Saturday, January 25, 2020

Health and Social Care Essays red dot system

Health and Social Care Essays red dot system Introduction In the frequently frantic and universally pressured world of the AE departments of this countrys hospitals, mistakes get made. This is a fact of life. In any human endeavour this is sadly true. Until recently, the blame culture that was prevalent within the NHS, made certain defensive behaviour patterns amongst staff almost endemic (Vincent, 1994). It is one of the characteristics of a professional life that you have to take responsibility for your actions. If you take the wrong action, you will be criticised. This defensive attitude was, to a large extent, fostered by the professional health insurers who, worried about paying out large quantities of their funds, demanded secrecy, no apology and a defensive stance from those that they insured.(Clinical Services Committee) It became apparent to those who were in a position to have an overview of the situation that such a situation was actually in nobodys interest (Barley, 2000). Healthcare professionals were practising defensive medicine, patients were being kept in the dark when mistakes were made, and most important of all, because problems were not examined in an open and constructive way, productive lessons were not learnt. All that was happening was that defensive stances were becoming entrenched. The advent of the no-blame culture is helping to erode these stances and attitudes (Aldridge 2000). It is allowing the development of practices which may help the efficiency of our hospitals and provide the patient with a better service. The red dot system arose as a product of both of these factors. The pressure on the AE department staff is often relentless and great. The structure of the system is that many decisions are taken by comparatively inexperienced staff members and often not the most appropriate for the decision that needs to be taken. Huge numbers of X-Rays are seen by junior doctors and decisions regarding treatment are initially made before a senior specialist has a chance to oversee them. It would follow, by any common sense analysis of the situation, that any measure that could help in the decision making process should be welcomed. This argument is taken further by the article by Vincent et al. (1988) . In the days before the red dot system was seriously considered, Vincent and his colleagues carried out a study of the radiological errors made by junior hospital doctors. They found an error rate of 35% when the X-Ray was assessed by the SHO alone. For errors with a clinically significant impact the rate was 39% (of abnormal films). The red dot system represents a mechanism to try to address this gap. It involves the radiographer usually, but not always, the one who has taken the film giving the clinician some feed back. Radiographers see many thousands of films and are generally very familiar with the structures that they show. Quite apart from their formal training, simply by everyday familiarity and experience, they get to know what is normal and what is not. The radiographer is therefore well placed to recognise an abnormality even though they may not fully appreciate the full clinical significance of what is on the film. The same argument can be applied to the clinician, who can generally recognise pathology in a patient but may not be so familiar with the X-Ray changes. The red dot system requires the radiographers to examine the film after it has been ordered by the clinician. If they feel that there is an abnormality on it they will place a self-adhesive red dot on it to denote that they believe that it contains an abnormality. Clearly this does not relieve the clinician of the responsibility of examining the film as, the legal responsibility for interpreting the film must rest with him. This is only reasonable since even the most experienced radiologist would only give a report on what he could see on the film, the full significance of the changes seen can only be fully assessed by a healthcare professional who has also seen and assessed the patient. As we will discuss later, the converse argument that the absence of a red dot does not imply that there isnt an abnormality it only denotes that the radiographer hasnt seen one. The red dot system In a letter to the BMJ Keith Piper (2003) outlined the case for the red dot system and the radiographer reporting system (See on). It was initially suggested by the Audit Commission in 1993 that radiographers could be trained to interpret certain images and this was found to be of particular interest in view of the difficulties that some departments currently experience with the reporting service The first accredited course was run in 1994 many radiographers have since been reporting on primary skeletal X-Rays in AE departments Piper points out that the system is designed to reduce errors in reporting X-Rays. It is ultimately totally reliant on the radiographs being finally reported by a senior radiologist in a timely fashion. Unfortunately, this is not always the case as Beggs pointed out in 1990 when it was found that over 20% of UK teaching hospitals did not report on all accident and emergency films With specific reference to the red dot system, the letter by Aldridge and Freeland (2000) passes comment on the system which is in use in their hospital and, having audited it, they present their results. The system in use conforms to that currently outlined by British Association of Accident and Emergencys guidelines (1983). The important facets of their system include The rapid return of X-Rays to the requesting clinician Reporting of X-Rays by a consultant radiologist within 24 hrs. Telephone recall of patients who have mistakes picked up The use of the red dot system by the radiographers The use of such X-Rays for teaching purposes for staff As far as the audit of the red dot system was concerned, they report the last audit showed an 1.5% false positive result, 2.0% false negative result with the rest categorised as true positive or negative results. The authors felt that this represented an excellent approach to what they described as an error prone activity, reducing mistakes by accident and emergency staff (often junior), increasing patient satisfaction, and reducing long term patient morbidity and litigation. This letter is a significant piece of evidence as it is written by two clinicians who are clearly anxious to assess the system and to make it work. They appreciate the problems, quantify them and address them by placing safeguards to minimise problems. Significantly, they suggest the use of the red dot system where it has picked up omissions by the clinical staff to be the basis of teaching junior staff in an attempt to further reduce potential problems. These results should be seen in the context of a study by de Lacey et al.(client to supply date) who considered the accuracy of casualty officers interpretation or X-Rays in their departments. They found that by comparing the casualty officers interpretation with that of a radiologist, it only compared favourably in 83% of cases. The 17% discrepancy clearly represents a major burden in terms of clinical implications for the patient, financial implications for the hospital and possibly litigation implications for the casualty officer. The study also examines the implications of a delayed reporting system (by the radiologist). It was found to reduce their workload by 25% by restricting their reporting to those films which the casualty officer was unsure or thought may have an abnormality. It clearly follows from this that any measure that is likely to increase efficiency inaccuracy of reporting is likely to have benefits of both economy and patient suffering. We therefore need to exami ne the premise that the red dot system does exactly that. These figures are clearly worrying insofar as the 17% discrepancy is a wide margin. The figures still have to be viewed in context however as, although they represent the interpretation of as specialist (the radiologist) as compared with that of the non-specialist (the clinician), the paper does not draw any distinction between the experience levels of the two groups. The clinicians may be comparatively inexperienced casualty officers and the radiologists probably are consultant grade. If that is the case, then the figures are much less alarming. This point is discussed in detail further on in the piece (Williams et al 2000) where radiologists in training are compared to radiologists of consultant grade. The point is brought into sharper focus by consideration of the next two papers. Before we consider this aspect however, we need to evaluate the accuracy of reporting in the AE Department environment. Benger and Lyburn (2003) attempted to investigate exactly that. They scrutinised the X-Ray output of an AE Department over a six month period (nearly 12,000 films). They identified the films which had discrepancies in reporting between the X-Ray staff and the AE Department staff. From the 12,000 films they found (only) 175 discrepancies. In clinical terms, this equated to a rate of 0.3% of patients who needed a change of management as a result. In all our deliberations on the subject, perhaps it is this that actually is the subjective criteria for whether a system works within tolerable limits or not. Different studies may find different discrepancy rates in interpretation of X-Ray films, but what is of practical value is the actual number of patients who require a change of management as a result. If a minor degree of subluxation of a proximal interphalangeal joint is missed by a casualty officer and subsequently picked up by a radiologist, it will appear on inventories of discrepancies such as the ones discussed above. In terms of patient care or treatment, it will not make a scrap of difference. This point is made, rather more eloquently and in a different context, by Fineberg (1977) and the Institute of Medicine (1977). This point should not be taken lightly and indeed, it goes to the core of this piece. Academic studies may show different abnormality detection rates between the different professional groups. While recognising that these are clearly important, they are not the yardstick by which we must judge the red dot system. We have already examined two papers on the subject that have reported differences in abnormality detection at each end of the spectrum one of 17% and one of 1.5%. We should not be blinded by these figures themselves. What actually matters is the number of patients who have a change of management decision as a result of this discrepancy. The paper quoted above (Benger and Lyburn 2003) is one of the few which actually gives us this information. They quote an observed change of management in only 0.3% of patients which, for any system, is a very tolerable level of error. This is clearly a very fundamental point and one that we need to examine further. The next paper that we sh ould consider looks at exactly this point and examines it in great detail. Taking a more academic approach Brealey and Scally (2001) tackle the difficult issue of just how to interpret the findings of a study that purports to evaluate the reading of X-Rays by two or more different professional groups. This is a very technical paper and is included here for the sake of completeness. It examines all of the possible margins for error and bias when reporting a trial. It throws little direct light onto our deliberations here because of its very technical nature, but it would be of considerable importance to one who wished to interpret the findings of a major trial independently. The point needs making that the trial design can influence the outcome of the trial (and therefore its usefulness) to a great extent. As we have made the point above, the actual figures produced at the end of the trial must be interpreted in the light of the trial design. Actual detected differences in readings between two groups of professionals may be of academic interest, but in the c ontext of our examination of the red dot system, they are not nearly as important as a critical examination of the discrepancies which resulted in a change of patient menagement. On the direct issue of the red dot system, an almost immediate precursor to the system was reported in the BMJ in 1991 by Renwick et al. . He discussed a system that was tried out of getting radiologists to indicate their diagnoses on the pre-reported X-Rays, in order to guide the casualty officers in their decisions. The conclusions of the study were that, because of the high rate of false positive reporting (7%) and higher rate of false negatives (14%) it was appropriate for radiologists to offer useful advice but to take no more responsibility than that. We shall discuss the issues of false positives and false negatives further on in this piece and clearly they are an inherent problem with the system. It follows that we should, perhaps, address the reasons why there are these discrepancies and use them as a learning exercise to try to reduce the gap. In the excellent and concise article written by Touquet et al. (1995) the authors address the Ten Commandments of AE Department radiology. They discuss the red dot system in the following terms. Inexperienced doctors will inevitably come across injuries that they have never seen before. In these cases it may not be possible to make a diagnosis but you will notice that the films do not look quite right. Good examples of this are lunate and perilunate dislocations of the hand. It is important to seek senior advice and also to listen to the radiographer. Many departments operate a red dot system, in which the radiographer flags up an abnormality. An experienced radiographer may be as good as or even better than a junior doctor at interpreting films. The problem with this system is that the absence of a red dot does not necessary mean that there is no abnormality. This is important to remember because the final responsibility lies with the doctor, and not the radiographer. Therefore never accept poor quality or inadequate films. The most salient point of this article is in the last paragraph. The absence of a red dot does not mean the absence of an abnormality and the liability lies with the doctor not the radiographer. This is clearly proper, as any experienced healthcare professional will state, any investigation (particularly an X-Ray) is only an adjunct to diagnosis, it is the person who is clinically in charge of the patient who has to assimilate all the available evidence to make a diagnosis. The radiographer has not seen the patient to examine, and certainly will not have to hand all of the other potential diagnostic aids that are available in a modern AE Department. It is entirely reasonable to ask for his opinion on an X-Ray film, but it is not reasonable to hold him responsible for its definitive interpretation when he has not seen it in the context of the patient. This statement is behind the reasoning for the legal responsibility of X-Ray interpretation. It would be clearly inappropriate to ask a radiographer for his opinion on a film and then make him responsible for any subsequent management decisions that were based on that opinion. Some commentators have criticised the red dot system for its clear lack of apportionment of responsibility to the radiographer. We would suggest that this shows a fundamental lack of appreciation of the problems involved. The radiographers are trained to be experts in taking X-Ray films. They are not, and do not pretend to be, trained in the biological sciences and their applications to pathology and the human disease processes. It is quite appropriate to ask their opinion in an area of their expertise (the interpretation of the X-Ray film), but it is quite inappropriate to ask them to make clinical management decisions. For this reason, all questions of liability always rest on the clinician in charge of the p atient, and it is only right that this should be the case. It is fair to say that some of the views reviewed so far have been old school necessarily so, as the intention was to document the evolution of the red dot system. It is equally fair to state that we have only considered the use of the system in the AE Department. The truth of the matter is that in the recent past, the status of the radiographer has increased in professionalism both within their own speciality and within the NHS as a whole. Many of the comments made in some of the earlier papers quoted will therefore, now seem rather outmoded and not consistent with the modern experience of working in the NHS. To redress the balance we shall look at an article from Papworth hospital by Sonnex et al; (2001) . The authors describe a system currently in use at an acute cardiothoracic unit. Radiographers were asked to assess all the X-Rays taken over a six month trial period. Those that were assessed as showing acute changes had a red dot placed on them to denote an abnormality and these were then assessed by a radiologist. The success or failure rate was then measured against this standard. The figures are rather different from the figures quoted in the studies that looked at skeletal X-Ray in AE Departments. The reason for this is almost certainly that a chest X-Ray is notoriously hard to interpret, even more so when it is a post operative X-Ray. The results were reported as a total sample of 8614, of which 464 (5%) had red dots applied. Over 100 of these were considered inappropriate. 38 X-Rays which were abnormal were not picked up. It would appear that radiographers tend to err on the side of caution when reviewing an abnormal chest X-Ray, even more so when previous comparative films were not available for comparison. This particular study had a high false positive rate. One should not lose sight of the fact that the radiographers concerned were dealing with a different population to those that we were considering earlier. The patients were generally very ill and often in a post operative state making assessment far more critical than perhaps the colder X-Ray of the AE Department where decisions could reasonably be delayed safely for 24-48 hrs. there was therefore perhaps far more pressure on them to report any possible abnormality. It is also appropriate to comment that this was the first stage of a study which then went on to review the radiographers performance after a further period of training. One would reasonably anticipate a higher agreement rate after appropriate training. As we have already seen the red dot system has evolved in several different variants. The basic premise is the same in each case how is it possible to minimise the potential sources of error caused by inexperience? A further variant is outlined by Williams et al (2000). His paper title specifically involves the cost effectiveness of the scheme as well as the overall impact on patient management. In this scheme ( which was running at the Radcliffe Hospital in Oxford) the original AE Department films were reviewed by radiologists-in-training. They identified 684 incorrect diagnoses over a one year period. These were then called red reports and reviewed by a consultant radiologist. During this process 351 missed fractures were detected with ankle, finger and elbow fractures being the main areas where pathology was missed. Williams also reported 11 incidences of pathology on a chest X-Ray as being missed. This amplifies the point made earlier that the radiologists-in-training tended to produce false positives at a rate of about 18% when compared to the subsequent, more expert opinion. In this particular study, further action was taken by the AE Department staff in 42% of those cases although no operative intervention was required in any patient as a result of the missed diagnosis. Despite these figures, it must be noted that these cases form a very small percentage of the X-Rays taken in a busy AE Department False positives and false negatives We have looked at a number of studies that have compared radiographers interpretations of X-Ray films against that of a Consultant Radiologist who has generally been used as the Gold Standard. The difference between the two sets of interpretations is then subdivided into false positives and false negatives. This group is actually the most important as it is firstly an indication of the usefulness of the whole system of red dot reporting and secondly it is also an indication of how much more training any particular reader (radiographer or casualty officer ), of the films has to undergo, in order to make fully competent assessments. The false positive is the situation where the radiographer has identified a problem that is not there. Conversely, the false negative is when they have missed pathology that is there. In most of the assessments that we have seen, there are more false positives than negatives. This implies that the radiographers are being over cautious when confronted with an equivocal film. Several of the papers that we have seen so far have stated (either explicitly or otherwise) that the absence of a red dot does not imply the absence of any pathology. Any common-sense analysis of the situation would suggest that this is clearly self-evident. It must be the case where two highly trained but clearly not expert healthcare professionals are looking at a film for pathology, they are probably more likely to arrive at the right answer than one alone. Brealey (2005) produced a Meta-analysis of studies involving radiographers input in interpreting films and found that radiographers involved either in the red dot system of X-Ray reading improved with experience and with training, acquired an accuracy approaching that of radiologists when dealing with skeletal X-Rays. The red dot system is designed to utilise the expertise of specially trained radiographers to interpret plain X-Rays. From the evidence presented above we can say that there is evidence that radiographers are clearly more expert in interpreting plain skeletal X-Rays than chest X-Rays or visceral radiographs. The red dot system appears to be a growing movement within the profession. A paper by Brealey (2003) pointed out the fact that between 1968 and 1991 the radiologists workload increased by 322% but the number of posts increased by only 213%. As a result of this the number of films successfully reported within 48hrs fell to 60%. As a result of this trend the Royal College of Radiologists decided to endorse the trend of radiographers giving indications of pathology on X-Rays . Brealeys paper examines the initial cohort of radiographers who were trained under this scheme and found that, statistically, there was no significant difference between the reading of an X-Ray by a radiograph er or a radiologist (in the case of plain skeletal X-Rays) which supports the view that the red dot system is viable. Any examination of this issue would be incomplete without a consideration of the detailed and analytical paper by Friedenberg (2000) which he provocatively entitled The advent of the supertechnologist. It is particularly relevant to our consideration of the red dot system and the role of the radiographer as it looks at the background to the whole issue. Friedenberg uses the term Skill mix as a specific term to define the current trend in medicine away from specialisation and departmentalisation and towards the communal utilisation of expertise from different individuals in related fields to complement or increase the expertise available to patients. He points out that this is not actually a new concept and cites the optician who relieves the workload of the ophthalmologist and the nurse specialist anaesthetist who relieves the anaesthesiologist by performing uncomplicated procedures. He quotes a whole host of paramedical providers who now assist the physician, in most cases without p roblems Loughran et al (1996a, 1996b, 1992) have specifically looked at the practicality of utilising the skills of the radiographer to better advantage than just taking the films. He contrasts the difference in practice between the UK and the USA, citing the cause of the complete separation of the roles of radiographer and radiologist in the USA as being due to the fact that in the USA, the radiologists still operate largely on a fee-per-service basis whereas in the UK the pressure is primarily on clinicians to become more efficient and to keep costs down. Friedenberg, interestingly also examines the evolution of the legality of the roles of radiographer and radiologist. Between 1900 and 1920, there was competition between radiographers and radiologists with regard to the performance of radiography and the interpretation of radiographs. In the middle 1920s in England, radiographers were prohibited from accepting patients for radiography except under the direction of a qualified medical practitioner (Quotes Larkin 1983) After this the professions came closer and by 1971 Swinburne (1971) was suggesting that radiographers could perfectly well separate normal from abnormal films, which after all is the basis behind the red dot system . As we have discussed earlier, this move then progressed into the first formal appearance of the red dot system in North Park Hospital in 1985. The first trials of the system found that approximately half of the abnormalities that were not picked up by the junior casualty officers were detected by the radiographers. The early safe guards were outlined by Loughran (1996) as follows: 1. It is made clear to the referring physician that the report is a technologists report. The physician is encouraged to consult the radiologist if there is a lack of clinical correlation. 2. The technologist must consult the radiologist if he or she is in doubt. 3. The physicians, radiologists, and technologists have devised a set of guidelines to create a safe environment for this practice. 4. Initially, the technologists practice is monitored on a regular basis. After the technologist is experienced, however, monitoring is no longer performed. Such monitoring should be performed if a new technologist enters this practice. Interestingly, Loughran also subsequently produced a set of guidelines for the radiographer : 1. The technologist should be confident in his or her report. 2. In cases of doubt, a radiologists opinion should be obtained. 3. In such cases, although the report may be issued by the reporting technologist, the consultants name should be appended to the report. 4. All reports by a technologist should be clearly designated as a technologists report. 5. If the patient re-presents for radiography of the same body part within 2 months, this should be reported by a radiologist. 6. Non-trauma examination findings should be reported by the radiologist. 7. All accident department images in patients who are subsequently admitted as inpatients should be reported by the radiologist. 8. Clinicians are to be advised to consult the radiologist if clinical findings do not match those in the technologists report. 9. Regular combined reporting sessions are to be held with the consultant radiologist. Robinson (1999) Defines the ideal areas for radiographers and radiologists with the following definition between cognitive and procedural tasks thus: Procedural tasks can be described, defined, taught, and subjected to performance standards that make them transferable to other staff with appropriate training. Cognitive tasks that are related not only to the interpretation of images but also to decisions about differential diagnosis and appropriate choice of further investigations are more difficult. We have examined the evolution of the red dot system and there have been moves towards the logical progression beyond the radiographer simply indicating that there may be a problem to the situation where radiographer who have undertaken further training have developed their skills in other ways as well, but this is beyond the scope of this piece. Perhaps we should leave the last thought to Friedenberg who envisages the future as being the era of the Supertechnologist and it is the specialist who is left to do a small number of very highly specialised procedures. References 1. Jonathan Aldridge, Peter Freeland, (2000) Safety of systems can often be improved BMJ 2000;321:505 ( 19 August ) 2. The Audit Commission (1995). Improving Your Image How to manage Radiology Services More Effectively. London: HMSO.1995 3. Victor Barley, Graham Neale, Christopher Burns-Cox, Paul Savage, Sam Machin, Adel El-Sobky, Anne Savage (2000) Reducing error, improving safety BMJ 2000;321:505 ( 19 August ) 4. Beggs I, Davidson JK 1990. AE reporting in UK teaching departments. Clinical Radiology, 41, 264-267. 5. J R Benger, I D Lyburn (2003) What is the effect of reporting all emergency department radiographs? Emerg Med J 2003; 20:40-43n. 6. Benger JR. (2002) Can nurses working in remote units accurately request and interpret radiographs? Emerg Med J. 2002 jan;19(1):68-70 7. S Brealey, A J Scally (2001) Bias in plain film reading performance studies British Journal of Radiology 74 (2001),307-316 8. S Brealey, D G King, M T I Crowe, I Crawshaw, L Ford, N G Warnock, R A J Mannion, S Ethell,(2003) Accident and Emergency and General Practitioner plain radiograph reporting by radiographers and radiologists: a quasi-randomised controlled trial British Journal of Radiology (2003) 76, 57-61 9. Brealey S, Scally A, Hahn S, Thomas N, Godfrey C, Coomarasamy A. (2005) Accuracy of radiographer plain radiograph reporting in clinical practice: a meta-analysis. Clin Radiol. 2005 Feb;60(2):232-41 10. Brennan TA, Leape LL, Laird NM, Herbert L, Localio AR, Lawthers AG, (1991) Incidence of adverse events and negligence in hospitalised patients: results of the Harvard Medical Practice study. N Engl J Med 1991; 324: 370-376 11. Clinical Services Committee, British Association for Accident and Emergency Medicine. X-ray reporting for accident and emergency departments. London: BAEM, 1983. (Currently under revision.) 12. C K Connolly (2000) Relation between reported mishaps and safety is unclearBMJ 2000;321:505 ( 19 August ) 13. Fineberg HV, Bauman R, Sosman M. (1997) Computerised cranial tomography: effect on diagnostic and therapeutic plans. Institute of Medicine. Policy statement: Computed tomographic scanning. Washington DC: National Academy of Sciences, JAMA 1977;238:224-7. 14. Richard M. Friedenberg, (2000) The Role of the Supertechnologist Radiology. 2000;215:630-633.) 15. Johansson H, RÃÆ'Â ¤f L. (1997) A compilation of diagnostic errors in Swedish health care. Missed diagnosis is most often a fracture.Lakartidningen 1997; 94: 3848-3850 16. Pia Maria Jonsson, GÃÆ'Â ¶ran Tomson, Lars RÃÆ'Â ¤f, (2000) No fault compensation protects patients in Nordic countries BMJ 2000;321:505 ( 19 August ) 17. G de Lacey, A Barker, J Harper and B Wignall An assessment of the clinical effects of reporting accident and emergency radiographs 18. Larkin G. (1983) Occupational monopoly and modern medicine London, England: Tavistock, 1983. 19. DD Loughran CF, Alltree J, Raynor RB, (1996) Skill mix changes in departments of radiology: impact on radiologists workloadreports of a scientific session.

Friday, January 17, 2020

Research Paper: Paternity Leave Essay

There is about a six week to six month period right after a child is born where forming a bond with your child is quite significant. This period of time will help the child with setting a certain healthy routine, getting the house set for the child, and adjusting to the new life in the household. The value of having both parents by the child’s side can make a difference in how the child is raised or even how the child may perceive their own life. There has been occurrences where people feel worthless without one parent in their life. The bond that you create with your family in those six weeks or so is important to uphold and will make for stronger families. Those children that have been through divorces or not even knowing who one parent is in the first place may be pressed with difficulties in their life. In â€Å"Leave Practices of Parents after the Birth or Adoption of Young Children† it is explained, â€Å"Children whose mothers did not report taking any leave (10 % of the total) were more likely to be from a lone-parent family.† I was raised by a single mother and when I was born my mother did not take any leave from work or school. She had me on the weekend and was back on a Tuesday. I was raised mostly by my grandmother at the beginning of my life. Growing up without a father has always been a difficult obstacle for me to overcome. When I was younger I could never understand why it seemed like everyone else had something I could never have. There have been men who come into my life and try to fill the role of a father to me, but there is always still a void. There is not a day in my life that I don’t think about my father: who he is, how he looks, or if I have brothers and sisters. Many people that I have come by in my life have a bond with their father that seems unrealistic to me because it is unattainable. Even though I do not have a father, I can tell that bond is extremely important. Paid paternity leave is an exceptional way to promote a healthy family and be able to form that very special bond. According to the Oxford English Dictionary paternity leave is, â€Å"a short period of authorized absence from employment granted to a father after or  shortly before the birth of his child.† Paternity leave is very close in definition to maternity leave but it is the leave taken by the father instead of just the mother. I believe that the father should always be able to take his six weeks and have it be paid for so that the he can still help support the family. Another term that is very pertinent to my argument is explained on the United States Department of Labor website. The term is the Family and Medical Leave Act which discloses, â€Å"The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave.† The website also discloses that employees will get twelve work weeks of unpaid leave within a twelve month period. Even though this act is beneficial to working parents, it does not entitle parents to any sort of paid leave. Even though there isn’t much evidence of the impact of men at home, the bond created between the parents and the child is not replaceable by any means. In the article â€Å"Fathers, Parental Leave Policies, and Infant Quality of Life: International Perspectives and Policy Impact† the author Margaret O’Brien states, â€Å". . . parental leave has the potential to boosts fathers’ emotional investment and connection with infants as well as the support of their mothers.† There is a couple I know personally where the father was only given a total of three days after his son was born. He has already taken all of his vacation days for work and could not call off even if he wanted to. Those vacation days were not even paid for and sometimes it caused their family to have to struggle to make ends meet. Situations like this could be avoided if men wer e always given the choice of paid time off. In time past, paternity leave has not been socially acceptable in the workplace. Men were to provide for the family, while woman were supposed to be the caretakers. As everything in our world is becoming more modern the idea of paternity leave is becoming more acceptable for men to take but it is not exactly what men always do. The article, â€Å"Without Taking Away Her Leave†: A Canadian Case Study of Couples Decisions on Father’s Use of Parental Leave† explains, â€Å"More than one in four Canadian fathers now takes some paid leave at the birth of a child.† While this certain explanation is shown in a positive perspective, more fathers in the workplace should be taking hefty advantage of paid parental leave  particularly to form the bond in the first six weeks. While in countries like Canada in the province of Quebec, paternity leave is more accepted by men than it is in countries like the United States. In the United States it is more likely for a father not to take any time off after his child is born. One might argue that taking too much time off after the birth of a child might take away opportunities in the workplace, but because paternity leave is becoming more accepted, it will be normal for a man to take time off. It is likely that they will have to use vacation time which might leave room for not being able to call off for an emergency. In most cases, taking twelve weeks unpaid could really hurt a family. That is why those first six weeks should be paid for. The idea will become even more accepted, more men won’t feel as obligated to not be around as much as they want to. Ariane Hegewisch, and Yuko Hara, the authors of â€Å"Maternity, Paternity, and Adoption Leave in the United States†, express, â€Å"Job-protected parental leave is crucial for the health and economic security of pregnant women, and new mothers, and their families.† That security is what will represent a stronger family. Men will be more involved with their children and create a bond with that child in the same way that a mother does. It will help the mother and father see eye to eye and make decisions for the child together. A reporter from CNN interviewed a father, Joe Schroeder, about his three month paternity leave in the article â€Å"Paid Leave Lets Dads Build Parenting Foundation†. Joe stated, ‘†It made me a lot more aware of how fundamental parental leave is to family stability,† Schroeder said. ‘It made me lament the fact that it’s not a right that everybody shares.’ This quote from this man shows how important it ca n be to take paternity leave in the case of building a stronger bond. He also helps reveal the importance of issue of men not being able to have this right. There are instances where even women do not receive a parental leave as well and if they do they may not even receive pay. If men take paternity leave it will help support women in the workplace. Women will more likely return to work, and men will also become more involved with their kids and be caretakers as well. Women won’t feel so pressured to stay at home if the father helps her out the first few weeks  setting up the foundation of the child’s routine and feeling stable enough to come back to work. The article â€Å"The Daddy Track† positively reinforces this statement. The article states in reference to paternity leave, â€Å". . . is a brilliant and ambitious form of social engineering: a behavior modification tool that has been shown to boost male participation in the household, enhance female participation in the labor force, and promote gender equality in both domains.† Fathers will be more likely to help around the house; they may help clean, and spend lots more time with the child or children. The women will more likely return to their job which could lead to more raises, and job advances. Women will also more likely not have postpartum depression because they will not feel as pressured. If the paternity leave that the man took was paid for, it wouldn’t lead to women never returning to work because they would still have financial security. In the article, â€Å"Who’s Bathing the Baby? The Division of Domestic Labour in Sweden†, the authors provide explanation to my last point as they conducted a case study on parental leave. The study revealed, â€Å"Men’s participation in child care and household chores increased as the women went back to work, most dramatically when women returned to work. . .† In the past, there has been inequality between men and women. Promoting paid parental leave for both sexes will definitely help balance the scale and will give the workplace more of a sense of equality. The United States is more of a modern country than most other countries but is actually one of the least evolved in paid paternity leave. Countries such as Sweden or territories in Canada promote an extended amount of time of paid paternity leave. According to the Pew Research Organization, â€Å"At the other end of the spectrum, Poland, Estonia, Spain, Lithuania, The Czech Republic, Slovakia, Germany, Hungary, France and Finland offer three years or more of protection for leave related to motherhood. The median amount of protected leave for new mothers among these countries is about 13 months.† The Pew Research Center is comparing these other countries to the policy that the U.S. has. The U.S. provides the least amount of time and doesn’t even make paid parental leave required by companies. It is surprising that the United States isn’t as evolved in parental leave policies as other countries since it is such a modernized country that tends to promote  equality . The men and women should have equal roles in a household, and a child should be able to feel close to both parents. Research shows that the longer amount of parental leave will help the fathers take more time off, as well as what was stated before, help more around the house. The country that I want to focus on most is Sweden. They have a large amount of time given out to parents for leave, and it is paid for. Men are required to take a certain amount of days to care for their child and promote the women taking on roles in the workplace. â€Å"The Best of Both Worlds? Fatherhood and Gender Equality in Swedish Paternity Leave Campaigns, 1976-2001† states that, â€Å"Moreover, a significant feature of paternity leave campaigns, 1976-2001, was the frequent reminder of what men could gain by using their right to paternity leave.† The campaigns in Sweden for paternity leave promoted many aspects of why taking paternity could help no only the child but the father as well. If the United States adopted more of a leave policy like Sweden, there would be more acceptance of the policy with many great benefits not only in the workplace but at home. There are the stereotypes in the image of the family. The father is to take care of the family by going to work and bringing home the money. The mother is to take care of the children, and take up household chores. According to Wall Street Journal one of these stereotypes said by Jennifer Berdahl is, ‘Active fathers are seen as distracted and less dedicated to their work—the same perception that harms career prospects for many working mothers. . .’ Our country has advanced from these types of stereotypes. Men should be able to feel they can take paternity leave despite the stereotypes of before or now. Promoting the use of paternity leave can be the basis for equality in the workplace and at home. The women will also be supported in the workplace and that will also promote equality. Also the first six weeks should be paid for because the idea of the stereotypes will be shed; it will also help with the stability and strength of the family. Compared to other countri es, the United States is lacking in its parental leave policies. Evolving the policy to have six weeks paid off, will help make advances in the work world and social aspects as well.

Thursday, January 9, 2020

The Stranger By Albert Camus - 1535 Words

What if our past has no importance and the only point in our life that really counts is that point in which is occurring at the moment? Thus, when existence is over, life is also over; The expectation of some sort of redemption from a god is useless. Albert Camus demonstrates his absurdist view of the world in The Stranger, through the protagonist, Meursault. His absurdist view on the world is portrayed by how one simply exists in a world physically and consequently the absence or presence of significance in one s life is only revealed through that event in which we are undergoing at a specific moment. Camus presents this topic of absurdist in conjunction to several themes, using imagery and symbols. In the beginning of the novel, Meursault s indifferent absurdist view sets the tone for the novel with the statement: Maman died today. Or yesterday maybe, I don t know (3). Although the insecurity originates with a telegram, it seems that the tone alone could explain changing the meaning of the words from an I don t know to I don t care’. Over the next couple of days, Meursault does not feel sad for his mother’s loss, he only goes through the motions of the vigil and then the funeral. This is the first moment when the readers get a glimpse of not only Meursault’s indifference but also his isolation from society. He asserts how he feels out of place. However, people are judging him due to his lack of emotion to his mother’s funeral which does not indicate he did notShow MoreRelatedThe Stranger By Albert Camus1391 Words   |  6 PagesThe Stranger â€Å"The Stranger,† written by the Algerian writer Albert Camus, is a novel about Meursault, a character who’s different and even threatening views on life take him to pay the highest price a person can pay: his life. This was Camus’ first novel written in the early 1940’s, in France, and it reflects the authors belief that there is no meaning in life and it is absurd for humans to try to find it places like religion. The main themes of the novel are irrationality of the universe and theRead MoreThe Stranger By Albert Camus1495 Words   |  6 Pages Albert Camus said, â€Å"Basically, at the very bottom of life, which seduces us all, there is only absurdity, and more absurdity. And maybe that s what gives us our joy for living, because the only thing that can defeat absurdity is lucidity.† In other terms, Camus is indicating that absurdity affects us all even if it’s hidden all the way on the bottom, but it’s the joy that comes from absurdity that makes us take risks and live freely without any thought or focus. Camus also specifies that the onlyRead MoreThe Stranger By Albert Camus1411 Words   |  6 PagesThe novel The Stranger, written by Albert Camus, encompasses contemporary philosophies of existentialism and absurdism. Existentialist and absurdist philosophies entail principles regarding that one’s identity is not based on nature or culture, but rather by sole existence. The role of minor characters in The Stranger helps to present Camus’s purpose to convey absurdist and existentialist principles. The characters of Salamano and Marie are utilized in order to contrast the author’s ideas about contemporaryRead MoreThe Stranger by Albert Camus720 Words   |  3 PagesAlbert Camus’ portrayal of the emotional being of the main character in The Stranger is an indirect display of his own personal distress. The use of symbolism and irony presented throughout this novel is comparable with the quest for such that death itself would be nonetheless happy. Camus’ irrational concept is based off the exclusion of any logical reasoning behind the events in the text. Meursault’s first impression given to the reader is that of ignorance and a nonchalant behavior to indifferenceRead MoreThe Stranger By Albert Camus1345 Words   |  6 PagesAbsurdism is a philosophy based on the belief that the universe is irrational and meaningless and that the search for order brings the individual into conflict with the universe. Albert Camus’s novel The Stranger is often termed an absurdist novel because it contains the elements of Camus’s philosophical notion of absurdity. Mersault, the protagonist, is an absurd hero that is emotionally detached and indifferent form society. Neither the external world in which Meursault lives nor the internal worldRead MoreThe Stranger By Albert Camus Essay1591 Words   |  7 PagesThe Stranger was written by the French author Albert Camus, and was first published in 1942 in its indigenous French. It’s described as being the most widely-read French novel of the twentieth century, and has sold milli ons of copies in Britain and the United States alone. It’s known by two titles; the other being The Outsider. The backstory to this is very interesting but, more importantly, the subtle difference in meaning between titles suggests certain resultant translative idiosyncrasies whenRead MoreThe Stranger By Albert Camus1628 Words   |  7 PagesAlbert Camus’s novel â€Å"The Stranger† revolves around a young man estranged from society. This man, Monsieur Meursault, lives the majority of his life fulfilling his own physical needs and social obligations, but has little emotional connection to the world around him. Throughout the book Meursault attends his mother’s funeral, begins a serious relationship with his former co-worker Marie, kills a man without motive, goes through trial, and is sentenced for execution. His lack of emotional responseRead MoreThe Stranger by Albert Camus1115 Words   |  4 PagesIn the novel, The Stranger, by Albert Camus, the point lessness of life and existence is exposed through the illustration of Camus’s absurdist world view. The novel tells the story of an emotionally detached, amoral young man named Meursault. Meursault shows us how important it is to start thinking and analyzing the events that happen in our lives. He does this by developing the theme of conflicts within society. Albert Camus’s novel The Stranger portrays Meursault, the main character, as a staticRead MoreThe Stranger By Albert Camus1365 Words   |  6 PagesThroughout The Stranger, Albert Camus uses routinesituations to demonstrate how the protagonist, Meursault is not just another ordinary individual. Camus depicts Meursault as an independent being, disinterested in his surroundings, contrasting him with the majority of his peers. Meursault traverses the entire novel, exhibiting little to no emotion. Instead, he displayscharacteristics synonymous to someone suffering from psychopathy. Regardless of the situation, Meursa ult refrainsfrom assigning meaningRead MoreThe Stranger By Albert Camus Essay1844 Words   |  8 Pagesof the novel, The Stranger, written by Albert Camus, multiple debatable topics have risen. Does Meursault have a heart? Is he an existentialist? Why does he seem to not be phased by his mother dying? This novel is definitely on the more controversial side, which is somewhat strange because although it seems like a novel about almost nothing, everything seems to have a much deeper meaning than it puts off. However, one topic that seems to be overlooked is the fact that The Stranger relates highly to

Wednesday, January 1, 2020

Social Health Research Essay - 1715 Words

Introduction This study aims at providing insight and documentation into the public’s understanding of cardiovascular disease, the global leading cause of death. Data shows that a large percentage of cardiovascular disease (CVD) is preventable, however, the numbers continue to rise (WHO, 2011). The first part of the report will explain CVD and discuss the related economic burden. Next, relevant literature is reviewed to report on previous studies of the same subject. Finally, the study paradigms and design have been explained. The objective of this research plan is to contribute to knowledge regarding women’s understanding of cardiovascular disease. By reviewing the population’s understanding, we can ascertain optimal strategies to†¦show more content†¦Literature Review Introduction Evaluating existing literature is an integral feature of any research project. Scrutinising relevant information assists in discovering missing information or â€Å"research gaps†. This literature review will analyse data collected regarding metropolitan dwelling Western Australian women and their understanding, perception and knowledge of cardiovascular disease focussing on providing further insight into the significance of knowledge of cardiovascular disease and CVD prevalence. Prevalence and current trends The prevalence of cardio vascular disease has reached disturbing levels on a global scale (WHO, 2011). Although treatment and professional understanding of risk factors is advancing, CVD remains the leading cause of morbidity and mortality in Australia, with 3.5 million people suffering from CVD between 2007 and 2008 and a total of 50 000 deaths attributed to CVD in 2008 (AIHW, 2010). Approximately 92% of Australian adults are afflicted with one risk of CVD, with approximately 40% of the population having ≠¥2 risk factors (AIHW, 2005). It is commonly believed that CVD predominantly affects men, however more women die every year from CVD than any other disease (Lloyd-Jones et al., 2010). Additionally, statistics show that 2 out of 3 women who suffer from a myocardial infarction (heart attack) never make a complete recovery and 52% of women will die from myocardial infarction before reaching a hospital, comparedShow MoreRelatedHealth And Social Care Research1505 Words   |  7 P agesIn health and social care research tends to accept the methods of social science research because the projects often involve investigating people’s feelings, observations and attitudes, which do not lend themselves to investigation by scientific methodology. Quantitative research Scientific method involves quantitative information. For example measuring changes in the body and analysing blood or urine samples. Body mass index is used to measure height and weight to distinguish whether an individualRead MoreResearch Methods Of Health And Social Care1726 Words   |  7 Pages Research Methods in Health and Social Care Throughout research in Health and social care settings, there are many implications with the research, which takes place. Many research methods include ethical issues which have to be considered when conducting research. Ethical issues need to be considered when research is being conducted, in all methods of conducting the research information. One method of research is using interviews. For example, when using interviews in a care home, when conductingRead MoreResearch Methodology in Health and Social Care2501 Words   |  11 Pageseat no more and sometimes even less that their friends but they still get fat. He argued that is not true because he tested thousands of overweight people and every single one had a normal metabolism’’. This belief or myth has interested me to do research on obesity and find out whether â€Å"we are what we eat or whether genetics is to blame for being overweight as well as obesity†. Obesity has always been a controversial topic and this was also the reason why I decided to look at this part of the topicRead MoreResearch Methods in Health and Social Care2462 Words   |  10 PagesResearch Methods in Health and Social Care Critical review of quantitative research Majid,S.Foo,S.Luyt,B.Ahang,X.Theng,YL.Chang,YK.Mokhtar,IA.(2011) Adopting and evidence-based practice in clinical decision making: nurses’ perceptions, knowledge , and barriers. Journal of the Medical Library Association 99(3) PP229-236. This essay will be a critical review on the study conducted by Majid et al (2011). The article which is titled ‘Adopting evidence-based practice in clinical decision making: Nurses’Read MoreCompare different research methodologies for health and social care637 Words   |  3 PagesP3: Compare different research methodologies for health and social care. In this assignment I will be comparing the different types of research methodologies for health and social care. INTERVIEWS: Interviews are usually taken for people when they are looking for jobs or looking places in college and universities. There are many advantages of interviews, one being that they will be able to get good information and some data, also they will develop their communication skills too when talking toRead MoreDifferent Research Methodologies For Health And Social Care Setting3787 Words   |  16 Pagesdifferent research methodologies, which might be used in health and social care setting. We use research in health and social care because this helps to explain the methods of social science research, projects usually involve investigating peoples feeling, perceptions and also attitudes. In a laboratory-based environment, research is usually linked into diseases and disorders by using tissues and chemicals for example. This is more likely to be based on scientific method until the research needs toRead MoreUnit 22:Functions of Research to Health and Social Care Essay1181 Words   |  5 PagesWHAT IS RESEARCH? It is a planned process whereby information is collected for a specific purpose, analysed and reported. FUNCTIONS OF RESEARCH TO HEALTH AND SOCIAL CARE: Research might have so many different functions or aims which are as follows: identifying needs, highlighting gaps in provision, planning provision, informing policy or practice, extending knowledge and understanding, improving practice, aiding reflection, allowing progress to be monitored and examining topics of contemporary importanceRead MoreGeneral Social Survey Essay807 Words   |  4 PagesStarting in 1972, the General Social Survey (GSS) used a four-category response scale for respondents to answer a question on how they view their own health, known as the self-reported health question (SRH) (Smith 2005, 1). The four-categories used were: poor, fair, good, and excellent (Smith et al. 2017, 385) Starting in 2002, the GSS started using both a four and five-category scale for people to respond to the SRH (Smith et al. 2017,1537). The five-category scale used the same measures from theRead MoreParticipatory Action Research And Prac tice1616 Words   |  7 Pages Evaluate the claim that participatory action research, by engaging in the development of policy and practice, empowers marginalised groups. (1500 words limit) Presented by Brigid Kent 11/04/2015 Participatory action research (PAR) is a process in which real people are included in the research of a project because they can bring further insight to the research and help make the policy more relative to the marginalised group being researched. Participation is defined as ‘taking part’ and ‘makingRead MoreIntroduction: There are many factors that contribute to students’ academic success, such as low800 Words   |  4 Pagestoward research method course. Therefore, it is an important to understand students attitude and helps them to create positive attitude toward research to improve their learning process. The aim of this study is to explore the multidimensional factor structure of â€Å"Attitude Toward Research† scale (ATR). Literature Review: A plethora of literature found that undergraduate students seem to have negative attitudes toward some courses such as statistics and mathematics that are related to research courses