. After all this a copy of the assessment it is handed over to the family once all this is finalized.

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As a general background Jake is a 7*(not his real age) year old young man and he has been struggling with accessing his education since nursery. He has been diagnosis with ASD and ADHD. When he feels that he is under pressure he has a tendency to present aggressive and violent behaviour. He is also a very chatty young man.
After a period of trial which consisted of Jake being in our house on Mondays and Fridays there has been a review concerning Jake’s updates which was all about his adaptability to the new settings and if we were going on the right track regarding his development and needs. Clearly something needed to be changed if I wanted that this process to work out. Asking my colleagues and the craft masters about what and how I should best support his needs. An idea came that if these would have to work the space between Mondays to Friday should change. The decision was consulted with his parents and with all staff of our house that Jake will attend every day of the week for a shorter period of time in order to make a difference. I find this method to be very efficient and it has been proven with another student of our house and clearly worked. Less time during the day but on a scale that will include the whole week.
Also during this review because of all the disturbing behaviour he was engaging when he was picked up by the taxi and his previous care workers, I decided that this will stop and he should be picked up by his mum or different taxi driver and staff. His mum agreed.
After all this changes Jake has shown a lot of more calm and ease to be with us. He started to engage more in the house and with his co-workers and he started to attend more and more workshops that he has dismissed previously. He had at the beginning a two to one co-worker and now after six months he has progressed to a one to one co-worker.
There are times still when he acts out but he has also learned to have a time out or a break when he needs it. The staff is focusing on the positive behaviour rather than the bad one and once Jake was calm and ready to listen everything has been explained to him. Everyone from the co-workers does the same thing and we all stand together on a common ground in order to help Jake.
Once the plan is set out, everyone is to care it out accordingly. When a set of practice are respected and applicable by everyone in the team as an united front this has proven to give tremendous results in the care of the child/young person’s needs.
As positive child behaviour methods and techniques CSA, uses a series of behavioural techniques which have been specified on page A of this paper. Through art, baking and always teaching them to ask nicely and to say thank you when they expect something to happen. Counselling and trying to make them understand is also a method that CSA uses which has been very effective with Jake. And lastly the consequences for example when they have less than a great day has been proven to be as equally effective when used as a united front.
At home it has been agreed that they should use similar techniques when Jake becomes a little bit less aware/unsettled. For example to keep his bedroom tidy, no video games after 10 and so on.
In order to keep and maintain a positive outcome but most importantly a positive behaviour Jake has agreed that he when overwhelmed will take a break/time out in order to collect his thoughts where he will not feel pressure from staff in order to attend the next activity for example.
In our weekly meeting we discuss and evaluate all sides. Everyone gets the chance to speak and to offer an opinion, support for the work. Once things are discussed especially on improvements and how to best support that positive behaviour within the program I take the decision to sustain or to cancel something that it is less than that.
For example Jake didn’t want to have snack with everyone else so instead was offered to have a picnic outside together with 2 other co-workers and another student which seemed to make Jake very happy. This has been later integrated in his program because of the positive impact it had on Jake.

Reflective Essay on Teamwork

This essay will critically reflect on the process of teamwork, change management and leadership; all issues pertinent to the role of the SCPHN. Barr and Dowding (2008) assert the necessity for leaders to critically reflect effectively, in order to raise their awareness and effect change where needed. Densten and Gray (2001) support this view, adding that leadership development depends on active reflection.

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A peer learning group (PLG) of five was formed; their goal to identify an area for change within their practice, justified by available evidence, and to formulate a plan of implementation. Our group was a mix of School Health and District Nurse SCPHN students, which made it more difficult to identify a common change initiative. However, our group overcame this obstacle and identified low staff morale in the workplace as an area to consider for change. A literature search revealed this to be a feasible initiative. The work of the PLG was to be delivered to an audience of peers through a presentation. We aptly named our team “The Motivators”.
Sullivan & Garland (2010) distinguish groups from teams and discuss the concept of how groups are transformed into teams, and the necessity for a thorough understanding of this process for effective team leadership and management. Morhman et al (1995) define a team as a group of individuals working together to produce a product or service for which they are all mutually accountable. They have a shared goal and are interdependent in it’s accomplishment, their interactions producing the collective result. It is argued that groups differ in that they perform their tasks independently of each other and sometimes also competitively (Sullivan & Garland, 2010).
It has been proffered that working in small teams is conducive to effective learning and involves collaboration and co-operation (Will, 1997). Conversely, Topping (2005) adopts a cynical stance by implying that the application of peer learning strategies by educational establishments is simply gathering together a group of individuals and hoping for the best. Co-operative learning is said to reinforce learning amongst group members through discussion and peer review, while collaborative learning is socially constructed knowledge assuming the negotiation of the individuals different perspectives (Will, 1997). In order to achieve a goal it is essential that teams work cooperatively (Sullivan & Garland, 2010). Further, Clements et al (1997) cite collaboration as the foundation of a healthy team and together with effective communication is key to producing high quality results. Parker (2008) suggests that working collaboratively requires a clear objective and a consensus of opinion when decision making; DFES (2004) reiterate the aspect of shared responsibility in collaborative working.
My own PLG worked both collaboratively and co-operatively, facilitated and evidenced by: a readiness to assume roles within the team, maintaining communication links, regular meetings and the sharing of information resources and ideas. The perspective offered by Slavin (1996) is that of social cohesion; peers helping each other because they want each to succeed. This idea is applicable to my PLG as our presentation was assessed as a joint effort. Sullivan & Garland (2010) maintain that strong group cohesiveness fosters greater personal support and cooperation amongst the group, which again was evident in our group. However, Slavin (1996) acknowledges the constraints of learning in this manner as each team member has limited time/exposure to the other members learning topic. Because our group had different timetables we experienced difficulties meeting up, however we overcame this by maintaining contact via e mail. Oliver (2006) acknowledges the complications that can arise in team-work and Eisenhardt (1997) stresses the need for stability when aspiring to produce optimum performance.
Tuckman, (1965) offered a model comprising four stages, advocating this as the ideal group- decision making process. Adair (2004) purports it to be a problem solving toolkit.
Forming: this did not present us with a problem as we all knew each other. From forming as a group we evolved quickly into:
Storming: this stage enabled the team to grow. We identified an area for change, which was limited by our mixed professional group, and planned our immediate work schedule. We completed a SWOT analysis to identify the strengths and weaknesses we envisaged in implementing the change. No one was immediately willing to take on the mantle of leader so we unanimously elected the person who had initially proposed the change initiative. We exchanged contact details, agreed a time plan and arranged our next meeting.
Norming: is said to occur when the team has developed trust and are working toward a common goal (Adair, 2004). At this time it is likely that some members will forgo their own ideas in order to progress the team function. In this stage all members assume responsibility for the success of the team goal. I was fortunate to belong to a group that worked well together and were well motivated. Due to this degree of co operation we passed through to the final phase quickly:
Performing: At this stage we worked cooperatively on delegated tasks maintaining contact frequently between meetings. We offered each other support and encouragement throughout the process and our team leader encouraged contact and mutual support.
Action learning (AL) has been defined as a continual process of learning and reflection which is supported by colleagues with the ultimate aim of accomplishing a goal (McGill & Beaty, 2001). It has a bottom up approach and is said to promote innovation rather than simply change (Pryjmachuk, 1996). In essence this is what our group did; by coming together to focus on the issues of individual group members and reflecting on them, the group were enabled to proceed with their planned action. Pedlar (2008) describes AL as an approach to problem solving whereby individuals are enabled to develop and form relationships that contrive to enhance the change process. The relationship between research and innovation was highlighted by Lord Darzi (2007).
Most organisations are concerned with effective team working and it is accepted that factors affecting team performance are multi-faceted (McGill & Beaty, 2001). Empirical studies suggest the validity of Belbin’s Self -Perception Inventory (SPI) (Aritzeta et al, 2005). Belbin (1981) developed the SPI to identify the behavioural characteristics of individuals within a team, thus enabling the creation of effectively functioning teams through a creative and appropriate mix (Broucek & Randell, 1996). An Observers’ Assessment (OA) which was later introduced has further increased validity (Belbin, 1994). . Although the tool has received criticism (Furnham et al, 1993), Belbin’s defence was that the tool was not intended as a psychometric instrument (Belbin, 1993b). Our group used a version of the tool (Foundation of Nursing Leadership, 2011) as a learning experience to identify our roles within the team. I emerged as ‘Supporter’ and ‘Questioner’ in equal measure closely followed by ‘Finisher’ (Appendix ). In Belbin’s SPI this would equate to Team worker, Monitor Evaluator and Completer-Finisher. A supporter of Belbin theory suggests that greater control is achieved through the ability to forecast team attitudes (Fisher et al, 2000). I was surprised at how accurate this was for myself although I would not entirely agree. Although we didn’t use the SPI to assess the characteristics of our team prior to beginning the project, it was an interesting and informative task to undertake. It happened that we had a mix of characteristics within our team which perhaps accounted for our collaborative cooperation. However, it has been argued that Maslow’s ‘Hierarchy of Needs’ Model favours the management of organisational dynamics as it maintains motivation through the desire to achieve (Burnes, 2004).
The current re-design of the health service requires a willingness and ability to adapt to change (Institute for Innovation and Improvement, 2011). Efforts to contrive change are unanimously said to be fraught with challenges (Parkin, 1997; MacFarlane et al, 2002), although McWilliam and Ward-Griffin, 2006; Darzi, 2007) argue that healthcare workers have both the mandate and the potential to lead and effect change initiatives. One of the major challenges to change is seen as resistance, which is said to have both positive and negative effects and to be expected by managers implementing change (Sullivan &Garland, 2010). Waddell and Sohal (1998) insist that resistance to change should be utilised and viewed as evaluative material to reassess the proposed change. Pederit (2000) found resistance to reveal valid concerns about proposed change worthy of reconsideration.
Bovey and Hede (2001) argue that resisting change is a natural human behaviour and unavoidable. Fisher & Savage (1999) identify through Personal Construct Theory, a model of personal change – The Transition Curve – (Appendix ), which identifies a process individuals may go through in the transition period of change. Similarly, the stages of grief identified by Kübler Ross (1969) (Appendix ) are also applied to the process of change, although Connor (1998) adapted the sequence in his ‘Cycle of Negative Response’ as he argued the emotions involved in change are less intense. Change is recognised as unsettling so it is logical that the change agent be a settling influence. A theory Y style of management is thought to aid change through it’s liberating and developmental aspects; McGregor espoused the theory that control, achievement and improvement are accomplished through enabling, empowering and giving responsibility (Appendix ).
There appears to be a lack of distinction between resistance and conflict in some of the literature (Parkin, 2009). Parkin differentiates the two by stating the more aggressive and emotional nature of conflict. Our PLG was fortunate in not encountering any conflict at all; DiPaola and Hoy (2001) suggest that large, diverse groups have a greater potential for conflict through the wider differences in objectives and perspectives. As our group was small with common interests and goals, areas for conflict should be minimal. Chuang et al (2004) supports this when arguing that the shared values of nurses promotes greater tolerance and respect, although it has been said that as a group, nurses are apt to avoid conflict to the detriment of effective change implementation (Valentine, 2001). However, Anderson (2005) argues the limitless potential for conflict amongst any group, small or large.
Historically, conflict has been viewed as having a negative impact due to the tensions it creates (Medina et al, 2005) but it has also been asserted that conflict can also benefit team performance (Jehn, 1995). McAdam (2005) suggests that conflict can be both constructive, leading to innovative results or destructive, which hinders innovation. It therefore follows that conflict is better managed rather than resolved. Bruce and Wyman (1998) suggest conflict can be channelled by good management into creativity and positive outcomes. It is important that learning opportunities are not missed through avoiding conflict (Fagan, 1985). Working through conflict can create enhanced understanding, increased motivation and lead to more effective working (Sullivan and Garland, 2010). Crawley and Graham (2002) describe the benefits of healthy conflict as culminating in providing a driver for change.
Nicholson (2011) asserts that leaders can create conditions to either hinder or aid innovation and Bruhn (2004) reiterates this when arguing that leaders set the limits of success by how they manage change. Innovation is currently the popular term within healthcare organisations, implying change with a positive thrust (Parkin, 2009), Pryjmachuk (1996) also supports this reasoning when stating that innovations are seen as welcome, while change is not. Reid (2009) stated the legal obligation on Strategic Health Authorities to promote innovation. Conversely, research suggests change in whatever form remains unpopular, causing stress and conflict (Stewart & O’Donnell, 2007). The literature abounds with a multiplicity of change strategies ranging from the dictatorial approach of ‘controlling’ to those which embrace the ‘involving paradigm’ (Dunphy and Bryant, 1996: 692).
The ‘Motivators’ identified Lewin’s ( 1951) three step approach to change management as an appropriate model to manage the identified change. The model has been dismissed as outdated and simplistic (Dawson, 1994), but according to Burnes (2004) criticism is based on a narrow interpretation of the model. The model should be viewed alongside the other elements of the planned approach: Field Theory; Group Dynamics and Action Research, which combine to create a robust model (Burnes, 2004b; Darwin et al, 2002) and involves:
Unfreezing: is said to refer to reducing the behaviours that maintain the present situation and recognition of the need for change to effect improvement (Goppee & Galloway, 2009). Good communication is a vital element at this stage; good practice would ensure those likely to be affected by the change agree, or at least are cognisant of the need for change (Kotter and Cohen, 2002; Curtis and White, 2002). Involving people in all aspects of the planning and implementation of the change discourages resistance (Curtis and White, 2002). A Gantt chart was developed as a tool to provide a timeframe/schedule for implementing and evaluating the proposed change as advocated by Borril et al (2001) (Appendix ).
Moving: The Gantt chart would provide a framework for revision and review of the change. It would be advisable to check that all those involved with the change are clear and informed about the change and that all other professionals involved are fully aware (Goppee and Galloway, 2009).
Refreezing: refers to the stage when the change has been accepted both emotionally and intellectually by colleagues. The change should be stabilised and reinforced through mechanisms of support such as policy and resources, as appropriate (Goppee and Galloway, 2009). Evaluation of the change is essential; evidence dictates that successful, well performing teams are characterised by the use of measurement in supporting improvement (Darzi, 2008). The use of measurement, benchmarking, and audit are recommended as a means of guiding local improvement and innovation (NHS, 2008., Care Quality Commission, 2009,. DH, 2008). Pre and post change data collection is also considered a valuable means of evaluating a change (DH, 2009; Cooper and Benjamin, 2004).
For change to actually happen requires effective leadership (Darzi, 2009). As SCPHN’s, cultivation of leadership skills is deemed essential to effecting change; NHS (2011) assert that leadership capacity and capability can be cultivated and is a core expectation of practicing professionals (Darzi, 2009). Hogan et al (1994) would refute this, stating the ‘trait’ theory of leadership whereby people are born leaders with inherent leadership characteristics which cannot be learned. Borrill and West (2001) identify leadership as critical in developing effective team working and should maximise the benefits and minimise the weaknesses within the team. Transactional leadership has been commonly used in healthcare (Curtin, 2001), mainly as it lends itself to achieving targets. It is equated by some as being managerial in its style (Finkleman, 2006) with the focus being task and organisation orientated, with sparse attention to the needs of the followers. Conversely, transformational leadership is said to be universally applicable (Bass et al, 1987) inspiring followers to disregard their personal interests for the good of the group or organisation.
We identified the transformational approach as the most appropriate one for both our team and in leading the change in the workplace, as this visionary style actively encourages and embraces innovation and change (Curtin, 2001). Bass (1998) also considers transformational leadership empowering, motivating colleagues to reach and perform to their maximum potential. Conversely Transactional leadership is thought to be inappropriate when teams are demoralised, demotivated or stressed (Stordeur, 2001)
NOTES FOR CONCLUSION
Nurses in the present working climate have to accept necessary changes Not only should they accept changes as they take place, but should also be constantly reviewing working practices and being proactive in implementing changes as and when necessary. If this does not happen, nurses will have to deal with the fallout of changes imposed on nursing by others
Overall, although management skills are important and necessary, the future requires leadership to provide the dynamics essential to challenge and lead organisations into an era where management of rapid change is the necessary key for future survival. Nursing leaders are ideally positioned to influence these changes and to play a major role in facilitating the changes
Transforming Community Services: dh 2009 Ambition, Action, Achievement
Transforming Services for Children, Young People and their Families
Developing and supporting people to design, deliver and lead high quality community services
Actions to consider in developing a ‘social movement approach’ to change owned and lead by local services and practitioners
Transformational change happens when those delivering care are motivated and inspired to do things differently.
The Next Stage Review emphasised the need for a high quality workforce to deliver high quality care and introduced the healthcare professional for the 21st century being ‘practitioner, partner, leader’. Contributors to the programme have built on the concept of practitioner, partner, leader to develop attributes for community practitioners that will generate radical improvement.
Many good initiatives flounder because insufficient attention is paid to the staff themselves and the actions needed to create the climate in which the desired attributes can ensure success. Organisations implementing change will want to consider how they promote such attributes in their own workforce, and the action needed on a number of fronts. How staff are educated and trained, managed and led, how services are commissioned and regulated, and how performance is monitored, can all contribute to the creation of a positive, enabling culture in which staff constantly strive to improve safety, effectiveness and experience of care. Conversely, the same factors can mitigate against empowerment, motivation and personal accountability, reducing the likelihood of success.
Social movement
A group of people with a common ideology who try together to achieve certain general goals; features include:

Energy
Mass
Pace
Momentum
Passion
Commitment
Spread
Sustainability

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PARKER, M. (2008) Team Players and Team Work:New Strategies for the Competitive Enterprise 2nd ed. USA: John Wiley
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Appendix 5
Five stages of grief – Elisabeth Kübler Ross
 
1 – Denial
Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It’s a defence mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored. Death of course is not particularly easy to avoid or evade indefinitely.
2 – Anger
Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps keep detached and non-judgemental when experiencing the anger of someone who is very upset.
3 – Bargaining
Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example “Can we still be friends?..” when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it’s a matter of life or death.
4 – Depression
Also referred to as preparatory grieving. In a way it’s the dress rehearsal or the practice run for the ‘aftermath’ although this stage means different things depending on whom it involves. It’s a sort of acceptance with emotional attachment. It’s natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality.
5 – Acceptance
Again this stage definitely varies according to the person’s situation, although broadly it is an indication that there is some emotional detachment and objectivity. People dying can enter this stage a long time before the people they leave behind, who must necessarily pass through their own individual stages of dealing with the grief.
Based on the Grief Cycle model first published in On Death & Dying, Elisabeth Kübler-Ross, 1969. Interpretation by Alan Chapman 2006-2009.
 

Volunteering Reflective Essay

Audit Assessment
As part of my degree I have been in Placement at Barnardo’s to help develop and acquire my knowledge, skills and values necessary to contribute effectively to the development of integrated practice.
Barnardo’s believe ” every child no matter who they are, what they have done or what they have been through, ensuring their needs are met and their voices and views heard”.(http://www.barnardos.org.uk/what_we_do/barnardos_today/what_we_believe.htm)
Barnardo’s vision is of a world where no child is turned away, there main purpose is to transform the lives of the UK’s most vulnerable children, reaching and helping children who are not heard and their needs unmet.
Working in the community as a voluntary service they defend, safeguard and support children at key moments to change their lives for the better, fighting to change policy practice and public opinion. They are not a social service provision and endeavour to work alongside families providing early intervention, giving the family itself the tools themselves to prevent Social Service involvement later on through practical parenting skills, attachment approaches and nurturing skills. Families self-refer or are referred to the service by schools, social workers, health visitors, G. P’s and school nurses if they feel that the family has a need for support or guidance helping the family overcome and resolve things that they are struggling with or concerned about.

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The services provided can be grouped into CAPSM/ Nurture First– Pre-birth- 5 years, Improved future (5-12years), which relates to families affected to Parental substance misuse, historically or ongoing. Early Years– 0-5y support and mental health team. Attainment- School years P1-3, offering support to increase engagement and school performance. Kinship-support for families with children under the care of their family. Befriending- engagement with children whose families are already functioning with the service.
The service is embedded with procedures and policies that have been delivered down from Scottish and UK legislations and Acts, such legislations stem down mostly from The United Nations Convention on the Rights of a Child and The United Declaration of Human Rights. Acts include, Children and Young People (Scotland) Act 2014, this new version of the act put a system in place to support children and young people and to help detect any problems at an early stage, rather than waiting until a child or young person reaches crisis point. The act also provides extra support for looked after young people in care to try to make sure they have the same opportunities as other children and young people. From this act staff and other agencies have become involved in a collaboratively producing a single child’s plan for each child at a “Team around the child” (TATC) meeting, instead of one per agency. This plan covers the support the child receives, why and how long they will receive it. The service now, because of this act, will offer support and advice to children through to high schools Year 1, but due to funding not children aged 12+. Barnardo’s also constructs it policies and procedures, for example Adoption, Kinship care, Children’s hearings in line with this act, while offering support and advice on accessing the free childcare this act now delivers to 2 and 3 year olds.
The Data Protection Act 1998 is another key legislation enshrined through the service right from the initial Staff Learning plan on the first day with Data Protection training, Safeguarding, IT training and is written through the policies and procedures instructing staff how to handle confidential data and personal details and the SSSC’s Codes of Conduct. The act is set to change in 2017 and Barnardo’s are ready to adapt their procedures ready for this review. Other acts whose principles can be identified in the workings of the Barnardo’s include Equality Act 2010, Child Protection Act 1989, Health and Safety Act, Additional Support for Learning (Scotland) Act 2009.
Steaming from these legislations the service incorporates the frameworks and approaches such as Getting It Right for Every Child (GIRFEC) which is a Scottish approach steaming from the UNCRC and Every Child Matters, which came about after the Victoria Climbie report (which also triggered changes to the Borders Citizenship and Immigration Act 2009, Children’s Act 2004 and created the role of Children’s Commissioner). These approaches have moulded and shaped the training and practice found in Barnardo’s entrenching their values and mission statements. Barnardo’s embrace the attachment theory (Holmes, 1993, Ch. 3) delivering early intervention strategies such as Five to Thrive developed by Kate Cairns which is then fed down into parent groups and all contact with children, reinforcing the need for parents to nurture a child, co regulate using Dr Williams (2011) technique of “Mindfulness” to approach anxiety, stress and depression.
To obtain a position at Barnardo’s you must possess either a HNC, HND (with or without an SVQ 3) or Degree relevant to the job in a range of social work, health, education or community development fields, or, for some posts, relevant experience. The job titles within the service include Project worker (Grades 1,2 and 3), Nurture facilitator, Attainment officer, Team Manager, Assistant Project worker, Children’s services manager, administration, volunteer co coordinator.
In accordance to the Child Protection Act all employees must possess an Enhanced Disclosure and provide at least 2 references, one at least from a previous employer. Upon commencement of a position with in the service Health and Safety training and Safeguarding code of Conduct will be given on the first day along with the corporate safeguarding, child protection policy and professional boundaries policy. This initial training is to protect the individual and the service, acknowledging the role and boundaries of the job, health and safety in the building and while out with service users. The employee is given training on computer usage, private, professional email accounts to maintain confidentiality,
During the following week, the employee will then be trained on Barnardo’s intranet “Bhive” to complete eLearning, Data Protection, Equality and Diversity, further Health and Safety training, Promoting Equality and Valuing Diversity at Work, Whistleblowing, Services Policy handbook, the Complaints Induction and Information Sharing Courses. This initial staff training must be completed in compliance with the Data Protection Act, Child Protection Act and the Equality and Diversity Act as all Barnardo’s staff should be working in alignment with the Codes of Conduct and With Barnardo’s being registered with the Scottish Social. Inverclyde Council provide 3 mandatory training sessions on GIRFEC that staff must attend and Kate Cairns associates deliver Five to Thrive training which is the attachment ethos Barnardo’s is built on.
Services employees must withhold the same values, principles and roles that the service depicts, adhere to the SSSC Code of Conduct with the service being registered and put the child first at all times.
Reference
Books
Cairns, K. (2002). Attachment, trauma and resilience: Therapeutic caring for children. London: British Association for Adoption and Fostering (BAAF). (Cairns, 2002)
Holmes, J. (1993). John Bowlby and attachment theory. New York: Routledge (Holmes 1993, CH 3)
Williams, M. J. G., Penman, D., Kabat-Zinn, J., & Professor of Political Science Mark Williams (2011). Mindfulness: An eight-week plan for finding peace in a frantic world. New York, NY, United States: Rodale Books. (Williams, Penman, Kabat-Zinn, & Professor of Political Science Mark Williams, 2011 p 46-89)
Websites
Barnardo’s – BHive – animation (2017, February 27). Retrieved from https://vimeo.com/103703202
Barnardo’s. (2017). UK’s leading children’s charity. Retrieved February 28, 2017, from http://barnardos.org.uk/
Borders, citizenship and immigration act 2009 – UK parliament. (2009, July 20). Retrieved February 28, 2017, from http://services.parliament.uk/bills/2008-09/borderscitizenshipandimmigrationhl.html
Data protection. (2017, February 27). Retrieved February 28, 2017, from https://www.gov.uk/data-protection
Equality, rights, S., updates, see all, Government Equalities Office, & Equality and Human Rights Commission. (2015, June 16). Equality act 2010: Guidance. Retrieved February 28, 2017, from https://www.gov.uk/guidance/equality-act-2010-guidance
Government, S., House, S. A., Road, R., & ceu, 0131 556 8400. (2013, January 30). Additional support for learning. Retrieved February 28, 2017, from http://www.gov.scot/Topics/Education/Schools/welfare/ASL
Government, S., House, S. A., Road, R., & ceu, 0131 556 8400. (2017, February 27). Getting it right for every child (GIRFEC). Retrieved February 28, 2017, from http://www.gov.scot/Topics/People/Young-People/gettingitright
Health and safety at work etc act 1974 ” legislation explained. (2016, June 30). Retrieved February 28, 2017, from http://www.hse.gov.uk/legislation/hswa.htm.
Leonard, A. (2017). The children & young people (Scotland) act. Retrieved February 28, 2017, from https://www.cypcs.org.uk/policy/children-young-people-scotland-act
SSSC codes of practice for social service workers and employers – Scottish social services council. Retrieved February 28, 2017, from http://www.sssc.uk.com/about-the-sssc/multimedia-library/publications/37-about-the-sssc/information-material/61-codes-of-practice/1020-sssc-codes-of-practice-for-social-service-workers-and-employers
The UN Convention on the rights of the child tenth report of session 2002-03. (2002). Retrieved from https://www.publications.parliament.uk/pa/jt200203/jtselect/jtrights/117/117.pdf
Universal declaration of human rights. Retrieved February 28, 2017, from http://www.un.org/en/universal-declaration-human-rights/index.html

Reflective Analysis of Viva Voce

Introduction
Viva voce and a reflection, both a requirement for successful completion of the course. For somebody not used to this form of assessment process, it is just but normal to ask oneself what? , why? and how?. Although a brief and complete orientation, description and information was provided in the early part of the curriculum, it is only in the end that I have fully understand its significance to my learning. Through the viva voce and a reflective writing that I was able to evaluate myself in terms of what I have learned? (Knowledge), what I can do? (Skills gained), and what I have become? (Attitude)… A competent practitioner. A highlight that I have to address in the Intensive Care Course. For it is in a reflective practise that we gain new understanding and appreciation (Mann et al. 2009).
Description
This is a reflective piece about my viva voce that revolves around my care of a 73 year old male referred to as Mr X, 6 hours post Coronary Artery Bypass Graft. As he became hemodynamically compromised, I have discussed Mr. X’s assessment in relation to a normal physiological compensatory mechanism involve and the care given.
Review of Mr. X history sheet and assessment details found in appendix 1, was suggestive of hypovolemic shock as further supported by his clinical symptoms. Clinically, it can be classified as mild, moderate or severe (Kelly, 2005).
This leads to organ hypoperfusion characterized by tachycardia, hypotension, oliguria, decrease cardiac output and high Systemic Vascular Resistance (SVR) as a result of hypovolaemia. It can be due to excessive fluid loss such as haemorrhage, vomiting, diarrhoea, burns or inadequate fluid intake (Adam and Osborne, 2005).
Strengths and Areas for Development
Stress and anxiety, is always a major predicament that I had been most worried about. I have tried to alleviate this from reading, rehearsing and any other form of preparation needed one would have conceived about. In the end, the anticipation that your next, was the most gruelling.
I believe, I was in its entirety at best well prepared, organized and chronological in my presentation of points and information with some hiccups along the way but acceptable although can be overall improve given the situation.
Upon presentation of Mr. X’s assessment details and laboratory result, and concluded hypovolaemia as a cause of haemodynamic compromise based on supporting evidences, I, at some point, preceded in the discussion of physiological responses as a result of decrease in cardiac output. This is due to decrease in circulating blood volume. His Haemoglobin level was acceptable and there is no signs of active bleeding. During my discussion, I have mentioned about how low circulating blood volume results in decrease End Diastolic Volume (EDV). This stimulates the baroreceptors located at the aortic arch and carotid sinuses to send signal to the medullary centre of the brain which in turn causes the release of adrenalin and noradrenalin by the action of the adrenal medulla (Jevon and Evens, 2008). This supported why Mr. X is tachycardic.

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The human body compensates in various ways through the involvement of different organ system working together to establish haemostasis. In renal response I have mentioned the involvement of the Renin Angiotensin Aldosterone System. Not to be exhaustive with information, this involves the release of renin through the action of the juxtaglomerular cells stimulated because of decrease renal blood flow , which in turn is converted to angiotensin 1 by angiotensinogen. Angiotensin 1 is then transformed by the Angiotensin Converting Enzyme (ACE) predominantly found in the lungs to Angiotensin II, a potent vasoconstrictor. Furthermore, the release of aldosterone from the adrenal cortex causes increase in renal sodium and water retention. A surge in osmolarity in the blood stimulates the release of Antidiuretic hormone (ADH) or vasopressin from the posterior pituitary gland. This results in the reabsorption of solute free water in the distal tubules and collecting system of the kidneys and further stimulates peripheral vasoconstriction (McGloin and McLeod, 2010). With the reabsorption of sodium and water, coupled with vasoconstriction the circulating blood volume is improved thus, result in the increase in the end diastolic volume. This improves muscle contraction of the heart and overall the cardiac output. Hence Mr. X low urine output.
Although I felt satisfied about my presentation of cardiac and renal responses to a decrease in cardiac output, my explanation in regards to metabolic acidosis more specifically in the aspect of cellular anaerobic metabolism was somehow lacking in its content.
Glucose being a major carbohydrate, is a fuel used by cells in our body. Its metabolism travels through a pathway called glycolysis with the end product referred to as pyruvate, a three carbon acid. Inside the cell with mitochondria and oxidative metabolism, this is converted completely into Co2 and water known as aerobic glycolysis (Baynes, n.d.). In contrary, lactic acid is the end product of anaerobic breakdown of glucose in the tissues during persistent oxygen deprivation secondary to an insult caused by decrease circulating blood volume, and owerwhelming of the bodies buffering abilities (Gunnerson et. al. 2013). These explains why Mr. X lactate shows an increasing pattern with a base excess noted at – 5.9.
Familiarity and consistency in my opinion is my area of development. I need to continually update myself with the ever changing needs of the client more so, of the profession. This includes current research based guidelines and policies. From reading books, journals, articles, new discoveries or trends in the field of critical care. More importantly, to continue to look after haemodynamically compromised patients to help facilitate maintain and improve a level of my competency and skills in Intensive care nursing.
Implication for Practice
With the knowledge and skills that I have gained from the viva voce and looking after clients with haemodynamic instability, supported with theory during lectures and mentoring, I am better able to understand what is happening inside the body as is tries to compensates to maintain haemostasis. More importantly, act upon the needs of the patient, and anticipates interventions with rationales for doing so. With the knowledge and skills that I will be bringing back to the unit, I will be able to help enhance the standard of care through mentorship.
References
Adam, S. K. and Osbourne, S. (2005) Critical Care Nursing: Science and Practice. Second Edition. Oxford: Oxford University Press.
Baynes, J. W. (n.d.) Anaerobic Metabolism of Glucose in the Red Blood Cells [online] Available from: http://molar.crb.ucp.pt/cursos/1º e 2º Ciclos – Lics e Lics com Mests/MD/1ºANO/2ºSEM/12-UBA5/TPs/TP1/Baynes Cap11- Metabolismo da Glucose.pdf [Accessed12/12/13]
Jevon, P. and Ewens, B. (2008) Monitoring of the Critically Ill Patient. Second Edition. Oxford: Blackwell Publishing
Kelly, D. M. (2005) Critical Care Nursing. Volume 28, no. 1 pp 2-19. Lippincott. Williams and Williams, inc.
Gunnerson, K et al. (2013) Lactic Acidosis[online] Available from: http://emedicine.medscape.com/article/167027-overview [Accessed12/12/13]
Mann, K., Gordon, J. & MacLeod, A. (2009) Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Practice, 14(4), 595-621. doi: 10.1007/s10459-007-9090-2
McGloin, S. and McLeod, A. (2010) Advance Practice in Critical Care – A Case Study Approach. Oxford. Blackwell Publishing
Appendix 1
On the start of the shift , received a patient in ITU who is 73 years of age, now 6 hours post CABG. He has been weaned off sedation and now ready for extubation. Pre operatively his echo showed good LV. Upon review of his chart showed a blood pressure of 140/60 mmhg. Now fully awake, proceeded with extubation at 20:30. His risk factors are; prev. MI, HTN, DM type 2, high Cholesterol, smoker and TIA x2. At 22:00 his assessment findings are:
HR 110- 120 bpm
BP 85/55 mmhg
MAP 55-60 mmhg
CVP 2
Temp. 36.5
Urine output 25mls/ hr ( Weighs 85kg)
GCS : E4V4M6
Mediatinal drain 25mls –serosanguineous
Bloods:
K+ 4.9 mmol/L
Na 143 mmol/L
Urea 8 mmol/L
Creatinine 80 umol/L
Hb. 9.0 g/L
Hct 35%
WBC 8.4 k/ul
ABG’s
pH 7.29
pCO2 5.54 kPa
pO2 18.4 kPa
HCO3 19.4 mmol/L
BE -5.9 mmol/L
Lactate 1.9 mmol/L
He is on maintenance fluids of 85ml/hour 5% Dextrose, 2L of geloplasma cautiously given against CVP and eventually started on Noradrenaline to achieve a MAP of 70mmhg.