Principles of research & evidence based practice Essay

Principles of research & evidence based practice - Essay Example In addition, concepts and theories of nursing allege that a nurse is bound to his/her practice policies as well as personal choices. Therefore, for nurses to undertake any course of actions, evidence is supposed to lead the decisions while concepts and information enabling such decisions is required prior to implementing decisions and deemed solutions. For the nursing career, care is the major responsibility which the nurse is entrusted with as it involves of use of interventions aiming at providing care for patients with differing and a wide range of personal and medical needs (Burns, & Grove, 20). Evidence in nursing is a function of both research and analysis of data regarding medical problems that the nurse may be presented with. This means that a nurse is entitled to provide diagnosis of illness through researching on symptoms, medical tests, and information on the best practices available. However, while nurses are categorized as care givers, their welfare in terms of performan ce and attachment with the work they do has been identified as problematic at personal development level. For example, the nurses are care givers and therefore are classified as the service deliverers but their welfare hangs on the balance as they do not have bodies or entities that care for them. This is according to a research conducted by Burtson and Stichler (2010) in which they allege that satisfaction of nurses is a function of how they are treated, both in compensation and how they are developed to adapt and deal with personal issues while at the same time providing the best care to their patients. According to the results from Burtson and Stichler’s research, nurses get their satisfaction from the work they do. The responsibility of providing care to patients is one among a cluster of factors that ensure that a nurse is satisfied. The level of satisfaction enables the nurse to conduct research and employ cohesiveness in their duties. In this case, a nurse with persona l issues and unsatisfied needs is unable to provide substantial evidence-based care. In this case, the quantitative research article ‘nursing work environment and nurse caring: relationship among motivational factors’ gives an account of the various factors that influence nurse satisfaction and the possible outcomes when caring is considered. The purpose and aim of this document is to analyze the various factors of consideration that connect nursing research with best practice. In addition, a critique to two articles, quantitative and qualitative research methods, will show the different types of research methods, designs, and approaches used by the nurses before they implement their interventions. Research methods and designs are used to determine the variables and factors that affect a group of patients, individual patients, or the relevance of using treatment and control groups in a research-based intervention. Nursing therefore includes research whose purpose is to provide evidence which in turn is used to implement interventions. A background study on evidence-based practice shows that during the 1980s, evidence-based medicine was the term

Anti Smoking Promotion Policies Difference Health And Social Care Essay

Anti Smoking Promotion Policies Difference Health And Social Care Essay According to the Oxford Medical Companion (1994) cited in the WHO report on the global tobacco epidemic 2008, tobacco is the only legally available consumer product which kills people when it is used entirely as intended. Tobacco is the leading preventable cause of death in the World which causes one in ten deaths among adults worldwide and in 2005, tobacco caused about 5.4million deaths, an average of one death every six seconds. At the current rate, the death toll was projected to reach more than eight million annually by 2030 (over 175 million deaths by then as shown in figure 1) and a total of up to one billion deaths in the 21st century (WHO 2007).Certain behaviours have been labelled as risky behaviours associated with negative health outcomes among which smoking is and which has been the subject of UK national health strategies (Naidoo Wills 2005). Smoking causes about one fifth of all deaths in the UK, most of which are premature and has hugely significant impacts on the wid er environment and community through causing air pollution, fires, litter and environmental damage (Ewles 2005). This essay will look into why smoking is an important public health issue in England by defining it from various perspectives and will analyse why people smoke. Also, it will examine various demographical and epidemiological data related to smoking and in addition, it will examine how smoking is addressed in International, National and Local policy. It will also analyse various measures adopted at various geographical levels to address inequalities in health on promoting anti-smoking. In addition, it will look into various values, norms and ethical principles that influence anti-smoking policy development. From the gaps identified, recommendations and conclusions will be made. According to Ewles (2005), smoking in the UK can be defined from three different perspectives in terms of; the activity, the product and the market. In terms of the activity, it is the largely use of tobacco in manufactured and hand-rolled cigarettes which is the most common form of tobacco use since the early twentieth century. In terms of the product, the manufactured cigarette consists of chopped tobacco that has been cured and mixed with a variety of additives to add flavour, increase nicotine availability from smoke and improve shelf life all rolled up in a paper tube with a filter at one end. In terms of the market, UK is home to several Worlds major tobacco companies such as the Imperial Tobacco, British American Tobacco, Gallagher and Rothmans UK who all together employ 9000 people in the UK and have more than 90% of UK cigarette market. The principal constituents of cigarette smoke are tar, carbon monoxide and nicotine and the paper used for manufacturing cigarettes is treated with chemicals to prevent self-extinguishing whenever the cigarette is lit. The filter usually consists of cellulose acetate which traps some solid particles in smoke and cools it (Ewles 2005). The principal constituents of cigarette smoke are carbon monoxide, tar and nicotine which is highly addictive (Cancer Research UK 2009). FIGURE 1: Cumulative tobacco- related deaths, 2005- 2030. Source: http://www.who.int/tobacco/mpower/mpower_report_tobacco_crisis_2008.pdf The impact of tobacco smoking on public health extends beyond the direct effects on the individual smoker and personal health being to economic, environmental and social effects (Ewles 2005). Tobacco smoking is an important public health issue because the smoke is very toxic to every human tissue it touches on its way into, through and out of the smokers body (Ewles 2005). Smoking harms nearly every organ of the body thereby causing many diseases, reducing quality of life and life expectancy. Also it has been estimated that in England, 364,000 patients are admitted to NHS hospitals each year due to smoking related diseases which translates into about 7,000 hospital admission per week and 1,000 admissions per day (ASH 2006). In the UK, smoking causes about a fifth of all deaths, approximately 114,000 each year, most of which are premature with an average of 21 years early (Ewles 2005). According to Peto et. al. (2003) cited in Ewles (2005), most premature deaths caused by smoking are Lung and coronary cancer, chronic obstructive heart diseases and coronary heart diseases with 42800, 29100 and 30600 deaths respectively every year. In addition, smoking is known to also bring increased risk of many debilitating conditions like impotence, infertility, gum disease, asthma and psoriasis (Ewles 2005). Research has also shown that non-smokers are put at risk by exposure to other peoples smoke which is known as passive or involuntary smoking and is also referred to as second-hand smoke (SHS) or environmental tobacco smoke (ETS) (Cancer Research 2009). Tobacco was first introduced to Britain way back in the sixteenth century when it was commonly smoked in pipes by men. Later snuff and cigar smoking became popular among men but as a result of the invention of the cigarette making machines in the latter part of the nineteenth century, mass consumption of tobacco was made possible and in 1919, more tobacco was sold as cigarettes than in any other form (Wald Nicolaides- Bouman 1991). According to Wald Nicolaides- Bouman (1991) cited in Cancer Research UK (2009), smoking was firstly common among men and the consumption rose steadily until 1945 when it peaked at 12 manufactured cigarettes per adult male per day. After the Second World War, there was a slight dip in consumption but thereafter it remained at around 10 manufactured cigarettes per day until 1974 which marked the beginning of a steady and continuous decrease to about 4.6 manufactured cigarettes per adult male per day in 1992. On the other hand, women began to smoke cigarette s in the 1920s but not in large numbers until after the Second World War when they were smoking 2.4 cigarettes per adult female per day. Later, consumption among women continued to increase until it reached 7.0 cigarettes per day in 1974 after which it declined to 3.9 cigarettes per day in 1992 (Cancer Research UK 2009). HISTORY The link between smoking and life threatening diseases began in the early 1950s when Dr Richard Doll and Prof Austin Bradford conducted the first ever large scale study between smoking and lung cancer which was later published in 1954. In 1957, the British Medical research Council announced that, there is a direct causal connection between smoking and lung cancer. Later in 1962, the Royal College of Physicians concluded that smoking causes lung cancer, bronchitis and coronary heart diseases and recommended tougher laws on cigarette sales, advertising including smoking in the public places. In 1965, the British Government banned cigarette advertising on television and in 1971, there was an agreement between the Government and the tobacco industry that, Government health warnings must be carried out on all cigarettes packet sold in the UK. In 1973, the first tar/nicotine tables was published in UK which was later upgraded and divided cigarettes into five categories of tar content in 19 74. In 1975, the Imperial Tobacco agreed to drop brand names and logos from racing cars in UK races as control of tobacco advertising switched from the Industry to the Independent advertising Standards Authority. In 1976, Prof Sir Richard Doll and Richard Peto published the results of 20 years study of smokers and concluded that, one out of three people died from the habit. In 1983, the Latest Royal College of Physicians report featured passive smoking for the first time and asserted that more than 100,000 people died every year in the UK from smoking -related illness which later resulted in the banning of smoking on London Underground trains in 1984. In 1985, the smoking ban was extended to stations that were wholly or partly underground and in 1986, new advertising and promotion guidelines agreed on including banning tobacco advertising in cinemas. In 1987, the London Underground smoking ban was extended to entire network following the Kings Cross station fire outbreak in which 31 people died. The Independent Scientific Committee on Smoking and Health report in 1988 concluded that, non-smokers have a 10-30% higher risk of developing lung cancer if exposed to other peoples smoke and in June 1988, a UK court ruled that injury caused by passive smoking can be an industrial accident. The first nicotine skin patch became available for prescription in the UK in 1992 and in 1993, Sir Richard Dolls study results suggested that smokers were three times more likely to die in middle-age than non-smokers and up to half of all smokers may eventually die from the habit. In May 1997, the New Labour Government pledges to ban tobacco advertising and in the same year, the Government called for Formula One to be exempted from proposed EU directive on tobacco advertising and sponsorship but later backed down in the face of widespread criticism that was threatening the entire directive. In 1998, a White Paper named Smoking Kills was published after the Government -appointed Scie ntific Committee on Tobacco and Health announced that, passive smoking was responsible for causing lung cancer and heart disease in adults. In 2001, their was a new EU directive requiring larger and more prominent health warnings on tobacco packaging and in 2002, the British parliament passed legislation that began as a Private Members Bill, banning tobacco advertising named the Tobacco advertising and promotion Act. In December 2002, the British Medical Association called for the banning of smoking in the public places because of threat to non-smokers and young children. The Cancer Research UK launched an advertising campaign in 2003 and was funded by the Department of Health which target smokers of mild brand of cigarette, warning on the risk associated with the habit. In January 2004, the British Heart Foundation used graphic images to reinforce the Government -sponsored anti-smoking campaign. In March 2004, the Irish Republic introduced the toughest anti-smoking laws in Europe d escribed as the landmark legislation with a complete ban on smoking at workplaces. In November 2004, a Public Health White Paper proposed to introduce smoking ban in workplaces in 2008 with the exemption of private members club and pubs that do not serve food. In, March 2005, the British Medical journal report produced data showing that smoking killed 11,000 a year in the UK and in April 2005, MSPs voted by 83 to 15 to introduce a ban on smoking in public places from April 2006 and any smoker who defy is liable to pay a  £1,000 fine. In October 2005, the discussions over the England smoking ban broke down at the cabinet level causing severe delays. In December 2006, the Government announced the smoking ban in public spaces in England known as Smoke free England, which began on the 1st of July 2007 (BBC NEWS 2007). On the 1st of October 2007, the law for selling tobacco changed and became illegal to sell tobacco products to anyone under the age of 18 (an increase from 16) (Smoke fr ee England 2007). In May 2008, the Health Bill then called the National Health Service Reform Bill was contained in the Draft Legislative Programme published and it was announced in the Queens speech during the state opening of Parliament on 3rd December 2008. The Bill was later introduced into the House of Lords on 15th January 2009 and was published on the 16th January 2009 which proposes measures to improve the quality of NHS care, the performance of NHS services and to improve public health (DOH 2009). DEMOGRAPHY EPIDEMIOLOGY The United Kingdom of Great Britain and Northern Ireland (UK) is located in Northern and or Western Europe and it comprises the Island of Great Britain (England, Scotland and Wales) and the Island of Ireland (Northern Ireland) (Wikipedia 2009). According to the 2001 census, the population of the United Kingdom was 58,789,194 and has increased to 60,587,300 according to mid -2006 estimates by the Office for National Statistics. EPIDEMIOLOGY The prevalence of smoking varies widely around the World and has been observed to be on the increase in many developing countries thereby creating huge health problems for the future. Approximately 1.3 billion people smoke cigarettes or other tobacco products Worldwide (WHO 2003) and Figure 2 shows the worldwide tobacco epidemic model which describes the rise and decline of smoking prevalence followed by similar trends for smoking. The first stage is characterized by a low smoking prevalence of less than 20%, which is commonly observed among the males with no increase in lung cancer and other chronic diseases caused by smoking. Countries in this stage includes those in the Sub-Saharan Africa that have not yet been drawn into the global economy but are vulnerable to growth and changing strategic initiatives of transnational tobacco companies (WHO 2003). Stage two of the model is characterized by increase in smoking prevalence to above 50% in men with early increase in cigarettes smoki ng among women and a shift towards smoking initiation at younger age with an increasing burden of lung cancer and other tobacco-attributable diseases. These are characteristics of countries in the Asia, Latin America and North Africa continents. In these regions, tobacco control activities have been observed to be poorly developed and the health risks associated with tobacco smoking are not well understood. There are very low public and political supports for the effective implementation of tobacco control policies (WHO 2003). The third stage is characterized by a decline in smoking prevalence in men and gradual decline among women. Here, there is a convergence of male and female smoking prevalence at 45% and the burden of smoking attributable diseases is on the increase. Also, smoking-attributable deaths comprises of 10%to 30% of all deaths within the region which is about three quarters of men. Countries within this stage are those in the Eastern and Southern Europe where health e ducation about the diseases caused by smoking decreases with the public acceptance of smoking, most especially among the educated ones (WHO 2003). The fourth stage is characterized by a decline in smoking prevalence among men and women with deaths attributable to smoking peaked at 30% to 35% of all deaths most of which are middle aged men. Among the women, smoking attributable deaths rose to about 20% to 25%. Examples of countries within this stage are the United States and United Kingdom where England falls. FIGURE 2: Four stages of the Worldwide Tobacco Epidemic. (Source: WHO 2003). According to the Cancer Research UK (2009), the survey of smoking in Britain began in 1948. Then, smoking was extremely prevalent among men and the survey showed that 82% smoked some form of tobacco while 65% smoked cigarette. Later on, smoking prevalence fell rapidly through the 1980s until the mid 1990s when the overall smoking rates stabilizes just below 30% among the population as shown in figure 3. The sharp fall in smoking prevalence during this period is as a result of several interventions put in place by the Government then such as banning of tobacco advertisement on TV in the 1960s and others. Since the mid 1990s, the rate of fall has been very slow and in 2007 it was observed that 22% of men aged 16years and over smoke cigarette. The percentage of female smokers on the other hand has remained constant between 1948 and 1970 as shown in Figure 2. Between 1970 and 2007, the % of women who smoked dropped from around 43% to 20 % still due to certain measures developed in the la te 1960s. FIGURE 3. % of person aged 16+ who smoke cigarettes in Great Britain from 1948 to 2007. Source: General household survey, ONS. Available from: http://publications.cancerresearchuk.org/WebRoot/crukstoredb/CRUK_PDFs/lung/cs_lu_f6.1.xls FIGURE 4: Prevalence of Cigarette smoking by sex, England and Govt. Office Regions 2005. Source: Cancer Research UK. Figure 4 shows the cigarette distribution of cigarette smoking prevalence in England and it can be observed that, the overall smoking prevalence in England is about 25% among men and around 22% among the women. Within the various regions in England, smoking prevalence is higher among men and women in the North East because the region is economically active and home to 588 overseas companies from 32 different countries employing over 27,000 people (UK Trade Investment 2009). There has been a link between socio economic class and high prevalence of smoking as demonstrated in Figure 5 which buttresses the reason why the prevalence is high in Northeast England. Regions with high manual employee, occupation and high numbers of Industrial factories are characterised by high smoking prevalence. FIGURE 5: Prevalence of cigarette smoking by sex and socio-economic groups in England in 1992, 1998 and 2002. Source: Cancer Research UK. As shown in figure 5, smoking prevalence is observed to be higher among manual workers than non-manual workers. From 1992 to 2002, smoking prevalence reduced as a result of some interventions introduced within these years especially the White Paper on Smoking Kills introduced in 1998 making the prevalence to reduce from 33% in 1998 among the manual workers to 28% in 2002. FIGURE 6: Prevalence of cigarette smoking by age, persons aged 16+ in Great Britain, 1974-2005. Source: Cancer Research UK. FIGURE 7: Self reported cigarette smoking percentages by sex and minority ethnic group persons aged 16+ in England 2004. Source: Cancer Research UK. Smoking is more prevalent among the younger age groups of 16-19, 20-24 and 25-34 as shown in figure 6, where highest rate was observed among the 20-24 age group. Between 1974 and 2005, smoking prevalence among the 20-24 age groups fell from 48% to 32 %. On the other hand, among the 60+ age group, smoking prevalence halved between the same year intervals from 32% to 14%. Therefore, smoking prevalence has been observed to reduce with age as smokers tend to give up in middle age or die of smoking-related illnesses. (ONS 2002). Smoking prevalence has been observed to vary among different ethnic minority groups in England as shown in figure 7. Smoking prevalence is higher among the Bangladeshi men of about 41% but rare among the women with about 3%. Although this rate is alarming but there has been a decrease as to what was observed in 2001, when cigarette smoking and tobacco use was around 44% among the men with a relatively small percentage among the women (ONS 2001). FIGURE 8: Prevalence of cigarette smoking and use of tobacco products among ethnic minorities in England 2001. Source: DOH 2001. SOCIO-ECONOMIC FACTORS Smoking in the UK has been observed to be closely associated with social class and deprivation. The prevalence of smoking among the low paid groups has been observed to be twice those of the affluent groups because of the great difficulty people in the less affluent groups experience in stopping smoking (Ewles 2005). Tobacco smoking is also widely recognised as a cause of health inequality in the UK because it is common among the deprived groups and also compromises the already poorer health of deprived population such as those that fall within the marginalized groups. Examples are people with mental problems and prisoners, who are more likely to smoke and less likely to have access to mainstream smoking cessation services (Ewles 2005). The Index of multiple deprivation ranks areas from the most deprived to the least deprived and the odds of smoking increases as deprivation in the area increases (The NHS Information centre 2008). Children smoke for all sorts of reasons. Some smoke to show their independence, others because their friends do while some smoke because adults tell them not to and others do smoke to follow the example of role models. There is no single cause. Parents, brothers and sisters who smoke are a powerful influence. Also is the way it is been advertised and the tobacco companies sponsor sport which makes children want to try it (DOH 1998). The problems of smoking during pregnancy are closely related to health inequalities between those in need and the most advantaged. Women with partners in manual groups are more likely to smoke during pregnancy than those with partners in non-manual groups: 26 per cent of women with partners in manual groups smoke during pregnancy, compared with 12 per cent with partners doing non-manual work (DOH 1998). Education is also another social determinant of health for smoking. Education empowers individuals to make healthy choices and provides practical, social and emotional knowledge needed to achieve a full and healthy life (The Annual Report of the Director of Public Health for Newham 2007). The relationship between education and smoking has been extensively examined in developed countries and in the1989 US Surgeon General report analyzed by Bao-ping et al.(1996), it was stated after reviewing the literature of smoking that, education is the best socio demographic predictor for cigarette smoking pattern. The general agreement was that, the fewer the year of education one has, the more likely the person smokes and this again accounts for why there is high smoking prevalence among the ethnic minority groups in England. Another factor is the social norms whereby, in environments where smoking is freely permitted, it becomes a normal thing and becomes more difficult for individuals to opt out from (Ewles 2005).Other factors that prompt people to start smoking includes, the price and availability of cigarette, colourful advertisement and accessibility to treatment facilities for those that want to stop, the more available the facilities, the more people will be willing to use the facilities and stop smoking (Ewles 2005). In response to the global tobacco epidemic, May 31st of every year was declared as the World No Tobacco day, so as to globally address the danger associated with smoking tobacco. Also, the World Health Organization developed a WHO Framework Convention on Tobacco Control in May 2003 (WHO 2003), which later came into force on the 27th o February 2005 (WHO 2009). This was the first global treaty for public health negotiated under the auspices of the WHO and requires participating countries to implement a range of legislative and other measures to control smoking by taking appropriate action on passive smoking, banning tobacco promotion, providing services to smokers , monitoring smoking prevalence and international cooperation to control smuggling (Ewles 2005).In order to expand the fight against tobacco epidemic, the WHO introduced the MPOWER package of six proven policies namely: Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco use, Enforce bans on tobacco advertising promotion and sponsorship, and Raise taxes on tobacco. (WHO 2008) Smoking has been addressed at Government level in the UK since the publication of the White Paper Smoking Kills in 1998 which takes a comprehensive approach and prioritises people who want to give up, pregnant women, children and young people (DOH 1998). Between 1998 and 2009, various policies have been developed as stated earlier in this essay under the historical perspective of smoking in England which includes; 1998: Smoking Kills à ¢Ã¢â‚¬  Ã¢â‚¬Å" 2002: Tobacco Advertising and Promotion Act à ¢Ã¢â‚¬  Ã¢â‚¬Å" 2006: Health Act à ¢Ã¢â‚¬  Ã¢â‚¬Å" 2007: Smoke Free England. à ¢Ã¢â‚¬  Ã¢â‚¬Å" 2008: National Health Service Reform Bill à ¢Ã¢â‚¬  Ã¢â‚¬Å" 2009: Health Bill. GOVERNMENT MEASURES TO TACKLE SMOKING In line with the WHO directive to address tobacco epidemic, the UK signed into the International WHO framework Convention on Tobacco Control in 2003 and has implemented a range of legislative measures to control smoking at different geographical levels and between various population groups. The overall measures were broadly classified into three sets of overlapping effects namely; Changing social norms, Influencing attitudes, and Supporting individual behavioural change (Ewles 2005). Measures classified under the changing social norms and influencing attitudes includes; educational programmes such as the Government-funded mass media education campaigns aimed to educate the public on the danger associated with smoking, bans on tobacco promotion with health warnings covering 30% of the front and 40% of the back of tobacco packaging while terms such as low-tar and light have been prohibited on cigarette packet (DOH 2003). Also education on the benefit of quitting smoking was also part of the measure and explaining why people get fat after quitting as a result of increased eating unbalanced by increase activity because smoking has slight appetite suppressant effect (Ewles 2005). In addition, picture warnings started appearing on tobacco products in autumn 2008 and by October 1st 2009, all cigarette packs will have to carry picture warnings including other tobacco products by 1st October 2010 (DOH 2003). Also, another measure employed was prohibiting sales of tobacco products to people under the age of 18 by directing tobacco retailers to ask for form of identification from buyers who are teenagers. Taxation has also been used frequently to increase the price of smoking with rises in duty imposed in each years budget by the Government (Ewles 2005). On average, a price increase of 10% on a packet of cigarette reduced consumption by about 4% in developed countries, however, price control is undermined by tobacco smuggling which currently accounts for 16% of the UK market (Cancer Research 2009). Another measure is ensuring a smoke free environment which has been introduced in 2007 as smoke free England whereby smoking in enclosed public places is illegal. Under the supporting individual behavioural change is the cessation treatment programme, examples of which includes; a national telephone help lines and NHS specialist services for smokers who want to stop (Ewles 2005). To help smokers quit, the NHS Stop Smoking Services was set up between 1999 and 2000 following the recommendations of the White Paper Smoking Kills in 1998(DOH 1998). It was later observed that between April and September 2006, approximately a quarter of a million people (246,254) in England set a quit date through this NHS Stop Smoking Services and majority of these people receiving Nicotine replacement therapy (The Information Centre 2007). CHALENGES OF PUBLIC HEALTH POLICY FORMULATION AND PRACTISE The formulation of anti-smoking policy in England has always been big issue in most developed countries. In the UK, the Government needs people to smoke because the economy largely depends on it. The Government obtains  £8billion per year from excise duty on tobacco products which is approximately 2% of its annual revenue (Ewles 2005). Both in the policy formulation and in the implementation phase conflicts of commercial and health interests have been strongest on three issues: the ban on advertisement and sales promotion, the setting of upper limits for harmful substances in tobacco products, and proposals for an efprice policy. In the political process Parliament has been much more sensitive to the public health interest and to public opinion than to the lobbying power of the tobacco industry and trade, which has been more clearly visible in many Government decisions MEASURES TO REDUCE INEQUALITY IN SMOKING/ POLICY CRITIQUING After thorough review of the various policies aimed towards reducing cigarette smoking at the International, National and Local level, various gaps have been identified. Firstly, banning of smoking in public places is not enough to reduce the effect of smoking on health because be it passive or active smoking, it still endangers the life of the smoker. Therefore, abstinence should be the only message since smoking is a major cause of litter. In the UK, 200million cigarette ends are discarded each day and each takes 18months or more to biodegrade (Ewles 2005). Also, smoking in bus stops tends to serve as passive smoking to others waiting to join buses and therefore smoking in areas like this also needs to be banned. Another lapse in the smoking in the public places law is that, when people are not allowed to smoke in public places, they tend to do so when they get into their private cars and homes and these could be dangerous to young children living in the same house. Another area worth reviewing is the use of taxation to increase the price of tobacco products. High price has helped dissuade people especially young children from smoking and prompted many smokers to stop; however, smoking is concentrated among the lowest paid sector of the society and common among the addicted population who continue smoking despite prices, therefore such measures by the Government is not fair because the poor people pay disproportionately more as a consequences of their acquired addiction caused by the Government originally (Ewles 2005). Another misconception of tackling smoking is the youth smoking prevention programme which has always assumed to be the best way to tackle smoking among children and youths. The Youth-oriented media campaigns has a poor record of credibility among the target group (youths) and is often difficult to differentiate between those created by the health organizations and those created by the tobacco manufacturing companies. Therefore, discrediting smoking among the adult population will lessen the attraction for the youths because they tend to smoke in aspiration to be more adult (Ewles 2005). In addition, the law prohibiting sales to under -18s tend to add to the allure of smoking as an adult activity and thus creating challenges to children on finding a way around it buy getting the cigarette through adult friends, older siblings or black market routes(Ewles 2005). Also people who stop smoking through the nicotine replacement therapy gets addicted to the cessation programme and use the product beyond the recommended period. Since the nicotine delivery rate in the content is slow, it mostly prompts a relapse making people return to smoking (Ewles 2005). Reducing inequality in smoking has always been an issue the UK Government have been addressing and in response to this, a specific inequality target on smoking was set up in The NHS Cancer plan and the Public Service Agreement (PSA) 2004 aimed to reduce smoking rates among manual groups from 32% in 1998 to 26% by 2010 in order to reduce the health gap between the two groups. (DOH 2000). RECOMMENDATION/ CONCLUSION Evaluation of smoking patterns indicates that there has been an historic reversal of trends in total consumption, but distributional data show a widening social gradient in smoking. Two developments are needed for further improvement: a price policy that would support health policy and not contradict it, and better understanding of the socio-cultural dynamics of smoking which would be required for new innovative approaches in health education. REFRENCES Action on Smoking and Health (2006). Smoking Statistics; Illness and death. [Online]. Available from: http://old.ash.org.uk/html/factsheets/html/fact02.html (Accessed 25/04/2009). Bao-ping, Z., Giovino, G., Mowery, P. Eriksen, M. (1996). The Relationship between Cigarette Smoking and Education Revisited: Implications for Categorising persons educational status. American Journal of Public Health.1996. Vol.86, No 11. British Broadcasting Corporation (2007). Timeline: Smoking and Disease. [Online] Available from http://news.bbc.co.uk/1/hi/health/4377928.stm (Accessed 28/09/2009). <

Ethics In Physical Therapy Essay -- essays research papers fc

Ethics in Physical Therapy   Ã‚  Ã‚  Ã‚  Ã‚  One of the most rapidly growing occupations in the United States today is Physical Therapy. The United States Department of Labor has projected 23,000 unfilled physical therapist positions in the year 2000 and a lack of qualified physical therapists to fill them (www.apta.org). While Physical Therapy grows rapidly, questions of ethics in this field have also grown in large quantities. Physical therapy is the treatment of disease through physical means, including light, heat, sound waves, electricity, magnetic fields, and exercise (www.byu.edu). This means that therapists use many different forms to treat people, and treating people can be a large challenge because of all the different possibilities that could occur with the different treatments. Physical Therapy is a very rewarding and lucrative profession if the problems that come along with the job are dealt with in a capable manner. The main problem with Physical Therapy is the problem of the ethics of the profession. There are many ethical conflicts such as how to charge based on your services, and what types of services to give to each individual patient. To guide physical therapists in their decision making the American Physical Therapy Association came up with a code of ethics for it’s members to set their standards to work by. Their members are required to work by this code and are also required to maintain ethical practices. The first principle in their code is to respect the rights and dignity of all individuals. This includes all patients, employees, and co-workers. The second principle is to comply with all of the laws and regulations governing the practice of physical therapy. Physical therapists learn these laws in school before becoming a therapist. The third principle is that they must accept responsibility for their actions and exercise sound judgment. Every therapist must own up to their mi stakes, and take responsibility for their patients. The fourth principle is that they must maintain and promote high standards for physical therapy practice, education, and research. No therapist should ever compromise his or her beliefs for any reason. The fifth principle is that they must seek remuneration for their services that is deserved and reasonable. This means that they should be paid for the work that they do, but that the pay shoul... ...hysical Therapy. V.77 N.11 (Nov. 1997): p1628. EbscoHost. MasterFILE Elite. A57797069. Owens Lib.  Ã‚  Ã‚  Ã‚  Ã‚   Maryville, MO. 18 Mar. 2000. Grover, James. Physical Therapy. 1999. Brigham Young University: Physical Therapy Department. 18 Mar. 2000. â€Å"How to Fix Therapy Services?† McKnight’s Long Term Care News. V.20 N.14   Ã‚  Ã‚  Ã‚  Ã‚  (Oct. 6, 1999): p.59 Owens Lib. Maryville, MO. 18 Mar. 2000.   Ã‚  Ã‚  Ã‚  Ã‚   Physical Therapy: Making a Difference. American Physical Therapy   Ã‚  Ã‚  Ã‚  Ã‚  Association. 18 Mar. 2000.   Ã‚  Ã‚  Ã‚  Ã‚  

Ways to Learn Speak English

Ways to Learn Speak English We can speak English confident if we native language is another than English, because we live in a homogeneous country, where the diversity of races abound, thereby dialect, ways of thinking, living and acting, but in this country the universal language is English, spoken different accents, so if we aren’t native north American there are several ways to learn speak English, for example, the practicing, living with other people who speak native English, learn and study English sentences, and watching television.We can practice the language listening our favorite music in English, so we can hear a song several time, playing attention and repeating again and again singing the melody to memory, what matters is that you try to get the words, sing it loud and rhythm, on YouTube you can find your favorite song with lyrics in English, this will facilitate our pronunciation.When we live with native English speaks, we have the opportunity to repeat the word t hat we do not understand or find another way to explain what we want to communicate, this do not happen when we hear music, so we have the opportunity to enrich both our accent and our vocabulary finding synonyms o different words for same meaning, reproduce and repeating. Additionally, if we know different words we can make sentences.This will help that must practice with our friends native English speaking these phrases every day, so when we come to know many sentences almost that we could speak English fluently. Finally, we can learn speak English comfortably when we watch a favorite movie, so we Liliana2 have the opportunity to pay attention to intonation and return the movie and repeat a phrase or complete sentences, this is a wonderful idea, we can also choose some favorite series and try to listen understand and then, try to tell the story in our own words.In conclusion, the reliability in the English language is growing as it is practiced, in some schools use technological a dvances to develop the English language and it accent, but practice certainly plays an important fact in the development, so find our own technique in which we feel most comfortable and practice away.

Critique

Arundhati Roy has dedicated her writing career to politics and social causes and is a vehement critic of neo-imperialism and globalization. Her essay, â€Å"How Deep Shall We Dig? † was published in a national Indian newspaper ‘The Hindu’ on 25 April, 2004 against the backdrop of the 14th General Lok Sabha Elections in India. In her essay she attempts to portray the harsh conditions prevalent in the entire India due to unjust laws and an increasingly fascist approach towards governance by the ruling parties and stresses upon the need to bring about a revolutionary change in the country.Roy presents her argument effectively with the use of sarcasm, irony and rhetorical questions complimented by a well supported and organized progression of ideas. However, her occasional arrogant tone and fallacious reasoning make the reader question the credibility of her case. Roy links the violent situation of Kashmir to the entire Indian state by highlighting unjust laws, advers e impacts of privatization, violence in various states and insensitivity of the ruling parties.She presents strategies of resistance and civil disobedience as the only way forward to a radical change in the country. Roy’s mastery over sarcasm and irony helps to depict the true picture of India’s stability and politics in the current era. Her use of sarcasm at various instances in the essay plays a pivotal role in helping the reader to identify the reality juxtaposed against the false picture of India presented by the government.For example, â€Å"Of course there is a difference between an overtly communal party with fascist leanings and an opportunistically communal party† (5) captivates the reader’s interest and helps to emphasize her point that there is no difference between the mandates of the two current ruling parties of India and neither will be successful in bringing a change to the country. Similarly in the line, â€Å"There'll be no more crimina ls then. Only terrorists. It's kind of neat. (2), the writer effectively conveys her disapproval of the POTA (Prevention of Terrorism Act) through sarcasm and enlightens the reader with the devastating consequences that could take place by the integration of this Act into criminal law. Along with sarcasm, the author makes effective use of irony and refers to the oppressed as â€Å"gangsters† (1) and their killing by the police as â€Å"eliminated on orders† (1) in order to illuminate the reader about the reality of violence and ruthless killings taking place across the country.The use of words in quotation marks such as â€Å"free press† (3) and â€Å"Creating a Good Investment Climate† (3) highlight the various instances of irony used by Roy to criticize the misleading image presented by the ruling parties of democracy and privatization in the country. Efficient use of sarcasm and irony throughout the essay allow the reader to critically analyze the imag e of the ‘Shinning India’ presented in the international community and agree to the author’s point of view in this context.Along with irony, the strategic placement of rhetorical questions through the course of the essay plays an essential role in the effective communication of the writer’s ideas and arguments. The topic ‘How deep shall we dig? ’ itself is a manifestation of a rhetorical question put forward by the writer to make the reader reflect upon the stance taken by many Hindus over the Muslim invasion of the subcontinent, more than a millennium ago. With this single question the writer conveys the importance of the Muslim community to India and makes the reader analyze the oppressions faced by them in states like Kashmir and Gujarat.The clever placement of questions such as â€Å"So how can ordinary people counter the assault of an increasingly violent state? † (5) make the reader stop and reflect upon the arguments presented by the writer and unconsciously agree to them. Similarly the use of repetitive questions and epiphora during the discussion of fascism in the essay lay emphasis on an important point of the argument and convince the reader to agree to the author’s claim. On a similar note, Roy has strengthened her argument with ingenious organization of ideas and effective support of facts and statistics from credible sources.She first establishes the problems faced by the country and then cleverly connects them to the policies of the current ruling parties and fascism. With this link and the repetition of the problems in the middle of the essay she creates an image of a violent state requiring urgent action. After setting up the stage, she proposes her solutions and effectively convinces the reader that civil disobedience in the current election scenario is the only possible way out of the volatile situation of the country. Her logical flow of ideas is complimented by statistics and allusion t o credible sources.Reference to facts such as â€Å"According to the records of the Association of Parents of Disappeared People (APDP) in Kashmir more than 3,000 people have been killed in 2003† (1) and â€Å"Utsa Patnaik, the well known agricultural economist. †¦Ã¢â‚¬ ¦. calculates that in the period between the early 1990s and 2001, food grain absorption has dropped to levels lower than during the World War-II years† (2) validate the claims made by the author and play a pivotal role in bringing the reader in agreement to the writer’s point of view.Hence, the smooth flow of ideas and strong support make the paragraphs coherent and the essay powerful. Despite presenting a well structured case, the arrogant tone used by the writer while referring to the middle class in the essay depicts bias in her argument. In paragraph 11, she mentions the middle class as the only sect of the country that accept India as a legitimate democracy despite the widespread viole nce in the country while at the end of the essay she arrogantly refers to them by saying â€Å"Not because of that middle-class squeamishness — `politics is dirty'† (6).With a sweeping generalization and a supercilious remark about a group that forms more than fifty percent of the essay’s audience, Roy has considerably damaged the credibility of her argument. Moreover, at the end of the essay she addresses to the Indian people and calls for a change in the system by massive non co-operation but by offending a class that represents thirty percent of the Indian population (Lanzeni, â€Å"The Middle Class in India†), Mrs. Roy might not be very successful in achieving her aim.Along with an arrogant tone, the presence of fallacious reasoning at certain instances in the essay deteriorates the strength of the argument. While discussing the privatization of state institutions and referring to the power these private companies hold, the author goes too far by sayi ng â€Å"in India a few of these CEOs are more powerful than the Prime Minister† (3) and thereby commits a logical fallacy called the ‘slippery slope’. It is true that the heads of private companies running state assets hold a lot of power but it is illogical to conclude that they possess more authority than the head of the state- the Prime Minister.Similarly, the writer while emphasizing on the need of enhancement of human rights in the country, illogically concludes that India’s recent abstinence from voting for a human rights resolution in the U. N. will lead to an assault of human rights in the country. The author fails to explore other possibilities that could have led to India’s abstinence and makes a hasty conclusion which compels the reader to question the reasoning of the author and weakens the overall strength and impact of the argument.Concrete examples of violation of human rights by the government at this point in the essay would have c onsolidated the argument and made the claim of the writer more viable. Despite its shortcomings, Roy’s article highlights important issues like privatization and lack of intelligence sharing with the public which are pertinent to developing countries. Privatization of national institutions is a problem prevalent even in Pakistan and has been openly criticized.The recent privatization of KESC (Karachi Electricity Supply Corporation), Pakistan Telecommunications (PTCL) and Railways in the country has sparked extensive debate since the efficiency of these institutions has depreciated tremendously and the government has lost control over crucial state machineries. This can be exemplified by the long power breakdowns faced by Karachi at the hands of the privatized KESC which is not accountable for its inefficiency to anyone in the country.The fact that the economic capital of Pakistan can be held hostage by a private electricity company supports the argument laid down by Roy that privatization leads to the deterioration of a state. Along with privatization, lack of intelligence sharing over matters affecting the public is another common aspect between Pakistan and India mentioned in Roy’s article. The details of the attack on Mehran Base in May, 2011 and the abduction of Osama bin Laden from Abbottabad are sensitive issues about which the common man knows nothing beyond the immediate videos shown on television.These incidents had a huge impact on the image of Pakistan across the globe and affected the lives of its citizens but Pakistani’s were not given any explanation regarding the events by the government or the army. As Roy states, the common man was forced to believe that lack of information sharing is â€Å"a poisonous brew which is stirred and simmered and put to the most ugly, destructive, political purpose. †(1) Therefore, the two major issues of privatization and hiding information from the public highlighted in Roy’s ess ay not only exist in India but also have strong roots in other developing countries like Pakistan.The author mentions the adverse effects of growing influence of nationalist groups like â€Å"Sangh Parivar† (6) and the extremist teachings given in their schools called â€Å"shakhas† (6) in Northern India. The situation in Pakistan is surprisingly similar where the Taliban extremist group represents the ‘Sangh Parivar’ of India and their ‘madrassas’ provide a reflection of the ‘shakhas’ mentioned by Roy. The lack of proper governance in the northern areas of Pakistan has led to a growing influence of the Taliban in the region and an unmonitored expansion of their schools called ‘madrassas. These schools instill extremism into our young generation and serve to fulfill the â€Å"deadly purpose† (6) of spreading terrorism in our country. As Roy pointed out in her argument, the government’s failure in fulfilling its responsibilities has led Pakistan into a volatile situation where like India it is battling out extremist groups and nationalist movements generated from within the country. Roy talks about the oppression of the current government in India (which is similar to the policies of the Pakistani government) throughout the essay and cleverly compares it with the British rule to arouse emotion and patriotism in the reader.The writer’s analogy of the Armed Forces Special Powers Act with Lord Linthigow’s 1942 Ordinance has a strong impact on the argument while her reference to â€Å"Dandi March† (7) and â€Å"civil disobedience† (7) (a common term for protests during the British rule) generates nationalism in the emotional readers of the subcontinent. Like the Special Powers Act, Section 144, a law in the Pakistani constitution from the colonial era (Warraich, â€Å"In Pakistan, Zardari's Crackdown Betrays Weakness†) has been repeatedly used by the current government to repress protests such as the lawyers ‘long march’, a strategy used by the British during their rule.Similarly, recent attempts of the Pakistani government to disseminate peacefully protesting crowds by teargas and stone attack provide reflections of the tyranny faced by the people of the colonial era. The ingenious link established by Roy between the current oppression faced by the people of subcontinent and the British autocracy makes us realize that there is a dire need to bring about a change in the current system, launch another ‘Dandi March’ and indulge into yet another ‘civil disobedience’.Roy successfully evokes emotion with this analogy and makes the reader agree to her argument that the limit to repression has arrived, â€Å"Enough is Enough. Ya Basta! † (5) On the whole, Roy’s effective use of literary devices, rhetorical questions and an ingeniously structured argument captivates the reader’s intere st and despite its shortcomings in terms of reasoning, it eventually persuades the audience to give in to the view presented by the writer.Articles of this genre in the past have influenced Indian history and it is their growing popularity and recent impact on politics that has led to an immense support by the common people to revolutionary movements like the anti-corruption campaign by Anna Hazare. Therefore, Arundhati Roy’s â€Å"How Deep Shall We Dig? † not only serves as a critique on the current political system of India but has far reaching consequences in terms of awakening a nation from ignorance and directing it to a path of revolution.