To What Extent Can Logic, Math or Music Be Classified as a Language? Tok

To what extent can logic, math or music be classified as a language? â€Å"Mathematics  is the language with which God has written the universe. † Declares the Italian physicist, mathematician, astronomer, and philosopher Galileo Galilei, when we think in modern sense language is a system of linguistic signs or symbols. In other words it’s the basis of communication. Some people communicate using sign language while others rely on gestures and facial expressions. Mathematics and music may also be used to communicate to some extent. On the other hand logic is only instrumental and it does not house any intention of communication.Mathematics is the systematic arrangement of numbers. These numbers could sometimes be used as a form of secretive code used for communication. Such codes are often used by agencies such as the NSA in exchanging valuable information. Many teenagers also use an alternative alphabet composed mostly of numbers and symbols, leetspeak (or 1337 ). Al though mathematics may be used as a language itself could be able to achieve true meaning while using such means of communication? Is it possible to use this nonverbal communication to express our feelings? We must be blind to truly understand the role of face to face communication in our lives.It would be impossible for you to use irony, connotation and metaphors. For example, if in our secret mathematical code 1446+ meant go away would there be any way to be sure if you said this in a friendly manner or not. This also makes everything vague and unclear. Raw information is put in front of you, you cannot have your own ideas you must accept what is given to you with no objection Music is an essential to most humans, it is a way of coping with life, and it sometimes may even be used to change the mood of the listener. Your mood shapes the music that you listen to.You would not listen to hard rock or metal after a recent breakup instead you will listen to romantic songs. You will also notice that some songs will make you feel happy. For example whenever I listen to a Beatles song let’s say ‘Love Me Do’ a fun/happy feeling forms inside of me. I do not believe that connotation of music is limited with its lyrics. Even when you listen to the tune of Bob Marley’s ‘Don’t Worry Be Happy ‘ you will find yourself feeling happier (positive connotation) businesses use this a lot in their advertisements in order to get the potential customers attention.Although music does have a sense of connotation and is able to shift your mood it cannot be classified as a language as the only knowledge acquired if any is acquired is one way thus there is no communication. For Aristotle, logic is the instrument by means of which we come to know anything. If logic is merely instrument of knowing can we say that it is a language? Could there be language without logic, logic without language? Since we use our own logic to understand the acquired knowledge and there is no intended communication except that of which is with ourselves.Therefore even though logic pays a major role in the apprehension of knowledge it cannot be classified as a language by itself. â€Å"Mathematics is, as it were, a sensuous logic, and relates to philosophy as do the arts, music, and plastic art to poetry. † Once said the German poet, Karl Wilhelm Friedrich Schlegel. Mathematics and music are frequently used to communicate, but without knowledge it would not be possible for us to express our ideas and communicate at all. Therefore we can conclude that mathematics music and language are used integrated with logic forming communication. 0nur Basman () l/l V 2

Primary and Secondary Data Essay

1. PRIMARY ANDSECONDARY DATA We explore the availability and use of data (primary and secondary) in the field of business research.Specifically, we examine an international sample of doctoral dissertations since 1998, categorizingresearch topics, data collection, and availability of data. Findings suggest that use of only primarydata pervades the discipline, despite strong methodological reasons to augment with secondary data. INTRODUCTION Data can be defined as the quantitative or qualitative values of a variable. Data is plural of datum which literally means to give or something given. Data is thought to be the lowest unit of information from which other measurements and analysis can be done. Data can be numbers, images, words, figures, facts or ideas. Data in itself cannot be understood and to get information from the data one must interpret it into meaningful information. There are various methods of interpreting data. Data sources are broadly classified into primary and secondary data.Knowing how the data was collected allows critics of a study to search for bias in how it wasconducted. A good study will welcome such scrutiny. Each type has its own weaknesses andstrengths. Primary Data is gathered by people who can focus directly on the purpose in mind.This helps ensure that questions are meaningful to the purpose but can introduce bias in thosesame questions. Secondary data doesnt have the privilege of this focus but is only susceptibleto bias introduced in the choice of what data to reuse. Stated another way, those who gatherPrimary Data get to write the questions. Those who gather secondary data get to pick thequestions. IMPORTANCE OF DATA AND DATA COLLECTION Data is one of the most important and vital aspect of any research studies. Researchers conducted in different fields of study can be different in methodology but every research is based on data which is analyzed and interpreted to get information. Data is the basic unit in statistical studies. Statistical information like census, population variables, health statistics, and road accidents records are all developed from data .Data is important in computer science. Numbers, images and figures in computer are all data . DATA COLLECTION TECHNIQUES There are two sources of data collection techniques. Primary and Secondary data collection techniques, Primary data collection uses surveys, experiments or direct observations .Secondary data collection may be conducted by collecting information from a diverse source of documents or electronically stored information, census and market studies are examples of a common sources of secondary data. This is also referred to as â€Å"data mining.† PRIMARY DATA Primary data means original data that has been collected specially for the purpose in mind. It means someone collected the data from the original source first hand. Data collected this way is called primary data .Primary data has not been published yet and is more reliable, authentic and objective .Primary data has not been changed or altered by human beings; therefore its validity is greater than secondary data.The people who gather primary data may be an authorized organization, investigator, enumerator or they may be just someone with a clipboard. These people are acting as a witness so primary data is only considered as reliable as the people who gathered it. IMPORTANCE OF PRIMARY DATA Importance of Primary data cannot be neglected. A research can be conducted withoutsecondary data but a research based on only secondary data is least reliable and may havebiases because secondary data has already been manipulated by human beings. In statisticalsurveys it is necessary to get information from primary sources and work on primary data: forexample, the statistical records of female population in a country cannot be based onnewspaper, magazine and other printed sources. One such sourceis old and secondly theycontain limited information as well as they can be misleading and biased. Validity Validity is one of the major concerns in a research. Validity is the quality of a research thatmakes it trustworthy and scientific. Validity is the use of scientific methods in research tomake it logical and acceptable.Using primary data in research can improves the validity of research. First-hand informationobtained from a sample that is representative of the target population will yield data that willbe valid for the entire target population.AuthenticityAuthenticity is the genuineness of the research. Authenticity can be at stake if the researcherinvests personal biases or uses misleading information inthe research. Primary research tools data can become more authentic if the methods chosen to analyze and interpret data arevalid and reasonably suitable for the data type.Primary sources are more authentic because the facts have not been overdone. Primary sourcecan be less authentic if the source hides information or alters facts due to some personalreasons. There are methods that c an be employed to ensure factual yielding of data from thesource. Reliability Reliability is the certainty that the research is enough true to be trusted on. For example, if aresearch study concludes that junk food consumption does not increase the risk of cancer andheart diseases. This conclusion should have to be drawn from a sample whose size, samplingtechnique and variability is not questionable.Reliability improves with using primary data. In the similar research mentioned above if theresearcher uses experimental method and questionnaires the results will be highly reliable.On the other hand, if he relies on the data available in books and on internet he will collectinformation that does not represent the real facts. SOURCES OF PRIMARY DATA Sources for primary data are limited and at times it becomes difficult to obtain data fromprimary source because of either scarcity of population or lack of cooperation. Regardless ofany difficulty one can face in collecting primary data; it is the most authentic and reliabledata source. Following are some of the sources of primary data. Experiments Experiments require an artificial or natural setting in which to perform logical study to collectdata. Experiments are more suitable for medicine, psychological studies, nutrition and forother scientific studies. In experiments the experimenter has to keep control over theinfluence of any extraneous variable on the results.SurveySurvey is most commonly used method in social sciences, management, marketing andpsychology to some extent. Surveys can be conducted in different methods. Questionnaire is the most commonly used method in survey. Questionnaires are a list ofquestions either an open-ended or close -ended for which the respondent give answers. Questionnaire can be conducted via telephone, mail, live in a public area, or in an institute,through electronic mail or through fax and other methods. Interview is a face-to-face conversation with the respondent. It is slow, expensive, and theytake people away from their regular jobs, but they allow in-depth questioning and follow-upquestions.The interviewer can not only record the statements the interviewee speaks but he can observethe body language or non-verbal communication such as face-pulling, fidgeting, shrugging,hand gestures, sarcastic expressions that add further meaning to spoken words and otherreactions to the questions too. A problem with interviews is that people might say what they think the interviewer wants tohear; they might avoid being honestly critical in case their jobs or reputation might suffer.And the respondent deliberately hides information otherwise it is an in depth source ofinformation. So this enables the interviewer to draw conclusions easily. Observations can be done while letting the observing person know that he is being observedor without letting him know. Observations can also be made in natural settings as well as inartificially created environment.Primary data can be relied on because you know where it came from and what was done to it.Its like cooking something yourself. You know what went into it. ADVANTAGES OF PRIMARY RESEARCH Targeted Issues are addressedThe organization asking for the research has the complete control on the process and theresearch is streamlines as far as its objectives and scope is concerned. Researching companycan be asked to concentrate their efforts to find data regarding specific market rather thanconcentration on mass market.Data interpretation is betterThe collected data can be examined and interpreted by the marketers depending on theirneeds rather than relying on the interpretation made by collectors of secondary data. Efficient Spending for Information Unlike secondary research where the marketer may spend for information that is not needed,primary data collections’ focus on issues specific to the researcher improves the chances thatresearch funds will be spent efficiently. Decency of Data Usually secondary data is not so recent and it may not be specific to the place or situationmarketer is targeting. The researcher can use the irrelevant seeming information for knowingtrends or may be able to find some relation with the current scenario. Thus primary databecomes a more accurate tool since we can use data which is useful for us. Proprietary Issues Information collected by using primary research is their own and is generally not shared withothers. Thus, information can be kept hidden from competitors and potentially offer anâ€Å"information advantage† to the company that undertook the primary research. This gives anedge over competitors replying on secondary data. Addresses Specific Research Issues Carrying out their own research allows the marketing organization to address issues specificto their own situation. Primary research is designed to collect the information the marketerwants to know (Step 2) and report it in ways that benefit the marketer. For example, whileinformation reported with secondary research may not fit the marketer’s needs (e.g., differentage groupings) no such problem exists with primary research since the marketer controls theresearch design.Greater ControlNot only does primary research enable the marketer to focus on specific issues, it also enablesthe marketer to have a higher level of control over how the information is collected. In thisway the marketer can decide on such issues as size of project (e.g., how many responses),location of research (e.g., geographic area) and time frame for completing the project. DISADVANTAGES OF PRIMARY RESEARCH High Cost Compared to secondary research, primary data may be very expensive since there is a greatdeal of marketer involvement and the expense in preparing and carrying out research can behigh and has to design everything. Time Consuming To be done correctly primary data collection requires the development and execution of aresearch plan. Going from the start-point of deciding to undertake a research project to theend-point to having results is often much longer than the time it takes to acquire secondarydata, which can be collected in much lesser time duration.Inaccurate Feed-backs In case the research involves taking feedbacks from the targeted audience, there are highchances that feedback given is not correct. Feedbacks by their basic nature are usually biasedor given just for the sake of it. More number of resources is required Leaving aside cost and time, other resources like human resources and materials too are needed in larger quantity to do surveys and data collection. SECONDARY DATA Secondary data is the data that has been already collected by and readily available from othersources. When we use Statistical Method with Primary Data from another purpose for ourpurpose we refer to it as Secondary Data. It means that one purposes Primary Data is anotherpurposes Secondary Data. So that secondary data is data that is being reused. Such data arecheaper and more quickly obtainable than the primary data.These secondary data may be obtained from many sources, including literature, industrysurveys, compilations from computerized databases and information systems, andcomputerized or mathematical models of environmental processes. IMPORTANCE OF SECONDARY DATA Secondary data can be less valid but its importance is still there. Sometimes it is difficult toobtain primary data; in these cases getting information from secondary sources is easier andpossible. Sometimes primary data does not exist in such situation one has to confine theresearch on secondary data.Sometimes primary data is present but the respondents are not willing to reveal it in such casetoo secondary data can suffice: for example, if the research is on the psychology oftranssexuals first it is difficult to find out transsexuals and second they may not be willing togive information you want for your research, so you can collect data from books or otherpublished sources. SOURCES OF SECONDARY DATA Secondary data is often readily available. After the expense of electronic media and internetthe availability of secondary data has become much easier.Published Printed SourcesThere are varieties of published printed sources. Their credibility depends on many factors.For example, on the writer, publishing company and time and date when published. Newsources are preferred and old sources should be avoided as new technology and researchesbring new facts into light. Books Books are available today on any topic that you want to research. The uses of books startbefore even you have selected the topic. After selection of topics books provide insight onhow much work has already been done on the same topic and you can prepare your literaturereview. Books are secondary source but most authentic one in secondary sources. Journals/periodicals Journals and periodicals are becoming more important as far as data collection is concerned.The reason is that journals provide up-to-date information which at times books cannot andsecondly, journals can give information on the very specific topic on which you areresearching rather talking about more general topics. Magazines/Newspapers Magazines are also effective but not very reliable. Newspaper on the other hand is morereliable and in some cases the information can only be obtained from newspapers as in thecase of some political studies. Published Electronic Sources As internet is becoming more advance, fast and reachable to the masses; it has been seen thatmuch information that is not available in printed form is available on internet. In the past thecredibility of internet was questionable but today it is not. The reason is that in the pastjournals and books were seldom published on internet but today almost every journal andbook is available online. Some are free and for others you have to pay the price. E-journals: e-journals are more commonly available than printed journals.Latest journals are difficult to retrieve without subscription but if your university has an e-library you can view any journal, print it and those that are not available you can make anorder for them.General Websites; Generally websites do not contain very reliable information so theircontent should be checked for the reliability before quoting from them.Weblogs: Weblogs are also becoming common. They are actually diaries written by differentpeople. These diaries are as reliable to use as personal written diaries. Unpublished Personal Records Some unpublished data may also be useful in some cases. Diaries: Diaries are personal records and are rarely available but if you are conducting adescriptive research then they might be very useful. The Anne Franks diary is the mostfamous example of this. That diary contained the most accurate records of Nazi wars. Letters: Letters like diaries are also a rich source but should be checked for their reliabilitybefore using them. Government Records Government records are very important for marketing, management, humanities and socialscience research. Census Data/population statistics Health records Educational institutes records Public Sector Records NGOs survey data Other private companies records ADVANTAGES OF SECONDARY DATA Ease of AccessThere are many advantages to using secondary research. This includes the relative ease ofaccess to many sources of secondary data. In the past secondary data accumulation requiredmarketers to visit libraries, or wait for reports to be shipped by mail. Now with theavailability of online access, secondary research is more openly accessed. This offersconvenience and generally standardized usage methods for all sources of secondary research.Low Cost to AcquireThe use of secondary data has allowed researchers access to valuable information for little orno cost to acquire. Therefore, this information is much less expensive than if the researchershad to carry out the research themselves. Clarification of Research Question The use of secondary research may help the researcher to clarify the research question.Secondary research is often used prior to primary research to help clarify the research focus. May Answer Research Question The use of secondary data collection is often used to help align the focus of large scaleprimary research. When focusing on secondary research, the researcher may realize that theexact information they were looking to uncover is already available through secondarysources. This would effectively eliminate the need and expense to carry out their ownprimary research. May Show Difficulties in Conducting Primary Research In many cases, the originators of secondary research include details of how the informationwas collected. This may include information detailing the procedures used in data collectionand difficulties encountered in conducting the primary research. Therefore, the detaileddifficulties may persuade the researcher to decide that the potential information obtained isnot worth the potential difficulties in conducting the research. DISADVANTAGES OF SECONDARY DATA Quality of Research There are some disadvantages to using secondary research. The originators of the primaryresearch are largely self-governed and controlled by the marketer. Therefore, the secondaryresearch used must be scrutinized closely since the origins of the information may bequestionable. Moreover, the researcher needs to take sufficient steps to critically evaluate thevalidity and reliability of the information provided.Not Specific to Researcher’s NeedsIn many cases, secondary data is not presented in a form that exactly meets the researcher’sneeds. Therefore, the researcher needs to rely on secondary data that is presented andclassified in a way that is similar to their needs.Incomplete InformationIn many cases, researchers find information that appears valuable and promising. Theresearcher may not get the full version of the research to gain the full value of the study. This is because many research suppliers offer free portions of their research and then chargeexpensive fees f or their full reports. Not Timely When using secondary research, one must exercise caution when using dated informationfrom the past. With companies competing in fast changing industries, an out-of-date researchreports many have little or no relevance to the current market situation. EVALUATION OF SECONDARY DATA Because of the above mentioned disadvantages of secondary data, we will lead to evaluation of secondary data. Evaluation means the following four requirements must be satisfied:- 1. Availability- It has to be seen that the kind of data you want is available or not. If it is not available then you have to go for primary data. 2. Relevance- It should be meeting the requirements of the problem. For this we have two criterion:- a. Units of measurement should be the same. b. Concepts used must be same and currency of data should not be outdated. 3. Accuracy- In order to find how accurate the data is, the following points must be considered: – a. Specification and methodology used; b. Margin of error should be examined; c. The dependability of the source must be seen. 4. Sufficiency- Adequate data should be available.Robert W Joselyn has classified the above discussion into eight steps. These eight steps aresub classified into three categories. He has given a detailed procedure for evaluatingsecondary data. 1. Applicability of research objective. 2. Cost of acquisition. 3. Accuracy of data. CONCLUSION Primary research entails the use of immediate data in determining the survival of the market.The popular ways to collect primary data consist of surveys, interviews and focus groups,which shows that direct relationship between potential customers and the companies.Whereas secondary research is a means to reprocess and reuse collected information as anindication for betterments of the service or product.Both primary and secondary data are useful for businesses but both may differ from eachother in various aspects. In secondary data, information relates to a past period. Hence, it lacksaptness and therefore, it has unsatisfactory value. Primary data is more accommodating as itshows latest information.Secondary data is obtained from some other organization than the one instantaneouslyinterested with current research project. Secondary data was collected and analyzed by theorganization to convene the requirements of various research objectives. Primary data isaccumulated by the researcher particularly to meet up the research objective of the subsistingproject.Secondary data though old may be the only possible source of the desired data on thesubjects, which cannot have primary data at all. For example, survey reports or secret recordsalready collected by a business group can offer information that cannot be obtained fromoriginal sources.Firm in which secondary data are accumulated and delivered may not accommodate the exactneeds and particular requirements of the current research study. Many a time, alteration ormodifications to the exact needs of the investigator may not be sufficient. To that amountusefulness of secondary data will be lost. Primary data is completely tailor-made and there isno problem of adjustments.Secondary data is available effortlessly, rapidly and inexpensively. Primary data takes a lot oftime and the unit cost of such data is relatively high.Often secondary data have been pre-processed to give totals or averages and the original details are lost so you cant verify it byreplicating the methods used by the original data collectors.In short, primary data are expensive and difficult to acquire, but they are trustworthy.Secondary data are cheap and easy to collect, but must be treated with caution. REFERENCES 1. http://www.ianswer4u.com/2012/02/primary-research-advantages- and.html#ixzz2B6ioqOwT 2. http://www.worldbank.org/poverty/impact/methods/datacoll.htm 3. Bryman, A. and E. Bell: 2003, Business Research Methods (Oxford University Press, Oxford, New York). 4. Dillman, Don A. Mail and Telephone Surveys: The Total Design Method. New York, John Wiley and Sons, 1978. 5. Galpin, T. The Use of Mail Questionnaires as a Method of Data Collection. (Sept, 1987) 14 of 15

Outline the current legislation covering home based childcare and the role of regulatory bodies Essay

?Legislation regulating home based child carer’s and the role of Ofsted the regulatory body All people working with children are governed by legislation that is in place to protect your children and the child care provider. In this document I have listed four important legislations that are of particular importance to home based child care providers and noted how I aim to incorporate them into my practice. Child care practitioners also have a regulatory body; in England it is Ofsted. This document gives you a brief description of their supervisory role in child care settings. However, the list of legislation is not comprehensive and nor is the short description of Ofsted’s Role, if you would like more information or would like to discuss anything written in this leaflet, please ask and I would be happy to provide you as a parent with more details. Children’s Act 1989 & 2004 The first time Children’s rights were recognised under UK Law was in the Children’s Act 1989, which summarised, means ‘the needs of the child are paramount’ (Riddall-Leech 2010 p18). Later, in 2004, the Every Child Matters agenda was born. This is the primary legislative Act that all childcare practitioners must observe. It outlines five conclusions that all children should meet. These are – Be healthy, stay safe, enjoy and achieve, make a positive contribution and achieve economic well-being. My childcare practice is committed to achieving all the outcomes of the every child matters charter by: – Be healthy By serving homemade healthy balanced meals and snacks. Providing daily opportunities for physical activity both indoors and outside. Ensuring a smoke free environment. Stay safe Everyone who frequently visits the setting including myself and my assistant have enhanced disclosures. There is a zero tolerance of bullying and all children are helped to understand their behaviour if they cause upset or bullying to another child. Enjoy and achieve By providing ample opportunities to experience new environments and activities. Tailoring activities to your child’s likes, needs and working in collaboration with you the parents and any other child care provider you may have. By being supportive, encouraging and positively feeding back to both your child and you. Make a positive contribution By building a trusting positive relationship built on mutual respect. Giving your child the time and attention and to listen to them so they gain confidence feel a part of our community within the setting. Achieve economic well being Although this is a difficult task to achieve for a child care provider in early years I believe we help to set up the foundations of this by teaching the basics of money, the importance of education and by igniting the ambition for knowledge and learning. Childcare Act 2006 When this act was introduced in 2006 it brought about huge changes to home based child care. It requires all child care provider’s to register with Ofsted, the regulating body and that all children up to the age of 5 in child care learn and develop well using the Statutory Early Years Foundation Stage Framework. By using carefully planned monthly topics and activity schemes it will ensure that all adult led and some of the child led play meets the various learning and development goals of the Early Years Foundation Stage. Through observation, both planned and spontaneous, the monthly planned schemes will be tailored to your child’s individual needs and ensure that they are developing to the best of their potential. The learning plans are always available for you to view and you will be able to view your child’s achievements in their ‘Unique Story’ book which will include all observations, examples and photos of their work and anything else your child would like to put in there for you to see. There will also be space for you to write and comment. This act has replaced all previous dicrimation laws and combined them into one Act to protect people from discrimation. Discrimation can come in many forms including religion, beliefs or the lack of either, age, race, disability, nationality and the list goes on. This law proctects people from prejudice and allows legal action to be taken against any person or company who is proven to have unfairly treated any of the protected groups covered by this Act. Everyone is welcome at my childcare service and we strive to ensure that the children learn about the importance of inclusion and the acceptance of others. I try to explain that in many cases it can just be fear of not knowing or understanding but this makes for a fantasic learning experience to discuss and learn about other peoples religions, cultures and so forth and that differences are good. In our play room there are many books, puzzles, pictures and other toys that promote the inclusion and acceptance of all groups of people including disabled, black and other ethnicities and the elderly but to name a few. You may also like to read the equal opportunites policy. The Data Protection Act 1998 The 7th Data Protection principle states ‘The Data Protection Act 1998 requires all organisations to have appropriate security to protect personal information against unlawful or unauthorised use or disclosure, and accidental loss, destruction or damage’ (ICO, 2012. P10). It referes to information that is kept on file whether it be electronically stored, i. e. on a hard drive, a flash drive or paper copies. The Act also gives individuals the right to request copies of all information a business may hold on them within 40 days of the request. The security and protection of yours and your child’s personal information is extremely important. Any information held will be password protected on a computer which has a firewall, Anti-virus software, mal-ware and spy-ware protection, all of which are kept up to date at all times. Your information will never be shared with anyone without your explicit consent, unless it is felt that there was a child protection issue. Any paper documentation is shredded if it is no longer required and we are registered with the Information Commissioner’s Office who is the Regulatory Authority. The Home Based Child Carers Regulatory Body Here in England, home-based child carers are regulated and controlled by Ofsted who have four main processes. These processes are in place to ensure that the prospective child care practitioner meets and maintains all the requirements of a suitable carer including understanding and providing learning and development as required by the Statutory Framework in the Early Years Foundation Stage document. They also make sure that the welfare of the children can be met and are continuing to be met after registration. It begins with the process of registering with Ofsted who ensure that the potential carer and any other adult living or working with the practitioner have suitable disclosure checks and are healthy enough to care for children. The carer must also complete the prescribed training including First Aid. Once the carer has been registered, Ofsted make regular checks in the form of inspections to ensure that the setting is being maintained to the required standard, that the carer is continuing to sustain the right environment for the children to learn and develop whilst being kept safe and cared for. The inspector will write a report and grade the child-minder based upon his or her observations during the inspection. These reports should then be made available to parents and are published on the Ofsted website. If a complaint or a concern is made, it is Ofsted’s role to investigate the practitioner and their setting to ensure that they are fulfilling all their safeguarding and welfare demands, regardless and in addition to any inspection that has been carried out. If the investigation shows that the setting is failing in their requirements it is down to Ofsted to enforce changes or to take action against the child carer and the setting. Ofsted help parents and guardians by providing them with information about the setting thereby they can make an informed choice when choosing their child carer for their child/ren. ___________________________________________________________________ Thank you for taking the time to read my leaflet. I hope you found it useful. If you require any further information or if you require this document is larger print and/or another language please let me know. For other languages I will use an online translation service which may take some time please allow 14 days. Thank you. Bengali: This / - ? 14 Chinese: / , 14 Polish: Dziekujemy za poswiecenie czasu na przeczytanie mojej ulotce. MAM nadzieje, ze warto. Jezeli wymagane sa dodatkowe informacje lub jesli chcesz, aby ten dokument jest wiekszy drukuj i/lub innego jezyka prosze da mi zna . W innych jezykach bede korzysta on-line tlumaczenia uslugi, ktora moze zajac troche czasu trwa 14 dni. Dziekujemy. Slovak: Dakujeme vam za as, ktory itat moje letaku. Dufam, ze ste nasli uzito ne. Ak mate zaujem o dalsie informacie alebo ak potrebujete tento dokument je va sie vytla it a/alebo inom jazyku dovolte mi vediet. Pre ine jazyky budem pouzivat on-line prekladatelske sluzby, ktore vsak moze trvat nejaky as prosim nechajte 14 dni. Dakujeme vam. Urdu: . . . . 14 . . Bibliography Riddall-Leech, S (2013) Home-based Childcare For childminders and nannies. Essex: Pearson Education Limited Information Commissioner’s Office (2012) Introduction to The Data Protection Act 1998. [Online] Available from: http://www. ico. org. uk/~/media/documents/library/Corporate/Research_and_reports/ico_presentation_EVOC_20120528. ashx [Accessed: 11th October 2013] Government Equalities Office (2013) Equalities Act 2010: Guidance. [Online] Available from: https://www. gov. uk/equality-act-2010-guidance [Accessed: 11th October 2013] Parliament UK (2010) The Role and Performance of Ofsted : Memorandum submitted by National Childminding Association. [Online]

Prolific effects of civil war on medicine Research Paper

Prolific effects of civil war on medicine - Research Paper Example Period prior to war During the time prior to the civil war, medical personnel’s received minimal training. Even those doctors who had attended medical institutions were poorly trained. This is because in America, medical students received only two years or less of training, gained no clinical or laboratory training experience due to lack of instructions. When civil war began in 1861, the army had only 98 medical doctors, and Confederacy had 24. The army recruits received only physical examination giving room for soldiers to enter the federal army camp with physical defects and chronic illnesses that would affect their performance at the battlefield as soldiers. The newly recruited soldiers were sent to large camp to gain skills and learn how to become soldiers. The first challenge they faced was disease even healthy soldiers were affected by illnesses that easily spread due to large concentration of people in the camp. In addition, the spread of these diseases was aided by poor diet of soldiers and unsanitary conditions in the camps which led to many people succumb to diseases such dysentery and diarrhea. According to statistics given by Shryock on his website (1962), they represent the real and grave statistics of deaths and wounds incurred by the soldiers in the Civil War and how medical doctors dealt with these numbers. During the battle of Gettysburg, the Union medical corps was armed with 1,000 ambulances, 650 officers, and 3,000 drivers but within 3 days, 21,000 soldiers were wounded. This left each surgeon with 900 patients that they were individually responsible for. According to Shryock report on its website (1962), these incredibly large numbers led to many amputations due to infections. This professional medical historian, one of the first of his kind, explores the fact that medical professionals of the 1860’s did not have a good understanding of bacteria. Since then, ‘cumulative experience’ of those doctors led to the improvement of techniques in medicine. Shryock gives a reflection of how severe the wounds of the Civil War were and how medical profes sionals used what they had available to treat them under great stress. This assisted

Cereal Aisle Analysis Assignment Example | Topics and Well Written Essays - 1000 words

Cereal Aisle Analysis - Assignment Example Consumer behavior process comprises of different stages which are undertaken by every customer. These stages are problem recognition, information search, and evaluation of alternatives, purchase decision, purchase and post-purchase evaluation. Customers need to firstly identify their need with respect to purchasing a product or service. This kind of need is further utilized to search information and take appropriate action. All possible alternatives available in the market place are identified by customers. Finally purchase decision is made and products or services are purchased (Alba and Hutchinson, 2008). Growth or success of a brand depends on post purchase evaluation. I visited a local grocery store where I observed behavior of three consumers who were going towards three different aisles. All of the three consumers had different demand such as one wanted to purchase breakfast cereals, another was looking at bread aisle, and third was visiting cereal aisle. Customer A had a need for breakfast cereals and the lady was visiting the store outlet with her kid. She compared prices of all breakfast cereals kept on the track and selected some like Kellogg’s, Lucky Charms and Cocoa Puffs. However while making final purchase decision her kid put across his preference towards Kellogg’s Apple Jacks. The lady finally purchased breakfast cereal of Kellogg’s. On the other hand, customer B was in a hurry, he smartly moved in and went to specific department to purchase a particular brand’s bread.

Consumer behaviour Essay Example | Topics and Well Written Essays - 2250 words

Consumer behaviour - Essay Example Government and leaders of the company have become increasingly aware of the people’s needs and understand that at times people would break the rules in place to satisfy them. With the help of Maslow theory marketer’s can judge consumer’s motivations they can identify the generic level of need the consumer product is capable of fulfilling. This would help the marketers better form any of the marketing strategy. Products such as foods and clothes are purchased as they fulfill safety needs; personal care products such as shaving cream, perfume, soap, toothpaste, are bought mainly as they serve social needs. While luxurious products such as expensive clothing, fancy house, jewelry, and cares are bought mainly to serve self-actualizations and ego needs. Though, Maslow's hierarchy does consider relevant from an intuitive standpoint, however, there is little evidence to proof its hierarchical aspect. Today there are evidences to contradict such aspects as explained by t his motivation theory. For example, today we find some of the cultures placing social needs ahead of any others. Maslow's hierarchy further has difficulty explaining incidents such as the "starving artist" where a person ignores lower needs to pursuit higher ones. Finally, it cannot be prove that people g up t motivated just to satisfy a single need at a time, except in situations where one finds conflict between needs. Therefore, it fails to predict and shape market well. 2. How influential is gender stereotyping in the popular magazine or the drinks markets in differentiating and expanding the total market? Gender stereotyping makes use of magazines and other advertising mediums to govern and shape people’s perception. How influential they might would depend on the assumptions made about men and women which may or may not be true. It could have been said to predict fairly for a fewer numbers however, it might not be true for the larger part. In short that everyone could con fide to the description of gender descriptions as mentioned neatly in various advertising mediums such as magazines and drinks market. Today readers are found to be much sophisticated and are aware that much of the advertising stuff does not portray their sets of beliefs, perceptions, attitudes and likings. Post modern reader would take out several magazines to form a mix up suiting their sets of thinking patterns. For instance, one of the women might select the top and sandals off a photo shoot posted in a magazine but paired it with his favorite pants. So today, readers are conforming to some parts of gender stereotypes exposed to them but have willpower to surpass them if they feel like. So, in this case it would be relevant to conclude that magazines target audience in manner that they could influence majority and hence raise the sales of their products. However, there would be many readers who would know when to absorb and what to buy. 3. Give an example of ‘cultural jamm ing’ that to your mind works really well in causing consumers to think twice about their attitudes towards a brand or a product. What techniques does this example of ‘cultural jamming’ utilize to make it so effective? Culture jamming is arousing attention in consumers of particular brand to react in an emotional manner. It can be commercial, social or political. If done properly it raises awareness among the people and is effective adding legal way to mend the consumer’s perception. One of the best examples of culture jamming that

Personal goal Essay Example | Topics and Well Written Essays - 1250 words

Personal goal - Essay Example Examination of such goals in the light of changing global dynamics can allow one to be prepared for future challenges. My personal goal is to become an educator in near future. The reason for selecting this field is its continuous innovation and evolution. Where becoming an educator requires one to remain upbeat with recent advancements in given field of study but also keep one’s skills inventory updated according to new inventions in the field of education. With advent of new technology, emphasis on second language learning and also changed educational regimes supported by changes in government policies, teachers are required to be highly skilled. Being skilled does not only means having command over the subject matter but also having capacity and capability of meeting individual students’ needs in a whole class. Furthermore, technological interventions have completely transformed the landscape of classrooms in past decade or so. Mobile lectures, online coaching and ex aminations are common tools used by instructors today. It is important to note that this scenario is highly different than what existed in schools some ten years back. In addition to that, government policies like no child left behind, no discrimination and care for vulnerable students has also increased the importance of educators. Today, educators are not only source of knowledge but they are also guardians and mentors of their students. This multi-faceted role increases further when global dynamics get involved. Universities, schools and colleges cater to students from different nationalities, cultural groups and religions. Such amalgamation of cultural and social values cannot be dealt with a uniform approach. Therefore, it is important that educators are culturally sensitive and neutral while dealing with such students (Burbules and Torres 23). In addition to that, there are also substitute replacement programs where educators from different countries serve in educational insti tutes across the border. Such robust environment requires educators to remain aware of advancement in their fields and adapt to changing environments, furthermore it is also important to have an ability of handling audience comprising of different demographic characteristics. Where I am well-aware of the requirement of global environment in education sector, I see myself progressing from a role of teacher to a researcher and published author in the given field. This role would be accompanied by continuation of the role of educator at senior level i.e. professor or lecturer in a reputed institute. I would also like to be part of curriculum designing in coming ten years. I am aware of the fact that due to changing global dynamics and interchangeable cultural, social and technological characteristics of educational sector, the concepts of lifelong learning will not apply to students but also to teachers as well. Therefore, I am willing to learn teaching techniques that would be require d in a global learning environment. Awareness of impacts of globalization on my personal and professional goals has enabled me to be prepared for future challenges. Due to information communication and technology (ICT) along with multiculturalism is the global curriculum, teachers are under a greater burden to adopt uniform educational techniques

Memo Essay Example | Topics and Well Written Essays - 1000 words - 3

Memo - Essay Example The insurer has a duty to defense before a court of law. Insurance companies lose the right to defense only when there is conflict of interest. Insurance companies do not compensate the insured automatically before thorough analysis of the real cause of the losses which call for compensation. According to Devine (2006), the insurance company has a duty and a right to defend itself basing this on the principles governing the insurance contracts as stipulated in insurance law. Mr. and Mrs. Turner entered into an insurance contract with Youngston Company when they took a cover against any liability that arises other than injuries resulting from discharge, release, dispersal or escape from pollutants. These clauses specified the kind and extent of losses to be compensated whenever such specific liability arises. The policy language excluded losses suffered due to discharge, dispersal, release, or escape of pollutants. From the excerpt, we noted that the child became ill because of too mu ch lead in the body system. Insurance company should defend itself basing this on the language of the cover i.e. the cover would not cover any liabilities resulting from losses suffered due to escape of pollutants. In addition, the company is not liable for the losses suffered by a third party. During inception of the insurance contract, neither Mr. and Mrs. Cavanaugh nor any other person who rented the apartment, was mention in the contract. Since, the child belongs to the third party; the insurance company has a duty to defense based on this. However, the insurance policy issued by the company did not specify exactly the boundaries of compensation. The exclusion language did not mention the specific pollutants which will be covered by the policy. In addition, the policy cover did not specify whether the company should compensate any damages suffered by the third party. It is therefore the decision of the court to

Nutrition for Life Essay Example | Topics and Well Written Essays - 750 words

Nutrition for Life - Essay Example Since man has lost touch with nature, he does not eat raw food available from it. The food that humans intake goes through a lot of processing, thus, they lose most of their nutrients. Another crucial field that is interconnected with human life is healthcare. Healthcare is one of the main reasons that death rates all around the world have decreased comparing to the ancient era. Humans have evolved a lot from the way they were during the primitive times. The advancements have made them reach new heights. However, along with such progress, comes their inability to live a healthy life. The fast paced lifestyle that everyone follows now lands them on the path of self-destruction. People nowadays are so busy with work that they do not have time to focus on their food or nutrition. They eat according to different food fads that they acknowledge in their day-to-day lives. People just read the nutritional information given behind different cartons and packets and buy according to what they assume to be healthy. They do not know what is best for them and producers take advantage of this situation sometimes giving false data about ingredients as well as nutirional qualities. Manufacturers have now come up with â€Å"functional foods, which provide a health benefit beyond what is provided by the same food in its traditional form† (Vitamins: Micronutrients with Macro Powers pg 186). These types of food products, also known as â€Å"nutraceuticals† are the new trend now. Various commercials and such other advertisements lure the people into buying these things, which have been transformed into something healthier, as per the commercial. People ponder upon the new terms related with these new products and undergo the dilemma of whether or not to buy it. In the end, that small voice inside their heads tells them that they really need â€Å"some extra vitamins, calcium fortified juices, soy milk, multivitamins† and various other â€Å"vitamin enhanced pr oducts† (Vitamins: Micronutrients with Macro Powers pg 186). When people come to know of water that has been filtered through reverse osmosis systems and undergone ozonization, they do not wait to think of another option. They think it better to drink this water than the one they get from their taps. It is only obvious how much the world is concerned with nutrition now, or else water would taste best when it comes out of a natural spring, not some UV sterilizing machine. There are various establishments and institutions that have devoted themselves to providing the best healthcare and medicine for the people. One such organization is the United States Pharmacopeial Convention (USP), â€Å"which sets standards for the identity, strength, quality, and purity of medicines, food ingredients, and dietary supplements manufactured, distributed and consumed worldwide† (About USP par.1). It is a non-profit institution, founded by an association of 11 physicians in 1820, who want ed to provide â€Å"a national lexicon of drug names and formulas† for the public (About USP par.1). During the time, medicines, drugs and such things were not closely administered by any authority. Patients bought medicine and consumed them according to what they thought would help. Wrong dosage and wrong intake of medicines and drugs also caused serious setbacks in the lives of people. It was not until the formation of USP that the essentiality and importance of this problem was recognized. People then were mostly illiterate and did not know how to read the information given about any product or medicine. Thus, USP played a very important role during the time and since has been catering to the needs of people regarding medicine, drugs and food. This organization follows the standards created and

Template communication plan strategy for Nissan Motor Assignment

Template communication plan strategy for Nissan Motor - Assignment Example To achieve the company’s goal, Nissan Company need educate its customers so that they can alter their attitude and behavior to the benefits of the company needs of selling more automotive while still engages with its stakeholders. Tertiary audiences affect and influence the communication of the company to the customers and its shareholders. The Nissan competitors would want to know how the company is strategizing for the market so they can also make changes to their company’s strategies. Therefore, any decision that Nissan have to communicate to its customers and shareholders has to consideration of the effects it has on its competitors such as Toyota (Audience Strategy for All Professional Business Communication ). Nissan has one of the most valuable customers among the automotive manufacturing companies. They devout their life using Nissan made vehicles and other automobile products because they get the best products and services from the company. Nissan surprised one of their loyal customer, a Canadian woman, Ms. Karen Ackroyd with a new 2015 Nissan Micra (Nissan Motor Corporation, 2014a). This was as a result of her good perception toward attitude toward the company’s products. Therefore as demonstrated by Ackroyd, Nissan customers are engaged and respond to company’s communications. One of the main barriers to customer communication is the lack of sensitivity. The customer may be affected by another issue that may make him or her nonresponsive (Barriers to Effective Communication). Moreover, physical destructions such as a network problem, noise and bad formatting for email break down communication. Shareholders are the sensitive people to communicate to because they are keen on making return on their investment. Therefore, they take into account whatever is communicated with uttermost precaution. The lack of proper knowledge of

Managing Across Cultures Essay Example | Topics and Well Written Essays - 500 words - 5

Managing Across Cultures - Essay Example Preparation is the first step in the process of negotiation. According to Metcalf et al (2006), at this stage the parties involved in the negotiation get build some background to the negotiation. The individuals intending to enter into the negotiation try to get the necessary information that may be required to make the negotiation successful. Therefore, the individuals get to research and get to get enough understanding of what they are going to undergo. As part of their preparation the individuals try to analyze the appropriate methods of persuading the other party and how to bargain in the negotiation. Therefore, this can be influenced by some cultural aspects. Decision on the method of bargaining and how to communicate will depend on the cultures of the different individuals involved in the negotiation. This is the second stage in the process of negotiation. After preparing for the entire negotiation, individuals should take time to get to know each other before proceeding for the planned negotiation (Metcalf et al, 2006). Therefore, how the different individuals will get to interact and relate in different occasions will be affected by their cultures. For example, the attitudes towards each other may differ as they get to interact due to different cultural mind-sets or the general national attitude towards time from the different individuals. After the different parties or individuals have prepared enough and have gotten to build their relationship, the next step to the negotiation is coming to the real negotiation where both sides exchange information. The different sides present the information it has and states its position concerning the issue or matter of negotiation. At this stage then cultural aspects can have an impact or great influence on the mode of present or how the parties will respond to each other (Trompenaars and Hampden-Turne, 2012). For example, if the parties are French nationals they will prefer to present their views in a

Nursing Research and Evidence-Based Practice Essay Example for Free

Nursing Research and Evidence-Based Practice Essay I did not understand why I had to take a research class when all I wanted to do was be a staff nurse in a critical care unit. Research? Evidence-based practice? Why are these topics in the nursing program? I have enough to do just learning all the content in my clinical courses. What do research and evidence have to do with developing my nursing abilities? I trust the faculty, the textbooks, and clinical experience to prepare me for nursing. I’m already getting what I need to know. That was my earlier attitude. Now that I am practicing, I have a new appreciation for nursing research and the evidence it provides for application to practice. I have an entirely different way of addressing clinical questions. I’m starting to ask questions about how I can improve the care I give to patients and how I can be involved in my workplace’s efforts to improve care for the patients it serves. I have discovered by purposeful reading in my practice area that research reports and research summaries contain many implications that apply to practice in the critical care unit.  ¦ QUESTIONS TO CONSIDER WHILE READING THIS CHAPTER: 1 How can faculty encourage students to read research journals? 2 How does research affect nursing practice? 3 How can nurses motivate colleagues to base their practice on research? KEY TERMS Clinical nurse researcher (CNR) An advanced practice nurse who is doctorally prepared and directs and participates in clinical research. Clinical nurse specialist (CNS) An advanced practice nurse who provides direct care to clients and participates in health education and research. Clinical practice guideline (CPG) an evidence-based guide to clinical practice developed by experts in a particular ? eld for direct application in clinical environments. Control group Subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. When a true experimental design is not used, this group is usually called a comparison group. Data collection The process of acquiring existing information or developing new information. 104 Nursing Research and Evidence-Based Practice CHAPTER 6 105 Empirical Having a foundation based on data gathered through the senses (e. g. , observation or experience) rather than purely through theorizing or logic. Ethnography A qualitative research method for the purpose of investigating cultures that involves data collection, description, and analysis of data to develop a theory of cultural behavior. Evidence-based practice The process of systematically ? nding, appraising, and using research ? ndings as the basis for clinical practice. Experimental design A design that includes randomization, a control group, and manipulation between or among variables to examine probability and causality among selected variables for the purpose of predicting and controlling phenomena. Generalizability The inference that ? ndings can be generalized from the sample to the entire population. Grant Proposal developed to seek research funding from private or public agencies. Grounded theory A qualitative research design used to collect and analyze data with the aim of developing theories grounded in real-world observations. This method is used to study a social process. Meta-analysis Quantitative merging of ? ndings from several studies to determine what is known about a phenomenon. Methodologic design A research design used to develop the validity and reliability of instruments that measure research concepts and variables. Naturalistic paradigm A holistic view of nature and the direction of science that guides qualitative research. Needs assessment A study in which the researcher collects data for estimating the needs of a group, usually for resource allocation. Phenomenology A qualitative research design that uses inductive descriptive methodology to describe the lived experiences of study participants. Pilot study A smaller version of a proposed study conducted to develop or re? ne methodology, such as treatment, instruments, or data collection process to be used in a larger study. Qualitative research A systematic, subjective approach used to describe life experiences and give them meaning. Quantitative research A formal, objective, systematic process used to describe and test relationships and examine cause-and-effect interactions among variables. Quasi-experimental research A type of quantitative research study design that lacks one of the components (randomization, control group, manipulation of one or more variables) of an experimental design. Randomization The assignment of subjects to treatment conditions in a random manner (determined by chance alone). Secondary analysis A research design in which data previously collected in another study are analyzed. State-of-the-science summary A merging of ? ndings from several studies concerning the same topic. Examples include meta-analysis with a quantitative approach and integrative review with a descriptive approach. Survey A nonexperimental research design that focuses on obtaining information regarding the status quo of a situation, often through direct questioning of participants. Triangulation The use of a variety of methods to collect data on the same concept. LEARNING OUTCOMES After studying this chapter, the reader will be able to: 1 Summarize major points in the evolution of nursing research in relation to contemporary nursing. 2 Evaluate the in? uence of nursing research on current nursing and health care practices. 3 Differentiate among nursing research methods. 4 Evaluate the quality of research studies using established criteria. 5 Participate in the research process. 6 Use research ? ndings to improve nursing practice. 106 UNIT ONE The Development of Nursing CHAPTER OVERVIEW This chapter provides basic knowledge regarding the research process and the ultimate importance of evidence-based nursing practice. The intent is to inspire an appreciation for nursing research and to show how it can improve nursing practice and how results can be translated into health policy. Nursing research is de? ned as a systematic approach used to examine phenomena important to nursing and nurses. A summary of major points in the evolution of nursing research in relation to contemporary nursing is presented. A description of private and public organizations that fund research is given, and their research priorities are listed. Major research designs are brie? y described, and examples of each are given. Nurses of all educational levels are encouraged to participate in and promote nursing research at varying degrees. The process of locating research and evidence for practice is reviewed. Students are introduced to the research process and guided in the process of critically appraising published research and research syntheses. Ethical issues related to research are examined, and historical examples of unethical research are given. The functions of the institutional review board (IRB) and the use of informed consent in protecting the rights of human subjects are emphasized. DEFINITION OF NURSING RESEARCH Research is a process of systematic inquiry or study to build knowledge in a discipline. The purpose of research is to develop an empirical body of knowledge for a discipline or profession. Speci? cally, research validates and re? nes existing knowledge and develops new knowledge (Burns and Grove, 2007). The results of research process provide a foundation on which practice decisions and behaviors are laid. Research results create a strong scienti? c base for nursing practice, especially when deliberately and carefully evaluated for application to speci? c clinical topics (Melnyk and Fineout-Overholt, 2005). In recent decades the nursing discipline has begun to pay much greater attention to the necessity of participating in research. Nursing research is a systematic approach used to examine phenomena important to nursing and nurses. Because nursing is a practice profession, it is important that clinical practice be based on scienti? c knowledge. Evidence generated by nursing research provides support for the quality and cost-effectiveness of nursing interventions. Thus recipients of health care—and particularly nursing care—reap bene? ts when nurses attend to research evidence and introduce change based on that evidence into nursing practice. The introduction of evidence-based change into the direct provision of nursing care may occur at the individual level of a particular nurse or at varied organizational or social levels. In addition to nursing research aimed at affecting the direct provision of nursing and health care to recipients of nursing care, nursing research also is needed to generate knowledge in areas that affect nursing care processes indirectly. Research within the realms of nursing education, nursing administration, health services, characteristics of nurses, and nursing roles provides evidence for effectively changing these supporting areas of nursing knowledge (Burns and Grove, 2007). Today the importance of nursing research to the discipline is recognized. However, much nursing history underlies the current state of acceptance. EVOLUTION OF NURSING RESEARCH Nursing research began with the work of Florence Nightingale during the Crimean War. After Florence Nightingale’s work, the pattern that nursing research followed was closely related to the problems confronting nurses. For example, nursing education was the focus of most research studies between 1900 and 1940. As more nurses received their education Nursing Research and Evidence-Based Practice CHAPTER 6 107 in a university setting, studies regarding student characteristics and satisfactions were conducted. As more nurses pursued a college education, staf? ng patterns in hospitals changed because students were not as readily available as when more students were enrolled in hospitalaf? liated diploma programs. During this period, researchers became interested in studying nurses. Questions such as what type of person enters nursing and how are nurses perceived by other groups guided research investigations. Teaching, administration, and curriculum were studies that dominated nursing research until the 1970s. By the 1970s more doctorally prepared nurses were conducting research, and there was a shift to studies that focused on the improvement of patient care. The 1980s brought nursing research to a new stage of development. There were many more quali? ed nurse researchers than ever, widespread availability of computers for collection and analysis of data, and a realization that research is a vital part of professional nursing (Polit and Beck, 2006). Nurse researchers began conducting studies based on the naturalistic paradigm. These studies were qualitative rather than quantitative. In addition, instead of conducting many small, unrelated research studies, teams of researchers, often interdisciplinary, began conducting programs of research to build bodies of knowledge related to speci? c topics, such as urinary incontinence, decubitus ulcers, pain, and quality of life. The 1990s brought increasing concern about health care reform, and now in the twenty-? rst century, research studies focus on important health care delivery issues, such as cost, quality, and access. Research ? ndings are being used increasingly as the basis for clinical decisions. Evidencebased practice (EBP) can be de? ned as the process of systematically ? nding, appraising, and using research ? ndings as a basis for making decisions about patient care. The rise of technology and the worldwide access and ? ow of information have transformed the decision-making processes of practitioners. Helpful informational websites for busy practitioners are listed in Box 6-1. No longer do nurses simply compare outcomes of patient care with other units in the B O X 6–1 Helpful Websites l f l b i National Guideline Clearinghouse—resource for evidence-based clinical practice guidelines www. guidelines. gov US Department of Veterans Affairs Clinical Practice Guidelines www. healthquality. va. gov AHRQ Healthcare Innovations Exchange—innovations and tools to improve health care www. innovations. ahrq. gov/index. aspx The Evidence-Based Medicine Education Center of Excellence—extensive list of databases, journals, and textbooks http://library. ncahec. net/ebm/pages/resources. htm U. S. National Institute for Health Consensus statements http://consensus. nih. gov Centre for Evidence-Based Nursing, based at University of York—United Kingdom www. york. ac. uk/healthsciences/centres/evidence/cebn. htm The Joanna Briggs Institute, based at Royal Adelaide Hospital and the University of Adelaide, Australia—multiple evidence resources for practice www. joannabriggs. edu. au Cochrane Center—resource for evidence-based clinical practice guidelines www. cochrane. org 108 UNIT ONE The Development of Nursing same hospital. Nurses and other health care professionals are more likely to look for solutions, choices, and outcomes for patients that represent the best available knowledge internationally (Hamer and Collinson, 2005). RESEARCH PRIORITIES Why set priorities for research in the nursing discipline? Can nurses do research in areas that match personal areas of interest? The answer to the second question is, yes, certainly. But nursing exists to provide high-quality nursing care to individuals in need of health-promoting, health-sustaining, and health-restoring strategies. The main outcome of research activity for a nurse is to eventually put the knowledge gained to work in health care delivery. Research priorities, often set by groups that fund research, encourage nurse researchers to invest effort and money into those areas of research likely to generate the most bene? t to recipients of care. Of course the funding opportunities offered by such groups do not hurt the research enterprise either. Research costs money. Thus nurses engaged in research often match personal interests with funding opportunities that are available during the planning phase for a proposed investigation. Two major sources of funding for nursing research are the National Institute of Nursing Research (NINR) and the Agency for Healthcare Research and Quality (AHRQ) (formerly known as the Agency for Health Care Policy and Research [AHCPR] and reauthorized as AHRQ by Congress in 1999). Both of these organizations are funded by federal congressional appropriations. Private foundations and nursing organizations also provide funding for nursing research. National Institute of Nursing Research As part of the National Institutes of Health (NIH), the NINR supports research on the biologic and behavioral aspects of critical health problems that confront the nation. The NINR’s research focus encompasses â€Å"health promotion and disease prevention, quality of life, health disparities, and end-of-life† (NINR Strategic Plan 2006-2010, 2006). A small sampling of potentially supported research topics includes those aimed at: ? Determining disease risk and treatment through utilizing genetic information ? Determining effective health-promotion strategies for individuals, families, and communities ? Discovering approaches that encourage people to effectively take responsibility for symptom management and health promotion ? Assisting in identi? cation and effective management of symptoms related to acute and chronic disease ? Improving clinical settings in which care is provided ? Improving the quality of care giving in settings such as long-term care facilities, the home, and the community ? Understanding predisposition to disease, socioeconomic factors that in? uence health, and cultural health practices that either protect from or expose to risk for health problems ? Improving symptom management for those at end of life The areas of research emphasis published by the NINR are useful guides for investigators developing proposals but are not considered to be prescriptive in nature. Investigators bring to bear their own unique expertise and creativity when proposing research in harmony with NINR priority research areas. Annually the NINR conducts a roundtable discussion with multiple nursing organizations to obtain the feedback of the disciplines regarding the need for continued or new research Nursing Research and Evidence-Based Practice CHAPTER 6 109 emphases. Information obtained is used in setting future research agendas and making decisions about funding of proposals submitted by researchers (Of? ce of Science Policy and Public Liaison, NINR, 2009). The NINR website details current announcements regarding research priorities (www. ninr. nih. gov/ResearchAndFunding). Agency for Healthcare Research and Quality The AHRQ broadly de? nes its mission as â€Å"improving the quality, safety, ef? ciency, and effectiveness of health care for all Americans† (AHRQ, 2009a). As an agency of the U. S. Department of Health and Human Services, the AHRQ’s health-related aims are to reduce the risk of harm by promoting delivery of the best possible health care, improve health care outcomes by encouraging the use of evidence to make informed health care decisions, transform research into practice to facilitate wider access to effective health care services, and reduce unnecessary costs (AHRQ, 2009a). Since the inception of the agency in 1989, strategic goals have centered on supporting improvements in health outcomes, strengthening measurement of health care quality indicators, and fostering access to and cost-effectiveness of health care. The 1999 reauthorizing legislation expanded the role of the agency by directing the AHRQ to: ? Improve the quality of health care through scienti? c inquiry, dissemination of ? ndings, and facilitation of public access to information. ? Promote patient safety and reduce medical errors through scienti? c inquiry, building partnerships with health care providers, and establishment of centers for education and research on therapeutics (CERTs). ? Advance the use of information technology for coordinating patient care and conducting quality and outcomes research. ? Establish an of? ce on priority populations to ensure that the needs of low-income groups, minorities, women, children, the elderly, and individuals with special health care needs are addressed by the agency’s research efforts. The research-related activities of the AHRQ are quite varied, but a recent shift emphasizes a more deliberate translation of research evidence into practice. In a process similar to that used by the NIH, investigators are invited to submit research proposals for possible funding through grant announcements. A listing of current areas of the agency’s research interests can be found online at www. ahrq. gov/fund/portfolio. htm. The AHRQ actively promotes EBP, partially through the establishment of 14 EBP centers (EPCs) in the United States and Canada. EPCs conduct research on assigned clinical care topics and generate reports on the effectiveness of health care methodologies. Health care providers may then use the evidence in developing site-speci? c guidelines that direct clinical practice. AHRQ also actively maintains the National Guideline Clearinghouse (www. guidelines. gov), an website that makes available to health care professionals a wide array of clinical practice guidelines that may be considered in health care decision making. Another recent addition to AHRQ’s initiatives is the Healthcare Innovations Exchange (2009b), which provides a public source of information about innovations taking place in health care delivery. Submitted innovations are reviewed for the quality of achieved outcomes, providing evidence as a foundation for decision making by others who may be searching for or considering similar innovations. Although most AHRQ activities are intended to support health care professionals and institutions, the agency supports health care recipients by designing some information speci? cally for dissemination to the lay public (AHRQ, 2009a). 110 UNIT ONE The Development of Nursing Private Foundations Federal funding is available through the NIH and the AHRQ. However, because obtaining money for research is becoming increasingly competitive, voluntary foundations and private and community-based organizations should be investigated as possible funding sources. Many foundations and corporate direct-giving programs are interested in funding health care projects and research. Computer databases and guides to funding are available in local libraries. In addition, grant-seeking enterprises often purchase subscriptions that allow computer access to enhanced listings of funding foundations that include information about the types of projects those foundations typically fund. Though subscriptions are expensive, costs are often balanced by the ef? ciency with which suitable funding prospects are identi? ed. An example of such a service is Prospect Research Online (www. iwave. com). Private foundations, such as the Robert Wood Johnson Foundation (2009a, 2009b) or the W. K. Kellogg Foundation (2009), offer program funding for health-related research. Investigators should be encouraged to pursue funding for small projects through local sources or private foundations until a track record is established in research design and implementation. After several years of experience in the research arena, investigators are more likely to be successful in securing funding through federal sources, such as the NIH. Nursing Organizations Sigma Theta Tau International (STTI), the American Nurses Association (ANA), and the Oncology Nurses Society (ONS), are a few of the nursing organizations that fund research studies. STTI makes research grant awards to increase scienti? c knowledge related to nursing practice. STTI supports creative interdisciplinary research and places importance on identifying â€Å"best practices† and benchmark innovations. Awards are made at the international and local chapter levels. The ANA awards small grants through the American Nurses Foundation. Specialty nursing organizations offer grants to support research related to their specialty. For example, the ONS awards grants that focus on issues related to oncology. To summarize, multiple potential sources of funding are available for research projects. The individual or group wishing to conduct research will need to carefully develop a proposal, search for a possible funding source, and submit the proposal. Libraries and the Internet provide ample information about the many foundations and organizations interested in funding research endeavors. Most research institutions establish of? ces that help in the search and procurement of funding. Thus researchers are supported in their work of knowledge building. COMPONENTS OF THE RESEARCH PROCESS The research process involves conceptualizing a research study, planning and implementing that study, and communicating the ? ndings. The process involves a logical ? ow as each step builds on the previous steps. These steps should be included in published research reports so that the reader has a basis for understanding and critiquing the study (Box 6-2). STUDY DESIGNS Study designs are plans that tell a researcher how data are to be collected, from whom data are to be collected, and how data will be analyzed to answer speci? c research questions. Research studies are classi? ed into two basic methods: quantitative and qualitative, two distinctly different approaches to conducting research. The researcher chooses the method based on the research question and the current level of knowledge about the phenomena and the problem to be studied. Quantitative research is a formal, objective, systematic process in which numeric

Personal Illness Narratives: Rheumatoid Arthritis (RA)

Personal Illness Narratives: Rheumatoid Arthritis (RA) Introduction This essay employs excerpts from the narrative of a 38 year old woman named Francesca, a lady who has been given a diagnosis of rheumatoid arthritis (RA), to illustrate key concepts form the sociological, and psychological literature. This approach will illustrate the writers ability to critically appraise the literature, its relevance to the narrative in question, and using narrative, places these concepts within a real life clinical situation. This in turn provides insight into the value of narrative as a methodological approach in the 21st Century and how it intertwines with the rich tapestry of sociological theories and concepts that are available to the researcher studying the current sociological evidence base. For the purpose of this assignment, peer reviewed articles and textbooks were searched within the past 10 years. The work introduces RA as a clinical entity (pivotal to understanding the comments of Francesca) and goes on to outline the use of narrative, particularly its utility in the study of chronic disease. The essay then goes on to cover some key important issues, namely: The biomedical versus the sociological approach of illness management The Study of Personal Illness Narratives Sociological perspectives on depression Chronic Illness and Disability Social construction of medical knowledge and the Politics of Disability Labelling Stigma. For each of the above, concepts are presented and mapped against selected statements from the narrative of Francesca (written in italics for clarity). These statements illustrate real world data gleaned from Francesca; valuable comments that are grounded in the experiences of a person living with a chronic disease. The work also contains an appendix comprising a reflective postscript which outlines the way that the work evolved from earliest outline, to the finished product. Rheumatoid arthritis (RA) is a chronic inflammatory disorder that affects not only the synovial joints but multiple body systems (Goodacre 2008). The exact cause of RA remains unknown; it is a disease that affects more women than men, often of a young or middle age demographic unlike osteoarthritis which affects predominately older people. RA follows a somewhat unpredictable course of exacerbations and remissions. RA carries huge psychological problems in view of its unknown aetiology, uncertain prognosis, and loss of function. Additional symptoms include early morning stiffness, pain, limitation of activities of daily living, and socio- economic problems inasmuch as it may have a severe impact upon a persons ability to work and function in society (Kojima et al 2009). The discussion now begins with a section on models of illness. Biomedical and biopsychosocial models of disease The biomedical model of health takes the reductionist view that people are biological entities (Lewis 2009 p745). In the clinical management of RA there is some merit in this biomedical approach, for example the monitoring of inflammatory mediators in the blood as a marker of disease activity or responses to drug intervention is well established in the literature (Lee Kim 2009). This biomedical approach is reinforced by the GP comments from the narrative, i.e. That there was no cure and that the tablets were the key to preserving normal function. This approach may contribute to Francescas frustration, as it ignores the wider psychological and sociological ramifications of living with a chronic debilitating disease such as RA. It is unclear form the narrative whether the GP tempered his comments by adding that there are means by which the signs and symptoms of RA can be successfully managed. Critical appraisal of the literature reveals that biopsychosocial models advocate a more holistic view of illness, for example according to Smith (2002) the biopsychosocial model seeks to address not only the client and his or her illness but also their capacity to deal with being ill. The value of adopting the narrative approach as part of the biomedical model is effectively illustrated at the point where Francesca states I just burst into tears At the perceived effect that this illness will have upon her loss of function in the future. So whereas the biomedical model will operationalise function using objective outcome measures, here the use of narrative permits a biopsychosocial approach that provides rich client centred data on how it feels to be diagnosed with chronic and currently incurable disease. This in turn can help to inform our understanding of Rheumatoid arthritis as a disease thereby influencing the social construction of medical knowledge by giving voice to service users (Balen et al 2009). The Study of Personal Illness Narratives. Illness narratives concern a persons views and beliefs about their illnesses and the effect on their lives (HydÃÆ'Â ©n 2007). There is increasing acceptance and recognition of the valuable role that such grounded narratives play in understanding the journeys that people with chronic diseases such as RA have to embark upon if they are to manage their illness on a day to day basis. For example Haidet et al (2006) found in a narrative study of people with diabetes that people narrated four illness-management strategies whose story elements were in dynamic interplay, each with unique variations for each individual revealing a level of complexity that had not been previously described. As a method, narrative provides rich data (Furman Cavers 2005; Poindexter 2002) and in this case gives a voice to Francesca that would otherwise remain unheard (Grills 1998).Much can be gleaned from studying Francescas narrative, for example Francesca begins to paint a picture of her hopes and fears upon being given a diagnosis of RA combined with an insight into her past and thoughts about the future. Francescas narrative provides us valuable insight into her views of the self- a key component of narrative (Voilmer 2005), her relationships to others, and how these relationships have changed or may change in the future. In her narrative Francesca gives us some insight into the pain of living with rheumatoid arthritis, in her comments we can detect also a stark dichotomy in that she notes how healthy she had been in the past then uses the term Excruciating to describe her current pain, thus Francescas narrative hints at the loss of self in that she will no longer be a dancer or even a valid spouse as exemplified by the narrative quote. I wont be the woman he fell in love with Here she literally describes herself as becoming another person. Here Francesca is able to provide the reader or researcher with valuable information on the loss of the self, which resonates with other narrative research (Roe Davidson 2005; Doba et al 2007). Francesca goes further and also hints at the change in her illness self concept (ISC) that is to say the extent to which a person is defined or consumed by their disease or disability (Morea et al 2008). Francesca also hints at the concept of disease as a biographical disruption, described by Bury, this is said to occur when a persons planned future cannot unfold as planned. (Bury 1982); will he even want to marry me? Im too young to have this. What makes Francescas narrative particularly interesting is the fact that she is a twin; this may emphasise any change in self since she has in essence an unchanging control (her twin sibling) to against which to compare herself as her disease, her self identity (and possibly disability) progresses. The next section outlines sociological perspectives on depression. Sociological perspectives on depression. Francescas depression is likely to be multifactorial; for example there is evidence that the disease RA itself causes depression (Kojima et al 2009) as will living with pain. From a sociological perspective Francescas strained personal relationships may contribute to depression, for example her fear of being rejected as a potential spouse (Waite Gallagher 2001), see below. will he even want to marry me? This feeds in to the earlier section on biomedical versus biopsychosocial models of health and illness and the different paradigms or world views in which they are situated. A biomedical explanation of depression is likely to focus on the biochemical aspects of the person whilst a more sociological approach would acknowledge the impact of socio economics, personal relationships and so on (Covic et al 2003). Caution is needed however here since the short excerpt of narrative that we have provides no direct evidence that Francesca is in fact depressed, indeed a review of the literature suggests that there is a tendency to over diagnose depression (Parker 2007). Chronic Illness and Disability. A chronic incurable disease such as RA would require Francesca to make significant adjustments to her life over time. The sociological literature now provides increasingly refined conceptualisations of these adjustments, acknowledging that the experience of chronic disease necessitates adaptations in multiple domains of the persons life. This adjustment is often referred to as a trajectory (Stanton et al. 2007). This concept, introduced by the sociologist Strauss in an attempt to capture experiences and behaviours occurring in response to chronic illness (Strauss Corbin 1998), goes beyond depicting the physiologic unfolding of disease and encompasses the total organisation of work done over the course of the illness (Strauss et al 1984). Francescas narrative hints at this changing trajectory tracing the commencement of her life changes to a time six months ago when she was much more active and defined herself as a dancer. Furthermore Francesca looks to her future and wonders about h er ability to fulfil the stereotype of a perfect spouse. It is important to engage with how Francesca and her fiancÃÆ'Â © will make sense of the illness. The term illness cognition has been defined as a patients own implicit common sense beliefs about their illness (Leventhal and Nerernz 1985, p. 517). When people experience symptoms, they embark upon a cognitive search which enables them to interpret and make sense of the symptoms they are experiencing. Typically a critical review of the literature distils out into five categories: Identity, including the description of symptoms experienced and their meaning (e.g. pain, fatigue).In the narrative Francesca describes her pain as Excruciating for example. Belief about causes (e.g. accident, genetics or stress). People like to have a label for their symptoms for legitimisation although, once given, people are likely to interpret diverse symptoms as evidence of the label. Francesca has problems with causality and is likely to do so for the foreseeable future since there is no established medical cause for RA. Timeline (beliefs about duration and time for recovery), namely is it acute or chronic? These beliefs will be re-evaluated as time progresses. Consequences (e.g. loss of lifestyle, goals in life). These representations may only develop into more realistic beliefs over time. Francesca uses the narrative to discuss the change in her life from active dancer to unappealing spouse within the space of six months. Beliefs about controllability. (Furnham, 1989; Landrine and Klonoff 1992, 1994) These categories are pivotal to understanding how people make sense of, and decisions about managing a changeable chronic disease such as RA. Evidence of Francesca attempting to make sense of her symptoms by embarking upon a cognitive search may be seen in the example below: I couldnt understand it Im the healthiest person I know. Ive never had problems with my health never had a day off sick in my life. I never go to the doctor, no matter what, Ive always been fit as a flea. From the narrative provided we also have limited information concerning Francescas partners views, for example (although not from Dave himself) Dave wore me down, telling me Ive got to see a doctor This may be interpreted in various ways, not least that Dave was keen for Francesca to obtain a diagnosis and thereby a label to legitimise the illness, whether such labelling is disabling or enabling is not fully resolved in literature (Huibers Wessley 2006). Francescas comment does however open up the interesting issue of how partners cope with chronic disease, in RA in particular there is evidence that a strong marital relationship correlates with the couples psychological adjustment to the illness (Mann Zautra 1990). These authors go on to claim that in RA, partners are most affected by their perceived vulnerability to disease and coping ability, whereas the wives who have RA were more affected by pain itself and how they will cope with the effects of the disease- reflected in Francescas comments below; I started having excruciating pains in my feet when I woke in the morning To further corroborate the findings of Manne Zautra (1990) concerning male worries about coping at a more abstract level see the example below: Dave has been great but he has his own worries hes just been laid off from his job and hes worrying about paying for the wedding Mann Dieppe (2006) have also more recently acknowledged coping differences between males and females in RA, (n = eight women with RA ages 31-60 years and their partners, and 4 men with RA ages 43-75 years) although methodologically their sampling may be flawed in that those couples currently experiencing severe martial problems are unlikely to submit to the type of phenomenological interviews that they undertook. The social construction of medical knowledge and politics of disability It is not possible in an essay of this length to provide a full account of the politics of disability, primarily since the topic is multi-factorial, fluid and indeed is covered to an extent in the other sub sections of this work, furthermore we have insufficient data from the narrative to comment in depth. Kitchen and Wilton (2003) comment that our views of disability as a medical entity viewed in paternalistic terms have changed in favour or equality and empowerment. However Francesca can expect to experience a host of politically related issues, for example social exclusion and poverty (Foley Chowdhury 2007). Francesca has already stated in her narrative; Ive got to work- we need the money. In terms of medicines social construction, as far back as 1982, Wright Treacher (1982) claimed that medical knowledge inevitably contains a social component incorporating moral values and prejudices, and that diagnosis ascribes a certain meaning. We still see this thirty years later where the GP abruptly (allegedly) advocates of drugs to preserve normal function. This reinforces the paternalistic medical approach. RA in its early stages does not present with any obvious physical deformity and affects the young demographic, it is conceivable that she may experience disbelief from her peers; this may in turn make her life difficult in an era of financial unease, Government budgetary cuts and political uncertainty. Labelling. Labelling theory (social reaction theory) has its roots in the work of sociologist Howard Becker (Becker 1997). It centres on peoples tendency to negatively label those who are different from ourselves. As a person with chronic arthritis Francesca will not be immune to this labelling, for example being labelled as disabled or arthritic are all real possibilities. Arthritis organisations and acts such as the Disability Discrimination Act ( DDA) are at great pains to encourage activity and maintenance of full function and contribution to society, however all this may be negated by her GPs comments that there is; no cure and I had to take tablets everyday to be able to function normally. Labels can however be positive, Francesca describing herself as glamorous for example on two occasions in the narrative, and her previous label of salsa dance teacher is something that defines her in a positive way. Yes, Im a salsa dance teacher Stigma Stigma has recently been defined by Scambler (2009) as a social process, experienced or anticipated by exclusion, rejection, blame or devaluation that results from experience, perception or reasonable anticipation of an adverse social judgement about a person or group(p441) Francesca may feel stigmatised by all of the factors previously discussed, attitude of her GP, loss of self, worry about the future, inability to act out the role of spouse. Factors such as depression, the lack of a cause for her RA and her inability to teach salsa dancing may amplify her feelings of being stigmatised, it is also important form the wider perspective to acknowledge that stigma may affect Francescas partner. Struening et al (2001) for example reported that 43-92% of caregivers (to people with mental health problems) reported feeling stigmatised, again this suggests that living with this disease does not only affect Francesca but also her partner. Conclusion This essay has employed extracts from the narrative of a 38 year old lady with Rheumatoid arthritis, to illustrate some key sociological concepts. The essay has provided a valuable opportunity to map some key concepts from the literature onto a narrative excerpt. Whilst the essay has not been able to enter the field in great depth; It is a testament to the thick description provided by patient narratives that such a wealth of information can be generated form a relatively short piece of description. References Balen,R., Rhodes, C., Ward,L., (2009) The Power of Stories: Using Narrative for Interdisciplinary Learning in Health and Social CareSocial Work Education: The International Journal, pp1470-1227. Becker, H., (1997) Outsiders. New York, NY. Free Press. Covic, T., Adamson,B., Spencer,D., Howe,G., (2003) A biopsychosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study Rheumatology, Vol 42 1287-1294. 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Appendix Reflective postscript This is written in the first person since it is a reflective piece of writing This was a challenging yet fascinating project to complete. I was unsure how to approach the topic and how much weight to attach to the various theories available and the comments of Francesca , once it became clear that I was actually trying to explain what was going on with Francesca by using academic theory to illustrate her comments the task became rather enjoyable. Tight word count restrictions as always meant that I had to do some brutal editing, but the positive side to this is that it makes one more selective in ones writing. For example my earliest version was heavy on sociological theory and light on mapping this theory to the comments of Francesca, whereas the final version makes more explicit links between what Francesca says and the theory behind why she says it. The fact that I had some real comments to sink my academic teeth into made the process of literature searching interesting and relevant since I was able to think about Francescas comments and her personal situation for each search that I undertook. The areas that gave me most difficulty were the political aspects of disability since they seemed so wide ranging and actually intertwined with everything that I was writing about. All in all I have learned a great deal about the usefulness of narrative form this project.