Children and parents Essay Example for Free

Children and parents Essay A new age man is a man that a man that believes in equality and shares all household chores with is partner exactly and contributes equally as much as the women. This is different from a house husband because this is a man who has had a complete role reversal and takes on the traditional role of a house wife and stays at home full time. We cannot generalise about role relationships across society because changes in role relationships have not occurred at the same pace or to the same extent through all sectors of society. Role relationships vary according to social class and ethnicity. Home based entertainment, for example DIY give spouses things in common which gives them a friendlier and more loving relationship. Contraception has allowed couples to have children later and also it means that a lot of couples choose to have smaller families or no children at all. This does not apply to some religions such as Catholics who do not believe in using contraception. Women can now plan when to start their families and to have children resulting in them planning them around their careers. Feminism is an approach that fights for the equal rights of women. This is a large factor in the changing equality in the home because more women demand to be treat as their partners equal. It has lead to the rejection of the housewife role. There is an increase in male unemployment more men have become more involved in domestic tasks. Jane Wheelock (1990) conducted research into this topic and found that men undertook a lot more housework and childcare while unemployed. One survey showed that mothers that also worked outside home had it worse because they still spend more hours on housework a week then they do at their paid place of work. On average these women spend 62 hours a week on house hold tasks were fathers who also worked only spent 23 hours on house work. Another survey shows that some traditional gender role are still being passed down to the younger generations( 1992-93) such as girls still taking more of a part in cooking, cleaning and child care but boys are doing more things for themselves like cleaning their own rooms, making beds and washing their own clothes. Sometimes sociologists say that social class and ethnicity change role relationships. It is suggested that working class families are more male dominated (patriarchal). Evidence proves that middle class conjugal relationships are more equal than working class ones but it is also said that working class fathers are more involved in childcare. It is believed that Asian families are usually based on unfair patriarchal relationships. Westwood and Bhachu (1988) challenge this idea arguing that images of the Asian family are usually based on prejudice and prejudgement. They point out that Asian families are in fact British families and are a strong source of resistance against the racism of British society. In reality there are ethnic differences between Asian people in Britain according to religion and social class, which makes it hard to generalise about the Asian family. Henriques and Slaugher talk about the patriarchal relationships between men and women. This means that the relationship is male dominated. They talk about the two different segregated roles. Relationships between children and parents have changed over time but it has always varied between working, middle and upper class families. Throughout the nineteenth century life chances varied a lot for different classes for children. A paid employee such as a nanny would often look after higher-class children. This would often separate their children from their parents and so it would be harder for them to develop a strong bond. Working class children on the other hand, especially boys would often have to start work very young. There was a wider range of jobs for boys were available but girls would often have to work in cotton factories. The hours would be long and the pay and conditions would often be unfair. Poverty prevented parents sending their children to school and sometimes they would only send their boys but keep the girls at home to teach them how to be a good housewife. Mothers would often have a close relationship with her daughter. People used to have children so they could send them out to work to earn money for the family. Sometimes parents thought that education just blocked this. Another reason why people used to have children was so they had someone to take care of them in old age. Factors that changed these relationships included the growth of the welfare state, which meant people no longer needed children to look after them in old age. Parents could no longer send children out to work at such a young age because of protective legislation, this meant that law including factory and mine acts stopped it. There was a growth of the meaning of childhood and they remained children for longer because of the state of education in 1870 meant you had to attend school. Children were given more attention by parents, media and toys invented a new childhood and children and parents spent more time together. Today the relationship is usually warmer and more caring than in the past. Children are seen as more important and taken a lot more seriously. There have been changing attitudes towards discipline and laws against hitting children in Scotland. It is now seen as wrong to hurt a child, if they do organisations (social services) get involved. There is more of an emphasis on freedom and childrens rights. Relationships are more children centred and because family sizes are smaller children get more attention. In 1976 a law was passed to say that the minimum age of leaving school was 16 and though a child can work before then the hours and law restricts times. This means that children are financially dependent on their families for long periods of time especially if they go on to further education. Children are fully dependent on their parents and this can sometimes bring stress and tension to the family. Not all relationships between child and parents have improved as sadly cruelty to children is still widespread and the National Society for the Prevention of Cruelty to Children (NSPCC) estimate that around 600 children are intentionally harmed by their parents each year.

A Literature Review On Adventure Tourism Tourism Essay

A Literature Review On Adventure Tourism Tourism Essay Adventure tourism has become more popular as an outdoor recreation activity in the tourism industry (Travel Industry Association of America, cited 2005). The term adventure can actually mean differently to different tourists because things that fill up the fear of one tourist may not fill up for another tourist (Buckly, 2006). Therefore, there is no any specific way to define adventure tourism. The word adventure is described as the risky activities in nature that are taken on by the tourist or the risky destination visited by the tourist and the tourist get an exciting and unusual experience from what the tourist had did (Farlex, The Free Dictionary). Adventure also is where the participants voluntarily putting themselves in a position that the participants believe that they are taking a step into the unknown where challenges will be faced and something valuable from the experience will be discovered or gained (Swarbrooke, Beard, Leckie, and Promfret, 2003). Consequently, adventure tourism is something related to nature and it is consisting of risk taking. Muller and Cleaver (2000) (cited in Swarbrooke et al. 2003, p. 29) defined adventure tourism as the capability to provide tourists with relatively high degrees of sensory stimulation. It is usually contained some physical challenging elements with the (typically short) tourists experience. While Buckley (2006) mentioned that the term adventure tourism is used to mean as guided commercial tours where these major attraction is an outdoor activity that has natural environment features and normally needs specialized sporting or equipment. It must be exiting for the tourists also. This definition does not mean that the tourists or clients have to prepare the equipments themselves, they may purely be travellers and rely on the agents to prepare the equipments for them. For example, tandem parachute harness or white water raft, etc. Therefore, adventure tourism can refer to activities done by the tourists, which have high level of perceived or real risk like diving, hiking, mountaineering, mountain biking, caving, sky-diving, skiing, snowboarding, white water rafting, kayaking, sailing, and sea kayaking. It also refer to a specific location of place with high degree of risk such as visiting desserts, jungles or mountaintops, polar regions and safaris. All these places have strong elements of adventure. Adventure tourism can be divided into soft adventure and hard adventure. These terms are developed by researchers who devised a scale to explain the diversity of behaviour, beginning with mild adventure also known as soft adventure at one end of the scale and progress to hard adventure at the other extreme. This continuum, illustrate in Figure 1.1, involves different degrees of challenge, uncertainty, setting familiarity, personal abilities, intensity, duration and perceptions of control (Lipscombe, 1995: 42). A simpler way to describe soft and hard adventure is that soft adventure does not necessarily require past experience whereas hard adventure requires some experiences and proficiency in the activity prior to the tourism experience (Millington and Locke, 2001). Hard Adventure Refers to activities with high levels of risk, requiring intense commitment and advanced skills. Soft Adventure Refers to activities with a perceived risk but low levels of real risk, requiring minimal commitment and beginning skills; most of these activities are led by experienced guides. Figure 1: The continuum of soft and hard adventure (source: Hill, 1995, cited in Beard et al. 2003, p. 33). Tourist behaviour is an in-depth topic as the behaviour of tourist change from time to time and sometimes it can be difficult to judge because not everyone shares the same behaviour. In order to understand tourist behaviour, psychologists have found that certain concepts are useful to understand the behaviour (Bhatia, 2006). According to Bhatia (2006), tourist behaviour can be understand by determining the motive, drives, or concerns being satisfied by the action and the attitudes and information that the person use to decide what kind of response should be made in a given situation. Motivation is one ways to describe tourist behaviour. Motivation is a verb derive from motivate Motivation is factor that influence or motivate trekkers to travel to Everest Base Camp. Motivation is defined as a reason or reasons for acting or behaving in a particular way or the desire or willingness to do something (Oxford online Dictionary). Hence, motivation of travel is why tourists travel to a place . It is important to know tourist travel motivations because motivations will affect travel decision process (Crompton and McKay, cited in Pan 2009, p. 216) and motivations are drivers that influence and affect the specific behaviour of a person or traveller. Furthermore, it also helps to develop strategies to attract tourists to a particular destination by understanding tourist behaviour. For example, travel agent or local authorities can find a way to increase the volume of tourists visiting a destination by understanding the tourist behaviour when the destination is kind of new in the tourism market or the number of tourists in the destination had decreased. Travel motivation is a wide theory where it can not be understood by looking at one part of the theory only. Figure 2: The Motivation Process (source: Holloway, Humphreys Davidson 2009, p.62). The process of translating a need into motivation to visit a specific destination or undertake a specific activity is quite complex and can be best demonstrated by means of a diagram (refer to Figure 2) (Holloway, Humphreys Davidson 2009, p.62). Potential consumers must be able to recognize their needs and wants and know what kinds of product actually satisfy their needs. Figure 2 shows that consumer perception of what will satisfy their need has to match with consumer perception of the attractions. Only when the consumer agrees on these 2 points, consumer will be motivated to visit a particular destination. For example, customer A and customer B have the same kind of need, where both of them like to do adventure activities and their think that trekking up to a mountain satisfies their need. Both customer A and B have the same interest but their perception on a particular destination may be different. Customer A may think that trekking to Mount Everest actually fulfils what he wants and his perception towards the destination is positive. While customer B may think that trekking to Mount Everest fulfil what he wants but he has a bad perception towards the destination as he think that the destination is very risky to him. Therefore, customer A will be willing to buy the package and climb up to Mount Everest because both the perception of the need and the attraction match. Customer B will not be motivated to go to Mount Everest as the perception of need and attraction do not match. According to Beerli and Martin (cited in Correia, Valle and Moco 2007, p. 46), motivation is the needs that drives and individual to act in a certain way to achieve the desire satisfaction. Therefore, people travel base on many different reasons. Motivation has also been referred as psychological / biological needs and wants including integral forces that arouse, direct, and integrate a persons behaviour and activity (Dann; Pearce; Uysal Hagan, cited in Shin 2009, p. 32). Travel motivators are the factors that create a persons desire to travel and are usually the internal psychological influences affecting individual choices (Bhatia, 2006). Travel motivations usually include a wide range of personal experiences and behaviours. Various studies have been done to find out why people wish to travel after the advent of mass tourism, especially after the Second World War. Macintosh (cited in Bhatia 2006) has group the basic travel motivators into four categories. Physical motivators, which are related to physical relaxation, refreshment of body and mind, sports, pleasure, and special medical treatment. All these are connected with individuals bodily well beings and connected to activities which help to reduce tension. Cultural motivators, which are related to individuals desire to travel in order to know more about other countries, natives of the countries and cultural heritage of the countries which expressed in art, music, dance, folklore, etc. Interpersonal motivators, which are related to individuals desire to meet new people, visit friends and relatives, and to seek new and different experiences. Travel is simply to escape from the daily routine or get away from the usual life or environment. Status and prestige motivators, which are related to the needs of personal esteem and personal development in an individual. Such motivators are more likely to be concerned with the desire for recognition and attention from others, in order to boost personal ego. Under this kind of motivations, people usually travel for business, for the purpose of education and the pursuit of hobbies. Crandall (cited in Hall Page 1999) who did a study on the motivations of the leisure travellers, outlined 17 motivational factors which derived from a synthesis of previous studies in this field. Below are the 17 motivational factors listed by Crandall. 1 ENJOYING NATURE, ESAPING FROM CIVILISATION To get away from civilisation for a while To be close to nature 10 RECOGNITION, STATUS To show other I could do it So other would think highly of me for doing it 2 ESCAPE FROM ROUTINE AND RESPONSBILITY Change from my daily routine To get away from the responsibilities of my daily life 11 SOCIAL POWER To have control over others To be in a position of authority 3 PHYSICAL EXRCISE For the exercise To keep in shape 12 ALTURISM To help others 4 CREATIVITY To be creative 13 STIMULUS SEEKING For the excitement Because of the risks involved 5 RELAXATION To relax physically So the mind can slow down for a while 14 SELF-ACTUALISATION (FEEDBACK, SELF-IMPROVEMENT, ABILITY UTILISATION) Seeing the results of your efforts Using a variety of skills and talent 6 SOCIAL CONTACT So I could do things with my companions To get away from other people 15 ACHIEVEMENT, CHALLENGE, COMPETITION To develop my skill and ability Because of the competition To learn what I am capable of 7 MEETING NEW PEOPLE To talk to new and varied people To build friendships with new people 16 KILLING TIME, AVOID BOREDOM To keep busy To avoid boredom 8 HETEROSEXUAL CONTACT To be with people of the opposite sex To meet people of the opposite sex 17 INTELLECTUAL AESTHETICISM To use my mind To think bout my personal values 9 FAMILY CONTACT To be away from the family for a while To help bring the family together more Table 1: Crandalls list of motivations. Source: Crandall 1980 (cited in Hall Page 1999). Pearce (cited in Pan 2009, p. 218) who had based and expanded on the theory of Maslows hierarchy of human needs, first developed the travel career ladder approach to travel motivation in 1988 and later made conceptual adjustment to the travel career ladder in 2005. The fundamental nature of this model connects the level of travel experiences with the hierarchy of travel needs. According to Pearce (cited in Pan 2009, p. 218), travellers who had more experiences in travel usually seek experiences that meet their higher order of travel needs such as self-esteem and self-actualization. On the other hand, inexperienced travellers will tend to seek experiences that meet their basic travel needs such as security and psychological ones. Tourism industry is a services industry and the products which offer in tourism industry are intangible. It is widely known that to travel is to experience. Consequently, tourist experience is fundamentally a service experience. The five level of travel career ladder, starting from the bottom are (1) concern with biological needs (including relaxation), (2) safety and security needs or level of stimulation, (3) relationship development and extension needs, (4) special interest and self-development needs, and (5) fulfilment of deep involvement needs which formally defined as self-actualization (Pearce cited in Marafa, Ho Chau 2007, p.8). This travel career ladder is later presented graphically by Ryan (cited in Marafa, Ho Chau 2007, p.8), refer to figure 3. It is not necessary that everyone has to start from the bottom because people change from time to time and some may try to seek for activities which satisfy high level of needs in pursuit of leisure and recreation (Marafa, Ho Chau, 2007). Figure 3: Travel Career Ladder by Ryan (cited in Marafa, Ho Chau 2007, p. 9). Another theory which often use by researchers when describing travel motivations is the push and pull theory. This theory shows that people travel because they are pushed and pulled to travel by some factors. Dann (cited in Pan 2009, p. 219) whom had combined and analyzed the relevant travel motivation literature, concluded that travel occurs due to the internal factors of indentified and unfulfilled desires (motivational push) and reinforce by external factors which is destination pull. Push factors are either internally generated or externally induced (Dann, cited in Pan 2009, p. 218). The desire to conquer a mountain by reaching the summit of the mountain is one of the examples of push factors. While pull factors are related to the attributes of the destination that serve to satisfy the needs and wants of travellers. Several authors assume that internal and external factors are factors that motivate human behaviour. For example, Kotler (cited in Correia, Valle and Moco 2007, p. 46) states that motivations can be the result of internal and external stimuli. Internal factors are factors derive from personal needs and wants such as psychological, social egocentric, self-actualization and safety. While external factors are usually result from promotion and publicity. Travel motivation can be either personal (personal training, compensation rest and knowledge) or interpersonal (resulting from social relation) (Crompton, 1979; Dann, 1977; Yoon and Uysal, 2005, cited in Corriea et al. 2007, p.47). Iso-Ahola; Ryan Glendon (cited in Pan 2009, p. 219) argued that travel motivation is closely related to leisure motivation and the former should not be studied independent of the latter. Iso-Ahola (cited in Alexandris, Kouthouris, Funk Giobani 2009, p. 482) defined tourism motivation as a meaningful set of mind which adequately disposes an actor or a group of actor to travel. Approach (seeking) and avoidance (escaping) are the two components in leisure motivation, identified by Iso-Ahola. Therefore, people travel in order to seek friendship, novelty, challenge, achievement, experience, and etc. while at the same time escape from the daily routine or personal problems. While Ryan Glendon (cited in Pan 2009, p. 219) applied an abbreviated version (14 items) of the Leisure Motivation Scale of 1,127 United Kingdom holidaymakers and identified four motivation factors from the scale which were intellectual, social, competence mastery and stimulus avoidance. The first three factors could be categorized as seek components and the last factor as escape component. Crompton (cited in Kao, Patterson, Scott, and Chung 2008, p. 18) studied travel motivation by using push and pull model and developed seven socio-psychological or push motives (escape from a perceived mundane environment, self-exploratory, relaxation, prestige and regression, enhancement of kinship relations, facilitation of social interaction) and two cultural motives or pull motives (novelty and education). This study refers to motives which are more specific and direct that can affect tourists decision on the travel decision or the type of holidays (Crompton, cited in Corriea et al. 2007, p.47). The author identify that psychological or social motives (push motives) sustain the desire to travel. While on the other hand, travel decision if affected by pull motives and pull motives are also associated to the destinations characteristic (Lundberg, cited in Corriea et al. 2007, p.47). A study was done to explore the motivations and satisfactions of Taiwanese Tourists who visit Australia (Kao, Patterson, Scott, and Chung, 2008). Push and pull approach was used to find 17 push motivations and 18 pull motivations for travel in this study. The most important push factor found in this study is Travelling around the world, while the most important pull factor is sunshine and scenery and most of the Taiwanese tourists are satisfied after visiting Australia. Study done by Chang (2007) on travel motivation of package tour travellers suggested that socio-psychological needs were an important motivation for travel, and socio-economic considerations were regarded as a crucial motivation for travel decision making. Furthermore, social relationships friends or relatives recommendations had a strong impact in the decision makings of the Taiwanese travellers (Chang, 2007). This study was done to examine travel motivations and travel decision-making of Taiwanese tourists with a g roup package tour abroad. Therefore, it can be said that tourists travel to a destination is strongly influenced by their socio-psychological needs. Tourist builds his/her perceptions based on intrinsic and extrinsic motivations (Gartner, 1993; Dann, 1996; Baloglu, 1997; cited in Corriea et al. 2007, p.47). Everyone receives and processes information differently. Therefore, individuals perception is also formed differently base on how the information is received and transformed. According to Oxford online dictionary, perception means the ability to see hear, or become aware of something through senses or the way in which something is regarded, understood, or interpreted. Perceptions are also defined as the perceived value of product by many previous researchers (Correia and Crouch, 2004; Correia et al., 2007C; Holbrook, 1996; oh, 2000; Sheth et al., 1991; Zeithaml, 1998; cited in Correia and Pimpao 2008). This concept develops based on cognitive and behavioural perspectives which result from the learning and motivational processes rendered by the tourist. Therefore, perception is the point of views about what the tourist think ab out the destination. Perception of a destination is linked to the destination image. Based on the image of the destination, perception of the destination will be generated and each tourist will have their own perception about the destination. Destination image is described as overall perceptions of individuals regarding a place or total set of impressions about a destination (Bigne et al., 2001; Fakeye and Crompton, 1991; cited in Alvarez and Korzay 2008). Destination image is usually formed through media, either positive or negative images. This is based on how the country promotes the destination in its country and through world news, people can easily know the problems or issues in the country. Hence, the destination image will be easily affected and it changes over time because people build up the destination images and representations based on the information that they receive (Avraham, 2000; So ¨nmez and Sirakaya, 2002; cited in Alvarez and Korzay 2008). In 21st century, internet is the most powe rful media that affect customers perception and destination image. In the world of internet, people can easily source for information regarding the destination and leave comments on the blogs or travel discussion forums after visiting the destination. Therefore, people nowadays not only listen to their friends past travel experiences but also read the worldwide tourists experiences from travel blogs or travel discussion forums. It is important to know what Malaysian trekkers think about Everest Base Camp which can be risky. Corriea et al. (2007) did a research on why people travel to exotic places by combining motivations and perceptions. This is the first time and they are the first few researchers that combine motivations and perceptions in order to understand how people can be pushed to travel to exotic places and how they form their perceptions. In this research, Corriea et al. (2007) try to find the relationship between push and pull motivation, push motivation and perception, and pull motivation and perception, based on a group of Portuguese tourists who go to exotic places such as Brazil, Morocco, Egypt, Sao Tome, and Principe. This study proves that perception of tourist destinations are formed based on push and pull factors but the relationship between push factors and perceptions in not significant and this proves that tourist decides to go for travel because he/she need to solve a conflict arousal (rest, social, and intellectual rewards) (Corriea et al. 2007). After that, the tourist will dec ide where to go based on the destination attributes. Destination attributes (pull motives) are seen as the way to solve intrinsic motives (push motives) in this study, but these constructs are not directly related to the overall perceptionof the destination because they are apparently solved when the tourist turns the attention to specific attributes (Corriea et al. 2007). Gnoth (1997) reports that the perception of a destination may be analysed from a cognitive or behavioural perspective. There are several types of perceptions which are cognitive component (which results from the evaluation of the destination attributes) and personal component (which results from the evaluation of the destination attributes) that a person can have, argued by Gnoth (1997). Travel motivation is an extensive researched area in tourism (Pan, 2009). Consequently, there are many theories that describe about tourist motivation to travel suggest by several authors or researchers as different tourist have different mindset and behaviour. Furthermore, there are many forms of tourism and tourists can be clustered into various types of groups. Perceptions of travellers on a particular destination can be unlikely because everyone thinks differently. Due to different in culture and the way they receive and transform the information will affect the perception of the tourists. Conceptual Framework Figure 4: Conceptual Framework Hypothesis Trekking in Everest region is the dream of most of the Malaysians trekkers. Its part of self-fulfillment of the trekkers and they want to challenge themselves as Malaysia does not have mountains which are more than 5000m and Everest is the highest mountain in the world. Malaysians trekkers travel to Everest Base Camp but not to the summit of Mount Everest because budget and time limit them to trek to the summit of Mount Everest. Additional information Objective To know the factors that motivate them to take Everest base camp trek To understand travelers perception on Everest base camp, Nepal as a tourism destination

Treatment of Paediatric Acute Pain

Treatment of Paediatric Acute Pain The attempt of this essay is to examine how the UK NHS paramedics treat acute pain in paediatric population. This essay will accentuate the importance of adequate training and research in paediatric care. Paramedics employed by UK NHS Ambulance trust have a diverse selection of analgesics at their disposal for acute mild to severe pain, ranging from paracetamol and ibuprofen to Entonox and intravenous morphine sulphate. (JRCALC) This essay will look at the management of acute moderate to severe pain with emphasis on the barriers that prevent paramedics from assessing and treating paediatric patients with pain adequately, as well as intravenous morphine versus intranasal fentanyl debate. Different ways of treating pain in emergency services and departments around the world will be discussed and appropriate literature from emergency care will be used to support the statements made throughout this essay. Hennes, Kim, Ronald and Pirrallo (2005) describe pain as a complex multidimensional phenomenon that is difficult to assess, particularly in young children. Combined with the fact that pain is the most common symptom in the emergency setting (Alonso and Wensley, 2003), it is fundamental that we understand and improve the care for all patients in pain. However, there is disparity between assessment and treatment of adults and paediatrics. This phenomenon has been described for over 25 years (Schechter, 1989). Watkins (2006) is in agreement with Schechter (1989) that adult patients are more than twice as likely to receive opiate analgesia for acute moderate to severe pain, when compared with children who describe similar pain scores. The UK NHS Ambulance trust has been under long term criticism, because of inadequate provision of analgesia for paediatric patients. This view has changed in 2003 when Medicines and Health care products Regulatory Agency approve the use of morphine in the aforementioned group of patients. Today, intravenous morphine sulphate and morphine sulphate oral solution can be safely administer by registered paramedics. Recently, many studies who targeted the emergency services around the world discovered that healthcare professionals are often unable to assess and treat paediatric patient in pain (JRCALC, 2013). Important step in addressing oligoanalgesia is by identifying the barriers to inadequate pain management. This statement is supported by numerous authors including Ricard-Hibon, Chollet, Saada, Loridant and Marty (1999), Bruns, Dieckmann, Shagoury, Dingerson and Swatzell (1992) and Jones and Machen (2003). Sequelae of inadequate treatment of acute pain may lead to alteration in immune function, delayed wound healing and a lower pain threshold in subsequent painful experiences. Firstly, a qualitative study by Murphy, Barett, Cronin, McCoy, Larkin, Brenner, Wakai and O’Sullivan (2013) explores what barriers prevent adequate treatment of paediatric population by emergency service. The study focuses on acute pain in children from the perspective of advanced paramedics in Ireland. Authors of the study believe that there are many factors, or barriers as they call it that render the potential pre-hospital treatment of children inadequate and ineffective. One of the biggest causes identified was the lack of training targeted specifically to paediatric care, current clinical practice guidelines for paediatric pain management, limited exposure to paediatric patients in pre-hospital setting and many others. A huge part of the concern that has arisen from interviews was the difficulty and even inability to assess pain intensity in young children, especially in preverbal age. Also, a disturbing reason listed for oligoanalgesia was short hospital transfer time, which further added to all possible situations, when practitioners would be reluctant to administer analgesia when dealing with children. Melzack and Wall (2003), Williamson and Williamson (1983) and Gilianu, Krane, Galloway And Yaster (2000) are all in agreement that exposure to severe pain in children can cause adverse psychological, biochemical, metabolic and behavioural changes. The study concluded that emergency services must emphasise improvement in paramedic education and training, specifically giving alternatives to assessing pain in preverbal children. Some advanced paramedics even suggest that treatment of acute pain in paediatrics should be approached differently to acute pain in adults. Through focused group interviews moderated by apaediatric emergency medicine specialist, the authors were able to collect the necessary data. Though the study was well designed, it had limitations. There were only twelve participants, however, as the authors point out, it has been argued by Howard and Moore (1989) and Kitzinger (1995) that aminimum of eight participants is accepted to be sufficient. Another factor that have been identified by advanced paramedics in the aforementioned study and a study by Hennes, Kim and Pirrallo (2005) from the perspective of paramedics in United States highlights the inability to effectively administer medications available to paramedics. A concern was raised in the area of cannulating a paediatric patient as well using medications that needed to be inhaled, such as Entonox. Both studies found that practitioners were in many cases unable to firstly, assess the pain score, and secondly treat the paediatric patient, due to the fact that children showed anxiety when trying to give intravenous morphine or oramorph. Murphy, Barett, Cronin, McCoy, Larkin, Brenner, Wakai and O’Sullivan (2013) strongly suggest that identification and mitigation of aforementioned barriers to the prehospital management and treatment of paediatric patients is crucial and should be one of the priorities in further development. Secondly, astudy by Watkins (2006) looked at whether the age of child influenced the likelihood of their receiving prehospital analgesia from their local ambulance services. The study investigated this question in Auckland. Jones, Johnson and McNinch (1996) again raised a concern about inadequate analgesia in paediatric population, which has been further highlighter by Watkins (2006). The study found that children less than 5 years of age are in significant risk of being undertreated of pain by ambulance service. When compared with children who were 5-15 years of age, Watkins (2006) also observed that there was a significant change as they received some form of analgesia in 50% of cases. The study also points out an interesting fact about the use of pre-hospital Entonox. Children given Entonox alone appeared to be in more pain than non-treated children, which is surprising as in adult population, it is reported to produce adequate analgesia for 50% of patients. (Ricard-Hibon, Chollet, Saada, Loridant and Marty, 1999). â€Å"I am sure the air in heaven must be this wonder-working gas of delight† (Fullmer, 2000) Watkins (2006) suggested several possible reasons for this perception of the effect of Entonox, such as incorrect use leading to inadequate effect, as children are in many scenarios crying preventing them from using the equipment properly. Also, it might be relevant to mention that children achieving sufficient level of analgesia using Entonox were 8 years of age or older. As indicated by Watkins (2006), further research is necessary to establish whether the use of Entonox is suitable for analgesia in children. The study also found that no child aged less than 5 years of age received analgesia in form of morphine, which disagrees with claims made by ambulance officers who participated in the study. Again, the author further confirms the theorem that even qualified practitioners have difficulties in assessing and administering analgesia to young children. As mentioned above, the pain caused by gaining intravascular access leads to underuse of opiate analgesia in younger children. As highlighted by Braude and Richards (2004), further investigation of non-invasive methods of pain relief in pre-hospital setting is absolutely crucial. This leads to a morphine sulphate and intranasal fentanyl debate, which has been the subject of several studies. In hospital setting, intravenous fentanyl was shown as an effective alternative to morphine sulphate, however during the last decade, a new option became available. Braude and Richards (2004) indicate that there are at least four reasons to use intranasal fentanyl in pre-hospital setting. This claim is supported by numerous publications including Watkins (2006), Maurice, O’Donnell and Beattie (2002), and Rickard, O’Meara, McGrail, Garner, McLean and Lievre (2007). Maurice, et. al (2007) identified that management of acute pain in paediatrics relies on successful intravenous cannulation that may be technically impossible to perform. Moreover, the author also acknowledged that this increases the risk of needle stick injuries to either the patient or patient’s family and to the staff. A possible replacement in the form of intranasal fentanyl has been long discussed by many authors. Braude and Richards (2004) have reported that intranasal fentanyl has a rapid peak, short duration of action and does not cause the release of histamine, which may cause hypotension. Also, there are very few instances of nausea being caused by administering intranasal fentanyl. Rickard, O’Meara, McGrail, Garner, McLean and Le Lievre (2007) conducted a randomised controlled trial to compare intravenous morphine and intranasal fentanyl for pre-hospital analgesia. Intranasal fentanyl has been used in the inpatient hospital setting, but prior to this randomised controlled trial, there has been no other trial comparing the aforementioned drugs in pre-hospital setting. The study found that there was no significant difference between the effect of intranasal fentanyl and intravenous morphine sulphate in pain reduction. The study identified that there were no previous randomised controlled trials available. The lack of supporting evidence for analgesics have been identified by Borland, Jacobs and Rogers (2002) who also recognised that there was paucity of data to support practice with no randomised trials. Moreover a trial by Borland, Jacobs and Rogers (2002) further confirmed that intranasal fentanyl was comparably effective at reducing pain paediatric in an emergency department. The study had several limitations, including the sample size, which was set out to be 400 patients. Due to time constraints, a total of 258 patients were randomised and out of them, only 227 were evaluable. Also, the side effects were observed by paramedics who were treating the patients, which may have produced biased results. The author notes that a more reliable way of recording such data would be by a trained physician or dedicated paramedic researcher who would not be busy with clinical care. The study notes that nausea and vomiting may still be a problem with the use of fentanyl, especially in the mucosal routes and particularly in children, as they may become uncooperative. It has also been noted that the ability to absorb any medication through nostrils changes throughout the day, because of mucous congestion. Following this conclusion, some Australian ambulance services increased the doses of intranasal fentanyl with reported beneficial outcomes. In conclusion, it is clear that the pain management in paediatric population continues to evolve not only in pre-hospital setting within the United Kingdom, but also around the world where doctors are using their experience with synthetic analgesia to drive the patient care further, broadening the scope of emergency practitioners, such as paramedics employed by UK NHS Ambulance trust. In 2003, morphine sulphate was introduced and marked as a solution to ever increasing problem with oligoanalgesia. More recently, complex studies evaluated the risk to benefit ratio of alternative analgesia more suited for specific part of our population, such as the use of intranasal fentanyl for paediatric patients. Moreover, the essay demonstrated that the improvement must start with clinicians, their understanding of protocols and ways to treat aforementioned group of patients. â€Å"Paediatric patients seldom need medication for the relief of pain. They tolerate discomfort well.† This citation clearly demonstrates how far the care for paediatrics in acute pain has come in recent decades and thanks to the research mentioned throughout the essay, it continues to improve within a hospital as well as pre-hospital setting.

VA Gulf Coast Veterans Health Care System :: essays research papers

VA Gulf Coast Veterans Health Care System Human Resources (05A) 400 Veterans Avenue Biloxi, MS 39531 Applicants must submit the following: 1a. On-station (VA Gulf Coast Veterans Health Care System) employees must submit an Application for Promotion or Reassignment, VA Form 5-4078, to Human Resources (05), Bldg 53, Room 2A-108. You must indicate the lowest grade you are willing to accept or we will only consider you at the Full Performance Level of the position. Application material can be delivered in person, sent via inter-office mail, or submitted electronically via VA intranet (VHABILHRM in outlook). Application material, to include VA Form 5-4078, must be received in Human Resources by the closing date of the announcement. Supplemental qualification form (i.e., VA Form 5-4676a) must be returned within 7 (seven) calendar days of the closing date of the announcement. No credit will be given for education unless substantiated by an official college transcript. OR 1b. Off-station applicants, to include on-station employees desiring consideration for a new appointment under non-competitive appointment authorities (e.g., VRA), must submit a written or electronic application for employment. You may use the OF-612 form (Optional Application for Federal Employment), a resume, or alternative format. You must indicate the lowest grade you are willing to accept or we will only consider you at the Full Performance Level of the position. You should also complete an OF-306 (Declaration for Federal Employment). You MUST include all of the information specified in the vacancy announcement and all information listed in the Office of Personnel Management’s brochure â€Å"Applying for a Federal Job (OF-510)†. Applications must be typed or printed clearly in dark ink. If application is submitted by mail, it must be postmarked by the closing date of the announcement and received within five (5) working days. If application is delivered in person ( VA Gulf Coast Veterans Health Care System, Human Resources (05A), Building 53, Room 2A-108, 400 Veterans Avenue, Biloxi, MS), it must be received by close of business (4:30pm) on the closing date of the announcement. If the application is submitted electronically, it must be received by the closing date of the announcement (i.e., by midnight Central Standard Time). Current permanent VA employees may electronically submit application material via the VA intranet (VHABILJOBS in outlook). NOTE: When submitting electronic application material, it MUST be in the body of the message. ATTACHMENTS TO EMAIL MESSAGES WILL NOT BE OPENED, NOR CONSIDERED. Submission of electronic application material WILL NOT BE a complete application package.

The Breakdown And Rebuilding Of South African Society Within The Novel :: essays research papers

The Breakdown and Rebuilding of South African Society within the novel Cry, The Beloved Country â€Å"...what God has not done for South Africa man must do.† (25)   Ã‚  Ã‚  Ã‚  Ã‚  In the novel Cry, The Beloved Country, written by Alan Paton, some major conflicts follow the story from beginning to end. Two of these conflicts would be as follows; the breakdown of the tribal community and the power hope and faith pocesses to rebuild broken relationships. Kumalo, as an indivigual, demostrates the power of this hope which mends the broken relationships of his friends and his fallen tribal community. Throughout the novel one aquires the perfect perspective about the hardships the natives went through as a society. Cry is a story about a Zulu pastor Stephen Kumalo and how he sets out to bring his family back to the community in which he resides. Kumalo, dealing with his family and congregation straying away from the church, does show the power of hope and faith and how it can rebuild broken relationships throughout the novel.   Ã‚  Ã‚  Ã‚  Ã‚  The tribal breakdown starts to show in book 1, with the land that the tribe must use and how the poeple of Ndotsheni have used up the natural resourses that used to lay within the community. The whites pushed the tribe out of where the community used to reside. The land was so rich that it was decribed as â€Å" holy, being even as it came from the creator†(3). In the rural areas much of this decay came as a result of the tight confinned living areas that the blacks were forced to live upon. With such a mass population and such a small place to occupy it is only a matter of time before the land is no longer able to be farmed. The decay of the tribe was not only confined to the natural resources of the land but also resulted in a moral and physical decline of the entire population. In result of these conditions, many people left the tribe to go to Johannesburg where there’s a false hope for a new start in life. A hope that almost vanished when Komalo left. Without his strong moral belief in God the people where left with nothing but a decaying landscape. Even though it may seem as if all hope is lost for a decent life in the tribal community, it is within this time that the relationships between others are tested and drawn closer through the power of hope and faith.

Air Jordan Marketing

4P: Jordan Air In order to briefly explain how marketing mix is applied, I am going to give you the example of the â€Å"Jordan Air† So you can see an example of marketing mix I will show you a product that you all know â€Å"Jordan Air†. Product: The product that I will present you is the â€Å"Air Jordan† by Nike. Air Jordan  is a  brand  of shoes and athletic apparel designed, owned, and produced by Nike  and  Michael Jordan  for Nike's  Jordan Brand  subsidiary but I will focus on the market of trainers. These are high quality trainers, and they are considered as high range of trainers. * The Jordan Nike shoes are unique in that the swoosh logo of the firm do not appear on the Jordan brand products, only the Jumpman appears. Price: * The Jordan shoes are very expensive and there are almost never promoted even when there is a new range. Why? Because it is possible to buy all Air Jordan! The Jordan 1 in 1987 is still marketed. The style of Air J ordan is doesn’t date. * The price for Jordan Shoes are around 180 euros Place:These pairs of trainers marketed in shops specialized athletic shoes. * We found Jordan shoes in the specialized sport stores like Decathlon, Go Sport, Citadium, JD Sports †¦ But to have a wider choice you have to go to the shops or Nike Air Jordan in Shops. It is also possible to buy them online, * There is also the possibility of buying shoes on the Internet (Nike official web stores or jumpman23 official stores of Jordan Brand). Jordan shoes even have a website independent of Nike. * Jordan’s are unique shoes and this is why we cannot buy in any store.Promotion: * Jordan Brand uses all traditional media to communicate: radio, television, cinema, Internet and press. The first promotion for the Jordan brand is the personality of Michael Jordan. In fact, MJ is the best player in history in basketball. * Jordan Brand communicates through commercials spots with Michael Jordan showing. * E vent with Michael Jordan who promoted the brand as for example the come out of Jordan CP3. Michael Jordan was there to show the pair of Jordan 2012 in the stores.

Discuss the various ways which Robert Swindells presents life in ‘The streets of London’ Essay

â€Å"I’m invisible see? One of the invisible people.† Link, a young 16 year old boy from Bradford who is homeless, desperate to escape his Brutish stepfather feels that he has become an invisible outcast. Another quotation to support this is when Link says, â€Å"They don’t like reminding I exist.† Link says this to show the reader that he is worthless uses this type of language to make the reader more aware of how difficult it is to live on the streets of London. Link’s character in the book also emphasises a feeling of coldness. An example of this is shown when link says, â€Å"Also I kept seeing people I knew Neighbours. Guys I’d even been at school with. I even saw one of my teachers once. And if you have ever been caught begging by someone who you knew before, you can’t possibly know how low it makes you feel† This also makes the reader think that Link has a very lo self esteem and is very depressed. Another quotation to support this is when Link says, â€Å"I was one of them now – poised at the top of that downward spiral†. Kink says this making the reader understand how hard it is to be living on the streets. Shelter, the less predominant character in the novel, who is trying to rid the streets of homeless people uses subject specific Lexis to show the reader that he has a background in the army or has worked for the army. This is shown to the reader as Shelter always starts his chapters with, â€Å"Daily routine orders†. Link uses sarcasm to emphasise a point, for example, â€Å"Good old Vince†. After Describing Vince as a Brutish, evil stepfather who is a boozer and a bastard, Link says, â€Å"Good old Vince†. The author, Robert Swindells uses this to create an irony. At the beginning of page three Link mentions, â€Å"Born March 20th 1977†¦ to Mr & Mrs X†. Link says this to show the reader that he has forgotten the past and wants to get on with life. The main quotation to support and emphasise this is, â€Å"Mr & Mrs X†. Another statement to support this is when Link says, â€Å"I strode out of the station with my backpack and bedroll, and it felt like a new beginning†. This also shows the reader that link was positive life would improve from what it was with Vince. Another quotation to support this is â€Å"Nobody knows you. Where you’re from and what’s gone before. That’s you’re business†. One other quotation to support this is when Link chooses the name to give to Ginger he says, â€Å"‘Link’ I said. I’d seen it on this signpost earlier. Thames – Link. It’s a railway.† Robert Swindells also uses various techniques to make living on the streets look very hard and scary. The reader is informed of this when Link says, â€Å"Sad is what it is, Sad and scary. You’re leaving a place you know and heading into the unknown with nothing to protect you. This also informs the reader that this novel appears to be tragedy in many respects. Link feels very depressed after applying for many jobs in London and not getting any because he was homeless and was looking rough and scruffy, also looking like a tramp because of sleeping in the same clothes on the solid concrete floor. When Link started living on the streets of London he thought he was a hard boy who everyone would be terrified of after hitting an old bloke but his hopes were soon dashed after he was kicked out of his ‘bedroom’ by the streetwise, tough person he wanted to be. An example of this is shown to us when Link mentions, â€Å"this guy was what I was kidding myself I’d become†. Robert Swindells uses Shelters storyline as a very good way in which to present living on the streets of London. As Shelter goes around London looking for young and old people, whenever Shelter says, â€Å"Hostel† he always manages to get them to his house so that he can kill them. This shows the reader that homeless people are desperate for somewhere comfortable to sleep at. An example of this is when Shelter gets his first client, â€Å"That got him ‘hostel’†¦he fell for it hook line and sinker†. On page twenty-one Shelter also says, â€Å"I am not a murderer at all – I’m a Soldier out of uniform, killing for his country.† After killing a homeless person shelter mentions to the reader that he is not a murderer but a soldier killing for his country. This statement is not true as Shelter has murdered people who have done nothing to him and his country. Shelter thinks he is doing a good thing and is particularly careful about every step he takes. The author, Robert Swindells uses this to create an irony. As the reader gets deeper and deeper into the book, they start to grasp knowledge of Shelters storyline and start to know the feeling of how it is to be homeless and the different setbacks and failures it may have. The reader also learns not to stereotype homeless people.