Effective Habits Worksheet Essay Example for Free

Effective Habits Worksheet Essay Review Phoenix Career Plan results of Career Plan Building Activity: Work Culture Preference, respond to the following in 50 to 100 words each: 1.Describe your ideal study environment. My ideal study environment has to be in a quit and organized place. I like to listen to soft classical music in the background while I study. My dominant intelligences is Visual, Verbal, and Interpersonal. Learning while I listen to music helps me focus. Having my desk organized, I spend less time digging through files and books to find the information I need for my studying. 2.List some of the distractions that might hinder your study progress or your performance in an online classroom. There are few distractions that can hinder anyone’s studying progress. With the online classroom, you need to go on the internet. There are many interesting pop-up ads and web site that will get your attention. Social community web sites such as Facebook can also distract your studying habit. The internet can be helpful in many ways, but it can also hinder your studying progress. 3.What actions can you take to manage and eliminate distractions? The best way to eliminate distractions is to set your homepage to the University of Phoenix web site. You should also bock any pop-up advertisement through internet options settings. Keep your desk organize for you to easily locate the things near your surroundings. This will help you focus on the subject your studying. 4.How will you apply your personal learning style? How does your personal Learning style affect your study habits? After finding out my VARK score, this gave me the best way for me to learn using different strategies. I have learned that I am better with Visual learning strategies. I will be more focused with underlining my notes, use symbols, charts, or graphs to display my notes. This will be more effective and going back to my notes will help me remember the lesson I have learned. 5.List 5 effective study strategies from this week that you will use. Explain why you selected them and why they are effective strategies for online learning. 1.Making studying into a part of my daily routine. Even with the busy schedule that I have, having it as my daily routine will allow me to go online and follow my syllabus and stay on track with my learning habit. This is also effective for online learners because, it is self-studies and you need to manage your time wisely to achieve your success. Your professors are not there to check up on you daily. 2.Collaborate with others will help me with the understanding of the topics. They can provide with the ideas that I haven’t thought of. Going into the discussion form, you can chat with others and express your own opinions to get feedbacks. This will help the online learns since they are not in the class room environment. 3.Trying to get more sleep daily. This is something I really focused this week. Sleeping will reduce your stress level and help you focus more on the topic. Online learners might be busy with their schedules. This is something they all should consider. It will improve your personal as well. 4.Following a regular exercise program is something I am going to try. Exercising is also related to stress level. It is very difficult to focus when you are stressed. The best way to release stress is to exercise. Exercise will help everyone who are studying online. 5.Getting a tutor will be something I will use later in the difficult courses. With my current busy schedule, it is very difficult keeping up with the subjects. Having a tutor will help me with the things I missed. This will help the online learners in the same way that I did. 6.Identify one change you can make immediately to increase the effectiveness of your study habits. Explain how this will help you become more effective. Making studying into a part of my daily routine will be the most effective way to increase the effectiveness of my studying. Set myself with a fixed time schedule and always committed to the studying schedules, As long as I follow the schedule well, this will change my daily routine and I will always make an appointment around my studying time. 7.How does your personal learning style relate to your ideal workplace and your personal work competencies? With my personal learning style, I am likely to gain more from visual, verbal, and interpersonal environment. With my work culture, I am better with teamwork centered and leadership intensive. This relates to my interpersonal skills and I share information with others and teach the information as well. This can also relate to my competencies strengths. I have well organizing skills which tells me that it also relates to my personal learning style, 8.How is understanding your ideal learning environment applicable to selecting your ideal workplace? Understanding you ideal learning environment, you will have the knowledge how to make it more effective and how to learn in a stress free environment. Everyone has a different ways to learn. Once you have mastered how to effectively study with you learning habit, you can look for a position which will allow you to work more effectively and produce the most profit for the company.

Concept of Flexibility in Architecture

Concept of Flexibility in Architecture 1.0 Introduction An Overview Of The Terminology And The Conceptual Framework This chapter aims to define the meaning of the term ‘flexibility’, †Adaptability’ and ‘typological variety’ are the other concepts that related to ‘flexibility’. Both N.John Habraken (2008) and Tatjana Schneider and Jeremy Till (2007) mention that flexibility and adaptability have overlapping meanings,but the colloquial and the technical meaning can provide a departure point for their clarification and the conceptual framework of the study. The meaning of the typological variety is more obvious, it points to freedom of choice (Duygu Albostan, 2009) The English colloquial usage of the word â€Å"flexibility† is : capabilities of being bent,pliancy. Susceptibility of modification or alteration; capacity for readily adaptation to various purposes or conditions;freedom from stiffness or rigidity. (Oxford English Dictionary Online,2009) It is important to refer professional or researchers who point out the technical meanings of the concept of flexibility ,according to their changing senses over time. Andrew Rabeneck, David Sheppard and Peter Town published two articles related to flexibility and adaptability. The articled entitled â€Å"Housing Flexibility† (1973) and â€Å"Housing Flexibility/Adaptability?† (1974) â€Å"Flexibility†is proposed against â€Å"tight-fit functionalism† (p.698) They introduced the term †tight-fit functionalism† that refers to the unhealthy situation of mass housing in the twentieth century of Europe.They explain it as miniaturized living areas with the cell types rooms which do not allow any changes(1973,p.698) The unsuccessful attempts in flexibility are criticized for they may lead to what they call the ‘fallacy of freedom through control†.(1973,p.701) Flexibility housing should be capable of offering â€Å"choice† and â€Å"personalization†. (1973,p.701) Rabeneck, Sheppard and Town involve the scope of flexibility in housing project. They see flexibility as a tool to make the minimal housing environments capable of offering for ‘choice’ and ‘personalization’. They criticize flexibility can lead to too technical or complicated housing projects. The adaptability approach,in contrast to the flexible,emphasizes planning and layout rather than constructional technique and services distribution.It is based on carefully considered variations in room sizes, relationship between rooms,slightly generous openings between spaces and little overt expression of room function.(Rabeneck, Sheppard Town, 1974, p.86) Rabeneck, Sheppard and Town claim that flexibility relates to design decisions about the permanent and fixed parts of the building:the structural system and service spaces, whilst adaptability related to consideration about the architectural layouts of the remaining spaces such as the organization of the rooms, their dimensions, the relation between the rooms and their functions. The concept of flexibility deals with the ‘constructional technique and services distribution†. (1974, p.86) As previous, they claim the flexibility related to structural system and services spaces, in â€Å"Housing Flexibility/Adaptability?† (1974) they again emphasize on the construction technique and the position of service spaces. They also compare the flexibility with adaptability. They claim that adaptability more towards the architectural layout. Herman Hertzberger emphasized the importance of the concept of flexibility in architectural design in his book entitled Lessons for Students in Architecture (1991). According to Hertzberger flexibility suggest and open-ended solution,which refers to what is called ‘rhetotic value’of flexibility that defines by Schneider and Till (2005). Flexibility signifies-since there is no single solution that is preferable to all others-the absolute denial of a fixed, clearcut standpoint. The flexible plan starts out from the certainly that correct solution does not exist Although a flexible set-up admittedly adapts itself to each change as it presents itself, it can never be the best and most suitable to any one problem;it can at any given moment provide any solution but most appropriate one. (1991, p.146) From Hertzberger’s perspective, flexibility refers to the caple of proposing different solutions for diverse users with no certain single solution but most appropriate one. He discussed flexibility in a different perspective by introducing the term ‘polyvalence’ which means a characteristic of a static form, a form that can be put into different users without having undergo changes itself, so that a minimal flexibility can still produce an optimal solution. (1991, p.147) Steven Groà ¡k discussed the difference between flexibility between flexibility and adaptability from a different perspective in his book entitled The Idea Of Building: Though and Action in the Design and Production of Buildings (1992). The spatial organization and internal environment may be suitable for only a limited array of uses. Here we should distinguish between ‘adaptability’, taken to means †capable of different social uses†, and â€Å"flexibility†, taken to means â€Å"capability of different physical arrangement†. The building’s capacity for accommodating changed uses will depend on the extent to which it is adaptable and/or flexible. (Groà ¡k, 1992, p.15-17) Groà ¡k tries to explain the the adaptability related to the use of space whilst flexibility refers to different physical arrangement.He emphasize that flexibility is valid not only for interior but also for the exterior adjustments. In this respect,it can be inferred that Groà ¡k agrees with the definition of Rabeneck, Sheppard and Town. Gerard Maccreanor explained the relation between the concepts of flexibility and adaptability by emphasizing the flexibility includes adaptability as well.(1998) Flexibility is a â€Å"designed idea that leads to the collapse of the traditional layout†. (1998, p.40) Adaptability is a different way of viewing flexibility.The adaptable building is both transfunctional and multifunctional and must be allow the possibility of changing use; living into working,working into leisure or as a container of several uses simultaneously. Adaptability is not primarily concerned with a designed idea of flexibility based on the collapse of the traditional layout. An apparent robust identity and enduring presence within an urban context is required that allows the building to cope with future needs and changing conditions. (Maccreanor, 1998, p.40) Flexibility has for a long time been a subject of interest for architects. In the years to follow this resulted in many buildings with open, changeable planning around fixed service cores.One conclusion is that flexibility doesn’t simply imply the necessity of endless change and breakdown of accepted formula. On the contrary, the buildings that have proven to be the most adaptable, were those not originally planned for flexibility. (Maccreanor, 1998, p.40) Maccreanor points out flexibility is neither a characteristic of indeterminate space that allows â€Å"endless change†, nor is it a characteristic of detrminate space with too much technical equipments.In other words, if architects leave thir buildings open for infinitely different solutions for the users;they lead to â€Å"open-endedness † (Scheneider Till, 2005, p.158) and â€Å"uncertainty† (Hertzberger, 1991, p.117). By the same token,if architects put more emphasis on flexibility through building with movable partition, they will create â€Å"false neutrality† as a result of too much technical or strictly defined spaces (Schneider Till, Theory, 2005, p.158). They are the two controversial approaches to flexibility in architectural design that belong rather to â€Å"the rhetoric of flexibility† by Schneider Till (2007, p.5) Gerard Maccreanor has a different view about flexibility. He said that flexibility does not imply ‘an endless change’. He also asserted that the building which are not originally design for flexibility, can be the most adaptable one. Adrian Forty (2000) deals with flexibility as an issue that requires long-term thinking in architectural design. The incorporation of â€Å"flexibility† into the design allowed architects the illusion of projecting their control over the building into the future, beyond the period of their actual responsibility for it. (Forty, 2000, p.143) The confusion in meaning of â€Å"flexibility† is based on two contradictory roles: †it has served to extend functionalism and so make it variable† and â€Å"it has been employed to resist functionalism. (200, p.148)

Concepts Of Medicine Adherence And Its Economic Burden Nursing Essay

Concepts Of Medicine Adherence And Its Economic Burden Nursing Essay Even though 45% of all medications prescribed in the UK are for older people, it is postulated that up to 50% of older people are non-compliant with their medication (SCIE, 2005). The prescription of various medicines is central to medical care and the overall drug costs account to about 10 percent of NHS expenditures. Surveys carried out in literature enlighten us with the fact that approximately 30% to 50% of patients do not use of take their medications as recommended by their prescriber. (1). Statistics show that in 2007- 2008, the NHS in England spent  £8.1 billion on drugs if as many as 50% of the patients dont take their medications as recommended, this could mean that  £4 billion worth of medicines were incorrectly used (2) . Furthermore the additional cost of unused or unwanted medicines within NHS totals up to  £100 million each year. On top of that the estimated drug cost of unused or unwanted medicines in the NHS is around  £100 million annually (3). A Cochrane review Interventions for enhancing medication adherence concluded that improving medicines taking may have a far greater impact on clinical outcomes than an improvement in treatments (4). Therefore if the prescription is inappropriate in the first place it not only translates as a loss to patient but also involves the healthcare system and the society. The costs included here are both personal and economic. Concepts of Adherence and terminology There are three major terms which are commonly used in the literature to describe medication-taking behaviours i.e Compliance, Adherence and Concordance (5). According to Pound (6) initially, the term compliance was used to illustrate the medication taking behaviour, which was then replaced by the term concordance. The term compliance came into disfavour because it suggested that a person is passively following a doctors orders, rather than actively collaborating in the treatment process (3) Whereas concordance refers to the anticipated outcome of the consultation between doctors and patients about medicine taking It is viewed as successful prescribing and medication taking based on the partnership with the patient (6). However the most current, fashionable and accepted terminology is adherence, which is defined by McElnay (7) , as the extent to which a persons behaviour (in) in terms of taking medicines, following diets or executing lifestyle changes, coincides with advice given by health care professionals Adherence shifts the balance between professional and patient about the prescribers recommendations. Pound (6) states that the above mentioned three terminologies tend to be used interchangeably but are incorrectly applied. Adherence can be viewed as the central aim, concordance is the process used to apply the central aim compliance is the outcome of the process. The benefits of medication might be restricted thereby causing a further deterioration in health as a consequence of non-adherence. . On top of this the economic costs do not only translate to wasted medicines only but also include the knock on costs which arise from increased demands for healthcare if (on the whole) health deteriorates. It is hence due to this reason that non-adherence is a major issue and should not only be seen as the patients dilemma. A fundamental drawback is represented in the provision of the healthcare, which is often due to a failure in completely agreeing with the prescription in the first place or to recognise the appropriate support that the patients might require later on during the treatment. Hence addressing non-adherence is by no means about getting patients to take additional medicines. Therefore tackling the issue of non-adherence involves the initial understanding of patients opinion on the medicine and then the various reasons to as why they are/m ight be reluctant or unable to use them. Causes of non-adherence There are many causes of non-adherence however they fall into two main overlapping categories i.e intentional and unintentional. Both types relate to the lack of an established pattern of medication taking which led to the incidental omission of medicines and may be experienced concurrently (8). Purposeful or intentional non-adherence occurs when a patient makes a specific decision not to take the prescribed medication. The anticipation of drug-related side effects and general dislike of taking medicines are common causes of intentional non-adherence (9). While accidental or unintentional non-adherence occurs as a result of forgetting or misunderstanding instructions about the drug schedule .Unintentional non-adherence is proposed to be range from a random departure to medication omissions from a prescribed treatment regimen (10). Hence the main features of unintentional non-adherence focuses on altering medication contingent on self assessment or perceptions of mental health, stress or anxiety, forgetting to take medicines or simply altering the doses of medicines to fit in with daily chores. A research carried out by Svensson (10) Kippen (11) showed that older people adherent with their medication often link the administration of medication to specific lifestyle events, location, time, and patterns of daily activities. Below table 1.3.1 shows the common perceptions and characteristics of adherent and non adherent medication taking behaviors. Table 1: Shows common perceptions and characteristics of adherent and non adherent medication taking behaviours. Perceptions related to medication taking behavior Intentional Non-adherence Unintentional Non-adherence Feeling unnatural taking medicines Fears of prescribing errors/addiction Life style change/ Disruption to daily routine Adverse effects of medicines Lack of faith in the prescriber Drug related memory loss/ Forgetfulness Long term risks of medicines Failure to accept diagnosis Altering dosing regimen Past experience of medicines Dislike of taking medicines Being asymptomatic Lack of comprehension of the need to take medicines. Testing medicines against symptoms Period of illness Vulnerable group of people Of all the age groups, medication taking behaviour in older people is of the highest concern. This is due to multiple reasons as described by Huges (12). Firstly, older people are highly likely to suffer from multiple diseases. Secondly, older people frequently administer three or more medicines concurrently to manage these conditions and third as a result of poly pharmacy, they are increasingly likely to mismanage their medicines (13). Furthermore, research shows the following as different lay beliefs by older people on medicine taking The need to reduce the symptoms of hypertension, to feel physically better (14). Fear of complications and desire to control blood pressure (10). Positive confidence in the prescriber (15). Apart from the elderly, another age group, where non- adherence is becoming a significant problem is in the pediatric population. In one of the studies carried out by Bush (16) it has been shown that one-third of the children in grades 3 to 7 reported they had used one or more prescription or non prescription medications in a 48 hour period. Adherence plans for children often require innovative approaches to encourage active participation in caring for their own health and how to use their medications appropriately. Consequences of medication non-adherence No matter how much critical the conditions are a patient might stick to his medication regimen, thus reflecting a loss of the health care system with increased use of medical resources, such as GP visits, unnecessary additional treatments, emergency department visits and hospital admissions. One of the recent research shows that about 3-4% of UK hospital admissions are as a result of avoidable medicine related illness (17) between 11 and 30 % of these admissions result from patients who dont use their medicines as recommended by their prescriber (3). In a similar manner, in 2006-2007, figures show that that the NHS expenditures on hospital admissions (excluding critical care costs) was approximately about  £ 16.4 billion (18). And the estimated costs of admissions, within the same year i.e. 2006 2007, resulting from patients not taking their medicines as recommended was found to be between  £36 and  £196 million respectively (18). Hence a reduction in these admissions and associated costs would be expected as the overall medicines adherence increases. Factors affecting medication adherence In accordance to WHO some of the main common factors reported to have a significant effect on adherence include: poverty, low level of education, illiteracy, poor socioeconomic status, unemployment, unstable living conditions, lack of effective social support networks, long distance from treatment centre, high cost of medication, changing environmental situations, high cost of transport, family related issues and culture lay beliefs about illness and treatment. In accordance to WHO the common belief of patients being the sole responsible for taking their treatment is misleading and most often reflects a misunderstanding of how other factors affect peoples behaviour and the capacity to adhere to their treatment. Adherence, in short, is a multidimensional phenomenon which is determined by the interplay of five different sets of factors, each of which are termed as dimension by WHO (5) . Each of these dimensions are listed as under and shall be discussed in detail Social/ economic factors Provider-patient/ health care system factors Condition related factors Therapy-related factors Patient related factors Social and economic dimension It includes limited access to health care facilities, medication costs, low health literacy, limited English language proficiency, unstable living conditions (homelessness), lack of family/social support network, and cultural beliefs about illness and treatment. Among these factors few shall be discussed in detail as under English language proficiency Both low health literacy and limited English language proficiency are barriers to adherence that deserve special consideration. Health literacy can be defined as the ability to read, understand and act on health information so that appropriate health decisions can be made. The risk of unsafe use of prescription medicine, is high among people with low health literacy and limited proficiency in English language due to the complex nature of the printed information that is available and because these people often do not receive adequate verbal communication or sufficient time from health care providers. Older adults with low health literacy may have trouble reading health information materials, understanding basic medical instructions, following prevention recommendations and adhering to medication regimens. Social factors Medication adherence is positively associated with social support and the availability of help from family and friends. Better outcome to treatment is observed in people who have social support from their friends/family (who assist them with their medication regimens) Cultural beliefs and attitudes Adherence to therapy, may overall be affected as a consequence of different attitudes which the patient may have towards health and medicine. Addressing these issues by the health care professionals is of prime importance so that the patients can get the most out of their medicines without compromising their health In case of adults, different components of health and healing cannot be explained by no one list. Therefore each individual must be considered on individual basis. Two major key components are requisite i.e asking non-judgmental questions listening, when it comes down to understanding the process of gaining an insight into patients beliefs (regarding health and healing) Patients belonging from various ethnic minorities bring along their practices in the health care system. This sometimes puts the health care professionals at test, who have been professionally trained in the light of western philosophy and medicine. Although groups of people may have beliefs or practices in common, yet that doesnt mean that they all can be classified under the same category. Within groups , the major differentiating factors include health status, educational level, sexual orientation etc (5). Respect Taking care of elder patients who belong from such backgrounds where they receive a great amount of respect (e.g. British Asian community ) should involve the element of respect combined with kindness. If they are approached with an attitude that consists even a tiny fraction of scolding or telling off, they might show resentment towards the adherence of medicine even though it may put their lives at risk. Therefore to put such patients at relieve it is of prime importance to show respect towards them . Traditional therapies and cause of illness Literature shows that two components such as religion and spirituality can play a vital role in the overall understanding of illness in its broadest sense among older people (19). The will of God for an improper behaviour, exposure to cold wind, natural causes etc are all different factors which older patients believe are major culprits for causing illness (20). This consequently leads them in such a situation where they end up giving God a chance to heal them or alternatively they seek help from a folk healer, try home remedies or pray for the treatment of their illness. An excellent example of this can be viewed within the Chinese culture where health may be seen as finding norm between ying yang, which is much more like hot and cold (21). Now patients who follow Chinese health belief may try such approaches which targets at restoring the balance between ying and yang (using different varieties of food and herbs). Likewise, some Asian ethnic groups rely solely on traditional remed ies for the treatment of long term conditions (21). At this stage it is also important to mention that the patient may not be cooperative if he believes that the health care provider may disapprove information surrounding the use of non-traditional remedies. This may ultimately lead to different interactions with the prescribed medications. Medication For some patients the preference lies in the dosage form or the size or colour of the medication. For example some cultures in Latin America view injections as more potent in comparison to oral medications. Likewise it is believed that Western medications are too strong by Chinese older patients hence therefore they might choose to not take the full dose of medicine (22). Health care system dimensions It includes different factors such as provider-patient relationship, provider communication skills, patient information materials written at too high literacy level, restricted formularies (changing medications covered on formularies), poor access or missed appointments, long waiting time and lack of continuity of care (23). The quality of the HCP-patient relationship is one of the most important health care system-related factors impacting adherence. Adherence to medicines can be increased as a result of good relationship between the patient and the HCP (which features the element of reinforcement and encouragement from the HCP), however there are many factors which have negative effect (24). These include lack of training and knowledge for health care providers on managing chronic diseases, lack of incentives and feedback on performance, poor medication distribution systems, short consultations, overworked health care providers, weak capacity of the system to educate patients and provide follow up, lack of knowledge on adherence and of effective interventions for improving it. Condition related dimensions It includes Psychotic disorders, severity of symptoms, chronic conditions, depression, lack of symptoms, mental retardation (25). Among these factors few shall be discussed in detail as under Chronic conditions and lack of symptoms Information within literature supports the fact that adherence to such treatment options (often declines as the time progresses) where medications have to be taken on an unlimited basis for the management of a chronic ailment. Example of two perfect clinical conditions which would fit into this profile include high BP and osteoporosis (26) , in which the symptoms are totally invisible to the patient. Furthermore, in the absence of symptoms these ailments lack the cues which would motivate the patient to adhere towards his treatment regimen. Depression A study carried out by Krueger (28) showed significantly lower rates of medication adherence among people with chronic illnesses and who are depressed. It is therefore crucial for the HCPs to be aware of the devastating impact, depression has on adherence consequently on regular basis should assess older patients who are sad all the time or who report symptoms of sleeping disturbances to eliminate the possibility of clinical depression. The slow onset of the pharmacological actions posed by different classes of antidepressants is classified as one of the major factor that contributes towards decreased adherence among elder patients. Adding on to that if the patient begins to experience the side effects (before even the symptoms are relieved), might consequence discontinuation of the therapy at a very early stage. In a similar fashion, a research conducted by Kemyttenaere (29) shows that once the patients (suffering from depression) start feeling bette,r they might stop the antidepre ssant therapy midway. Psychotic disorders A patients experience with unpleasant side effects is mainly one of the key causes which drives them from continuing their antipsychotic therapy. Literature shows that interventions which focus mainly on the persons attitude and beliefs about medications 9rather than on the knowledge) helps improve adherence. The addition of two key ingredients i.e Behavioral techniques motivational interviewing within compliance therapies, have proven to be very effective in improving medicines adherence among patients who suffer from psychotic disorders (31). Therapy related factors/dimensions It can be sub-divided into other different factors such as duration of therapy, lack of immediate benefit of therapy, frequent changes in medication regimen, actual or perceived unpleasant side effects, medications with social stigma attached to use, treatment requires mastery of certain techniques, complexity of medication regimen and treatment interferes with lifestyle or requires significant behavioural changes. Research by Tabor (32) Krueger (27) showed that decreased adherence is associated with medications with a social stigma attached to its use and with medications which require following complex regimen ( e.g. duration of therapy, number of daily doses required, or therapies that interfere with a persons lifestyle. Adherence can also be affected by other factors e.g. if administration of a medication requires the mastery of specific techniques like injections (32). In a similar fashion, when medications such as antidepressants are slow to produce effects, the patients/older person may believe that the medication is not working and might stop taking it. Likewise the side effects of a medication too can lower adherence if the patients start believing that they cannot manage or control them (25). Patient related factors/dimensions They can be sub-divided into two major factors i.e psychological/behavioral factors and physical factors. Psychological factors include fear of dependence or possible adverse effects, knowledge about disease, motivation, perceived risk to disease benefit of treatment, understanding reason of medication need, confidence in ability to follow treatment, feeling stigmatized by the disease, frustration with health care providers , psychosocial stress, expectations towards treatment and substance (alcohol) abuse. Physical factors include issues like swallowing problems, hearing, visual cognitive impairments and impaired dexterity or mobility. Few of these physical and psychological factors can be discussed in detail as under: Psychological factors that influence adherence The WHO proposes a foundation model for medication adherence which is based on three major factors i.e. motivation, information and behavioural change. Behavioural change has been found to be influenced effectively by making interventions based on this model (33). In accordance to WHO, adherence and non-adherence are different behaviours. In order to change behaviour, information is a prerequisite, but in itself it is insufficient to achieve this change. Hence at this stage behavioural and motivational skills are critical determinants. Motivation and information work largely through the behavioural skills to produce an impact on the behaviour. However, when the behavioural skills are uncomplicated or are familiar, the two aspects i.e motivation and information can produce a direct effect on the behaviour (33). Physical Factors that influence adherence The risk for non-adherence among older patients is increased due to physical and cognitive limitations. Visual Impairment Decreased ability to perform activities of daily living and an increased risk for depression is associated with vision impairment (34), (35). Furthermore there are many other medication safety issues associated with vision loss. A persons ability to read patient information leaflets, prescription labels, determine the colour and markings distinguishing a medication is affected by low vision and blindness. Therefore consequently people who cannot read prescription labels or distinguish among different medications have to rely on their memory or depend on someone else for help and hence may not be able to take their medications correctly. Hearing Impairment Hearing loss is directly related with age. The natural aging process not only affects the ability to detect sounds at lower levels but also the capability to understand speech at a normal conversation level (36). This condition does gets worse with age and is progressive. It is therefore important to not assume when a deaf person nods his head in acknowledgement that he/she has understood, as he/she might be relying on a family member or a companion to explain later (36). Impaired Mobility Older patients with poor mobility may have difficulty in self administration of medicines or in obtaining medicines from the pharmacy (37). Cognitive Impairment Poor medication adherence is associated with Impaired cognition (25). Elderly patients with memory problems and cognitive impairment may have difficulty in understanding when to take, how to take or how much to take their medications. Others factors also include as swallowing difficulties and impaired dexterity. PREDICTORS OF medication non-adherence Predictors of medication non-adherence can be a useful tool in the improvement of medicine adherence among older adults. Few of the non-adherence warning signs (38) include failure to fill in a new prescription, failure to fill in prescription for choric medication or failure to obtain refills as often as expected for medications taken on chronic basis. Below are some of the more common predictors of medicines non-adherence (38): Forgetfulness Lower cognitive function or cognitive impairment. Lack of insight into illness Lack of belief in benefit of treatment. Belief that medications are not important or are harmful. Complexity of medication regimen Tied of taking medications. Inconvenience of medication regimen. Side effects or fear of medication side effects. Missed Appointments. Substance Abuse Limited English language proficiency. Role of NICE (National Institute of Clinical Excellence): The issue of non-adherence to medicine is a very important issue in its own essence. After assessing and understanding the impact of non adherence on the NHS the NICE (National Institute of Clinical Excellence ) came into action and published a guidance in January 2009 (Medicines Adherence: Involving patients in decisions about prescribed medicines and supporting adherence) to tackle and address this core issue (of non adherence). Before moving further it would be essential here to describe the role of NICE in terms of its function. NICE was established as a special health authority on 1st April, 1999 is an independent organisation that provides national guidance on promotion of good health and prevention and treatment of ill health in England and Wales (39). The institutes main purpose is to offer NHS health care professional advice on how to provide patients with the maximum attainable standards of care and to decrease the variation in the quality of care . Furthermore, NICE is not part of the European Medicines Evaluation Agency (which assess the efficacy and safety of drugs), only licensed drugs on the basis of their added value relative to existing practice in the NHS are assessed by NICE (40). It has four programmes that produce guidance which are mentioned as under (39): Public health guidance Clinical Guidelines Interventional procedures Health technology appraisals ( for surgical interventions, pharmaceuticals, medical devices, etc) Most programmes take into account both the elements of cost-effectiveness (how well an intervention works relative to its cost) and effectiveness (how well an intervention works) NICE has an annual budget of 33 million pounds annually with over 250 full-time staff members working at offices based in London Manchester. The processes NICE uses in the development of its guidance are highly consultative, evidence based and transparent. It also involves all relevant stakeholders, including policy makers, health professional managers, specialist, academics, representatives of health care industries, general public and patients (39). The guidance that NICE produced to address the issue of medicine adherence was CG76 Medicines Adherence: Involving patients in decisions about prescribed medicines and supporting adherence. This guideline was produced taking into account the patients views as to what they perceive as barriers to effective medicines adherence and thus encourages healthcare professionals to have a discussion with patients about their prescribed treatment especially for long term conditions. In addition to this the guidelines also open a pathway for dialogue and negotiation between the patient and the health care professional regarding their medication. A quick summary of the guidelines is as mentioned below Summary of the NICE guidelines Bullet-points below quote from summarise recommendations from the CG76 guidelines (41). The key recommendations from NICE guidelines are as under Table 1: Shows the key recommendations from NICE CG76 guidelines. Involving Patients: Improve communication with patients Increase patient involvement in the decision making process about their medicines. Understand the patients perspective on their condition and possible treatments. Provide information about their condition and possible treatments. Supporting Adherence: Assess adherence levels Identify adherence issues Address adherence issues Review medication and its effective use Improve communication between health care professionals in the care pathway. From www.nice.org.uk/pdf/CG76fullguidelines.pdp Significance of the Study Community Pharmacists are the health care professionals which are most readily accessible to the general public and therefore continue to be the first line of Healthcare. They are experts on medicines and represent an important link in the chain of the health care professional team. Thus the main objective of this research project will be to provide a new insight as to what the community pharmacists reflect/perceive about these NICE CG76 guidelines. Hence their views and opinions will be assessed and analysed with regards to these NICE recommendations (as this would help in the implementation process). Any differences in the views of the pharmacists or any disagreement on the effectiveness of the NICE guidelines would mean that further investigation could be required to improve or update these recommendations. Hypothesis: H0 = There will be no statistically significant relationship between the years of experience of the pharmacists and the awareness of NICE CG76 guidelines. H1 = There will be a statistically significant relationship between the years of experience of the pharmacists and the awareness of NICE CG76 guidelines. H0 = Majority of the community pharmacists will not agree (on to a large extent) that CG76 recommendations have been effective in the improvement of medicines adherence among their patients. H1 = Majority of the community pharmacists will agree (on to a large extent) that CG76 recommendations have been effective in the improvement of medicines adherence among their patients.

Daffyds Journey :: English Literature Essays

Daffyd's Journey His feet weren't going where he told them too!!! It was cold, so cold, and even though he knew where he was going, an advantage over most, he couldn't shake off the morbid feeling of doom, no matter how hard he tried. Guns were sounding in the distance, and although he was well away from the fighting, he was panicking. Amidst the feelings of doom and panic, he was confused. It wasn't even this bad on the front line!! Why was he feelign this way? Was his gut telling him the truth? As if out of nowhere, a man dropped out of the tree above him in a shower of leaves and twigs, and with an evil grin, blew him up. The old man sat up in his bed, waking with a start. For a moment, he was slightly disorientated. The adrenalin was still coursing through his body like a fire out of control. With a few breaths, he tried to calm himself. The old dream, he thought. I will never forget it, it will never let me out of its steely indifferent grasp. The veteran, who went by the name of David, was an old man now. His youth had deserted him, the war had aged him. He couldn't fight the dreams like he used to. But he did have wisdom and experience on his side, though he was hard-pressed to figure out how that could help. He cast around for another subject. His mother's mother was Welsh. His mother had brought him up Welsh, her name for him had been 'Daffyd'. He wondered why he remembered that. He was confused, he didn't know what he was feeling or why. He shook his head, and with some small sense of purpose, climbed out of bed. He had decided to walk down to the beach, which was only a street away, to clear his head. He knew not why he would do this, his worst memories were of a beach. He figured he was 'confronting his fears' like they do in the stories. It could work, stranger things had happened. David reached the beach, and made his way to the cliff that he had always loved as a little boy. This was his home, where he had grown upm where he had laughed, played, and where his mother had died. All because of him. He shuddered, trying not to think about it. He sat down on the mossy grass, and remembered.

American Legion :: Essays Papers

American Legion The American Legion: A Right To Membership Introduction The United States Congress chartered the American Legion in 1919. Its purpose was to benefit veterans and their families, promote Americanism and serve the greater good of communities nationwide. First welcomed to membership were veterans returning home from the battlefields of Europe. But over the years, Congress amended the Legion’s charter so as to include those who had served in World War II, Korea and more recent conflicts. Ineligible for American Legion membership, however, remain the many men and women who had answered our nation’s call while American military forces were not actively engaging an enemy of the United States. Serving with valor and distinction, these members of the armed forces have guarded America’s shores and protected the nation’s strategic assets at U.S. military bases across the world. They have been on the front lines of American efforts to mediate conflicts between warring factions in Europe, Asia and Africa. And they, too, have been prime targets for armed aggressors, terrorist attacks and saboteurs. The question is: have these veterans not earned the right to membership in the American Legion as well? This essay seeks to explore whether the American Legion’s charter should be amended so as to better reflect our nation’s appreciation for those who serve in times of war and peace. Indeed, it is an issue made all the more cogent today: With increasing numbers of young Americans rejecting the armed forces as a career option, recruitment goals are not being met and the military is being forced to lower its entrance requirements. If this trend is not soon reversed, the U.S. military could be perceived as incapable of implementing our nation’s strategic policies abroad -- a perception that can only encourage the most aggressive ambitions of other nations. A Resource for Veterans In seeking to determine whether the American Legion should open its doors to non-wartime veterans, we must begin with a look at the organization itself: its mission, its outreach programs and, above all, the benefits today’s Legion is able to provide for a worldwide membership now approaching three million men and women. Meeting in Paris some five months after the armistice of November 1918, delegates from combat and service units of the American Expeditionary Force resolved to found an organization that would protect the interests of veterans through the years that followed.

Case Analysis (Tuesdays with Morrie) Essay

CASE ANALYSIS: TUESDAYS WITH MORRIE I. Synopsis Morrie was Mitch’s favourite teacher. He was diagnosed with amyotrophic lateral sclerosis, or ALS. One night, Mitch saw and recognized his old professor in a television show. He suddenly remembered the promise he made with his teacher, so he called him to set up a visit. Mitch began visiting Morrie every Tuesday and every time they meet Morrie taught Mitch lessons about life. The disease gradually overcome Morrie as days go by and during their last meeting, Morrie was nearing death. Morrie and Mitch hugged for the last time, and as they did Morrie noticed that Mitch is finally crying. Morrie died simply and peacefully with his family around one Saturday morning. II. Character Description Morrie is a former sociology professor who is compassionate, free-willed, and clever. He is suffering from a disease called ALS (amyotrophic lateral sclerosis) which prevents him from doing what he loves most, dancing. Mitch is journalist who is living a very fast paced life and succumbs himself in work that it consumes him. After reuniting with his old professor, he finally discovered the meaning of his life. III. Answers to case questions and requisites 1) a. Morrie’s father brought him to a factory to work and on that day he realized that he has asthma. So he vowed that he will never do work that used people and so he became a teacher with the help of his stepmother. b. Mitch’s visit with Morrie. It taught him how to pause for a while and rediscover the meaning of his life. c. Mitch after graduation who throw away his dream as a pianist and became a newspaper reporter. 2) a. Mitch taking interviews b. Mitch as a journalist c. Mitch being a sports writer and a boyfriend to Janine d. Mitch who has a lot of deadlines 3) a. The case of Mitch Albom, he was a journalist, a boyfriend, a taxpayer, a son, an employer, a student but most of all he was a friend to Morrie. b. Morrie as a former sociology teacher. 4) In the movie Tuesdays with Morrie, the primary group of Mitch is Morrie and his family because Morrie and Mitch exemplified a lasting and personal relationship. The work group of Mitch on the other hand stands as his secondary group. 5) The type of leadership roles that is very apparent in the movie is instrumental leadership and the leadership style that is also noticeable is authoritarian as illustrated by Warner, the boss of Mitch who gives him orders to get things done and demands him of his deadlines. 6) Bureaucracy was obvious in the area work of Mitch. It demonstrated characteristics such as specialization, hierarchy of offices as exemplified by Mitch’s boss and Mitch being his subordinate, and impersonality demonstrated also by Warner who didn’t have an idea of Mitch’s personal whereabouts he found about Morrie’s condition later in the story. 7) In the film, Mcdonalization is present through the use of laptops and telephones these are mediums of equipment used by Mitch to be efficient in his work as a journalist and to quickly transmit articles to his boss especially when meeting deadlines. The presence of airplanes also exemplifies a Mcdonalization society because airplanes are also under the control of computers, pilots merely oversee the process. IV. Conclusions There are a lot of Mitch’s around us whose fear of death disillusioned us into living life racing with the clock. I too am like Mitch whose fear of death made me live life as if tomorrow will never come. But I realized that it’s only when we know how to die that’s time when we know how to live. Sometimes, I do things that I thought would fulfil and would give meaning to my existence. And I thought I’m happy doing that, but I realized that I’m only living in the emotions of the moment that is after that moment passes and I’m alone emptiness starts to crawl back. And because I live life to the extremes, I often forget about the things that matters the most and I know now that all I need to do is to click that pause button and to use every moment of that time doing something that I will never regret that is to appreciate and value everything and everyone life has given me. In the film, Morrie said that when we live we need other people to survive and when we die we need other people to survive and we must love one another or die. Indeed it’s true, because all of us are connected to one another. In some ways, I, function for other people. I play an important part in my professors’ lives because without students their roles as teachers will never have meaning. Since we are connected with one another, everyone is dependent to other people so we must love and treat well those who give meaning to our lives because they are one of the reasons why we are still alive. After watching the film, I know now, what scares me most about death, its saying goodbye to someone whom I will never have the chance to say hello again. When I think about death, I automatically linked it with nothingness that is when someone dies they become nothing. But what I didn’t realized is that soon they will return to something larger afterlife and I can still greet them again. I know I can never command life to treat me well and be the way I want it to be because life has it’s own mind but if there’s one thing I know I’m sure of, that is I can treat life well and make the most out of it. Morrie perceived life as a rubber band it pulls us back and forth – pull as one way we think that’s what we want to do, pull us the other way we think that’s  what we have to do. For him, this is the tension of the opposites, we learn from what hurts us as much as what loves us. In the movie, Morrie taught us to love those people who have hurt us. He recommends that we try to understand them and be selfless even if we have developed a hardness of heart against them. We must learn how to forget all the pain that they’ve inflicted in us because even if we try to erase them in our lives, they are still a part of the person that we become. And one important lesson Morrie taught is learning how to forgive, now. We shouldn’t wait for our death sentence to come before we could finally find it in our hearts to forgive everyone and everything because every day is an opportunity to die and opportunity to live.

Macbeth Article Critique Essay

Overall darkness is at fault for the tragedy of Macbeth. Most scenes in story were dark and held an evil atmosphere. A.C. Bradley stated that with so much darkness surrounding the hero, (Macbeth), he was bound to be corrupted by it. The witch’s prophecy, Lady Macbeth, and the constant spilling of blood both innocent and guilty. This darkness that corrupted him led Macbeth to madness as well as his wife. He and Lady Macbeth feared the night when sleep would succumb them and their guilty conscious plagued their dreams. All their evil deeds were brought to the for-front of their minds when they were asleep and this recurring nightmare drove Lady Macbeth to take her own life. When surrounded by darkness one will eventually succumb to its overwhelming power. A.C. Bradley’s argument about the atmosphere of Macbeth was fairly logical. Except for paragraph three where his words caused confusion. Bradley states that momentary flashes of light are shown at random parts of the play. Then he proceeds onto listing those moments. However, this confuses one’ because he doesn’t state what he believes is the reason for these flashes. This paragraph makes one question whether these flashes are good or bad? Are they a sign of Macbeth turning a new leave? All these questions are a burden to the readers. Another confusing matter that comes into play after reading the article is its clarity. The article is partially written in an advanced jargon. This jargon trips up the readers and forces them to re-read the article, divide it into sections, then analyze and translate the meaning of his words. At first it is difficult to interpret the meaning of his words but once understood one would think â€Å"OH, How come I didn’t get it the first time I read it or was it always this clear†? The analyzing of Bradley’s words take up too much time and he should have written them in simpler terms. This article may have its confusing parts but it is well constructed and states the writers’ opinion clearly and methodically. The reactions it evoked from one’ were confusion, stress, and amazement. A.C. Bradley can truly write an amazing paper that makes the readers think deeply without restraint. This article made one think of questions such as â€Å" Did Shakespeare really use light as a fore-warning of an evil deed instead of a good deed?† or â€Å"Does living in a negative environment warp a person’s personality and make them evil and deadly?† the article is great and should be read and critiqued by others. The atmosphere of Macbeth was indeed dark and did weigh on the characters souls, but it is not what caused the tragic events in Macbeth. What caused the tragedy was pure human greed and lust for power. In the beginning of the play when the witches for-told Macbeth of his destiny to become king he began to think of all the ways he could hasten his crowning. However, he feared his treasonous thoughts but his wife didn’t. Ensnared in her lust for power, riches, and fame Macbeth acted on those treasonous thought and killed his king. The man he swore ever-lasting allegiance to. All this just to satisfy his and his Lady’s’ greed for the power King Duncan held. However, his crowning only led to paranoia and un-satisfaction. This is because a senseless act done out of greed can never satisfy or settle ones heart and conscious. Like Erich Fromm stated â€Å"Greed is a bottomless pit which exhausts the person in an endless effort to satisfy the need without ever ending satisfaction.† The hole that could never be filled in Macbeth drove him to madness and in the end led to his and many others’ demise. Greed, lust, and power all added together never result in a happy ending. It only leads to tragedy. The tragedy that was the atmosphere of Macbeth.