Eating Disorders and the Media

Eating Dis hunting lodges and the MediaThe neighborly function of doing this research project is to provide a distinguishable perspective on the role of the media in this modern era. This research project examines the impacts of media influence on alimentation attitudes and it contains relevant studies and statistics regarding this particular topic. The findings of this research atomic number 18 confined to the linked States of America and fall in Kingdom due to the high prevalence of feeding disorders as comp atomic number 18d to other countries. In essence, the report c overs the do of media portraying carious body learns, slant prejudice advertisements and candor shows as well as the power of lucre in promoting eat disorders. Based on the evidence, it is profit that the media is responsible for the break outment of ingest disorders in the corporation. Hence, it is important to take disciplinal measures and grimace into this matter seriously forwards furthe r damage is d bingle.1.0 launchEating disorders argon serious psychological illnesses that result in hoi polloi having on the hook(predicate) take habits. plenty with ingest disorders usually induct a negative apprehension of their body compass and entrust attempt to turn back their weight through excessive fast, exercising or purging. In fact, ingest disorders notifynot be separated from the culture in which they arise. In western countries where keep downness is emphasized as an important societal value, millions of women atomic number 18 suffering from eat disorders want anorexia, bulimia and binge take in.According to National Eating Disorders connectedness (2005), approximately 10 million females and 1 million males in the coupled States are suffering from anorexia and bulimia while 25 million much are struggling with binge consume disorder. Other than psychological and ancestral factors, research shows that the media overly has a pro gear up impa ct on have disorders. The media has grown rapidly over the years with the advancement in engine room and now it has the persuasive power that can manipulate the whole society by shaping piles attitudes and beliefs. This mind-bending power of the media has brought about galore(postnominal) debates from contrary institutions especially on the cut back concerning the evil effects of media exposure on eating disorders. Therefore, immediate actions need to be taken before this issue scrams more and more controversial.Even though the media has the power to shape spates behaviors and attitudes, do you agree that the media encourages people to break dance eating disorders?Looking further into the issue, we bequeath see that the media is indeed guilty of encouraging eating disorders in the society. It portrays an unachievable standard of body find out, gives leeway for pro-anorexia ag hosts to spread on Internet and kindles fasting and weight loss.This report will show comp elling evidence on how media encourages people to develop eating disorders. They are many negative effects than positive one. The research findings are confined to the United States of America and United Kingdom due to their high prevalence of eating disorders in affinity to other countries.2.0 Media Promotes Ideal Body ImageBody image refers to peoples perception and imagination of their physical way. It is not inborn, but learned (Ojeda, 2003, p. 8). A claim conducted by Anne Becker in Fiji, where television was introduced as late as the mid-1990s, found that 83% of the people felt television had influenced their perceptions and thoughts about body image and size (Friedman, 2007, p. 31). Therefore, the role of the media in promoting an ideal body image should not be taken lightly as it can cause harmful effects on ones self-image and egotism.2.1 Portrayal of Ultra-ThinnessTwenty years ago, the middling mystify weighed 8 per cent less than the average woman, but todays models weigh 23 per cent less (Media Awareness Network, 2010). As condemnation goes by, models and celebrities are beseeming lean and thinner to match the unrealistic cultural standard of kayo. hear shows that unrealistic portrayal of women stereotype in the media can sop up destructive effect on ones health. According to Healthy Within (n.d.), an average American woman is 5 feet 4 inches tall and weighs 140 pounds while an average American model is 5 feet 11 inches tall and weighs 117 pounds. These super-thin models portrayed by television and magazines make women smack unhappy and dissatisfied with their physical appearance. As a result, millions of women who fail to overstep this standard of beauty incur humiliated and guilty and the desire to be thin drives them to develop eating disorders.2.2 price message is conveyed to the SocietyTelevision has always been viewed as a book of facts for entertainment and information, but nowadays it begins to influence peoples thinking and attitudes by evince thinness as a way to measure womens worth. For example, heavier actresses often see negative comments about their bodies and 80% of these negative comments are followed by put up audience laughter (Media Awareness Network, 2010). at any rate that, carriage magazines, television and movies are constantly delivering the wrong message that women must be thin in order to be loved, trustworthy and sure-fire (Schlundt Johnson, 1990, p. 59). The portrayal of happy and successful women creation extremely thin has a huge impact on womens perception of beauty. It has forced women to adopt the mindset that thin is beautiful and beauty is success. When women begin to equate thinness with beauty, they will strive hard to become thin so that they are attractive enough to be accepted in the society. Therefore, in order to achieve the ideal body image standard, women violently manipulate their weight and appearance by diet, purging and nonetheless self-starvation.Fa mily InfluenceStudies show that family influence is also one of the factors that trigger eating disorders. Parents especially mothers assume significant influence over teenagers body image problems. In this society where thin is still in, close mothers would want their children to look beautiful and slim. Therefore, parents some cartridge clips inadvertently encourage their children to fall asleep weight scour though most of them are not overweight. Parents usually encourage their children to diet with good intentions but teenagers may misunderstood their meaning as being fat is not good and they should lose weight to become thinner and more beautiful. Besides that, parents with weight problems tend to be over-concerned about their childrens weight and body images. This may cause teenagers to feel the pressure to be thin and start developing un legal eating habits to control their weight. Since teenagers take their parents haggle seriously, negative comments on their weight an d eating habits may diminish their egoism (Ojeda, 2003, pp. 21-25).In conclusion, media promotes ideal body image that can cause women to feel dissatisfied with their body size and shape. The portrayal of ultra-thinness through television commercials, fashion magazines and movies will deliver the wrong message to the society. As a result, women develop dangerous eating patterns to stay thin so that they can reach the standard of beauty portrayed by the media.3.0 Power of InternetInternet is a powerful agent of socialization and it allows easy access to different kinds of information. The online world of pro-ED (pro-eating disorders) consists of hundreds of web orders and discussion groups created by people who claimed that they have the disorders (Healthy Place, 2010). Every time we come across a pro-anorexia site, a warning sign will appear on the opening page releasely specifying that the contents of the site is pro-anorexic and should not be viewed by those who are in retrieval or those who do not suffer from an eating disorder. However, many people terminate the warning and enter these sites due to curiosity.3.1 Impact of Pro-Anorexia WebsitesPro-ana websites are online communities for people with anorexia nervosa (Suite101, n.d.). These websites have proliferated rapidly due to the rise of Internet usage in the stick out decade. They promote anorexia as a lifestyle choice rather than a life-threatening disease (Friedman, 2007, p. 60). Most of the contents in these sites glorify eating disorders and provide tips on how to lose weight more effectively. Therefore, those people without eating disorders but actively seeking for ways to lose weight and those with eating disorders seeking for advice to conceal their disorders become the victims of pro-ana websites. Besides that, these sites also contain excite quotations and poetry that encourage eating disorders. The impact of pro-ana websites is so immense that there is no way back after their first visi t on these sites.Most of the pro-ana websites display thinspiration pictures of waif-thin models and famous celebrities with eating disorders like Mary-Kate Olsen and Karen Carpenter to stay the attention of impressionable young person women (Healthy Place, 2010). After vie getg these pro-ana websites, teenagers are more likely to be unhappy with their physical appearance and have a negative body image. Study shows that individuals subjected to a single viewing of a pro-ana site are more likely to have low self-esteem and become preoccupied with exercise and weight loss, as compared to the control group (Wikipedia, 2010).3.2 Online Social NetworksNowadays, there are many social network groups visible(prenominal) online such as MySpace, Xanga and Facebook. These online social networks have gained popularity among young people in the recent years and at long last become a tool to promote eating disorders among the members.After connecting with each other for years on unappreciate d and secret websites, pro-anorexia groups are now moving to more public forums like Facebook to attract more people to join their groups ( radicalsweek, 2008). Many socially dislocated anorexics join and become members of these sites because that is the only means of support available to them. rough said that the sites can help them to combat the feelings of loneliness and isolation as well as to get attention from others (Healthy Place, 2010). Moreover, they can find a circle of friends with the similar disease who understand and accept them as who they are. This makes them feel that they are not alone and thus motivated to carry on with their disorders. In short, pro-ana online networking website is a place for anorexics to establish friendship, gain support and seek solace by sharing their sorrows, joys and accomplishments with each other.Social PressurePeople in professions where there is a particular social pressure to be thin such as athletes, models, dancers and actors are more likely to develop eating disorders during the course of their career. Studies found that around 15% to 25% of athletes have eating disorders, especially those involved in sports that emphasize on appearance such as figure skating, cheer leading and gymnastics (Schulherr, 2008, p. 244). Besides that, celebrities and models also suffer from eating disorders because they are placed under social pressure to look perfect in front of the camera. In order to look super skinny and sexy, they adopt excessive dieting and self-starvation which can lead to fatal health consequences in the future. For example, Ana Caroline Reston, a come up star in the modeling industry died of anorexia in 2006. Due to social pressure, she starved herself by just surviving on fruit juices, apples and tomatoes for many years. Finally, when she achieved the desired image of a supermodel, the fatal eating disorders took her life at the age of 21.In conclusion, the power of Internet in developing eating disor ders among teenagers should not be underestimated. The slippery nature of the web makes the pro-ED world some impossible to control (Healthy Place, 2010). Therefore, pro-ana websites and social networks should be monitored so that less people would be misled by the harmful information inside these sites.4.0 Media Promotes dietingDieting can be defined as the attempt to lose weight by restricting food intake. Excessive dieting behavior may eventually lead to the development of eating disorders because severe weight loss is the primary symptom of anorexia nervosa. When the power of the media is misused by the advertisers to promote dieting and their diet products, the media can become a formidable force that leads millions of people worldwide to the possibility of eating disorders.4.1 Exposure to Magazines and AdvertisementsAdvertisements in magazines and television are featuring extremely thin models and celebrities to make women think that they are fat. When women start to busine ss organisation of gaining weight, they will pursuit dieting as a way to lose weight. As a result, Americans spend over $50 billion on dieting and diet-related products each year (Healthy Within, n.d.). Since the standard of beauty portrayed by the media is unattainable to most people, consumers will never feel satisfied, and therefore creating an perennial demand for beauty and weight loss products. Hence, it is certain that these industries are really earning profit from encouraging a life-threatening disease in millions of women (Friedman, 2007, pp. 27-31).Furthermore, studies also show that adolescent girls who are frequent readers of fashion magazines record higher(prenominal) prevalence of dieting and exercising behaviors to lose weight as compared to those singular readers. Many people start to take up dieting because they are motivated by the pictures in the magazines. Dieting books are usually the best-seller because most people are attracted by the diet tips provided in side these books (Schlundt Johnson, 1990, p. 59). Thus, it is evident that the precaution of being fat has dominated many young women and adolescent girls and this eventually leads them to engage in excessive dieting and unhealthy eating habits.4.2 incubus Loss Reality ShowsAn increasing number of weight loss reality shows are appearing on television screens and all of them demonstrate study results that can be achieved through dieting and exercising (DietWords, 2010). For example, The Biggest Loser is one of NBCs most-watched prime-time programs and it has attracted approximately 10 million viewers each week (The New York Times, 2009). The programs target is to obtain a weight loss of more than 15 pounds per week through severe caloric restriction and many hours of straining exercise. However, health care professionals disagree with such extreme routine as it is not advisable to lose more than two pounds a week.These weight loss reality shows can have detrimental effects on th e health of the contestants as well as the viewers. In order to win the money reward, some contestants may develop harmful practices to lose more weight within a shorter time. On the other hand, viewers are do to believe that rapid weight loss can be obtained from dieting. Consequently, they may try to emulate the contestants by developing unhealthy eating behaviors to lose weight, which eventually leads to long term fatal effects on their health.Peer PressurePeer pressure refers to the influence exerted by a peer group in encouraging a person to modify his or her attitudes, values, or behavior in order to conform to group norms (Wikipedia, 2010). This is common among teenagers because most of them spend more time with their groups of friends rather than staying at home. However, when teenagers encounter with negative peer pressure relating to their eating habits, it is very dangerous because they may lack the maturity to handle this kind of pressure. When teenagers are teased by their friends about their body size and shape, they will feel the compress to control their weight by dieting, which may lead to the development of eating disorders. Therefore, peer pressure is a factor that triggers dieting and eating disorders among young people.In conclusion, the media has brought about a dieting obsession in the society. Hence, it is clear that frequent exposure to weight loss reality shows, magazines and advertisements can lend to the development of eating disorders.5.0 ConclusionIn summary, the media is the driving force basis the development of life-threatening eating disorders in millions of people worldwide. It reinforces the intense caution of weight gain among women by portraying pictures of super-thin models, encourages the development of eating disorders through the expanding online world of pro-ED and promotes dieting through weight loss reality shows and advertisements. all(prenominal) three arguments mentioned are clear cut showing that the med ia is guilty of promoting eating disorders in the society.In time to come, more people will be suffering from eating disorders because of the influence of the media. As the impacts of media influence cannot be seen in the short run, many people do not realize that it can actually lead to serious health consequences in the future. By the time they suffer from an eating disorder, nothing much can be through except to seek treatment and counseling for recovery. Prevention is better than cure. Thus, before it is too late, we should find ways to harness media power for good or else of evil.When there is no enemy within, the enemies outside cannot hurt you (Quotes Daddy, 2010). Therefore, love yourself more and enjoy life to achieve happiness within yourself, only then(prenominal) you will not be conquered by the fear of weight. Stay outdoor(a) from eating disorders and you will never regret.6.0 RecommendationThe following recommendations have been made to rectify the role of media in promoting eating disorders.Avoid using stunted models in the fashion industry as they portray thinness as the standard of beauty. In addition, this report recommends further work toSet a minimum entry for modeling industry where all models should have a Body Mass Index (BMI) of between 18.5 to 25Ban models who have a BMI of less than 18Organize fashion shows that promote healthy body imageBan pro-ana websites that promote eating disorders as a lifestyle. In addition, this report recommends further work toIntroduce laws to impose punishments or fine on any means of green goddess communication that promotes eating disordersEstablish pro-recovery websites and support groups to encourage those people who wish to seek recovery from an eating disorderResearch the claim that government control over the media (e.g. censorship) can help to reduce the harmful contents in advertisements and reality TV shows. In addition, this report recommends further work toMonitor and gain vigor the harmf ul contents available on any means of mass media including movies, television and InternetOrganize Eating Disorders Awareness Week and photo competition to raise awareness on eating disorders

Burnout in Nursing Profession

Burn step up in Nursing ProfessionThe level of this publications review is to bring out the signifi tailt performers reachd to to burnout in the nursing profession. Nurses ar most susceptible and vulnerable to the development of burnout, mainly because of the spirit and stirred demands of their gambol. Burnout in the nursing profession is a significant concern in nursing, because it has detrimental effects twain on privates and organisations. For the psyche nurse, the neuroendocrine response yields physiologic reactions that may ultimately contribute to illness. In the wellness keeping organisation, ferment burnout may contribute to absenteeism and turnoer, both of which detract from the quality of perplexity. Burnout is inform to originate from work itself as well as from characteristics of the individual nurse. at that place be withal buffers to mitigate the development of burnout.BackgroundFreudenberger (1974) first coined the end point burnout to describe the build-up of feelings that professionals association when their emotional resources ar depleted (Janssen, Schaufeli Houkes 1999). Maslach and Jackson (1981) go on refined this term as a syndrome of emotional exhaustion, de ainisation and decrease personal accomplishment. Their record is a piece of seminal work and their fancy on burnout has been widely accepted since. Emotional exhaustion manifests in nurses as a general loss of feeling and concern, trust, interest, and spirit. It to a fault involves feelings of fatigue, being utilise up, irritability, frustration and wearing out (Maslach et al 1981). Depersonalisation refers to showing a detachment of the nurse from the patient by actively ignoring the qualities that make them curious and engaging people (Maslach et al 1981). The third dimension of the burnout syndrome is the tendency of nurses in evaluating their work negatively. Nurses feel unhappy about themselves and dissatisfied with their accomplishments on the jo b (Maslach et al 1981).Burnout is measured by the Maslach Burnout Inventory (Maslach et al 1981). The internal consonance of this mari unitarytte has been widely tested utilise Cronbachs coefficient alpha (Maslach, Jackson Leiter 1996) and accordingly could be considered to be a standard measure for burnout (Hannigan, Edwards, Burnard, Coyle Fothergill 2000). This survey tool is a 22 item questionnaire consisting of the troika subscales mentioned above of the burnout syndrome. The items ar scored in a 7-point Likert scale ranging from 0 (never) to 6 (daily). A elevated grade of burnout is reflected in high scores on the emotional exhaustion (EE) and depersonalisation (DP) subscales and a utter score on the personal accomplishment (PA) which is rated inversely. An reasonable stop of burnout is reflected in average scores on the three subscales and a low degree of burnout is reflected in low scores on the EE and DP subscales and a high score on the PA subscales (Maslach e t al 1981).RationaleBurnout is often been account as a causing figure for attrition of nurses from the nursing profession (Armstrong-Stassen, Al-Maaitah, Cameron Horsburgh 1994). In addition burnout in nursing has been associated with poor patient satisfaction and poor patient outcome (Vahey, Aiken, Sloane, Clarke Vargas 2004, Nayeri, Negarandeh, Vaismoradi, Ahmadi Faghihzadeh 2009). These adverse outcomes of burnout could abide significant indelible impact on the Singapore governments aim to establish Singapore as a reputable medical hub in the ASEAN region. Studies and statistics clear shown that nurses in Singapore argon at stake of development burnout (Boey, Chan, Ko, Goh Lim 1997, Lim Yuen 1998, EnterpriseOne 2006), however, surprisingly, no re seem have been through in Singapore to mensurate the level of burnout and the related to cistrons of burnout in their nurses. Therefore, this belles-lettres review is initiated to generate a comprehensive dread of what i s known about burnout in the nursing profession. This could have implications for understanding the over entirely well-being of the nurses in Singapore.Aims and ObjectivesAim and objective To identify the significant factors related to burnout in the nursing profession.MethodA belles-lettres search was conducted using the keywords nurses and burnout on CINAHL and MEDLINE. The search is supplemented with a manual search in journals published in Singapore for further information regarding related research conducted in the local context and a supplementary fulfill of other cited materials in Google Scholar, where appropriate.FindingsCollating the evidence from the literature led to the identification of three main themes for the related factors of burnout for nurses. The themes atomic number 18 render of the health sympathize with professionals, individual variables and leadership as the buffering factor.The proposition that high nervous strain clinical guardianship settings a s organisational focusors have been extensively examined. Therefore not surprisingly, studies on burnout done in medical, surgical and high dependency units were most prominent (Nayeri et al 2009, Adali Pirami 2002). Gillespie and Melby (2003) purported that the reason is because the nursing staffs running(a) at these demanding areas are likely to surpass considerable time during their working day in intense interactions with people. era Maslach-Pines (2000) suggested that it is because the nature of the work of these departments is often described as physically demanding and nurses are alike continually faced with heavy demands for pity, sympathy and compassion. However, while legion(predicate) studies demonstrate a strong coefficient of correlation between high levels of form in high punctuate work environments and plusd incidence and degree of burnout among nurses (Schmitz, Neumann Oppermann 2000), others produce evidence showing thither is no correlation (Buunk, Ybem a, Zee, Schaufeli Gibbons 2001). In the study conducted by Buunk et al (2001), it is being demonstrated that nurses working in high stress, specialised environments are less burned out than their counterparts working in those perceived as low stress environments. However, it should be noted that the participants for their research are nurses who have at least 10 years of working get word. They would have been able to handle their stress much efficiently and would have been less prone to burnout. Therefore, it can be argued that this research lost its reliability because the sample represents a group of generally sanguine workers (Demerouti, Geurts, Bakker Euwema 2004997). Moreover, the researchers also conducted a face-to-face interview with the participants. By the interview questions, the participants could infer that the researchers are interested to determine their stress related behaviour. Therefore, the sensitive nature of these questions would have inflicted a response bias as participants do not want to be stigmatised as not being able to pick out (Maslach, Jackson Leiter 1996).In to a greater extent recent years, among the organisational stressors, workload as a contributing factor to burnout is more leafy vegetablely reported and associated with the emotional aspect of the burnout syndrome (Greenglass, Burke Moore 2003, Lin, St John McVeigh 2009). Taris, Le Blanc, Schaufeli and Schreurs (2005) suggested that a high score on this single aspect of the burnout syndrome will be sufficient enough to venture burnout. Authors proposed that the 21st century health care reform has further increase nurses workload. The work intensification studies in and around health care are providing convince evidence on the extent to which efficiencies achieved by health care organisations are largely due to the increased workloads of nurses as a result of both staff reductions and increasing activity and patient complexity (Green 2004, Aiken, Clarke, Sloane Sochalski 2001). It is argued that increased workload will lead to increased stress and in turn leads to higher(prenominal) chances of burnout (Maslach Leiter 2008). Therefore, it can be speculated that there should be widespread concomitant increase in reported severity of burnout due to the increased pressure on nurses. Nonetheless, the question remains as to why in the same situational conditions, roughly nurses burn out, whereas others show no syndrome.The most likely explanation is that causes of burnout are effectuate in both the environment and the individual. Significant kins between burnout and sure demographic characteristics have been reported but the results are still farthest from conclusive. The few socio-demographic variables most greensly being inquired are age, gender and marital status. In their study, Maslach, Schaufeli and Leiter (2001) reported that age has most consistently been related to burnout. Burnout has been discover more often among green wo rkers than among those aged over 30 or 40 years and it seems to occur or else early in ones work career.Schaufeli and Greenglass (2001) accounted that regarding gender disagreements in burnout, results are mixed and may reflect difference in roles or occupations. Maslach et al (2001) found that emotional exhaustion has commonly been reported to be more common among women, whereas depersonalisation has been more common among men. Bakker, Demerouti and Schaufeli (2002) conducted a study in which a wide range of several(predicate) occupations and organisations were recruited and answered through the internet, women reported higher levels of burnout than men did, particularly when they were relatively young or had relatively little work experience. However, the respondents were mostly men and rather young (Bakker et al 2002). Schaufeli and Enzmann (1998) with regard to marital status, those who are unmarried, especially men, turn up to be more prone to burnout compared with those w ho are married. Singles seem to experience level(p) higher burnout levels than those who are divorced.Personality characteristics as the psychological aspects of individual variables were explored as an historic variable in the burnout regale in a number of investigations (Simoni Paterson 1997, Allen Mellor 2002, Bhler Land 2003). However, the specific features of constitution that affect the detection of burnout remain unclear. Garrosa, Moreno-Jimnez, Liang and Gonzlez (2008) proposed a archetype of annunciateion of burnout in nursing and they reported that their findings give support that personality factors are significant predictors of the three aspects of burnout. further the authors were not clear on which personality characteristics were studyd. Allen et al (2002) and Zellars, Perrew and Hochwarter (2000) reported that psychoneurosis is associated with the emotional exhaustion aspect of burnout and external locus of control also demonstrated unconditional relatio nship with burnout. However, Bhler et al (2003) and Toscano and Ponterdolph (1998) reported that findings are mixed for hardiness.Interestingly, more recent studies indentified leadership as a factor related to burnout (Kanste, Kyngs Nikkil 2007, Corrigan, Diwan, Campion Rashid 2002). Leadership issues did not appear as a noteworthy factor related to burnout in earlier studies, even though it had been discussed some twenty years ago by basso (1985). Nonetheless, leadership issues cannot be considered as new, but rather they appear to have increased in relative significance. Weber (2007) articulated that the increasing calls over the last decade for considering leadership as a related factor of burnout is particularly because of the chronic recruitment and retention issues confronting the nursing profession. There is also a rich source of comment on the impact of health care reform on nurses and nursing in the health care sector research literature (Aiken et al 2001). In a study c onducted by Laschinger and Leiter (2006), their findings also support the key role of strong nursing leadership in creating conditions for work engagement and ultimately, safe, high-quality patient care. Demerouti, Bakker, Nachreiner and Schaufeli (2000), in their proposed model of burnout and life satisfaction amongst nurses, identified that an individuals engagement with their work will predict a degree of low burnout. However, Stordeur, Dhoore and Vandenberghe (2001) warned that if leaders are too lordly and control-oriented, their leadership could exacerbate the burnout process.Among the different types of leadership, transformational leadership has been most commonly proposed and viewed as a buffer which moderates the impact of burnout (Stordeur et al 2001). Transformational leaders are visionary, balanced, conscious and confident of breaking existing professional boundaries (Stordeur et al 2001). Nonetheless, findings from the study by Stordeur et al (2001) have to be viewed with cautious. This is because they only attempted to measure the relationship between leadership and the emotional aspects of the burnout syndrome. The other two dimensions, depersonalisation and pretermit of personal accomplishment were not measured. Further studies would have to be taken to establish implicit links between leadership and burnout. Ulrich, Buerhaus, Donelan, Norman Dittus (2005) found that effective control over practice resulted in increased status, gaze and recognition. Hochwlder (2008) further emphasised that through a chain reaction, transformational leadership vogue engenders group cohesion and empowerment in nurses and hence it has been found that transformational leadership is inversely correlated with burnout in nurses.DiscussionsPast research on burnout in Singapore is generally anecdotal in nature (Tung 2000). Others attempt to investigate the nurses stress level and their association with the psychological well-being and several work-related outcom es much(prenominal) as job satisfaction, organisational commitment, intention to quit and job-induced tension (Boey et al 1997, Lim et al 1998). In a study on stress among nurses in the requisite department in Singapore, Lateef, Ng and Anatharaman (2001) reported that the nurses who are older, have more working experiences and hold higher positional post had lower stress scores as compared to those who are younger, have less working experience and have lower positional post. However, the authors did not proffer insights to explain these plain facts. While such research gives indication that there is a high level of stress in the nurses in Singapore, it cannot be implied that there would be a high degree of burnout in these nurses. While it is clear that stress results in burnout among some individuals, also apparent, yet not explained by the verifiable evidence is the fact that others faced with high levels of stress do not experience burnout. Therefore an implicit relationship of high level of stress and high degree of burnout cannot be deduced because there is evidence of high stress being associated with low burnout (Bunnk et al 2001). Therefore, studies on burnout have to be conducted to investigate the burnout phenomenon among the nurses in Singapore. For the time being, it could only be speculated that nurses in Singapore are at risk of developing burnout.From the findings, it is shown that nursing burnout appears to be the result of not only contextual factors but also individual factors. Results from the studies on the socio-demographic variables and personality characteristics are weak and ambiguous. Only age has been identified as a relatively good correlate to burnout, with younger nurses being more susceptible. It would be reasonable to believe that younger nurses are more at risk to burnout because they have to move from a familiar educational environment into the workforce where there are high expectations of them to rapidly function as a co mpetent nurse (Schaufeli et al 1998). As a result, they experience challenges transitioning from disciple to practicing professional nurse (Godinez, Schweiger, Gruver Ryan 1999).Transformational leadership could result in low burnout. It is important to note that low degree of burnout represents a positive psychological carry and an effective state of well-being (de Rijk, Le Blanc, Schaufeli de Jonge 1998). In the emerging literature, there is a shift from the traditional focus on weaknesses and malfunctioning toward understanding human strength and optimum functioning at work (Gustafsson Strandberg 2009). Conceiving of low burnout as wellness makes a part to the literature because it focuses on the positive aspects of work. Positive research has the potential to improve the image of nursing and depict a new generation to the profession. It also have implications for identifying and modifying possible areas of frustration that would result in burnout and thus help relieve the high be of turnover by improving nurse retention (Teng, Shyu Chang 2007). The major contribution of such an approach is that it enhances the understanding of how the management of the health care organisational can affect nurses well-being. This knowledge is essential for the future development and well-being of all nurses and the profession of nursing.Research implicationsCurrent research focuses on examining the burnout phenomenon in slap-up settings and their findings have presented evidence that the level of burnout might not be influenced by different clinical settings. Therefore, future studies should move beyond the acute care settings to better understand the burnout phenomenon.Except for one, all authors of the research used for this literature review use cross-sectional methodology, therefore, casual relationships cannot be made from their results. Their findings also cannot be generalised in another milieu. Longitudinal research is compulsory in order to enhance the understanding of the burnout process. Maslach et al (1981) had pointed out that longitudinal research although presents a large challenge, it is of critical importance for the comprehension of burnout. future(a) longitudinal examinations should establish a profile of the nurses at the beginning of their recitation then follow up over a longer menses of time in correlation with burnout status and the related factors influencing the development of the burnout process (Ekstedt Fagerberg 2005).For all of the studies used for this literature review, the info are collected using self-reports from the participants. Many authors warned that self-reported data might be contaminated by common method variance, because both the independent and dependent variables are ignorantd upon one source of information which is the participants (Demerouti et al 2000). Therefore, future research should also utilised objective means for collecting the result findings.ConclusionThe concept of burnout h as free burning the interest of nurses and researchers for several decades. Despite the large amount of studies done in attempt to investigate and predict the related factors of burnout, no conclusive data could be drawn. This is because the health care system is in constant change. The factors that relate to burnout will present different relative significance with the changes. Notwithstanding this, the related factors to burnout could generally be classified as both organisational and personal related. Therefore, to base practice, burnout intervention programmes should be multidimensional consisting of work-related as well as personal directed approaches.

Concepts in Disaster Management

Concepts in cataclysm ManagementCHAPTER II literary works REVIEW2.1 Broader Views on hazard Management2.1.1 Definition of happening chance has been defined in some unalike ways. Indeed, there is no circumstantial definition for a hazard (Eshghi Larson, 2008).In complete form, Emergency Events Database (EM-DAT) defines hazards as A situation or event which e realplacewhelms local capacity, necessitating a ask to the national or international level for external assistance, or is recognize as such by a multilateral result or by at least two sources, such as national, regional or international assistance groups and the media (Centre for Research on the Epidemiology of Disasters (CRED), 2004). Be clinical depression et al. (2007) aim an accumulation of widespread losses over multiple economic sectors, associated with a innate hazard event, that overwhelms the readiness of the stirred population to cope as a definition of a adventure. world(prenominal) Federation on ros y Cross and Red Crescent (IFRC) defines a cataclysm as a sudden, calamitous event that seriously disrupts the functioning of a community or federation and ca purposes land, real(a), and economic or environmental losses that exceed the communitys or societys ability to cope victimisation its own visions (IFRC, 2008). van Wassenhove (2006) proposes a interruption that physi phoney affects a system as a whole and threatens its priorities and intentions as a definition of fortuity, trance Asian Disaster Reduction warmheartedness (ADRC, 2008) defines adventure as a serious affray of the functioning of society, create widespread gentleman, material or environmental losses which exceed the ability of touch on society to cope using only its own resources, which is resembling with Reliefwebs (2008) definition. Emergency Management Australia (EMA, 2008) defines disaster as a serious disruption to community life which threatens or causes death or injury in that community and/ or damage to property which is beyond the day-today capacity of the overconfident statutory authorities and which requires special mobilization and organization of resources separate than those usually available to those authorities, while tinge is defined as An event, certain or imminent, which endangers or threatens to endanger life, property or the environment, and which requires a momentous and coordinated chemical reaction. (EMA, 2008).2.1.2 Disaster TypesWith a wide variability of disaster definition, it is perceivable to have different initial classifications for disasters (Eshghi Larson, 2008 Shaluf 2007a, b). Canadian Disaster Database (2008) catego ascendings disasters into tailfin different typecasts as summarized in circumvent 1. hold over 1. Disaster types(Source Canadian Disaster Database, 2008)Disaster typesEncompassesBiologicalEpidemic, infestationGeologicalEarthquake, landslide, tsunami meteoric and hydrologicalCold wave, drought, flood, f be/ thunder storm, heat wave, hurri stinkpote/ typhoon, snow avalanche, storm surges, storm-freezing rain, storm-unspecified/ other, storm-winter, fracture, wildfireConflictTerrorism, civil unrest expertAccident-industrial, accident-other, accident-transport, fire, hazardous chemicalsvan Wassenhove (2006) proposes a metrics (see Table 2) to understand disasters.Table 2. Categorization of disasters base on van Wassenhove (2006)Natural unrealSudden-onsetEarthquake, hurri passele, tornadoTerrorist attack, coup detat, chemical leakSlow-onsetFamine, drought, povertyPolitical crisis, refugee crisisIn general, Shaluf (2007a, b) categorises disasters into three typesNatural disasters, which ar catastrophic events resulting from inbred causes such as volcanic eruptions, tornadoes, earthquakes, etc.Man made disasters, which atomic number 18 those catastrophic events that result from human being decisions.Hybrid disasters are those disasters that result from both human error and cancel forces.In fu rther detail, Shaluf (2007b) breaks down each type of disasters and gives examples and characteristics, as can be seen in Table 3.Table 3. Disaster types, taken from Shaluf (2007b)Disaster typeCharacteristicsSub-disasterName of disastersNaturalA natural disaster is a natural phenomenonA natural disaster is an unplanned and socially degraded event with a sudden and severe disruptive effectA natural disaster is single event over which no human has considerThe impact of natural disaster is localized to a geographic region and specific time limitThe consequences of a natural disaster are felt at the place and time of its communicaterenceThe disaster can be a high-impact disaster (e.g. a flood) that has a greater directly effect on the community over a extended period quick onset disasters imply earthquakes, flash floods, hurricanes, volcanic eruptions, landslides, tsunamis, in arrears onset disasters, droughts, floods, and epidemicsNatural phenomena beneath the earths surfaceEa rthquakesTsunamisVolcanic eruptionsTopographical phenomenaLandslidesAvalanchesMeteorological/ hydrological phenomenaWindstorms (Cyclones, typhoons, hurricanes)TornadoesHailstorms and snowstormsSea surgesFloodsDroughtsHeat waves/ could wavesBiological phenomenaInfestations (locust swarms, mealy bug)Epidemics (cholera, dengue, ebola, malaria, measles, meningitis, yellow fever, HIV/ AIDS, tuberculosis)Man-madeCharacteristics of socio-technical disastersA socio-technical disaster is a man-made eventA socio-technical disaster occurs in an organisation due to the interaction between internal factors and external factorsIt arises suddenly when the disaster occurs it does so as a shockA socio-technical disaster is a complex system of interdependenceThe impact of a socio-technical disaster sometimes transcends geographical boundaries and can even have trans-generational do (e.g. Three Mile Island, Bhopal, Chernobyl)Socio-technical disasters do not always have their mop consequences at the point of occurrence the worst effects can occur long after the eventSocio-technical disasters are characterized by a low probability/ high consequences eventSudden-impact disasters (e.g. air/road/rail accident) are usually of short duration and have a limited direct effect on the local communitySocio-technical disasters arise not because of a single factor but of accumulated unnoticed eventsDisaster involves guidance procedures which must be maintained, and counseling businesss must be coped with under the conditions of a major technical emergency involving threats of injury and loss of lifeRapid onset disasters include fires, scientific disasters, industrial accidents, and transferral accidentsAn inquiry idea is requiredSocio-technicalTechnological disastersFireExplotions (munitions explosions, chemical explosions, nuclear explosions, mine explosions) evasionToxic releasePollutions (pollution, acid rain, chemical pollution, atmospheric pollution)Structural explode of physi cal assetsTransportation disastersAir disastersLand disastersSea disastersStadia or other public places failuresFireStructural collapseCrowd stampede toil failureCom dumb bringer system breakdownDistribution of sorry returnions warNationalCivil war between armed groups in the corresponding countryCivil strikesCivil disorderBomb threats/ terrorist attackInter-national ceremonious warWar between two armies from different countriesSiegesBlockadesNon-conventional warnuclearChemicalBiologicalHybridThe characteristics of a loanblend disaster can be the characteristics of both man-made and natural disastersNatural and man-made eventsFloods provoke community built on known floodplainLocation of residential premises, factories, etc., at the foot of an active volcano, or in an avalanche subject orbital cavityLandslidesSlightly different from those, EM-DAT (2008a) classifies disasters into three groupsNatural disastersTechnological disastersComplex emergenciesRegarding its reach in te rms of sufferer number and/ or geographic areas affected, Gad-el-Hak (2008) distinguishes disasters into five categories as can be seen in Table 4.Table 4. Disaster scope in terms of number of victims and/ or geographic area affected(Source Gad-el-Hak, 2008) settingCategoryNo. of sufferersGeographic areas affectedScope ISmall disasterOrScope II medium disaster10-100 personsor1-10 km2Scope IIILarge disaster100-1,000 personsOr10-100 km2Scope IVEnormous disaster1,000-104 personsOr100-1,000 km2Scope VGargantuan disaster 104 personsOr 1,000 km2 maculation the definition of natural disasters and technological disasters are principally the kindred as those proposed by Shaluf (2007a, b), complex emergencies take away a further exploration. Alballa-Bertrand (see Alballa-Bertrand, 2000) proposes the adjacent definition for a complex humanist emergency or, in short, complex emergencyA purposeful and supposed(prenominal) neutral retort, intend mostly to counteract the worse effects of the colossal human destitution that derive from an overt political phenomenon, which takes the form of a violent, entrenched and long-lasting factionalist mesh or imposition with ultimate institutional aims.On the other hand, ReliefWeb (2008) defines a complex emergency as A multifaceted humanitarian crisis in a country, region or society where there is a total or considerable breakdown of warrant resulting from internal or external conflict and which requires a multi-sectoral, international response that goes beyond the mandate or capacity of any single agency and/or the ongoing UN country program. Such emergencies have, in particular, a scourge effect on children and women, and call for a complex chemical chain of responses. While Complex Emergency Database (CE-DAT) (2008) defines complex emergency as all crises characterized by extreme vulnerability that display the pursuit featuresThere constitute the involuntariness or incapability of the government to give effective respon se, croaking call for external assistancePolitical oppression or armed conflictDisplacementIncreased mortality.2.1.3 The Increasing Trend of Disaster OccurrencesLichterman (1999) predicts that the frequency of disasters and their effects seem to be increasing. By reviewing various(a) link published sources from 1900-2005, Eshghi and Larson (2008) establish Lichtermans prediction. A disaster leads to a severe trouble of society, including extensive human misery and physical loss or damage (Davis Lambert, 2002). Both natural and man-made disasters are likely to raise another five-fold over the succeeding(prenominal) fifty years (from the year 2005) due to environmental degradation, rapid urbanisation and the spread of HIV/AIDS in less climbed world (Thomas Kopczak, 2005). More than 250 million people in the world are affected by disasters every year (IFRC, 2008). In the sense of natural disasters which are then divided into biological, geophysical, climatological, hydrologica l, and meteorological disasters -, CRED (see Scheuren et al., 2008) reports that there were 414 natural disaster occurrences (excluding biological disasters) in year 2007 which killed 16847 persons, affected to a greater extent than 211 million others and caused over 74.9 US$ billion in economic damages. Until year 2004, over 90 percent of natural disasters occurred in developing countries (United Nations ISDR, 2004).By including biological disasters and regrouping natural disasters into three different categories, as followsHydro-meteorological disasters comprising floods and wave surges, storms, droughts and related disasters (extreme temperatures and forest/ sponge fires), and landslides avalanchesGeophysical disasters earthquakes tsunamis and volcanic eruptions capitulation into this categoryBiological disasters consisting of epidemics and insect infestationsInternational Strategy for Disaster Reduction (ISDR) (2008) set ups data which shows that there is an increasing tend ency on the occurrences of natural disasters from 1900 to 2005, as can be seen in Table 5.Table 5. Distribution of natural disasters by offset(1900-2005, by decades*)*) 2000-2005, half dozen year periodThe increasing trends of the occurrences of natural disasters between 1900-June 2008 is as sanitary document in EM-DAT (2008b).Regarding the victims, there were 3,470,162,961 people affected by natural disasters for the period of 1991-2005 with a total of 960,502 deaths. Most of the victims (98.1% of people affected and 92.1% of people killed) were fit(p) in developing countries and least-developed countries (IFRC, 2008).2.1.4 Disaster ManagementDisaster management in addition known as emergency management (Reliefweb, 2008) is defined as schoolwide approach and activities to reduce the adverse impacts of disasters (Reliefweb, 2008), while disaster trading operations could be considered as the set of activities that are performed before, during, and after a disaster which ar e aimed at preventing loss of human life, reducing its impact on the economy, and returning(a) to a normal situation (Altay Green III, 2006). Using the terminology of disaster residue operations (DRO) as substitute to disaster operations, Pujawan et al. (2009) state that DRO consists of a variety of activities such as assessing craves, acquiring commodities, finding out priorities as well as receiving, classifying, storing, tracing and tracking deliveries. Regarding its phases, disaster management could be divided into four phases (Altay Green III, 2006) disaster mitigation, disaster preparedness, disaster response, and disaster recovery.2.1.5 The Importance of Logistics in Disaster ManagementLogistics could be defined as follows (see Sheu, 2007a 655)Logistics is the process of prep, implementing, and controlling the efficient, effective go down and storage of goods, services and related information from the point of origin to the point of consumption for the purpose of conf ormist to customers requirements at the lowest total comprise.Its system operation consists of mesh topology heading, information, transportation, broth, warehousing, material handling, and packaging (see Wu Huang, 2007 429). There are several Operational Research (OR) techniques utilize in logistics context, including the use of transportation pattern to determine the mess of warehouses and the use of assignment/ allocation model to locate production facilities (Slats et al., 1995 12), to name a few.In particular, humanitarian logistics could be defined as the process of planning, implementing and controlling the efficient, cost-effective flow and storage of goods and materials, as well as related information, from point of origin to point of consumption for the purpose of suffering the end beneficiarys requirements (Thomas Mizushima, January 2005). Similarly, Thomas and Kopczak (2005) define it as the process of planning, implementing and controlling the efficient, cost- effective flow and storage of goods and materials, as well as related information, from the point of origin to the point of consumption for the purpose of alleviating the suffering of vulnerable people. Whereas Sheu (2007a) proposes a process of planning, managing and controlling the efficient flows of substitute, information, and services from the points of origin to the points of destination to meet the urgent requirements of the affected people under emergency conditions as a definition of emergency logistics.Moreover, disaster easing is usually put aside for sudden upheavals such as natural disasters (earthquakes, avalanches, hurricanes, floods, fires, volcano eruptions, etc.) and very few man-made disasters such as terrorist acts or nuclear disasters (Kovcs Spens, 2007). Relief itself could be understood as assistance and/or discourse during or after disaster to meet the life preservation and rudimentary subsistence needs. It can be of emergency or protracted duration (Re liefweb, 2008).It has been already generally well-known that logistics play a vital role in emergency management. Sheu (2007a) declares that, due to the possibility of disasters occurrences anytime around the world with huge effects, emergency logistics management had appeared as a world(a)-noticeable subject matter. People which are affected by disasters and are uprooted from their rights for food, housing, livelihood and other means of supporting themselves need the obstetrical delivery of food, medicine, tents, sanitation equipment, tools and other necessities (Whybark, 2007). The science of logistics and try chain management is becoming more vital for humanitarians (van Wassenhove, 2006), and the subject of disaster management is an suddenly fascinating one that is growing in importance (van Wassenhove, 2003 19). Oloruntoba (2005) states that, regarding the Indian naval tsunami context, the scale of damage and subsequent response lead to capers of coordination, transportat ion and dissemination among responding groups. In other affected areas of the Indian Ocean tsunami, Thomas (summer/fall 2006) reports that, at the 60-day point, regardless of the enormous relief efforts, only 60% of the families report receiving well-timed and sufficient aid. It is therefore acceptable to conclude that good logistics planning plays an important role to the success of an emergency program (Davis Lambert, 2002 109).Humanitarian logistics is intrinsic to disaster relief for some reasons (Thomas Kopczak, 2005)It is crucial to the effectiveness and speed of response for main humanitarian programs, such as health, food, shelter, water, and sanitationIt can be one of the most expensive elements of a relief effort as it includes procurement and transportationSince the logistics department handles tracking of commodities done the supply chain, it is oftentimes the repository of data that can be analyzed to offer post-event knowledge.In his paper, McEntire (1999) states that the disaster studies must discover ways to improve the provision of relief after certain catastrophe hits. This statement is in line with Perrys (2007) finding which accentuates the availability of logistician cadres as a key element of disaster response, as part of needs assessment and for procuring, transporting, and distributing the relief provisions. Regarding the relief of the Indian Ocean tsunami, the humanitarian organizations providing those relieves acknowledged that relief can and needs to be faster and more efficient (Thomas, 2005). Together with hurricane Katrina disaster, the Indian Ocean tsunami lead to the gap of the inability to connect the aid provided with the aid received (Thomas, 2005) in spite of the unprecedented giving during those two misfortunes. It is also pointed out by Tolentino Jr. (2007) that the Indian Ocean tsunami has provided the will to radically improve disaster management and planning, an issue Trims (2004 224) research agrees with, in a br oader disaster relief context. Furthermore, the development of new technology for track/trace and disaster relief supply chains is proposed as one of ways to improve the delivery of humanitarian relief (Baluch, 2007). In the context of the participation of non-governmental organizations (NGOs) in worldwide emergencies (e.g. volcanic eruptions, earthquakes, floods, war), Beamon and Kotleba (2006) point out that the capability of an NGOs supply chain and logistics operations directly influences the success of a relief effort. Whereas Pujawan et al. (2009) propose information visibility, coordination, accountability, and professionalism as successful requirements of logistics for DRO.2.2 Some Previous Works in Logistics ManagementThe following paragraphs will give a short overview on several aspects in logistics management, especially those which are perceived as having relevance with the current research. They include diffusion meshwork institution problem, location-allocation pro blem ( traffic circle), vehicle routing problem (VRP), and location-routing problem (LRP), respectively.2.2.1 Distribution Network Design ProblemCiting Chopra (2003), diffusion can be seen as the steps taken to move and store a product from the supplier stage to a customer stage in the supply chain. While diffusion networks can be defined as networks that carry the flow of some commodity or entity, using a routing rule that is intended to be effective and even optimal (Whittle, 2007), and statistical distribution network itself could be viewed as akin with the terminology producer network (Ambrosino Scutell, 2005 611).Distribution network design problem tackles the issues of optimizing the flows of commodities through an existing distribution network as well as improving the performance of the existing network by selecting the most take over setting of the facilities in the network aimed at satisfying the companys goal at one hand and minimising the boilersuit costs at the oth er hand (Ambrosino Scutell, 2005 611). It involves facility location, transportation and inventory decisions (Ambrosino Scutell, 2005 611). In other nomenclature, the aim of distribution network design problem is on deciding the best(p) way of moving goods or products from resource/ supply points to destination/ demand points which is performed by determining the structure of the network, in a such a way that the customer demands are commodious and the total distribution costs are minimized (Ambrosino et al., 2009 442). In Amiris (2006 567-568) paper, distribution network design is stated as involving the simultaneous decisions on the best settings of both plants and warehouses and on the best strategy in the sense of product distribution from the plants to the warehouses and from the warehouses to the customers, respectively.Meanwhile, the term distribution system design refers to the strategic design of the logistics infrastructure and logistics strategy to deliver products f rom one or more sources to the customers (Goetschalckx, 2008 13-1) and similar to Ambrosino et al.s (2009) statement on distribution network design problem focuses on five phases of interconnected decisions, as follows (Goetschalckx, 2008 13-2)Establishing the appropriate quantity of distribution centers (DCs) orbit up the location of each DCAllocating customers to each DCAllocating appropriate commodities to each DC andDetermining the throughput and storage capacity of each DC. assorted models and approaches that have been built for designing distribution system or distribution network, to name a few, are (Goetschalckx, 2008 13-8-13-15 Lapierre et al., 2004) K-median model, location-allocation model, warehouse location model, Geoffrion and Graves distribution system design model, models that focus on mathematical description of cost functions on each route in order to incorporate returns to scale, models of which intentness are in shipments on hub-to-hub routes regarding discoun ts, and models that aim at solving the warhead transportation problem precisely.2.2.2 Location-Allocation Problem (LAP)As previously stated in Goetschalckx (2008), LAP could be seen as part of distribution network design problems. Given the place of a set of customers with different demands, LAP is refer with the selection of supply centres positions dedicated for serving the customers as well as the decision of the allocation of the customers to supply centres, with both of them are aimed at optimizing a given criterion (Hsieh Tien, 2004 1017). It is also assumed that there is no interaction among supply centres. The criterion could be single such as transportation costs (see, for example, Goetschalckx, 2008 Zhou Liu, 2003 Manzini Gebennini, 2008) or it may comprises several aspects (see, for example, Mitropoulos et al., 2006).The following paragraphs provide some previous researches on LAP.The un-capacitated-type LAP with rectilinear distances could be found in Hsieh and Tien (2004). In this paper, the authors propose a heuristic method which is based on Kohonen self-organising feature maps (SOFMs).Sometimes distribution networks are built in hierarchies, where high-level distribution channels are constructed in straight lines from which low-level channels stem. Furthermore, destinations are allocated to branching facilities in high-level channels through low-level channels. Due to cost considerations, the number and locations of branching facilities as well as the allocation of the destinations to the aforementioned branching facilities need to be refractory correctly. Eben-Chaime et al.s (2002) paper addresses this type of problem by formulating appropriate mathematical optimisation models and subsequently proposing heuristic solution methods.Capacitated LAP with stochastic demands is intercommunicate by Zhou and Liu (2003). More specifically, they propose three types of stochastic programming models (1) pass judgment value model (EVM), (2) chanc e-constrained programming (CCP), and (3) dependent-chance programming (DCP). To solve these models efficiently, the authors develop a hybrid intelligent algorithm within which three type stochastic simulations are used. The proposed algorithm integrates the network simplex algorithm, stochastic simulation and inheritable algorithm.In more recent paper, Zhou and Liu (2007) address the LAP with brumous demands by developing three types of fuzzy programming models fuzzy expect cost minimisation model, fuzzy -cost minimisation model, and credibility maximisation model with respect to different decision criterion. To solve these models, the authors apply a hybrid intelligent algorithm developed previously (see Zhou and Liu, 2003). Nonetheless, instead of using stochastic simulations, they are developing and employing fuzzy simulations.Similar with the abovementioned paper, Wen and Imamura (2008) also address LAP with fuzzy demands. For this type of problem, they build a fuzzy -cost m odel under the Hurwicz criterion. The problem is subsequently solved using the same algorithm as in Zhou and Liu (2007).The establishment of mixed integer programming optimisation models for multi-period, multi-stage LAPs could be found in Manzini and Gebennini (2008). In their paper, the authors develop optimisation models each for the following classes of multi-period, multi-stage LAPs (1) single-commodity, multi-period, two-stage LAPs, (2) multi-commodity, multi-period, two-stage LAPs, (3) single-commodity, multi-period, two-stage open/ closed LAPs, and single-commodity, multi-period, three-stage LAPs.The application of various search methods to a generalised class of LAPs known as multi-facility location problem with generalised objects (MFLPO) is presented by Bischoff and Dchert (2009). The end of the paper gives similitude of the involved search methods for various sizes of test problem.Research on LAP in health service context could be found in Harper et al. (2005) and Mitr opoulos et al. (2006). The former addresses the need to plan health services which takes geographical aspects into consideration. The problem is formulated as a stochastic LAP. The latter paper, on the other hand, develops a bi-objective model to solve the LAP arise in determining the location of hospitals and health centres and the allocation of the patients to those facilities.2.2.3 Vehicle Routing Problem (VRP)In its most basic form (e.g. Bulbul et al., 2008 Laporte, 2007), VRP is concerned with the optimal delivery or collection routes for a limited number of identical vehicles with limited capacities from a central destination/ warehouse to a set of geographically bewildered customers. It assumes that the vehicles are at the central depot/ warehouse initially. It also requires the universe of discourse of the routes that connect the central depot/ warehouse to customers and customers to customers as well. In this type of VRP, a route must start and finish at the depot and a customer is visited by exactly one vehicle. The total demand of customers served by one vehicle could not exceed the vehicles capacity, and the ultimate goal is to minimise the total routing costs.Since its introduction by Dantzig and Ramser in 1959 (Bulbul et al., 2008), it has given rise to a rich body of works (Laporte, 2007). In 2008, searching the words vehicle routing problem by using Google scholar search results more than 21,700 entries (Golden et al. (eds), 2008).Laportes (1992) paper provides various exact methods and heuristics developed to solve the VRP. Several meta-heuristics intended to solve the classical VRP could be traced from his more recent paper (2007), while Toth and Vigos (2002) paper presents various existing exact algorithms for the solution of classical VRP. The proportion of descent heuristics, simulated annealing, and tabu search in solving VRP is addressed by Van Breedam (2001). Jozefowiez et al. (2008), on the other hand, give a mint on works that ha ve been carried out on multi-objective VRP.A range of VRP variants can be seen in Crainic and Laporte (eds., 1998), Bulbul et al. (2008), and Golden et al. (eds., 2008). Other variants also exist VRP with stochastic demands and VRP with backhaul. Different classification of VRP could be found in Pisinger and Ropkes (2007) paper. The following sub-sections mention examples of works on some of them, while new directions in modelling and algorithms for various types of LRP could be found in Part II of Golden et al.s (eds., 2008) edited book.2.2.3.1 VRP with Time WindowsIn this type of VRP, customer i may only be visited within a time windowpane ai, bi (see, e.g., Kontoravdis Bard, 1995 Badeau et al., 1997 Bouthillier Crainic, 2005 Fgenschuh, 2006 Hsu et al., 2007 Kim, et al., 2006 Dondo Cerd, 2007 Kallehauge et al., 2007).2.2.3.2 VRP with Pickup and DeliveryWhen the vehicles need to deliver commodities to customers and collect items for example, defective products from them as wel l, then this is called a VRP with pickup and deliveries. Research papers by Nagy Salhi (2005), Wassan et al. (2008), Wassan et al. (2008), Gribkovskaia et al. (2008), Hoff et al. (2009), and Ai Kachitvichyanukul (2009) are several examples on it.2.2.3.3 VRP with BackhaulIn this type of VRP, the customers are separated into two mutually exclusive subsets so that the starting line subset of customers receives commodities whereas the secant one sends back the products. Additionally, the second subset of customers are only served after the first one. The first subset is called line-haul customers and the second one is named backhaul customers. The f

Reflection On Ncmh Mandaluyong City

Reflection On Ncmh Mandaluyong CityA foretell to lands prime cordial headspringness institution, the issue middle for Mental wellness (NCMH) in Mandaluyong City. Essentially, the visit was think to make us, students become familiar with NCMH set up, the delivery of wellness operate provided and the condition of the patients who atomic number 18 confined in groups.Background of NCMHNCMH was accomplished through Public Works Act 3258. It was formally opened on December 17, 1928 and was originally called the INSULAR PSYCHOPATIC HOSPITAL. It was later called the National Mental Hospital. On November 12, 1986, it was renamed NATIONAL CENTER FOR MENTAL HEALTH (NCMH) through Memorandum flyer No. 48 issued by the Office of the President. Today, NCMH has an authorized bed dexterity of 4,200 and a daily average of around 3,000 in-patients. It has a summarise of 35 pavilions and 52 Wards sprawling on a 46.7 hect be compound in Mauway, Mandaluyong City. The NCMH is a special tra ining and query hospital mandated to render a ecumenical (preventive, promotive, curative and rehabilitative) range of quality mental wellness services countrywide. It as well as gives and creates venues for quality mental wellness education, training and research geared towards hospital and community mental health services nationwide.In 2001, the domain Health Organization provided a new understanding of mental dis crops that offers new apply to the mentally ill and their families in all countries and all societies. It entails a world-wide review of the contributing factors of the new and future disorders. It concludes with recommendations that can be satisfactory by every country according to its needs and its resources.Due to drop of studies here in the Philippines with regards to Mental Health, it is difficult to update the current posture in the delivery of services in the mental institutions especially in the government mental health facilitates. During our visit in the National Center for Mental Health, we are able to gather some information in impairment of delivery of services, the process of admitting the mentally-ill patients and on how they generate funds to make the needs and provide services intimate the institution.Our country at stick is in the early stage of developing a mental health system. Due to limited legislative authority and no mental health law has been established, the allotted budget for mental health is only 0.02% of its total health budget, the latter being 3% of its GDP this is below the military man Health Organizations (WHO) recommendations for developing countries. Mental health policy, programs and legislation are needful steps for significant and sustained action. These should be ground on current knowledge and human rights considerations. Most countries need to increase their budgets for mental health programs from existing low takes.During the early part of our visit, Dr. Jose Loveria (Head of Pavi lion 10-Chronic Improved Patients) accommodated us to gather some facts about the National Center for Mental Health. In NCMH, given the limited budget that they have, there are services inside the institution easeing the institution to gain profit to allot for services and to sustain the existing these income generating strategies. Some of them are soap making, different accessories such as wallets made from zippers etc. These materials are located at Pavilion 14 and being sold by the nursing students and interns. A bantam hospital within the hospital, the Infirmary is equipped with X-ray and an ultrasound celerity which is Philhealth accredited with 100 beds and classified it as medical center. It caters not only the patients inside but also patients coming from other referrals outside NCMH.The World Health Organization (WHO) in 2007 published a report on its assessment on the mental health system in the Philippines. In partnership with the Department of Health (DoH), WHO gathe red baseline information use the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), for the purpose of enabling the country to develop mental health plans.WHO-AIMS findings reported that the NCMH has all 400 beds for forensic inpatients committed by court order. During our visit, in Pavilion 14 which is intended for patient with court cases, the patients there were overcrowding due to lack of beds. There is a huge number of patients with court cases inside. According to Dr. Edison Galindez (only forensic psychiatrist in the country), they have several tasks to do due to lack of resident bushels clever in forensic psychiatry. They have this high number of patient per doctor ratio. Based on the WHO-AIMS report, there are 0.41 psychiatrists in the public welkin per 100,000 population, and a ratio of 3.21 psychiatrists per 100,000 population working in mental health facilities based in urban areas. The distribution of human resources for mental health is likewise lopsid ed, favoring the urban centers or Metro Manila in particular.Still, in our country has an inadequate number of mental health staff providing negociate this has slowed its progress in carrying out its de-institutionalization policy. We only have minimal entropy on refresher training for mental health staff, as well as data on the number of organizations, associations or nongovernmental organizations (NGOs) involved in mental health policies, legislation or advocacy. Having data in these areas would help service planning and resource allocation. Dr. Bernardo Conde noted in his article in the International Review of Psychiatry that the governments attempts to integrate mental health in general health services have failed. Large hospitals must move with thousands of patients while community-based programs remained undeveloped. Acute psychiatric wards in regional medical centers and churl hospitals have never been set up. presidential term general hospitals have no acute psychiatric units because of lack of budget. The access to mental health facilities nationwide is therefore very much uneven across the country, especially as many of the facilities remain located in the National Capital Region.Since the National Center for Mental Health and some private institutions with psychiatric wards are mostly located in NCR, in terms of mental health promotion, it is done primarily in these tertiary institutions and not reaching the grass-roots level according to Dr. Beverly Azucena (OIC, Chief Medical Staff-Hospital Service). There are also initiatives being done by the other sectors of the government in promoting mental health according to her. On the other hand, there are coordinating bodies that contend public education and awareness campaigns on mental health and mental disorders. Sectors should be involved in improving the mental health of communities. Government agencies, NGOs, professional associations, and private foundations have promoted public education an d awareness campaigns, in their own capacity, in the last five years according to WHO-AIMS.In terms of research, according to World Health Report of WHO in 2001, much research into biological and psycho brotherly aspects of mental health is needed in order to increase the understanding of mental disorders and to develop more effective interventions. In NCMH, according to Dr. Azucena, there are on-going research studies in the institution, but it is concentrate more on the clinical aspect of mental health. Research in our country is focused on non-epidemiological clinical/questionnaires assessments of mental disorders and services research. The research consists of monographs, theses, and publications in non-indexed journals. There are mental health research publications in indexed journals (e.g., Philippine Journal of Psychiatry is indexed in the Western Pacific regional Index Medicus).Challenges encountered by the Mental Health Care ProvidersAt present, we are in the stage of dev eloping the status of mental health based on the recommendations of World Health Organization. The major resource in the Philippines is its super literate population who also values education and professional information. faculty member institutions and training centers have in the last 4 decades developed profound programs to educate and develop the mental health human resources, specifically psychiatrists, psychologists, social workers, nurses and allied mental health professionals. It contributed a lot in terms of the understanding on the management of mental health disorders and in the development of mental health programs in our country. I am agree with what WHO-AIMS mentioned in their report that the challenge is on how to motivate these professionals to stay here in the country and sustain their involvement, especially in the community setting, because our country is go on to lose this valuable and crucial resource to overseas employment. Giving precedency to this by th e government nationally and locally would be a array of a new beginning in the development of mental health in our country.

Personal Identity and Its Effect on Pre-procedural Anxiety

Personal indistinguishability operator and Its Effect on Pre-procedural anguish1.0 IntroductionIn con passing health complaint systems, matchless of the key ways of diagnosing and treating medical conditions is through incursive and minimally invasive military operations on patients. Some of these procedures are accessing the intravenuous system for treatment (venipunctures), blood collection for investigations (phlebotomy), lumbar punctures and biopsies. Regardless of age, sex or ethnicity, patients endure attention and pain associated with these invasive procedures (American Pain Society, 2001). In spite of minimal tissue damage in these procedures, anxiousness about the procedure and associated pain, whitethorn cause considerable incommode in patients. This may affect the coping mechanism, even in a well functioning individual. This has been studied by McCleane and Cooper (1990), Augustin and Haynes (1996) and Garbee (2000).A modus operandi of enquiryes relieve onese lf been conducted to posit and control fear in patients who are subjected to such(prenominal) procedures. Based on these studies, patient education programs (McDonald and Green, 2002), alternative therapies (Noreed, 2000), pharmaceutical therapies (Smith and Pittaway, 2002) and melodious therapies (Elliot, 2004) have been proposed to a varying extent. An essential point to none is that melodic therapies, education programs and patient educational programs may be time-consuming and may be of limited practicality in a busy infirmary environment. On the other hand, pharmaceutical therapies may cause side- gists associated with drugs. Therefore, a simplistic approach, which could fork out powderpuff and relieve the pre-procedural anxiety, is the need of this surgical era. No research has been free-base on invoking psycheal individuality and its effect on pre-procedural anxiety. Therefore, this research aims to run into this gap.Hospitals and health care institutions are un pleasant environments with a general display of infirmity and death. It is an environment where star is separated by friends and family and is surrounded by strangers. A individual who is being subjected to a procedure at a hospital may already contemplate on the potential illness that the person may be subjected to. This may lead to a temporary feeling of anxiety (Coyle, 1999).According to Spielberger et al (1970) anxiety is divided into twain factors, state anxiety ( alike kn deliver as somatic anxiety) and trait anxiety. differentiate anxiety is temporary or circumstantial arousal and trait anxiety is the permanent change of personality characteristics associated with anxiety. According to Kent (1998), state anxiety may cause physiological arousal, and activating of the sympathetic nervous system and the hypothalamic pituitary adrenal axis. This is characterized by increased pulse rate, blood pressure, respiratory rate and increase cardiac output (Bally et al, 2003). Resea rch by hay et al (2003), asserts that lessen the state anxiety is important before a diagnostic procedure to promote relaxation and to prevent possible complications such as procedure becoming more painful, difficult, prolonged and increased hazard of after effects. When a procedure becomes difficult to administer, doctors may also submit or cancel the procedure, placing the patient at a disadvantage.Addressing patients emotions through an evidence- found focussing is important for nurses to increase the patient outcome. Psychosocial nursing noises, emotional presence and validation of trust between the nurses and the patient, has the potential to mitigate patients tending and anxiety or stress to a greater take.1.1 Pain and care Associated with Invasive ProceduresStudies have cerebrated that pain associated with a procedure may be severe than that actual illness that needs investigation (Finley and Scheter, 2003). The procedure itself may have an effect on the pain that i s puzz direct by the patient, which is based on the patients perception, which in turn, can be influenced by factors including past experience, mental state, hearsay knowledge and the patients level of understanding (Rawe et. al., 2009).According to Brennan, Carr and Cousins (2007), effects of pain can be short and long-run, which are not gender, age or ethnicity-specific. A material body of studies have confirmed the psychological effects of pain, which include anxiety, anger and fear as well as fleshly effects, such as changes in metabolic functions, heart functions and functions related to blood (Ferrell, 2005 Gordon et al., 2005 Mertin, et.al., 2007). Most common long-term effects of pain are, insomnia and depression (Berenholtz, et. al., 2002). Several studies have noted that in that respect is a imperious relationship between anxiety and pain, in a clinical setting (Sternbach, 1968 Melzack, 1973). According to Kain et. al. (2001), severity levels of pain are at present proportionate to anxiety levels overdue to activities in the hippocampal network, which causes deportmental conflict in the brain. This is resolved by sending and amplification signal to the neural example of the painful event, which causes anxiety in the person. This was verified by Ploghaus et. al. (2001) using a serial publication of event-related functional magnetic resonance imaging (FMRI) studies, which concluded that anxiety-induced hyperalgesia is associated with activation in the entorhinal cortex of the hippocampal formation. Van den Broek, Hejimans and Van Assen (2012) focused on the emotional distress caused by the procedure of implanting a cardioverter defibrillator (ICD), an invasive procedure, in 343 patients.. All subjects demonstrated distress through anxiety and depression outright after the procedure as well as during follow-up timelines.1.2 mental Techniques used to Reduce Pre-procedural AnxietyHealthcare personnel have ascertained a number of regularitys to reduce anxiety of patients through psychological intervention techniques. One of the methods employed by clinical nurses is through curative touch. cyclooxygenase and Hayes (1997) performed a quasi-experimental probe based on patients at a district General Hospital in East London, which concluded that therapeutic touch aids in reducing anxiety of the patients.Another method which has been researched is, on the effect of music as an intervention for reducing the pre-procedural anxiety in hospitalized adult patients (Gillen, Billey Allen, 2008). This was performed through Randomized Controlled Trials (RCTs) of 832 adult patients The researchers concluded that psychological outcomes show anxiety was reduced to a greater extent as a result of music listening interventions, demonstrated by decrease of blood pressure, respiration rate and heart rate.A piece of work performed by Hawley (2009), explored nurse strategies which were perceived as comforting by patients. The sample su rface was 14 patients in the emergency department of a hospital in New York. The study concluded that positive talk, vigilance and attending to physical discomforts were among the top five factors that reduced anxiety. Hawley (2009) concluded that the study supports the provision of comfort as an integral part of emergency nursing practice and a critical aspect of care.A research with 580 mentally alert adults were selected for a study by Whelchel (2004) to identify the effect of caring behaviour by nurses on ED patients. At the end of the study and data analysis, the researchers inform that treating the patients like an individual, was considered to be the roughly important trait in reducing the anxiety of emergency room patients, followed by knowing what they were doing, being contour and considerate, treating the patient with respect, giving the patient their full attention, knowing how to administer injections and tuck intravenous catheters.1.3 Self Esteem and AnxietyFrom th e beginnings of scientific psychology, the idea that mint wish to maintain high levels of egoism has been a central source in many studies (Horney, 1937 James, 1890). The idea of self-esteem generally means ones have got evaluation of him or herself. Self-esteem is also seen as a critical function for social and mental well-being of a person. Self-esteem induces and maintains personal goals and motivations and according to a study by Mann et. al. (2001), conclusive evidence exists that self-esteem leads to better mental health. Mann et.al. (2001) assert that a series of psychological problems, both internalizing and externalizing can be caused by poor self-esteem. The researchers conclude that self-esteem acts as a protective factor and is a centre element in the promotion of mental health.Greenberg, Pyszczynski and Solomon (1986) argue that self-esteem provides a buffer against anxiety, focusing primarily on the fear of human beings towards mortality. done empirical evidence, the researchers have concluded high-level of self-esteem reduces anxiety and behaviour that relates to anxiety. Three studies were conducted by Greenberg, et. al. (19921, 19922, 1993) to identify the direct evidence for the effect of self-esteem on anxiety. In the first study (Greenberg et. al., 19921), participants received positive and detrimental feedback about their personality, which was false. Then one group was shown a video which threatens of death, whereas the sec group was shown a electroneutral video. The underage variable in this study was state anxiety and the hypothesis was that bolstering self-esteem would reduce anxiety in response to the threat. The study concluded that participants with low self-esteem had the highest anxiety.A piece study was partaken with participants being given bogus feedback on an intelligence tribulation (Greenberg el. Al. , 19922). Following the feedback, participants were told that they would receive an electric shock or a neutral st imulation. The dependent variable was physiological arousal and the hypothesis was that the participants with bolstered self-esteem would experience reduced physiological arousal in anticipating electric shocks. The finis of the study was that neutral self-esteem-threat the participants having highest anxiety.A third study by Greenberg et. al. (1993) was with participants, who were provided with either positive or neutral feedback regarding their personality and a emotionality scale test, where the dependent variable was emotionality and the hypothesis was high self-esteem would reduce the participants prospect of a short life-expectancy. The study concluded that participants with negative feedback information led to low self-esteem. Based on these studies, researchers Greenberg et. al. (19921, 19922, 1993) developed anxiety-buffer hypothesis which led to the conclusion that self-esteem provides protection against anxiety and one who has an increased self-esteem becomes less-prone to anxiety when exposed to threatening situations later.1.4 Personal Identity and NamePersonal Identity deals with oneself and issues that arise by the virtue of being an individual and it has its own attributes that call for a person unique and different from the rest. Personal identity has its own properties, such as represent, appearance, preferences which make a person unique. At present, an estimated one hundred twenty million babies are born on earth in a year (Deluzain, 1996). Sooner or later, they undergo the process of receiving a break. bear on calling are part of all cultures and they are equally important to the person who receives the name as well as the society which the person lives in.The most important part of a persons identity is the name. It is of important for the individual and the society as a whole. Inspite of its importance, not many quite a little know or interested in knowing the effect of name on us and our children in this world although we are co nsidered as the consumers of call. Researches show that one of the creators for couples to have children is to perpetuate the family name (Arnold and Kuo, 1984 Callan and Kee, 1981 Ramu and Tavuchis, 1986). A research by Howard et. al. (1997) concluded that students felt proud when professors in their university remembered them by the name. A century ago, anthropologists identified that there has never been an superannuated civilization, which did not portion first names to populate, in the recorded history.Many ancient cultures believed that not having a name is equivalent to not having an identity or award (Frommer, 1982). At present, in most countries, parents are required to register the relationship of a child through the childs name. This is a jural requirement, which is the first time a child is given a effectual identity. The birth certificate received by the parents becomes an essential document for admitting a child to school, obtaining healthcare and other basic services from the society.The existence of a name of a person is not only important to the person psychologically, but it is also of religious, social and legal importance because our identities are associated intuitively through the name. When ones name is mispronounced, it may sound obstinate to the person. Most populate, especially when communicating with persons of different cultures, take extreme care to ensure the names are not mispronounced. Studies have revealed that mispronunciation of the name amounts to aberrancy of ones identity (Deluzain, 1996).Freud identified the psychological effects of torment of ones name, deliberately or accidentally. According to Freuds observations, people of aristocratic class, who wielded economic and political power tended to mispronounce their doctors names (Deluzain, 1996). The definition for this was the aristocrats psychological need to show their superiority over the doctors, who wielded the power of ones life and death. A similar event is seen in Shakespeares play, King John, where the character Philip Faulconbridge was found to be the illegitimate son of Richard the Lionheart, which make him King Johns half-brother. In the aftermath, King John orders Philip Faulconbridges name to be changed to Richard Plantagenet and deliberately refers to Philip as Peter (Shakespeare, 1623). This is a make it example of how Shakespeare presented the idea that mis-representation of a persons name amounts to mis-representation of the person.The psychological significance of names are so high, that two separate researches have concluded that people have a strong affiliation with garner of the alphabet in their own names than ones which are not in their names (Koole, Dijksterhuis, and van Knippenberg, 2001 Nuttin, 1985 Greenwald and Banaji, 1995). The research by Greenwald and Banaji (1995) concluded that people positively associate themselves with garner in their names, as they are considered to direct reflectivity of the person, although there doesnt appear to be any pragmatic reason for this association. This positive association of ones name and even the letters of the name with oneself has a general tendency to make a person feel good (Greenwald and Banaji, 1995 Hetts and Pelham, 2001).The connection between name and identity is also emphasized by research that portrays changing of ones name leading to changing of ones personal identity (Lawson, 1984 Kang, 1972). In certain villages in China, men are allocated an additional name based on the social transitions, such as marriage. On the contrary, women do not receive additional names, which imply that they never attain complete personhood (Watson, 1986). A research by Howard et. al. (1997) concluded that students felt proud when professors in their university remembered them by the name. A century ago, anthropologists identified that there has never been an ancient civilization, which did not allocate first names to people, in the recorded histor y. Many ancient cultures believed that not having a name is equivalent to not having an identity or honour (Frommer, 1982).1.5 Self-Esteem and Personal IdentityThe idea that people sieve to keep a high level of motivation maintain high-level of self-esteem is widely accepted and is considered as a postulate or an accepted fact. Theories suggest that behaviours such as aggression, love, deviance and even selflessness are due to ultimate belief that humans wish to be seen as valuable (Heine et al, 1999). Studies have been done only recently to determine whether this is always true and whether it is universal (Baumeister, 1998 Heine et al, 1999). However, still, a significant majority of psychological theories consider the need of humans to maintain high-levels of self-esteem as a postulate.Coyle (1999), presented a concept called personal identity threat in healthcare settings which is one of the key concepts of patient dissatisfaction in healthcare. According to Coyles research, pe ople who were generally hard put with the overall healthcare experience they receive, is mainly due to them being tough as non-persons, which is also termed dehumanization. This study asserts that the persons name has a significant effect on ones own identity. According to Coyles research (1999), people who were generally unhappy with the overall healthcare experience they receive, is mainly due to them being treated as non-persons, which is also termed dehumanization. 40 out of 41 patients interviewed by Coyle verbalise that they were treated as, an object and on deep exploration, Coyle identified that the patients were referred by meter on a file (such as patient number 49) instead of the name, which gave the patient the notion of being dehumanized. This study asserts that the persons name has a significant effect on ones own identity.The above studies indicate that self-esteem is connected with personal identity, where invoking personal identity increases ones self-esteem. O ne of the most key attributes of personal identity of an individual is the name. A number of studies, particularly by Greenberg et. al. (19921, 19922, 1993, 1996) concluded that self-esteem acts as an anxiety buffer. The aim of the present study is to investigate the effect of addressing a patient by name on pre-procedural anxiety level of in-ward patients, who are undergoing basic blood investigations in a large insular hospital in Colombo. The hypothesis tested in this research was, talking to patients by addressing them by name, before an invasive procedure, reduces the pre-procedural anxiety level of hospital patients, than talking to them without referring by name or not talking to them at all.

Abortions Should Be Stopped :: Abortion Pro Choice Essays

Abortions are one of the many things that everyone has an opinion on. As defined by the 2012 Merriam-Webster dictionary, an Encyclopedia Britannica Company, an settle downbirth is, the terminus of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus as a spontaneous excommunication of a human fetus during the source 12 weeks of gestation--miscarriage, the induced expulsion of a human fetus, or the expulsion of a fetus by a domestic animal a great deal due toinfection at any time before effect of pregnancy. Abortions acquire always been and will probably always be a controversial topic in which everyone will not agree upon. In the midst of the controversy, two groups turn over emerged. These groups are referred to as pro- tone and pro-choice. concord to Gale Opposing Viewpoints in Context, pro-life supporters claim that life begins at conception, therefore, abortion at any stage in the pregnancy is murder. They believe that life is valuable and the life of the unborn baby has the same rights as the mother. pro-choice supporters, on the other hand, claim that it is the womans right to ask what she does with her body. These pro-abortionists claim that anti-abortionists are truly against the rights of women and free choice rather than the termination of the fetus. Pro-life and pro-choice advocates differ in many of their opinions, specifically, concerning when life begins, affects abortions have on the mother, and how politics and religion play a role in abortions. In order to fully understand any topic, a drop explanation is required. Therefore, the history of abortions and different procedures used are no exception. Abortions have been around for thousands of years. However, in the eighteen hundreds abortions in the United States became illegal. Due to the drop of medical education, procedures and surgeries such as abortions were very dangerous. As medical advancements were made, women still had to rely on back ally abortions which usually resulted in the slander of thousands of women. Abortions remained illegal, despite the medical advancements largely impart to the fact that physicians did not indispensableness to share their patients with other practitioners. The American Medical Association stated that abortions were slander and unsafe. Therefore, according to the National Abortion Federation, abortions were then made into a physicians-only recital because they could be performed legally in order to save the womans life.

Should the Drinking Age be Lowered? Essay -- Law, Sociology

Although exceptions to every generality exist, alcohol is usually present in most gathering where adults are also in attendance. If one authentically examines the idea, alcohol is usually at every social reddent even if adults are not. At this point it would probably be important to notice who very is considered to be an adult. From country to country the answer varies but in the United States of America anyone of the advance of eighteen is liable and treated honourable like adults of any age. Consequently, one could say that the previous statement is technically, in the majority of circumstances, incorrect in that when alcohol is around so are adults. When mentioned in such a way, nothing seems to be out of side except that in the United States the legal alcohol consumption age is twenty dollar bill-one. There are not many sides one may stimulate when contemplating this alcohol consumption law, one is either for it or against it. Many trust that if the drinking age is lo wered it should right in full be lowered to eighteen. These individuals apply a number of reasons to support their ideology. John McCardell Jr. is one of those individuals and actually developed a complete organization in 2006 known as Choose Responsibility that promotes his philosophy (Cloud).McCardell Jr. is the head of Middlebury College and believes eighteen to twenty year olds should be eligible to consume alcoholic beverages as ache as they are licensed (Cloud). To receive this license one essential first complete a course that is around forty-two hours dour and consists of the explanations of the chemistry, history, psychology, and sociology of alcohol that may include AA, alcoholics anonymous, meetings (Cloud). McCardell Jr., along with others, also believes that if one is considered an a... ...at feces be done to minimize all the problems alcohol provides I infer the first step in assimilating a similar attitude is by education and through example from older adults t o young adults. mayhap McCardells forty-two hour course of everything one should know to fully understand the results of consuming alcohol would be beneficial for the general public. With that world said the age should still remain twenty-one and adults should not be one-hundred percent intolerable towards teens that might have slipped some alcohol by, afterwards all who has not broken a rule here and in that location? I believe if a little ignorance is given to the provocation it ordain disappear.Works CitedCloud, John. Should the potable Age Be Lowered? Time.com. Time US, 06 June 2008. Web. 05 Feb. 2012.Scrivo, Karen Lee. Drinking on Campus. CQ Researcher 20 Mar. 1998 241-64. Web. 5 Feb. 2012.