Literature review Essay Example | Topics and Well Written Essays - 5000 words - 1

Literature review - Essay Example Health Organization (WHO), 2007, p.1, defines falls as â€Å"inadvertently coming to rest on the ground, floor or other lower level, excluding intentional change in position to rest in furniture, walls or other objects†. As age increases so does the incidence of falls. Consequently it is the older people that face the brunt of the problem of falls, which is demonstrated by the incidence of falls being between 28 to 35% in people between 65 and 70 years and between 32 to 42% in people over the age of 70 years (The World Health Organization, 2007). Falls among the older population and the consequent injuries suffered are a major public health problem. The reason for this is that besides the enhanced frequency of falls in the elderly, such falls result in mild to severe injuries to the tune of 20 to 30%. This leads to more than 50% injury related hospitalization among the elderly and 10-15% emergency of all emergency department visits (The World Health Organization, 2007). In comparison to hospital stays for other injuries among the elderly, hospital stays due to injuries from falls are much longer. In the United Kingdom hospital admission rates owing to falls to individuals over the age of sixty is between 1.6 to 3.0 per 10,000 of the population and the emergency department visits as a result of falls in the elderly is between 5.5 to 8.9 per 10,000 of the population (The World Health Organization, 2007). In addition, to high hospitalization rates, falls in the elderly carry the higher risk of mortality, with falls being responsible for about 40% of all deaths from injuries to the elderly (The World Health Organization, 2007). Post-hospitalization complications can also arise in the form of post-fall syndrome that include the elements of dependence, loss of autonomy, immobilization and depression. This reduces the ability to perform daily activities, making them dependent on caregivers from the family. In the United Kingdom, the average earnings per annum lost on

Health care Essay Example | Topics and Well Written Essays - 500 words

Health care - Essay Example Although the coverage changes will largely take effect after 2014, yet the changes made so far are likely to benefit the rural people by improving their coverage rates. Children in the family plans would be qualifying for coverage up to 26 years of age as dependents. The implementation of changes would develop high-risk pools which would be particularly meant for those whose health conditions have existed for quite a while in the past. Owners of petty businesses as well as their workers would benefit from the subsidies and the addition of tax credits. People in rural frontier and nonadjacent areas conventionally have very low rates of health care insurance as compared to those in the urban regions. Therefore, effects of the provisions of ACA will generally be much more profound in the rural areas as compared to the urban areas. Rural people happily accept to work for little compensation. Volume of business does not matter much for them. It is important to note that the effect of ACA in rural regions will be the aggregate of appreciable advancements in coverage, which would be steadied by the imposed limitations on payments to the health care providers in rural areas particularly through such programs as the Medicare program.

Immorality of Abortion Research Paper Example | Topics and Well Written Essays - 1500 words

Immorality of Abortion - Research Paper Example Contrary to popular belief that abortion is a modern operation, there is retrospective evidence that it was practiced as long ago as the 5th century BC by ancient civilizations. Even in biblical times, a form of abortion was practiced, as is evidence in the book of numbers where a woman accused of infidelity would be made to drink â€Å"the bitter water† which would bring out the â€Å"curse† (Fox). Other recorded cases of abortion were in ancient Egypt (1550 B.C.E.) and China in the 5th century where among other things used to induce it was mercury (Fox). Notably, many the methods used in the past were dangerous and could have killed the mother just as easily as induced the abortion. In the recent past, abortions were illegal for moral, religious and health issues. However, after the 20th century, women rights groups and doctors have been often able to repeal this ban and as a result, many countries, especially in America and Europe, have legalized it to the chagrin of the pro-life groups. The issues that have made abortion such a controversial and pertinent issue include the fact that apart from the guaranteeing the unborn child’s death, it also jeopardizes the life of the mother; in addition, several of those who undergo abortions are underage girls who are pregnant and have no one to support them or the baby. Bearing in mind that it is the moral duty of the strong to protect the weak and comparably pro lifers consider it their duty to protect the life and rights of the unborn child. While the modern methods of carrying out the operation are mostly safe and performed by qualified doctors, from an objective perspective the action is immoral. Nonetheless, in view of the fact that a woman has agreed consciously and actively to end the unborn life in her is immoral in itself (Lee and Robert 13). Proponents of abortion have been trying to justify abortion and paint it with a moral brush for as long as the pro-lifers have been condemning it. O ne of the principal arguments put forward to humanize abortion and portray it in a moral light is that the fetus is not yet human being. They claim that if the pro-life side agrees a sperm and ovary are not considered human, yet they have potential to become human then the same should be said of the fetus. Therefore, should the pro choice concede it is human, they will go ahead and claim for one to be recognized as a person; thus, they would need to be self-aware. As such, anything in the womb is not self aware, ergo, cannot be human and the same argument has been proposed by advocates defending suspects of infanticide (Lee and Robert 15). However, these arguments are untenable and illogical at best; therefore, comparing the sperm to the fertilized egg flies in the face of logic since the sperm will only have potential for life if it is merged with the egg. On its own, it does not have a chance to generate life, the fertilized egg, on the other hand, in an autonomous genetic unit on ly requires the parent to host it and supply it with nourishment for the duration of the pregnancy. This is no different from when a child stays with its mother fully dependent on her for the first few months. However, at this point, even the diehard pro-choice people will not agree that the mother is free to terminate

Matriarchy versus Patriarchy Research Paper Example | Topics and Well Written Essays - 1500 words

Matriarchy versus Patriarchy - Research Paper Example Such a society implies male privilege and rule, and entails women's subordination (Asadi 4). Most patriarchal societies are as well patrilineal, indicating that only males inherit the title and property. Women, in a patriarchal society are matriarchal. On the other hand, matriarchy is a social system in which women or older females are the headers of their families. In such societies, women determine relationships and descent and they play major roles in the government. Currently, many religions believe that males should be the leaders in their families and society and both children and women must obey to their authorities (Asadi 72). The main purpose of this paper is to compare and contrast how women are presented, treated and importance in different religious. The content of this paper compares and contrasts women treatment in Islamic and Christian religions. Women treatment in Christianity and Islam Religions Throughout the religious history, men believe that they are more superio r to women in most diverse religions (Eller 121). Is this belief true in Islam or Christianity religions? In Christianity view, a woman's role is different from other religions since their roles are equal to those of males. In Galatians chapter 3 verse 28, Apostle Paul writers, â€Å"in Christ there is neither female nor male in Christ, Greek or Jew†¦Ã¢â‚¬  all human beings are equal before Christ. However, the two religions have expressively denied accepting the significant roles that women can influence in the society. Despite the advent of civilization, the prevalence of male chauvinism has served to suffice the importance of women in the society. Majority of the people professing the two religions hold that women are subjects to their husbands and they can never be equal. Similarities In both religions of Islamic women and Christian women, worship is a vital part of their responsibilities although the reasons behind this worshiping differ. Women from Islamic religion wors hip by adhering to a schedule of prayer and fasting, therefore, after their death, their good actions and ability to keep the Islamic laws, will enable the women enter â€Å"paradise† (Kanra 111). While Islamic men in â€Å"Paradise† are assured the company of various virgins for their pleasures, Koran does not offer much information for those women who afford their way in. It is evident that Islamic men derive the assurance that they will dominate the women in paradise since it is the case on earth while still the women are knowledgeable of passing into paradise as virgins to become subjects to their men. On the other hand, Christian women love God because He initially showed love to them. God offered is only beloved son, Jesus Christ, to die on the cross for the sinners since they were unable to earn any of the heavenly grace. Similarly, Christian women worship God through praying and fasting, but this is practiced in response to God’s commandments, and not fo r earning God’s favor (Kanra 42). A Christian woman is always aware of the awesome ease of acquiring God’s favor. As Jesus Christ said in John chapter 3 verse 16, â€Å"whoever believes in me shall not perish, but have everlasting life†. Christian women worship and praise the Lord to enable them to enter the Kingdom of heaven after death. Further, Christian women abide by Biblical teachings in order to draw God’s favor and become certain of the resurrection after death and acquisition of eternal life in paradise. In both religions, women play a major role of taking care of their husbands and children. They have the role of preparing and serving meals for their husbands and children. Women are only supposed to concentrate with home duties such as

Arthur Millar Essay Example for Free

Arthur Millar Essay In this essay I am going to analyse the dramatic techniques that Arthur Millar uses in his 20th century drama called, A View From The Bridge. The play is set in Brooklyn in the 1940s when the Italians were immigrating to America to find work as they were poor and they needed to get away from Italy to find work to feed their families in Italy. Many of these immigrants entered America Illegally. The play is about a skilled docks worker in Brooklyn named Eddie Carbone. Eddie lives with his wife Beatrice and their niece, Catherine. Beatrices cousins named Marco and Rodolfo come to America from Italy to find work to feed Marcos family in Italy, as they are very poor. They plan to enter illegally. Eddie has feelings for his niece Catherine that he should not have. Meanwhile Catherine falls in love with Rodolfo and Eddie hates him because he is jealous as he loves her and he cannot stand any other man looking at her and touching her. As a result Eddie decides to let the Immigration Bureau know that there are illegal immigrants in his building. In the play, Arthur Miller uses a number of dramatic devices many of which are seen in the first act but their significance only becomes apparent to the audience in the second act. These dramatic devices are: use of language, dialogue and its sub textual meanings, stage directions, characters actions, props and lighting. The first dramatic technique I am going to analyse is the use of language in Alfieris speech at the start of the play. Miller has put this at the start of the play to prepare the audience for what will happen later on in the play. The speech starts to develop tension because there are a lot of negative and violent words used. For example, Alfieri uses terms such as Machine Gun. The effect of using a term like this is to create tension for the audience, as they now know that something bad is going to happen later on in the play. As the play progresses the audience realise that this is the only time when Alfieri uses negative and violent language. So his words take on a deeper meaning when the audience realises this. I am now going to look at Eddies language in the first act. His speech is simple but at the start of the play his words are more vibrant towards Catherine as he tells he that she is walking wavy. At the same time he also refers to her as a Madonna. This gives the audience the idea that she is pure and she is a virgin and Eddie wants her to stay as she is. Listen, B. , shell be with a lot of plumbers? And sailors up and down the street? This illustrates Eddies feelings for Catherine and it can also mean that he does not want any other men looking at Catherine or marrying her. Eddies dialogue changes when the cousins arrive. He uses working class American colloquial words, such as Yiz have a nice trip? when he asks the cousins Marco and Rodolfo about their journey. Eddie wants to make it clear that he is the man of the house and that he is in charge. These expressions are only used in the first act when he is speaking to Marco and Rodolfo. This builds tension because the audience know that Eddie is going to start trouble with Marco and Rodolfo later on.

Exploring the Relationship Between Mother and Baby Essay Example for Free

Exploring the Relationship Between Mother and Baby Essay Exploring the relationship between mother and baby in the NICU in relation to nursing support. Abstract Aim -To explore the effect of interaction related to care-giving and information exchange between nurses and mothers in relation to maternal stress and maternal-infant relationship in the newborn intensive care unit (NICU) throughout the hospital stay. Background Mothers in the NICU experience depression, anxiety, stress, and loss of control, and they fluctuate between feelings of inclusion and exclusion related to the provision of health care to their neonate. This literature review helps to identify nursing interventions that promote positive outcomes between mother and baby by reducing maternal feelings of stress and anxiety. Search Method A literature search covering the period 2008-2012 was conducted. Five articles reporting both quantitative and qualitative studies relative to the subject were retrieved. Findings Findings reveal that positive and trustful relationships between nurses and mothers develop when nurses communicate and interact with mothers. This alleviated mother’s anxiety and enhanced their confidence when interacting with their baby. Discussion Critical analysis as well as strengths and weaknesses of the relative journals reviewed is given together with useful recommendations that emerge from the evidence. Conclusion The literature reviewed shows that nurse-mother interaction improves mother-infant relationship. In turn, this will eventually assist in decreasing maternal stress and improve the maternal well-being. INTRODUCTION Mothers develop attachment to their baby during pregnancy, which continues and develops more fully after the child is born (Cleveland 2009). However, the pathway to becoming a mother is threatened with the admission of the baby to the NICU. This occurs due to the unfamiliar and intimidating environment of the NICU (Obeidat et al 2009). During the initial admission parents can believe that the healthcare team is more able to care for their baby and this can instill feelings of inadequacy (Cockfort 2011). As a result, maternal attachment may be delayed by the lack of socialisation between mother and baby as most of the care is done by nurses (Cleveland 2009). DeRouck and Leys (2009), found that the parents of an infant admitted to the NICU face challenges including access to information, disclosure about the diagnosis, treatment and prognosis of their newborn, as well as a lack of control over the care of their newborn. Adding to this distress is the uncertainty of survival or the eventual impact of the infant’s condition on later health and well-being. In addition, feeling guilty to mother an unhealthy infant creates fear of social prejudice. Further, the structure of the NICU places significant barriers on mothers’ abilities to enact the parental role since decision-making and the daily care of the infant is taken over by medical and nursing staff restricting interactions with the babies stripping off their maternal authority (Cleveland 2009). In fact, when babies are in the NICU, traditional conceptualizations of the parental role are altered. The situation demands heightened parental participation while simultaneously placing severe restrictions on parental involvement. In response, parents need to negotiate this tension and traditional definitions of the parental role, which must be continually redefined throughout their experience What emerges is that the predominant source of distress is inability of the mother to protect the infant from pain and provide appropriate pain management. (Fenwick et al 2008). A lot of procedures cause pain in the neonate creating concerns for the mother, starting from peripheral cannulas, indwelling catheters and intubation to mention a few. In intubated babies, even though morphine infusions are administered, the baby still shows signs of distress during nursing times. In this case, we administer a small bolus of pain relief prior to nursing so that the baby would be more comfortable. Conversely, Fenwick et al (2008) describes factors that contribute to parents’ satisfaction in the NICU. These include; assurance and psychological support, the provision of consistent information, education, environmental follow-up care, appropriate pain management, and parental participation and proximity, as well as physical and spiritual support. Therefore, it is imperative that nurses should do their best to improve the mothers’ sense of confidence, competence and connection with her infant through guided participation (Domanico et al 2011). Johnson (2008) notes that skin-to-skin holding or kangaroo care promotes maternal-infant feelings of closeness, builds maternal confidence, and may be a stress-reducing experience for both the mother and infant. Hence the importance of providing the opportunity for kangaroo care to occur. Hunt (2008), notes that KMC is also crucial to stabilize parameters, such as cardio-respiratory parameters whilst being beneficial for maintaining body temperature. They add that even the incidence of nosocomial sepsis and the duration of hospital stay decreased with practicing KMC. In addition, Ali et al., (2009), found that Kangaroo mother care also showed positive outcomes towards practicing exclusive breastfeeding. Cockfort (2011) notes that, continuity of care needs to be ensured hence the importance of documentation. Therefore, it is suggested that handover should not be rushed, whilst a more comprehensive handover can ensure the smooth transition of care for staff and the family. When parents ask questions relating to their baby they feel assured in the competency of staff when information has been passed on correctly. When information is not shared effectively parents can lose trust and the partnership breaks down. In Malta, even though handover of 2 consecutive days is given, conflicting advice is still given at times due to the nurses’ different view-points. Consequently, this requires ward meetings in order to clarify important issues so that advice given and practice is consistent. In Malta, about 373 babies are admitted yearly (Grech et al 2012). In view of the benefits discussed, nurses should do their utmost to improve the overall experience of the mothers of such babies. Search Method A review of published research consisted of the following steps; broad reading to determine areas of focus, identification of inclusion and exclusion criteria, literature search (appendix 1) and retrieval, critical appraisal and analysis of the research evidence and synthesis of evidence. Evidence was reviewed with the aims of identifying barriers that affect the motherinfant interaction within the neonatal intensive care unit and how nurses can actively support attachment. Articles were included if the setting was primarily in a neonatal intensive care unit (neonatal unit or neonatal intensive care unit) and the participants were mothers of infants admitted to neonatal intensive care units or nurses working within that setting. In addition, All articles were critically analyzed with two primary questions in mind: (a) What are the needs of parents in the NICU? (b) What nursing behaviors support parents in meeting these needs? Articles were also included if they were primary research studies published between 2008 and 2012 and written in the English language. Primary and secondary literature searches were conducted through the EBSCO, ERIC, Sciencedirect and Medline databases. The primary search terms included â€Å"NICU,† â€Å"Neonatal Intensive Care Unit,† â€Å"family support,† â€Å"communication,† â€Å"nurse† and â€Å"early intervention.† The secondary literature search terms included â€Å"nursing support,† â€Å"efficacy,† â€Å"family,† â€Å"communication,† â€Å"support†, â€Å"neonatal† and â€Å"Kangaroo Mother Care†. These terms were used and utilised in all possible combinations to perform an extensive literature search of the above mentioned electronic databases. Thirdly, a review of references was conducted of the identified articles for any further studies. Eighteen articles were found through the search. Six studies met the inclusion criteria of which, 3 were qualitative and 3 quantitative (appendix 2). The subject was limited to the last 5 years. This time frame helps in the getting the most recent experiences since NICU is a changing environment especially as regards to technology which effects the mothers as well as the nurses. Both quantitative and qualitative studies were found. Both qualitative and quantitative research was conducted to identify what is known about the needs of NICU parents and what behaviours support these parents. Both methods of research were included because of the potential for each to contribute to a more complete understanding of this topic. In selecting a research design, researchers should be guided by one overarching consideration: whether the design does the best possible job of providing trustworthy answers to the research questions. One needs to note that both studies have limitations (Cottrell McKenzie, 2011). In quantitative research, the researcher’s aim is to determine the relationship between one variable (an independent variable) and another (a dependent or outcome variable) in a population (Morrow 2009). In contrast to quantitative designs, qualitative designs do not result in numerical data for statistical analysis (Schira, 2009). In qualitative methods, researchers are interested in interpreting social phenomena and exploring the meanings that people attach to their experiences (Polit and Beck 2010). Moreover, views, attitudes and behaviours may be explored (Wood Kerr, 2011), through grounded theory as it develops theories that are grounded in the groups observable experiences, but researchers add their own insight into why those experiences exist. Findings Table 1 includes information about the 5 studies that met the inclusion criteria . Once an infant is admitted into an NICU, many factors account for parental stress. Admission of the infant to the NICU places mothers in a stressful situation where they must cope with the NICU environment and its associated demands. In the study conducted by Parker (2011), a grounded theory approach was used to understand feeling and stressors of 11 mothers whose new-borns were in the NICU. It was found that the early days shock and numbness accompanied feelings of none or little control over their lives. Moreover, all mothers described feeling unprepared for the premature delivery and the sight of their baby in the NICU. Comparative results were found by Lee et al (2009), with regards to the shock experienced with the initial sight of the baby. Everyday unpredictable changes occur leaving no time for adjustment or preparation. Constant fears about the life and death of the baby do not subside and several mothers spoke about their experience of always anticipating the death of the baby. These findings are also reflected in my clinical setting when mothers would be recounting their experience once the baby’s condition improves. This is in line with the findings of Fenwick et al (2009) and Lee et al (2009). In addition, the findings imply that the positive reassurance of the effects of a positive and caring environment and support network between parents and nurses in the NICU is not always evident among every unit. Nicholas-Sargent (2009) found that assurance is the most important aspect to be fulfilled. Her quantitative study of 46 mothers found that the length of stay in the NICU and mothers’ information needs were found to be significantly inversely correlated. Therefore, this suggests that the longer an infant remains hospitalized in the NICU, the less emphasis the mother places on receiving information about the infant’s condition. This shows that the needs of the mothers in the NICU can change over time. My observations match these findings since mothers familiarise themselves and adapt to the situation. Moreover, they would eventually want to be successful with the care of the baby. This is reflected in the grounded theory analysis conducted by Fenwick et al (2008), using semi-structured interviews. They found that the nurse-mother relationship had the potential to significantly affect how women perceived their connection to the infant and their confidence in caring for their infant which occurred through a three way interaction. Being successful in their desire to care for the baby, engendered feelings associated with being a ‘‘real’’ mother. However, not all women in this study were able to successfully employ these strategies. In the situation where the mother perceived herself as ‘‘quiet and unassertive’’, and in a position without any power, it was very difficult to gain the confidence needed in order to be able to openly question, negotiate and direct the care of her infant. Therefore, it is very important to identify these mothers in order to help them by giving them continuous reassurance. This would particularly be required when the situation changes from support needing to encouragement in participation. Lee et al (2009) found that mothers received support from the healthcare professionals and the social networks that mothers made. These helped to create the connections that developed between the mothers and infants making their journey towards parenthood possible. They discovered that challenges are further compounded in Taiwan, where women are traditionally required to practice the cultural ritual which includes confinement to the house with a special balanced diet for the first month postnatal. Lee et al (2009) used the grounded theory approach with in-depth interviews and constant comparison. All interviews were audio-taped and notes were made during and immediately after the interview concerning actions and body language of the mother during the interview. The finding of this study further indicated that the initial sight of the life-support equipment was shocking. The technological environment created a fearful atmosphere, and the medical equipment attached to their infants caused the mothers further physical separation. The mothers indicated that they were so afraid of the equipment that it took them a long time to be able to participate in their infants’ care. In turn, this hampered them from establishing positive mother–infant interactions. Chiu and Anderson (2008), found that preterm births often negatively influence mother–infant interaction due to lack of physical contact. In addition, they found that skin-to skin contact post-birth has positive effects on infant development. These researchers conducted a randomized controlled trial (RCT) using questionnaires for data collection. In addition, mothers were further video-taped during a feeding session. Ali et al., (2009),highlight the importance of kangaroo care in their RCT where the researchers conducted their study with one hundred and fourteen infants. This study showed that the infants exposed to kangaroo mother care had an increase in rectal temperature compared to conventional care, therefore having a decreased risk of hypothermia. The mean temperature during kangaroo mother care was of 37 degrees Celsius while the mean temperature during conventional care was of 36.7 degrees Celsius. The data collected was through posted questionnaires. Discussion In the 3 qualitative studies found, the data was collected through interviews of which 2 were semi-structured while 1 was unstructured. Parker (2011), Fenwick et al (2008) and Lee et al (2008), used the Grounded theory approach. However, while Parker and Fenwick use semi-structured interviews, Lee uses unstructured interviews. In semi-structured interviews there is a topic guide with list of areas or questions to be covered with each respondent. This technique ensures that researchers will obtain all the information required, and gives respondents the freedom to respond in their own words, provide as much detail as they wish, and offer illustrations and explanations. Lee et al (2009) uses ground theory approach but incorporated with unstructured interviews. Unstructured interviews also known as are flexible but are more time-consuming than semi-structured since the interviewer listens and does not take the lead. The interviewer listens to what the interviewee has to say. The interviewee leads the conversation (Wood Ross-Kerr, 2011). However, anonymity for confidentiality which is of utmost importance is not possible. When using unstructured interviews, the researchers have to be able to establish rapport with the participant. The reason is that the interviewers have to be trusted if someone is to reveal intimate life information. This may lead to interviewee bias. Also, it is important to realise that unstructured interviewing can produce a great deal of data which can be difficult to analyse. Lee et al (2008) and Fenwick et al (2008) conducted the interviews themselves while Parker (2011) did not, thus reducing the bias. However, interviewer bias occurs even if someone else is conducting the interview. The number of mothers in the study of Lee et al (2008) was adequate since with in-depth interviews 20 participants are enough. However, to account for the small sample, more interviews and observations were done with the same participants in order to reach theoretical saturation. Usually informants are selected for in-depth interviews in a purposive manner questioning the generalizability of the results (Wood Kerr, 2011). A major controversy among grounded theory researchers relates to whether to follow the original Glaser and Strauss procedures or to use the adapted procedures of Strauss and Corbin (Polit Beck 2010). Grounded theory method according to Glaser emphasizes induction or emergence, and the individual researchers creativity within a clear frame of stages, while Strauss is more interested in validation criteria and a systematic approach. Parker (2011) uses the original Glaser and Strauss (1967) paradigm while Lee et al (2008) and Fenwick et al (2008) use Strauss and Corbin (1998) procedures. One of the fundamental features of the grounded theory approach is that data collection, data analysis, and sampling of study participants occur simultaneously. A procedure referred to as constant comparison is used to develop and refine theoretically relevant categories. Categories elicited from the data are constantly compared with data obtained earlier in the data collection process so that commonalities and variations can be determined. As data collection proceeds, the inquiry becomes increasingly focused on emerging theoretical concerns. All 3 studies use constant comparison. All the above 3 studies use audio-taping for data collection except for Fenwick et al (2008) who used field note documentation as well. Audio-taping enables eye contact to be maintained and to have a complete record for analyses, however, some interviewees may be nervous of tape-recorders. On the contrary, in note taking on the other hand, a lot of eye contact is lost unless a type of short-hand is learnt. However, the interviewer will have plenty of useful quotations for report when transcribing the interview. Randomized controlled trials consist of a complete experimental test of a new intervention, involving the random assignment of a large and varied sample to different groups (Polit Beck, 2010). The intention of an RCT is to arrive to a judgment as to whether the novelty of an intervention is more effective than the traditional intervention (Polit Beck, 2010). This intention was well noticed throughout the RCTs chosen by Ali etal., (2009). Wood Kerr, (2011) sustain that RCTs are the most rigorous method to determine a cause-effect relationship between the treatment and the outcome. Furthermore, RCTs were also described as the gold standard trial for evaluating the effectiveness of a clinical intervention ((Muijs 2010). One of the primary aims of RCTs is to prevent selection bias by distributing the patient, randomly between the two groups, so that the difference in the outcome and results can be justified and attributed only to the intervention under study. Thus, through random selection there is a better balancing of any confounding factors, therefore creating similarity between the groups (Cottrell McKenzie, 2010). In effect in this literature review, RCTs were found to be useful and beneficial to compare the effect of KMC and conventional care on the physiological aspects of the infant. Ali et al., (2009) chose to add blocking to randomisation so as to ensure a better balance in the number of infants allocated in the groups. These groups were randomized through simple randomization and the disruption of groups was achieved by delivering a concealed envelope technique. Through random sampling, Polit Beck (2010) explain that each element in the population has an equivalent, autonomous chance of being chosen. However, this design is not used frequently as it is lengthy and may be expensive (Wood Kerr, 2011). Chiu and Anderson (2008), use mixed methods of data collection by using both questionnaires and video-taped interviews. The use of multiple sources or referents to draw conclusions about what constitutes the truth is called triangulation. This is one approach in establishing credibility as it enables the researcher to counteract the weaknesses in both designs. The use of video-taping provides the most comprehensive recording of an interview since it captures body language, facial expressions and interaction (Gerrish and Lacey 2010). However the interviewee may become uncomfortable and act differently than in normal circumstances questioning the reliability of the data collected. In addition, questionnaires are the main research tools used in quantitative research. They are very advantageous as they can be constructed in such a way as to meet the objectives of almost any research project. In the Family Needs Inventory used by Nicholas-Sargent (2009), the ‘not applicable’ part was removed from the Likert scale in order to report definite opinions. Questionnaires can measure the participants factual knowledge about a certain subject or an idea or else they can be used to explore opinions, attitudes or behaviours (McNabb, 2008). Moreover, questionnaires are also less expensive than most other research instruments and are also less time-consuming . Self-administered questionnaires provide the participants with anonymity, and responses are not affected by the interviewers mood or presence (Wood Ross-Kerr, 2011). On the other hand, the main disadvantage of questionnaires is that there is a high possibility of a poor response rate since some questions are ignored, misinterpreted, incorrectly completed or inadequately detailed (Polit and Beck 2010). The RCT of Chiu and Anderson (2009) and Ali etal. (2009),, is one of the most powerful tools of research where people are allocated at random to receive one of several clinical interventions. However RCT’s are vulnerable to multiple types of bias at all stages of their workspan (Geretsegger et al 2012). Hence the need to establish validity and reliability. In the study done by both Ali etal.,(2009) and Chiu and Anderson (2009),the researchers increase the rigor on the study by using a large number of participants. In addition, Chiu and Anderson (2009) use the Nursing Child Assessment Satellite Training Program (NCAST) Feeding and Teaching scales. Nicholas-Sargent (2009), improved the rigour by using the Critical Care Family Needs Inventory (CCFNI), as a framework for the FNI. CCFNI has been thoroughly reported with results indicating internal consistency and construct validity (Gerrish and Lacey 2010). Despite this, Nicholas-Sargent (2009), use a small scale study and therefor e the results cannot be generalized. Limitations In the study done by Lee et al (2008), the data were only collected from one hospital in this present study causing generalisability of the results to be low. Moreover, the sample was restricted to those who did not have additional social, cultural or medical circumstances to consider. Moreover, coding was done by researcher itself and this might have caused some bias. Both Nicholas-Sargent (2009) and Parker (2011) use small scale studies but these were qualitative studies. Therefore, to a certain extent the findings cannot be generalized across the population of families involved with the NICU. In addition, Parker (2011) uses a retrospective study, which might have been subject to bias in recalling information. There was absence of pilot study in both Nicholas-Sargent (2009) and Chiu and Anderson (2009). The use of pilot studies helps to assess the design, methodology and feasibility of the tool and typically includes participants who are similar to those who will be used in the larger research study ( Wood Kerr 2011). Hence, their importance. Also, the instruments chosen by Chiu and Anderson (2009), being the (NCAST and the feeding and teaching scales) for this study might not be sensitive enough to capture any between-group difference in changes resulting from the intervention. Finally, Ali et al., (2009) fail to mention intention to treat analysis where researchers can introduce reality into research by outlining that not all randomised participants will continue throughout the study. Therefore, this might be a potential weakness in this study. It was also noted the there was no detailed report about the time intervals between the two different groups. Hence, this may also have introduced performance bias. In the grounded theory approach taken by Fenwich et al (2008), limitations lie in the method of data collection itself through semi-structured interviews that were tape-recorded and field note documentation done. The authors did not acknowledge limitations in the study. Recommendations Maternal contact Fenwich et al (2008) suggests prioritising maternal-infant closeness when underpinning policies and protocols and suggests the unrestricted access to their child. Lee et al (2008) found that in Taiwan mothers are allowed to visit for 30 minutes twice a day. In Malta, mothers are allowed to stay with the child 24 hours a day. In addition, skin-to-skin contact is recommended by both Lee et al (2008) and Chiu and Anderson (2009). The latter suggests that all mothers, if they are able and whether or not they ask for it, skin-to-skin contact should be encouraged. My suggestions on interventions for critically ill infants include encouraging the parents’ presence at the bedside, assisting the parents in personalizing the bedside, and teaching the parents to gently touch their infant. Another approach is to hang a simple picture board with the first names of nurses and practitioners near the entrance to the unit. This picture board helps anxious families feel welcomed in this healing environment. In our unit, those babies who have central lines such as umbilical arterial catheters (UAC), the mothers are not allowed to hold the baby for fear of bleeding if the UAC gets dislodged. However, if the mother shows signs of needing contact with the baby, we allow her to hold the baby with constant supervision. In the case of babies that are ventilated mothers are only allowed to hold their baby if the prognosis is very poor. Therefore, this shows that, if the baby is on long term ventilation, skin-to-skin is hindered from being introduced. Fenwich et al (2008), recommend the development of tools that can better evaluate the satisfaction of the mother. Hence, the need for longitudinal qualitative research. In my opinion this would yield good results when past experiences would show which improvements were helpful and which were not. NICE standards (2010), specify the use of surveys. We can incorporate these surveys after consideration with the midwifery officer. Mother-nurse-infant interaction Because of the complexity of illness, parents of critically ill infants are anxious and fear the worst with every visit to the NICU. Strategies need to be adapted to decrease maternal anxiety while supporting the needs of these infants. (Nicholas-Sargent 2009). Nurses play a vital role in helping parents throughout the stressful and challenging experience of the NICU by developing therapeutic relationships and providing emotional support. These approaches enable parents to feel more supported, more involved, confident, and more effective as parents of their vulnerable newborn. The experience of parents in the NICU occurs during an emotionally intense period fraught with anxiety, stress, depression, and feelings of hopelessness. Therefore, Nicholas-Sargent (2009) suggests that, it would be vital to do an NICU orientation for expectant parents with a high risk of giving birth to a premature infant or a compromised newborn. Supporting and facilitating their parenting role will help decrease their stress, strain, anxiety, and depression. Lee et al (2008), nurses need to respect the cultural preferences of mothers as this would promote desired health outcomes. This would aid in meaningful, holistic and individualized care. According to Nicholas-Sargent (2009), personalized one-to-one as opposed as opposed to group support would be helpful. In addition Nicholas-Sargent (2009), suggests that nurse education is needed to improve the awareness of the impact of the counselling service. However, the service needs to be more flexible due to fluctuations in the health condition of the baby. In fact, what we notice is that mothers would require counselling at different stages of the hospitalization. Therefore, if the service was refused once, it may still mean that mothers would need it at some other point in time. Nicholas-Sargent (2009), further suggests that the counselling service would be extended to the whole family from the hospital as well as in the community., Both the DH (2009), and NICE (2010) highlight the importance of Family-Centered Care (FCC) views the family as the ‘child’s primary source of strength and support’ and allows for collaboration, respect, and support with the parents and family during all levels of the service delivery. To foster participation in care for the infant, unrestricted visiting hours should be encouraged for the nuclear family of the neonate. In Malta, visiting hours are restricted to parents only due to increase in cross infection when family members were allowed to visit for 1 hour everyday during the day. However, timing of care may still be arranged to facilitate parents’ participation. In addition, special moments such as baby’s first time off CPAP (continuous positive airway pressure) needs to take place during parents’ presence. Cockfort (2011), highlights that missed opportunities to involve parents in care, heighten anxiety and can create a sense of sadness and loneliness . Information for mothers Mothers vary in the amount of information they can assimilate under stress. Therefore identifying parents’ feelings through active listening and observing will help us to pick up on parents cues and respond appropriately in order to provide parents with accurate and clear information (Fenwick et al 2008). Nicholas-Sargent (2009), adds that, information regarding the health status of the baby needs to be give in a timely provision. Parker (2011), recommends the access to certified interpreters for non-English speaking parents to enable them to ask questions and get the information they need as well as information regarding the counselling services. Likewise, an updated information board at the infant’s bedside helps mothers retain information while feeling welcome at the bedside. In my opinion, these interventions create an environment that facilitates maternal- infant attachment by promoting maternal competence with meaningful positive parenting skills and fostering partnership in care.. Conclusion In summary, the findings showed that parents of infants admitted to the NICU experience stress, depression, anxiety, and feelings of powerlessness, hopelessness, and alienation within the environment of the NICU. These situations are often overwhelming and catastrophic for the mothers keeping in mind that the process of motherhood is a protecting and loving phenomenon. Therefore mothers should participate in the care of their sick, fragile infant in the NICU through mother-infant interaction. Nurses need to be supportive and informative in dealing with parents in the NICU. Therefore, the need for parents to be given the access of interpretation by certified interpreters in order to overcome language barriers has been identified. Further, information and emotional support is required throughout the stay in the NICU, However, it was further found that information in preparation for discharge planning is vital. This enhances parental knowledge and decreases stress, which promotes more effective parenting. Further, as understanding of the parents’ experience of having an infant admitted to the NICU increases, nurses will be better prepared to meet parental needs and alleviate parental suffering. Providing holistic, developmentally supportive care and open communication with parents in this stressful experience is essential. Moreover, the need for family-centered care has been identified. REFERENCE LIST Ali, M.S., Sharma. J., Sharma. R., Alam. S. (2009). Kangaroo mother care as compare to conventional care for low birth weight babies. Dicle Tip Dergisi. 36(3), 155-160. Chiu S. Anderson G.C., (2009). Effect of early skin-to-skin contact on mother–preterm infant interaction through 18 months: Randomized controlled trial. International Journal of Nursing Studies, Vol. 46, pp.1168–1180. Cleveland, L.M., 2008. Parenting in the neonatal intensive care unit. Journal of Obstetric, Gynecologic, and Neonatal Nursing, Vol. 37 (6), 666e691. Cockfort S., (2011). How can family centred care be improved to meet the needs of parents with a premature baby in neonatal intensive care? Journal of Neonatal Nursing, Vol.95(5), pp.365-368. Cottrell, R.R. McKenzie, J. F. (2011). Health Promotion and Education Research Methods using the Five-Chapter Thesis/Dissertation Model (2nd ed.). Sudbury, Canada, United Kingdom: Jones and Bartlett Publishers. DeRouck, S. Leys, M., (2009). Information needs of parents of children admitted to a neonatal intensive care unit. A review of the literature. Patient Education and Counselling, 76 (2), pp.159-173 DH: Department of Health, 2009. Toolkit for high-quality neonatal services. DH, London. Domanico R., Davis D.K., Coleman F. Davis B.O. (2010). Documenting the NICU design dilemma: comparative patient progress in open-ward and single family room units. Journal of Perinatology, Vol.31, pp. 281–288 Fenwick J., Barclay L., Schmied V.,(2008). Craving closeness: A grounded theory analysis of women’s experiences of mothering in the Special Care Nursery. Women and Birth, Vol. 21, pp.71—85. Geretsegger M., Holck U. and Gold C., (2012). Randomised controlled trial of improvisational music therapys effectiveness for children with autism spectrum disorders (TIME-A): study protocol. BMC Pediatrics Vol.12(2), pp.1471-2431. Gerrish K. Lacey A. (2010). The Research Process in Nursing. Blackwell Publishing Ltd. UK. 6th ed. Glaser, B.G., Strauss, A., 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine, NewYork. Gray, D. E. (2009). Doing Research in the Real World (2nd ed.). London, California, New Delhi, Singapore: Sage Publications. Grech V., Cassar M. Distefano S., (2012). Nurse staffing levels on a regional neonatal paediatric intensive care unit. Journal of Paediatric Intensive Care, Vol. 1(1), pp.25-29. 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The Parental Experience of Having an Infant in the Newborn Intensive Care Unit. The Journal of Perinatal Education | Summer, Vol. 18(3), pp.23-29. Parker L., (2011). Mothers’ experience of receiving counselling/ psychotherapy on a neonatal intensive care unit (NICU). Journal of Neonatal Nursing, Vol.17, pp.182-189. Polit D.F. Beck C.T. (2010) Essentials of Nursing Research: Appraising Evidence for Nursing Practice, 7th ed. Wolters Kluwer Health | Lippincott Williams Wilkins, Philadelphia. Nicholas-Sargent A., (2009). Predictors of needs in mothers with infants in the neonatal intensive care unit. Journal of Reproductive and Infant Psychology, Vol. 27(2), pp.195–205. Schira, M. (2009). Appraising a single Research Article. In Mateo, M. A. Kirchhoff, K. T. (Eds.), Research for advanced practice nurses: from evidence to practice (pp. 73-85). New York: Springer Publishing Company. Strauss A. Corbin J.( 1998). Basics of qualitative research. 2nd ed. Newbury Park, CA: Sage Publishers;. 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Literature Review: Access to Care for Addicts

Literature Review: Access to Care for Addicts Hettema, J., Sorensen, J. L. (2009). Access to Care for Methadone Maintenance patients in the United States. International Journal Mental Health Addiction. 7 (3) 468-474. DOI:10.1007/s11469-9204-6 This paper was presented to increase the awareness of individual with Opiates treatment programed Dependency are denied access to residential treatment. Although, Methadone Maintenance Therapy has been proven to reduce illicit drug use, improve psychosocial functioning, ability to keep employment, decrease criminal activities, and contracting HIV, AIDS, and Hepatitis. There are great concerns for those clients in Methadone Maintenance Therapy who need more intensive treatment. MMT does provide basic medical screening, dosing, and outpatient counseling. The more services provided for the client leads to a better outcome. The study found that treatment dose measured by number of days in treatment, number of treatment session attended and number of services received leads to a positive outcome. Some factors to consider are limited availability of residential treatment, insurance payment and the impact of abstinence philosophy. Mainstream views addiction as a moral problem rather than a medical issue. Hettema Sorensen (2009) identifies philosophical differences separates mental health and addiction services is hard to integrate. Society regards methadone as a necessary evil. There are ongoing empirically evaluated treatment approaches who do not follow an abstinence oriented philosophy. There are issues with the Americans with Disability Act because client is being denied services because of their use of a prescribed for their substance dependency. There are ambiguities in the interruption of that. The author is not aware of any litigation now. Ducharme, L.J., Knudsen, H.K., Roman, P. M. (2006). Evidence-based treatment for Opiate-Dependent clients: availability, variation, and organization correlates. The American Journal of Drug and Alcohol Abuse. 32.569-576. DOI: 10;1080/009529906000920417 This article examines the availability and correlates with evidence-based practices for opiates dependence in the United States. This research sampled addiction treatment with and without MMT services. This article also examined community based treatment programs with MMT units as one of their modalities. The researchers included both methadone available and non-methadone setting, then compared the number and type of service available to users. The method used was a data analyses collected in 2002-2003 national representative sample of addiction treatment centers in public and private sector. There was extensive face to face interviews conducted with administrators and clinical directors of 763 treatment center. The data collected in 2002-2003 face to face interviews included  organizational characteristic, size, ownership, accreditation, staffing, treatment practice methadone availability, level of care, pharmacotherapies, wraparound service, The findings suggested the majority of opiate dependents clients are not in Methadone Clinics. Many agencies are not willing to refer opiates dependent patient. to MMT. The opiate dependence client would benefit from the referral that uses evidence practices if referred. The research suggests further study to determine which opiate dependence client would benefit from evidence client care. Parks, C., Fullerton, C.A., Kim, Meekee, Montejano,, L., Lyman, Russell, Dougherty, R. H., Daniels A. S., Ghose, S. S., Delphin- Rittmon, M. E.., (2013). Medication-Assisted Treatment with Buprenorphine: assessing the evidence. Psychiatric Services in Advance.DOI10.1176/appi.ps201300256 This article reviews Buprenorphine treatment as an alternative to Methadone Maintence Treatment for long term treatment of Opioid Use Disorder. Buprenorphine is not considered as abstinence treatment. The purpose of buprenorphine is to reduce or eliminate opioid use. The authors conducted the research that examined abstracts of identical articles for compliance with the review. The research provided evidence of the effectiveness of improving treatment retention and decreasing illicit opioid use. The evidence is growing both BMT and MMT improved pregnancy outcomes. Ongoing treatment is necessary.