Effectiveness Of Non Medical Nurse Prescribing Primary Care

Effectiveness Of Non Medical Nurse Prescribing Primary Care Nurse-led clinics have been increasing for some time and Marsden (1992) identified the benefits of using specialist nurses to compliment services already offered by doctors. Read (1999) defined nurse-led care as being the interface between nursing and medicine. Miles (2003) cited ten individual authors as saying that research shows that nurses are capable of carrying out procedures usually in the domain of doctors, often resulting in greater patient satisfaction. Patient satisfaction is an important quality indicator. Yellen (2002) felt that the measurement of patient satisfaction with nursing care was particularly important as it provided a good measure of overall satisfaction with services. Ford (1997) agreed with this principle but concentrated more on the competitive edge and financial survival being reflected in patient satisfaction. Cohen (1994) advocated the use of satisfaction questionnaires, but both Avis (1997) and Westbrook (1993) doubted their efficacy, questioning the validity of questionnaires and the way in which they are measured. Westbrook (1993) felt that questionnaires may be limiting and poorly evaluated, giving rise to a poor reputation for satisfaction questionnaires. Duffin (2002) commented that questionnaires with tick boxes appear to have limited use and may include leading questions where there is no scope for the patient to enlarge upon their answers. Both Robson (1993) and Wiles (1996) warned that the results of surveys can sometimes paint a falsely positive picture and may be difficult to translate into a course of action. However, Backhouse (2000) says that the power of a successful nurse-led user satisfaction survey lies in the immediacy and relevance of the results. This may have enormous potential to transform practice, especially if the staff are able to remain positive about any possible negative feedback. Backhouse (2000) commented that nurses may tend to take praise for granted, as a regular stream of cards and thanks is often the only feedback they receive. This may produce the belief that the service is satisfactory, but it has been found that although there is a great deal of satisfaction, there is also some dissatisfaction, particularly with respect to information (McColl (1996), Backhouse (2000), Byrne (2000), Duffin (2002)). As a Business Manager in General Practice in an affluent rural environment, the author has found that there are increasing frustrations and limitations with time and resources where a competent healthcare professional could manage a patients care more than adequately during one appointment. Additionally, continuity of care and health care management in a more patient centred, balanced way could benefit the patient. Discussion around the management of their medicines and general health education could aid to the patient taking responsibility for their own health care management. The Welsh Assembly Government (WAG) (WAG 2001, WAG 2005) has prioritised patient access to primary care services for the last few years which has impacted on patient expectation around the need for an urgent appointment. This has caused pressure on appointment systems, and subsequently changes have been made to deal with the demand. One way in which the practice would like to cope with these demands is by enabling the Senior Practice Nurse to give more holistic care, making the consultation seamless for the patient, thus reducing the need for additional appointments, having already consulted with an appropriate healthcare professional (WAG 2001, WAG 2005). This practice nurse is currently undertaking the Independent Nurse Prescribing (non-medical). When qualified, this will tie in with the nurse-led diabetes clinic and Minor Illness clinics for which she is qualified. The natural progression would be for her to prescribe appropriate medicine or dressings in relation to the competencies she has accumulated following evidence based practice in these disciplines. A nurse may spend a considerable amount of time dealing with the assessment and management of a patient, then waiting outside a GPs door for a prescription to be signed. This situation is far from ideal, and with the enhancement of the prescribing qualification, this could be done in a more appropriate way. This literature review looks at aspects of nurse prescribing in primary care, and how this can lead to patient satisfaction, autonomy and job satisfaction for nurse prescribers. Literature Search Strategy (Method: 10% c350 words) 582 LoBiondo-Wood (2002) describes a literature search as an efficient retrieval of scholarly literature related to the topic of interest, while Cormack (2000) describes a literature search as a review of previously written literature on a related topic in order to provide the researcher and the reader with knowledge of the field being researched. Research literature can originate from many sources. The volume of literature would be unmanageable if careful selection was not carried out (Cormack 2000, LoBiondo 2002). Polit (2004) recommends using electronic databases to locate relevant research information and points out the limitations of manual and internet sources as being time consuming and inconvenient, internet searching possibly not providing required results and bibliographic information. Polit (2004) likens locating all relevant information on the chosen subject to being like detective work. Primary research only was sought. CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature) with Full Text and MEDLINE were used to search for key words non-medical AND nurse prescib AND primary care with published dates between January 2004 to present, resulting in 209 hits. These were restricted to research, years 2004-2010 and English-only articles in order to reduce the number of articles to 29. Playle (2000) suggests that the title of a research article is extremely important and should cover focus as well as identifying the research approach used (McCaughan, 1999 Stevens et al, 1993). In the authors case, an informative abstract facilitates the choice of research article. The abstract or introduction, as Bailey (1991) suggests it should prepare the stage for the problem to be investigated, as well as being brief. As suggested by Playle (2000) a well written abstract identifies the main points of the study, although the main weakness can be the word restriction as suggested by Burns and Grove (2001). It should represent an accurate picture (Reid, 1993) of the study with concise methodology, sample subject, reported findings and conclusion. This would enable any reader to base a decision to read the article (Reid, 1993). The rationale for choosing the critique guidelines from Benton Cormack (2000) is based on the convenience and manageability of a well structured process that enables to author to appraise with ease. A literature review is an important element of a research question. Rees (2003 p. 17) indicates that a thorough review of the literature is essential to provide the theoretical and conceptual context for the study. Parahoo (1997) supports this stating a literature search provides the identification and locating up to date material, relevant to the topic under review. It involves the scanning along with critical reading of the literature chosen to assess usefulness to the question under discussion. The authors knowledge and prior reading of literature directed at change management in primary care dictated the final choice of research articles to Richards, L.A; Richards, A; Gilead, L; Stessman, J; blab la bla and Raz, I (1999) title of an article International Journal of Dermatology 38, 623-627 (appendix 1). Those chosen for review were three qualitiative and one quantitative research articles relating to the question under evaluation. AUTHORS All eleven authors have either the appropriate professional qualifications or academic qualifications, for example MD or PhDs. A further research on the authors names and using databases CINAHL and Medline xx to present showed that between them they have published xxx articles in various medical journals with different topics. Most have no bearing on the subject of maggots and wounds blab la bla, while most of them have some bearingà ¢Ã¢â€š ¬Ã‚ ¦. The review (50% c1750 words) 2168 THE REVIEW (PAULAs) LITERATURE REVIEW A good literature review draws on a wide range of sources (McCaughan, 1999) and will identify the need for research. Nevertheless, A poor literature does not invalidate the findings but a good one does enhance the status of the research (Stevens et al, 1993:135). HYPOTHESIS A hypothesis is not included and an explanation could be that the aim of this study is to provide new information by utilising a descriptive research method. Burns and Grove (2001) suggested that if there is very little or no research being conducted on a particular question, then researchers state objectives or questions and there is an objectiveà ¢Ã¢â€š ¬Ã‚ ¦. OPERATIONAL DEFINITIONS Quantitative research should have all terms explained or defined. Stevens et al (1993) refer to common error by researchers in the assumption that readers are knowledgeable about the jargon and terminologies employed. METHODOLOGY The research approach is not acknowledged within the article. Howedver, it can be assumed that the approach is quantitative, in that it involves manipulation of the independent variable.. On the other hand, to provide the strongest evidence with a greater degree of à ¢Ã¢â€š ¬Ã‚ ¦.. Also included are certain qualitative components such as à ¢Ã¢â€š ¬Ã‚ ¦.. that would indicated possible combination of the two approaches, qualitative and quantitative. Using this combination in approach to research may not appear to be very scientific, however Docherty (2000) suggests that this method may produce a more meaningful and richer data. Even so, there is strength and weakness to both approaches and neither have been stated within this study. On the other handà ¢Ã¢â€š ¬Ã‚ ¦ but backed up with à ¢Ã¢â€š ¬Ã‚ ¦. And the author agreed with this type of approach as it enables a reader to scrutinise the data, without having to be familiar with research methodology, data statistics or the terminology. SUBJECTS The subjects are identified as 43xx in five depts. Of xx hospital à ¢Ã¢â€š ¬Ã‚ ¦. Nevertheless, many potential or suitable candidates for this type of research may be unwilling to participate (burns Grove, 2001 and Reid Boore, 1987) due to the xxxx. SAMPLE SELECTION The approach to the sample selection is not clearly stated and a good research study should explain the sample selection method as suggested by Baxter (2001b). Howeverà ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ On the other hand, all the subjects are typically,à ¢Ã¢â€š ¬Ã‚ ¦. DATA COLLECTION Data collection procedures areà ¢Ã¢â€š ¬Ã‚ ¦.. not acknowledgedà ¢Ã¢â€š ¬Ã‚ ¦.. The validity and reliability are undefined within this study and McCaughan (1999) suggests that if the researcher has not mentioned testing for reliability and validity then it is unlikely that it has been done. ETHICAL CONSIDERATIONS Xxxxx ethical committee à ¢Ã¢â€š ¬Ã‚ ¦.. In the authors opinion, ethical consideration should have been an important part of this articleà ¢Ã¢â€š ¬Ã‚ ¦.. Nonetheless Appendix 3 shows/à ¢Ã¢â€š ¬Ã‚ ¦.. As suggested by Matthews Venables (1998) every published research report should include a description on how the informed consent is given. On the other hand, lack of acknowledgement of anonymity, confidentiality as well as the description of informed consent does not necessarily mean they have not been considered (Firby, 1995 McCaughan, 1999), merely that the researchers assumed that the results and method were more interesting to the reader. RESULTS The results are presented as xxxxx and backed up by xxx, which showed that xxx. However, quantitative data is limited wtug xxxx. In spite of this, there is sufficient detail that would enable a reader without any research experience to look at the results and understand what they signify and to judge with confidence the findings. DATA ANALYSIS The data analysis is appropriate to the type of data collected that is percentages and for the type of read that xxx was aiming for. In some ways the method employed is simple and easy to replicate. However, thereà ¢Ã¢â€š ¬Ã‚ ¦ Clarke (1999c) suggests that the data analysis relies heacily on the researchers skill and judgement to see that it is accurately exeuted, also not reported are values such as test values df and p. In addition, poor quality analysis will render the data anecdotal and unfocused, yet the analysis is focused, credible and to improve upon this, the author would suggest the inclusion of statistical tables. DISCUSSION The discussion is not really balanced, as it only mentions and draws upon xxxx However, what is discussed is very concise and knowledgeable. There is also no acknowledgement of the limitations or weakness of this particular stify and there is only one reference to disadvantages, THAT IS à ¢Ã¢â€š ¬Ã‚ ¦.. (Teresas) LITERATURE REVIEW The aim of the literature review was to find out what the nurses role is in primary care, in relation to providing xxxxx. To assist in the critiquing process, quantitative and qualitative papers were reviewed using the Benton and Cormack (2000) framework. Although the author finds this framework comprehensive and simplistic, it is noted Rees (2003) states qualitative and quantitative research are extremely different, and same method of critiquing cannot be used. This opinion is not upheld by Benton and Cormack (2000) as they promote the use of one framework for both. Within the articles reviewed the evident themes that emerged are xxx and xxxx. In order to guide the reader to continue reading a paper, the abstract should set the scene for the rest of the report. Playle (2000) states an abstract that is soundly written will list the main points of a study. It is noted three out of the four articles reviewed have concise detailed abstracts. Although, that by xxx (2006) lacked depth, understanding and did note cite up to date government papers to support the topic of xxxx. Burns and Grove (2001) highlight that a potential weakness noted wihin Gibbs et al (2004b) paper was the difficulty the reader encountered at determining whether the paper was quantitative or qualitative. Parahoo (1997) concedes this should have been obtained within the abstract, as this should briefly summarise the method, sampling and main findings within a study. Within the abstracts of the articles reviewed, the researchers have clearly portrayed and accurate image of all study methodologies, reported findings, sample subjects and conclusions. EDUCATION Gibbs et al (2004a) initial quantitative research paper tested one hundred and forty-one general practitioners and sixty-six practice nurse opinions relating to xxxx. Results favourably showed that ninety-seven percent of practice nurses raised xxxx but the article concluded xxxx within primary care and mainly relied upon xxxx. Leading on from this study, Gibbs et al (2004b) carried out a quantitative study involving eight general practices and one thousand five hundred and forty-nine kxdffdsdf. The article reports on xxxx. This quantitative paper involved structured interviews where questions were asked in a planned format. A structured interview involves set questions with no deviation from these (Parahoo 1997). A limitation of the study was the elevated drop-out rate but positively forty percent achieved a five percent or more weight loss at twelve months. It highlights whether the researcher has performed the study in a logical, systematic method, having paid attention to pointers that may influence the accuracy of the results (Rees 2003). Although Burns and Grove (2001) argue that a rigorous study should have exact measurement tools, a representative sample and a tightly controlled design. Audit was conducted in all practices prior to the study, where measurement tools such as weighing scales, height measure and large blood pressure cuffs were assessed. The provided consistency of the tools used at each centre along with evidence of their validity. Validity refers to whether an instrument measures what it stated to be measuring whilst reliability relies upon individuals using the tools and reporting accurate measurments obtained (Carter and Porter 2000). It was noted those practices participating in this study were self-selected, already having an interest in obesity management, thus possibly weakening representations. It was encouraging that a cross-section of those involved included large practices, rural, urban, single handed and those fro low deprivation areas. This appeared to provide a representative population with no evidence of bias selection. The xxxx project was ethically approved by xxxx. In contrast Moore et al (2003) in a cluster randomised control studyxxxxxxxx Cluster randomised trual means the sampling frame are geographically spread or the individual elements of the population are not know (Rees 2003). The advantage of this process is achievement of an accessible sample from an almost impossible total population (Rees 2003). Donnan (2000) states experimental research is the gold standard way of representing in a rigorous style that a treatment or intervention is effective. It concludes it si an essential tool for qualitative evaluation of a studys worth. Greenhalgh (2006) draws attention to the fact that publication of an article does not mean the evidence is robust. In conclusion as found in xxxx. Rees (2003) states bias is anything that distorts or affects a study, potentially altering or influencing the accuracy of the findings. Results noted that xxxx. They conclude more in=depth training of health professionals is needed xxxx. This would involve further implementation of training progrmmes and additional research. Ethical approval was granted by the xxxx ethics committee. The research paper by XX (2007) mixes quantitative and qualitative approaches and is known as triangulation,. Docherty (2000) suggests use of triangulation provides richer, more meaningful data. Holloway and Wheeler (2002) support this method stating it to be a way of obtaining rigour in qualitative research. Rees (2003 p. 235) lists this as being the use of more than one method of data collection within the same study in an attempt to produce more accurate information and understanding. This was a cross-sectional study with questionnaires being completed by forty General Practitioners and forty-seven practice nurses. A limitation to this study was no indication was made of the total number of initial questionnaires sent out in comparison to the response rate. A cross-sectional study is a survey that gazes at a situation at one point in time (Rees 2003). The qualitative results by xx (2005) were not shown within the report and rigour was disputed on reading the research paper as a full conclusion of the findings could not be made. It is realised word restriction could be the main reason for the results being omitted, but unfortunately it leaves the reading having to guess what they might have concluded. Ethical approval was supported by xxxx. In comparison with Gibbs et al (2004b) article the outcomes indicated mirror one another, with both papers coming to the conclusion that opportunties for xxxxxx in primary care are often missed or inadequate time given to education and support. Although the report by xx(2-3) shows xxxx, it was indicated this was in accordance with increasing responsibilities in implementation of chronic disease management. It is highlighted in the report that caution regarding results needs to take place. Also this article, although mainly quantitative, has a small sample size. Parahoo (1997) states quantitative research usually involves large numbers in probability samples. The importance of large numbers aims to lessen the chance of bias and correctly achieve statistical procedures (Rees 2003). A pilot study was not carried out prior to this research. Piloting of a questionnaire increases research validity and reliability as it highlights any anticipated problems accessing data, and ensures the method used to gather data works (Parahoo 1997). Research should be instigated because the researcher wants to extend knowledge base and understanding through rigorous collection of information, answering a question objectively and with accuracy (Rees 2003). SUPPORT Soanso (2009) article is a qualitative study and deals with support and perceptions of the patient who is obese. This is a primary study that reports research findings first hand (Greenhalgh 2006). Rees (2003) states to have involvement in qualitative research and understand a topic, individuals first have to see it through the eyes of those who experience it. This method aims to summarise perceptions, experiences, behaviour or interpretations. This process included a qualitative study with semi-structured interviews drawing on grounded theory methodology. Grounded theory aims to produce a concept or explanation that is grounded in the results and arises inductively by researchers understanding and analysis (Rees 2003). Polit et al (2001) strongly supports interviews stating they by far outweigh questionnaires. The response rate is higher, reaching a wider population than questionnaires, are less likely to mislead those reading the questions and provide wealthier data. Rees (2003) ag rees with the above adding, those involved can experience the belief of being in control and positively feeling more valued. It is noted there are disadvantages such as high cost, participants providing socially acceptable answers, affect of interviewer status and difficultly in expressing feelings (Rees 2003). Five general practices from differing socioeconomic backgrounds in Sheffield were involved with interviews conducted at their homes. This provided a varied population adding rigour to the study, and it could be generally assumed an individual would feel more comfortable being interviewed within their own surroundings. Although, it can be argued that interviewers have less power to control the interview within this environment as there is no assurance that the interviewee will maintain a safe place with no interruption, disturbance or being overheard (Pontin Webb 1995, Webb Pontin 1996). Kdfsdfsfhskdfhsd. Ethical approval was sought prior to this study from xxx Ethics Committee. Application to clinical practice (30% c 1050 words) 1086 APPLICATION TO PRACTICE At present within the authors practice setting issues of xxxx are raised xxxx. Since April 2006 the General Medical Service Contract (National Health Service 2006) awarded points for the xxxx. This critical review of the literature has aimed to answer the question: xxxxxxxxxxxxxxxxxxxxxxxxx? It is well documented that xxxx. Research that has been carried out in an ethical manner and is of robust design can benefit all involved and improve practice (Royal College of Nursing 2004). The document Best Research for Best Health (Department of Health 2006a) states research provides the support and evidence to tackle increasing challenges that disease and ill health have placed on society. This document supports a pilot study within primary care in England to improve evidence based practice of care by facilitating the conduct of clinical trial and other well designed studies. It would hardly be an exaggeration to say, pending successful results in 2014, the use of this structure within primary care in Wales could potentially benefit application of much needed research findings into practice. Findings of this review showed the counterweight project by Gibbs et al (2004a, 2004b) provided the best evidence of implementation within practice, showing xxxx. The Cochrane Library for Sytematic Reviews (2004) supports the Counterweight Project (2004b) stating The Counterweight Programme is an evidence-based weight managmentxxxx Brown Psarou (2007) in their literature review also supported this project stating it was rigorously conducted and soundly funded. Presentation of these research findings were undertaking xxxx. Banning (2005) suggests the management of obesity should focus on xxxx. The National Institue for Clinical Excellence (2001) states that primary care nurses are ideally placed to manage and assess obese individuals. This comprehensive package addresses issues and management of à ¢Ã¢â€š ¬Ã‚ ¦.. The material is simplistic with the alforithm providing an easy guide for the primary care nurse to follow, The à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ pathway opportunistically at routine appointments or reviews. To implement this in the clinical setting, xxxx. Successful implementation of this pathway into the practice setting would require change management issues to be addressed. Implementation of change following research can be a difficult process. Resistance, resentment and jealousy can all impede implementation of the change process (Cormack 2000). To overcome resistance to change the key factor is leadership, along with effective communication and a sound understanding of what motivates people (LaMonica 1994). Those involved in the change process must be kept informed and involved at each stage of change. Individuals like equilibrium and are keen to be involved once they know the process will not cause problems or a change of workload (Broome 1998). (Paulas) CONCLUSION A conclusion was included within the abstract, xxxx As suggested by McCaughan (1999) and Playle (2000), there is a restriction placed on researchers and authors by publications to condense from a much larger and more detailed research report. It can be assumed that this is the case with this research article. However, as suggested by Baxter (2001c) that in qualitative research to aid the flow and understandings, discussion and conclusion are kept together under one heading. In the authors opinion, the conclusion should have à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ RECOMMENDATIONS Stevens et al (1993) suggests the realistic researcher would draw conclusion from the data presented and then make further recommendations on what other research is required. However, there is no heading of recommendation or any indication that one was included. Alternatively, suggestions for further research studies and in the authors opinion threr should have been a recommendation for future randomised control trial. There is a possibility as suggested by Playle (2000) that the actual research report is more detailed with recommendations, but this may have been lost when condensed for publication. Teresas conclusion In conclusion, this literature review has shown xxxx. To achieve this, implementation of findings along with ongoing research is necessary to sustain the evolving needs of xxxx. It should be noted that a limited number of research articles were used for this review, providing partial evidence. Thus, it is suggested more concrete evidence is needed requiring a further search and review of the literature on xxxx. It would hardly be an exaggeration to say that this review has highlighted the need for further research on the topic of xxxx relating to support and education. It can be said this would potentially emphasise additional studies, which in turn could be applied to practice improving nurse education and support to the obese patient. APPLICATION TO CLINICAL PRACTICE AUTHORS CONCLUSIONS The article on à ¢Ã¢â€š ¬Ã‚ ¦. Appeared to be a concise, informative and innovative piece of research on first perusal. However, what appeared at first glance to be justà ¢Ã¢â€š ¬Ã‚ ¦.. turned out to be more complicated upon closer iinvestigation and mmmmmm. The reader begins to questionà ¢Ã¢â€š ¬Ã‚ ¦ It has a focus and direction, which is to assess the efficacy of maggot therapy and a very concise and informative methodology, which would enable anyone to reproduce a similar type of research. The data collection procedures are not clearly identified, although the simple representation allows it to be easily followed and replicated. This is further confounded by the entwined discussion and conclusion and as suggested by Baxter (2001c) this often occurs with qualitative research. Nevertheless, the reader must balance the evidence presented and sometimes more than one type of evidence (Roberts, 1999) is needed to determine if the interventions is practicable or efficient, as well as ethical and morally sound (Freak, 1995). Another point is the ethical considerations à ¢Ã¢â€š ¬Ã‚ ¦. Ethical significance à ¢Ã¢â€š ¬Ã‚ ¦. An assumption is the researcher focus on the results or alternative the method, as being more interesting or important (Firby, 1995) to the reader. As suggested by various authors including Polit Hungler (1991) all research has limitation and can be imperfect and if this research article has been condensed from a much larger research report, then this critique has been conducted on a published condensed research article and not the actual research report. Therefore, what imperfections or liitations that are identified within this critique, is the ability of the researchers to actually condense their work and the readers have to assume that the researchers have honestly presented their fndings (Firby, 1995). For all the points highlighted like ethical, operational definitions, qualitative/quantitative approach, this is a very good informative research article that allows anyone to replicate the study. AUTHORS RECOMMENDATION The author would like to recommend thatà ¢Ã¢â€š ¬Ã‚ ¦ Furthermore, it à ¢Ã¢â€š ¬Ã‚ ¦. However, as reported by XX, the main disadvantage is,,,, nevertheless, A readonable recommendation in the authors opinion would beà ¢Ã¢â€š ¬Ã‚ ¦, In addition, if there isà ¢Ã¢â€š ¬Ã‚ ¦ INTEGRATING RESEARCH INTO PRACTICE Sdfhsdkfhshdfhdfh to advocate and support the patient. References Avis, M. Bond, M. Arthur, A. (1997). Questioning patient satisfaction: an empirical investigation in two outpatient clinics. Social Science Medicine. 44,1:85-92 Backhouse, S. Brown, Y. (2000). Using a patient satisfaction survey to close the theory-practice gap. Nursing Standard. 14,38:32-35 Byrne, G. Richardson, J. Patel, A. (2000). Patient satisfaction with emergency nurse practitioners in AE. Journal of Clinical Nursing. 9,1:83-93 Cohen, L. Delaney, P. Boston, P. (1994). Listening to the customer: implementing a patient satisfaction measurement system. Gastroenterology Nursing. 17,3:110-115 Cormack, D. (editor) (2000). The Research Process in Nursing. (4th ed). Blackwell Science Ltd. Oxford. Duffin, C. (2002). If youre happy and you know it. Nursing Standard. 16,32:12-13 Ford, R. Bach, S. Fottler, M. (1997). Methods of measuring patient satisfaction in health care organizations. Health Care Management Review. 22,2:74-79 LoBiondo-Wood, G. Haber, J. (2002). Nursing Research, Methods, Critical Appraisal and Utilization. Mosby. Missouri. Marsden, E. (1992). Outpatient nurses must adapt to survive. British Journal of Nursing. 1(7) 356-357 McColl, E. Thomas, L. Bond, S. (1996). A study to determine patient satisfaction with nursing care. Nursing Standard. 10,52:34-38 Miles, K. Penny, N. Power, R. Mercey, D. (2003). Comparing doctor and nurse-led care in a sexual health clinic: patient satisfaction questionnaire. Journal of Advanced Nursing.42 (1), 64-72 Polit, D. Beck, C. Hungler, B. (2004). Essentials of Nursing Research, Methods, Appraisal a

Respiration & Homeostasis

RESPIRATION * The release of energy from food * All living cells need energy to carry out M R S G R E N, contraction of muscles, build up of larger molecules (e. g. proteins), maintains steady body temperature (homeostasis) * Aerobic: * needs oxygen * only occurs when a certain amount of oxygen is available * C6H12O6 + 6O2 6CO2 + 6H2O + Energy * releases large amount of energy (2900 KJ) * Anaerobic: * without oxygen * [glucose lactic acid] C6H12O6 2C3H6O3 * releases small amount of energy (120 KJ) * poisonous waste (lactic acid) removed to produce joined with O2, H2O + CO2 BREATHING Inhalation: taking air in lungs * muscles contract – diaphragm, intercostal muscles * volume increases * outside of lungs: high atmospheric pressure; inside lungs: low pressure * air flows into the lungs because of the difference in pressure * Inhalation: taking air out of lungs * muscles relax – diaphragm, intercostal muscles contract – internal intercostal muscles * volume decreases * outside of lungs: low pressure; inside lungs: high pressure * air flows out of the lungs because of the difference in pressure * GASES EXCHANGED INHALED EXHALED * Carbon Dioxide: 0. 4% 4% * Nitrogen: 79% 79% * Oxygen: 21% 16% * Water: Variable High * Temperature: Variable High * Alveoli are the site of gas exchange. Adaptations: * large surface area * good supply of oxygen and blood (surrounded by capillaries) for rapid diffusion of gas * thin walls * moist lining for dissolving gasesHOMEOSTASIS * the maintenance of a constant internal environment in the body * Conditions that are kept the same: 1. Body Temperature 2. pH 7. 4 (Blood) 3. water content 4. oxygen 5. glucose concentration * thermoregulation: maintaining a constant temperature (370C) * enzymes work best at 370C * temperature is monitored by hypothalamus (thermoregulatory centre) as the blood passes * BODY TEMPERATURE RISES: 6. hairs lie flat: less air trapped (less insulation) more heat is lost from the skin 7. weat i s produced: water in swear evaporates taking away heat from the skin 8. vasodilation: blood vessels near the surface of the skin dilate to increase blood flow from the capillaries so more heat is lost * BODY TEMPERATURE FALLS: 9. hairs stand up on end: air is trapped for body insulation 10. less/ no sweat is produced 11. vasoconstriction: blood vessels near surface of skin constrict to decrease blood flow to capillaries so less heat is lost 12. shivering: muscles produce heat by respiration

Gangs in Our Society

Running head: GANGS: THE EFFECT ON SOCIETY 1 Gangs: The Effect on Society 2 Abstract Crime is a growing problem in cities around the United States. A big part of this problem can be attributed to gangs. The number of people who get injured or killed by gang violence continues to rise. Some people feel the criminal justice system is failing to control the growth and strength of gangs in communities and prisons alike. In today’s society, the age of gang members continues to decrease while the number of them continues to increase. As youth continue to age the chance that they will end up in prison increases. There will be focus on the relationship between prison and street gangs and how society is affected as a result of these gangs. It is important to look at how gang violence can be reduced if not prevented all together. Introduction and Background Gangs in America flourish in an environment where basic social institutions such as family, role models, and education are weak. Often found in ghettos and poor, lower class neighborhoods, gangs can also thrive in rural and suburban areas (Palmer, 2010). Before we begin to explore the various aspects of gangs, it is important to define what a gang is. There are many definitions and much debate about gangs among law enforcement and scholars. For this reason constructing a definition that represents all types of gangs becomes problematic and almost impossible. For this paper I will use the Ohio Revised Code definition of a gang which is, â€Å"Any organization, association, or group of persons, either formal or informal, which may have a common name or identifying sign or symbol, whose members or associates engage in activities Gangs: The Effect on Society 3 which include, but are not limited to: planning, organizing, threatening, financing, soliciting, or committing unlawful acts† (Steele, 2011). History of Gangs It is not known when gangs first came into existence but the word thug dates back to the 1200’s. Thug is derived from the word â€Å"thugz†, which is an Indian word that refers to a gang of criminals who would travel the country causing trouble (Padilla, 1992). Gang activity became most prominent in the United States in the 1920’s due to Al Capone, also known as Scarface. Due to Prohibition during this time, criminal gangs began to distribute alcohol on the black market. Capone influenced many would-be gangsters and by the 1950’s there were a number of cities with gangs committing crimes at an alarming rate. Street gangs have changed over the years with respect to their goals, the age of members, their commitment to delinquency, and the level of violence. Adamson (1998) attributes this change to immigration, population movement, economic transformations, racial and ethnic conflict and the changing fabric of neighborhood and family life. Methodology Information presented in this paper came from a variety of sources. Among them are interviews, review of literature, and gang training. There have been many residents of the correctional facility this author has worked over the years who are members of youth gangs in their communities. The majority of them have family members who are currently serving time in prison for gang related crimes. This author attended a gang training put on by the Ohio Supreme Gangs: The Effect on Society 4 Court Judicial College in which many of the speakers are experts in the fields they work in. Vinko Kucinic, a Security Threat Group Investigations Coordinator with the Ohio Department of Rehabilitation and Corrections provided a great deal of information along with insight as to the severity and seriousness of prison gangs. Literature review included books, journal articles, and websites. Objectives The objectives of this paper are to give a little background into the formation of gangs and how they got to where they are now. Gangs continue to grow due to the number of youth joining these gangs for various reasons. Youth who prefer the gang life may find themselves in trouble with the law, which will lead us to the relationship between street and prison gangs. After we explore the particulars about street and prison gangs we will look at the various theories that explain why people join gangs. The paper will end with what and how society and law enforcement can reduce or prevent the increasing number of gangs in our society. Data Results of Youth Gangs The Office of Juvenile Justice and Delinquency Prevention (OJJDP) performed a National Youth Gang Survey in 2007 that found there were more than 27,000 active gangs across the United States and more than 788,000 gang members, a 7. 7% percent increase from 2002 (Marion & Oliver, 2006). There are many reasons why youth decide to join gangs. Some of the reasons boys join include protection from the streets, access to illegal drugs, a substitute for Gangs: The Effect on Society 5 family, and they have family members who belong to gangs. Girls join because family and friends are involved and they want to get a reputation (Huff, 2002). According to Howell (2010) youth are at higher risk of joining a gang if they engage in delinquent behaviors, are aggressive or violent, experience multiple caretakers, have problems at school, associate with other gang-involved youth, or live in communities where they feel unsafe and where other youth get into trouble. When youth do not get love and support from their families, especially their parents eventually they will look elsewhere for it. The teenage years are often the most vulnerable, a time when they need guidance and acceptance in their lives. Gangs are viewed to many members as â€Å"family† because people care them, watch out for them, and will never leave them. Many youth who grow up in crime-ridden neighborhoods because of gangs may feel the only way to stay safe is to join a gang. Rival gangs often walk the streets coercing younger kids to join their gangs. Some may feel as though they have no choice but to join. Youth who have family members in gangs can sometimes feel persuaded or pressured into joining the gang as well. Deanna Rodriguez, gang bureau chief in New York says, â€Å"We’re seeing more children who are being exposed to the gang world because their parents are members† (Parks, 2011). From the time they are babies they are dressed in the colors and taught the signs with their hands. When children are raised in this type of environment from such an early age, it becomes the only lifestyle they know. Another reason youth join gangs is a much debated issue and is based on the media. According to Mike Carlie (2002) there are three main views of the effect that violence in the media has on children. Gangs: The Effect on Society 6 The first view is that children who are raised in violent environments get confirmation of that violence when observing it or gang activity in the media. The second view is that non-violent children who are not supervised growing up while watching violent television, playing violent video games, or listening to violent rap music, begin to mimic what they witness or hear. The last view is that violence in the media allows for the purging of negative emotions and feelings. Bill O’Reilly gives his perspective on the relationship between violence in the media and gangs. The excerpt from Dudley & Gerdes (2005) reads: The debasement of our culture, of which gangsta rap is a big part, has coarsened children in general and put high-risk kids in a dangerous place. Taking drugs, carrying guns and disrespecting human beings is now not only socially acceptable in many situations, it is downright glamorous. Prison and Street gangs It is estimated by the U. S. Department of Justice that the number of gangs totaled about one million in 2008. Of those 147,000 were documented gang members incarcerated in correctional facilities (Parks, 2011). Gang activity is a growing problem in America’s prisons. Gangs in prisons are known as security threat groups (STGs) because of the interference with prison discipline. The major threats that gangs pose include the smuggling of contraband, violence, and bribery (Newton, 2008). The top leaders of gangs in prison are the ones who have been imprisoned the longest and run the street gangs. The STGs have the same agenda as other gangs but instead of them starting on the street and ending up in prison, they organize in prison and take their activity out on the streets through the use of visitors and parolees. Gangs: The Effect on Society 7 Street gangs are exploited for money and other resources through prison gangs. This occurs in a number of ways. Family members often operate as messengers and drug couriers. They are normally given instructions by gang members during visits to pass on to members of the street gangs. Family members are also known to smuggle contraband in to inmates that can include cellphones, drugs, and money. According to the National Gang Intelligence Center (NGIC) and the US Federal Bureau of Prisons (BOP), cell phones smuggled into correctional facilities pose the greatest threat to institution safety (â€Å"2011 National gang†, 2011). These cell phones, including smartphones, give incarcerated gang members power over street gangs through text messages, internet access, email, and unmonitored conversations. Cell phones are used to plan or direct criminal activities such as assault, murder, and drug interactions. The main difference between street gangs and prisons gangs is their motivation for violence. Street gangs normally commit violent acts to terrorize its enemies; if a murder occurs it is usually of secondary importance. The prison gang uses murder as a specific act of revenge; the terror created by the killing is of secondary importance (Landre, Miller, & Porter, 1997). In many cases, the â€Å"wannabes† pose more of a threat in prison then do actual gang members. This is due to the â€Å"wannabes† carrying out numerous violent acts as they attempt to impress other members with their ability to be ruthless and to show support for the activities of the group. Aryan Brotherhood One of the top prison gangs is the Aryan Brotherhood (AB). AB is a white supremacist group that was formed in 1967, at San Quentin prison in California (Walker, 2011). They initially formed for the protection of whites against blacks in prison and have since become a Gangs: The Effect on Society 8 criminal enterprise. The AB is concerned with white-supremacy, and is known to murder those who oppose the system. In the prison system they are known for their control of the sale of drugs, gambling, â€Å"punk,† or male prostitutes. The only way to become a member of the AB is to abide by their philosophy of â€Å"Blood In- Blood Out† (Steele, 2011). This means that you kill somebody to get into the gang and die to part from it. Mexican Mafia Another of the top prison gangs is the Mexican Mafia. The Mexican Mafia was formed in the 1950’s within the California Department of Corrections, and is one of the oldest and most powerful prison gangs in the United States (Walker, 2011). They are well known for drug trafficking, extortion, and murder. They often use the number 13 as their gang identification, due to the letter â€Å"M† being the 13th letter of the alphabet. One unique characteristic of the Mexican Mafia is that a member of the gang itself may not be murdered without the vote of at least three members, non-members do not require a vote. Theories of Gang Membership There are numerous criminological theories that give explanations to the reasons why people become members of a gang. Social disorganization theory was first introduced by Clifford Shaw and Henry McKay in 1942. Prior to this Frederic Thrasher is credited with the research that led up to this in 1927 with his study of 1,313 Chicago gang youth (Howell & Curry, 2009). Thrasher felt that economic destabilization contributed to social disorganization, which in turn, led to the breakdown of conventional social institutions such as the school, the church, and most importantly the family (Wood & Alleyne, 2010). When families or schools were Gangs: The Effect on Society 9 ineffective in the socialization of children, the gang was there to fill the gaps. Furthermore, neighborhoods that lack organization ultimately lack the ability to provide essential services to the residents of the community. Shaw and McKay felt that personal ties among neighbors are what constitute community organization. Differential association theory The idea of differential association was introduced by Edwin Sutherland in 1939 (Conrad, Cox, Allen & Hanser, 2008). His approach combines principles of the learning theory with the idea that learning takes place in interaction within social groups. Sutherland recognized that criminal behavior is learned and that young people develop attitudes and skills necessary to become delinquent by associating with individuals who are â€Å"carriers† of criminal norms (Wood & Alleyne, 2010). The family is the primary point of learning social behavior, including deviant behavior. Individuals learn how to define situations as being law-abiding or law-violating behavior based on what they have experienced in life experiences. Strain theory There are several variations of the strain theory but the central concept is that society sets universal goals for its populace and then offers the ability to achieve them to a limited number of people (Wood & Alleyne, 2010). Albert Cohen depicts gang members as working class youth who experience strain resulting in status frustration. Status frustration can be resolved when the youth associates with others like them in order to get back at middle class ideals and standards. Gangs: The Effect on Society 10 This leads to the formation of a delinquent subculture where instant gratification, fighting, and destructive behavior become the new values (Wood & Alleyne, 2010). Reducing/Preventing Gang Violence Gang violence is a societal problem, and all parts of our society play a role in tolerating it and enabling it. The steady growth of gangs and gang-related crime presents a challenge for law enforcement and communities alike on all levels throughout the United States. There is evidence that some progress has been made however. The FBI’s Safe Streets Violent Crime Initiative has focused on the most violent gangs, crimes of violence, and the apprehension of violent fugitives (Parks, 2011). As a result of this from 2001 to 2008 over 40,000 arrests and 17,000 convictions of gang members were made (Parks, 2011). Law enforcement is not the only ones who should be worried about gang activity and crime. The community is an important part of reducing and preventing gang violence. Community Involvement The most important thing a community can do to address gang problems is to prevent them from developing. Early intervention programs in schools can identify youth who are truant and/or who show signs of violent or disruptive behavior and get them assistance before it becomes too late (Alonso, Coles, & Fry, 2000). Schools can also encourage those youth to join extra-curricular activities whether it is sports or clubs such as drama, band, choir, and art to name a few. These activities can give a youth a sense of accomplishment and can also provide them with a sense of belonging. Gangs: The Effect on Society 11 Communities have also started imposing anti-gang ordinances known as injunctions. Injunctions vary from city to city but the idea is that they prohibit gang members from engaging in activities in â€Å"safety zones† (Parks, 2011). In these safety zones, gang members may not display gang signs, wear gang colors, associate or intimidate others. Violators are subject to fine and/or jail time. Parental Involvement Parents can be the most active players in preventing and reducing gang problems. Parents and other responsible adults need to learn everything they can about gangs and why youth join gangs as this can help keep children and neighborhoods safe. Chanequa Walker-Barnes, a psychology professor at the University of North Carolina concluded from research that parents- especially those in African American families have a lot of influence over their children and can help them avoid gangs (Hamilton, 2002). What parents do not realize is that losing a child to the gang can be avoided. They need to show their children love, support, and acceptance before it is too late. Law Enforcement and Government Involvement Gang units and task forces are important in targeting gangs and have played a major role in mitigating gang activity in a number of US communities. Other efforts to control the spread of gang violence include RICO. RICO is the Racketeer Influenced and Corrupt Organizations Act, which increases penalties for various crimes, such as murder, arson, robbery, or extortion, when the offender belongs to an organized criminal group (Newton, 2008). Gangs: The Effect on Society 12 Gang Resistance Education and Training (G. R. E. A. T. ) is a gang and violence prevention program built around school-based, law enforcement officer-instructed classroom curricula (â€Å"Prevent youth crime,,† 2011). The main purposes of the program are to immunize against delinquency, youth violence, and gang membership for children before they reach the age that gang temptation is rampant. Discussion The most interesting and intriguing thing learned in this authors research is that it is not easy to get out of the gang. One story by a gang member commented that it is not uncommon for members to be told they cannot ever leave the gang. Even if they are allowed to quit, they are often required to be â€Å"jumped out†, meaning they must undergo a beating by gang members. In addition to be beaten by gang members, someone who wants to leave the gang may be stabbed by gang members as well. It seems as though anything goes when it comes to being jumped out. Gang members don’t care if they are use fists, knives, guns, or if there are two or 50 members doing the beating. Membership in gangs is taken seriously and quitting is considered an insult and a sign of disloyalty. Relationship between prison and street gangs Before this research was started this author had the perception that street and prison gangs were two separate entities. The literature clearly proved that perception wrong. Prison gangs run the street gangs and control most aspects of the drug world as well. Gang members in prison control not only the street gangs but family members as well as prison staff. Corrections officers and parole officers are also known to smuggle contraband in for inmates. Prison staff Gangs: The Effect on Society 13 can play two roles in prison gang culture. As active participants they may provide alibis, take bribes or payments for their silence, and provide opportunities for crimes to be carried out. Passive participants may â€Å"overlook† situations long enough for gang members to do what they want. Prison staff is not immune to the violence of gangs. They may be threatened, physically or sexually assaulted and harassed. Youth gangs All the literature on youth gangs just reinforces how vulnerable children are in the early years. The number of youth who join gangs to find belonging and acceptance is unreal. One cannot blame a child for wanting to feel needed or to want protection when they are not getting that from the one place that means the most, the home. What is more heartbreaking are the children who do not get the choice of whether they want to be a gang member as they are born into it and that is the only life they know. Conclusion The prevalence of gangs and the number of crimes committed by gang members demonstrate that while gang activity may not be a new problem, it certainly presents serious issues. Youth gangs are an increasing problem in societies across the country and are the easiest time of a person’s life to prevent them from joining a gang. There are so many programs in schools and the communities that parents can access for their at risk youth. Prison gangs do not just affect the correctional systems as they control what happens on the streets. What is the prisons problems spill out to become the community’s problems as well. Several theories were looked at to help explain why people join gangs such as the strain theory, differential association Gangs: The Effect on Society 14 theory and the social disorganization theory. There are a number of ways given that parents and communities can help in the reduction and prevention of gang involvement as well as what law enforcement and government agencies are doing. Gangs: The Effect on Society 15 References Adamson, C. (1998). Tribute, turf, honor and the American street gang: patterns of continuity and change since 1820. Theoretical Criminology, 2(1), 57-84. Retrieved from http://journals. ohiolink. edu/ejc/pdf. cgi/Adamson_Christopher. pdf? issn=13624806&issue=v02i0001&article=57_tthataocacs1 Alonso, A. , Coles, C. , & Fry, R. (2000). Gangs, crime, and social deviance: a dialogue. Focus on Law Studies, 16(1), Retrieved from http://www. americanbar. org/content/dam/aba/publishing/focus_on_law_studies/publiced_focus_fall_00. authcheckdam. pdf Carlie, M. 2002). Into the abyss: a personal journey into the world of street gangs. Springfield, MO: Self Publication. Conrad, J. J. , Cox, S. M. , Allen, J. M. , & Hanser, R. D. (2008). Juvenile justice: a guide to theory, policy, and practice. (6 Ed. ). Thousand Oaks, CA: Sage Publications, Inc. Dudley, W. , & Gerdes, L. (2005). Opposing viewpoints: gangs. Farmington Hills, MI: Greenhaven Press. Gangs: The Effect on Society 16 Hamilton, K. (2002 ). Gangbusters: Parents still play a key role in saving kids from the streets. Black Issues in Higher Education, Retrieved from http://www. highbeam. com/doc/1G1-89379977. html Howell, J. C. (2010). Gang prevention: an overview of research and programs. Retrieved from U. S. Department of Justice website: https://www. ncjrs. gov/pdffiles1/ojjdp/231116. pdf Howell, J. C. , & Curry, G. D. (2009). Mobilizing communities to address gang problems. Retrieved from Office of Juvenile Justice and Delinquency Prevention website: http://www. nationalgangcenter. gov/Content/Documents/NYGC-bulletin-4. df Huff, C. R. (2002). Gangs in America iii. Thousand Oaks, CA: Sage Publications, Inc. Landre, R. , Miller, M. , & Porter, D. (1997). Gang: a handbook for community awareness. New York, NY: Facts on File, Inc. Marion, N. E. , & Oliver, W. M. (2006). The public policy of crime and criminal justice. (2 Ed. ). Upper Saddle River, NJ: Pearson Education, Inc. Gangs: The Effect on Society 17 Newton, M. (2008 ). Criminal investigations: Gangs and gang crime. New York, NY: Chelsea House Publishers. Padilla, F. (1992). The gang as an American enterprise. New Brunswick, New Jersey: Rutgers University Press. Palmer, O. (2010, May 27). Why the gang culture exists (a 3-part series). Retrieved from http://oceanpalmer. com/blog/? p=660 Parks, P. (2011). Gangs: Current issues. San Diego, CA: Reference Point Press. Steele, K. (2011). Gangs and security threat groups. The Supreme Court of Ohio Judicial College. Walker, R. (2011). Gangs or us. Retrieved from http://www. gangsorus. com/prison_gangs. html Wood, J. , & Alleyne, E. (2010). Street gang theory and research: where are we now and where do we go from here?. Aggression and Violent Behavior, 15(2), 100-111. (2011). Prevent youth crime, violence, and gang involvement. Retrieved from U. S. Department of Justice website: http://www. great-online. org/ Gangs: The Effect on Society 18 (2011). 2011 national gang threat assessment: Emerging trends. Retrieved from Federal Bureau of Investigation website: http://www. fbi. gov/stats-services/publications/2011-national-gang-threat-assessment

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