Care Giver Perceptions of End of Life Care for COPD Patient

Care Giver Perceptions of End of Life Care for COPD Patient RESEARCH PROPOSAL Title: Exploring the primary family care givers perceptions of care giving for end of life care of COPD ICU patient. Introduction: The world perspective is shifting towards non-communicable diseases, with chronic conditions such as heart disease, stroke and chronic obstructive pulmonary disease (COPD) as chief causes of death globally. COPD is a chronic progressive disease of air flow obstruction which includes emphysema and chronic bronchitis. COPD is predicted as 3rd leading cause of death in 2030 according to 2008 WHO statistics. In terms of social burden of disease quantified by disability-adjusted life-years (DALYs) lost, COPD ranked as the 12th leading cause of DALYs lost worldwide in 1990, but will be the 7th leading cause of DALY lost worldwide in 2030.COPD is more common among world age people due to decreased lung function capacity. The world population above 60 years was1.7% in 2013 and will continue to grow as a reaching 21.1 per cent by 2050 (world ageing population 2013). COPD is one of the major 8th leading causes of death in Singapore. According to MOH 2013 census COPD causes 1.6% of deaths per 18938 populations.COPD is a treatable disease but not a curable one. So ultimately it increases the economic burden of the country by its chronicity, rate of hospital readmission and affects the quality of life activities of daily living of the patient and family members. The total expenditure for COPD was $9.9 million per year. $ 7.2 million accounts for inpatient care cost (W.-S. Kelvinteo et.al, 2011). For last 10 years no studies found in Singapore on family care givers perspectives on end of life care in ICU. Primary family care givers most of the time the spouse are the carer for the COPD patient The Singapore old age percentage is in increasing trend 7.3% in 2000 9.3 in 2011 expected to rise up to 18.7% 2013. When a family member is dying, conversations about the end of life can be uncomfortable and difficult. Still, discussing end-of-life care is important. Patients with end-stage of diseases may suffer from distressful symptoms.The Advanced COPD patient suffer from severe distressful symptoms such a dyspnea anxiety and depression. Palliative care of malignant disorder gained more attention when compare to non-malignant diseases (Blackler et al., 2004; Lynn, 2000; Simonds, 2004).The palliative care needs of patients with end-stage respiratory diseases are increasingly being recognized (Curtis, 2008; Lanken et al., 2008) . The COPD patient experience significant impairment of quality of life and physical and psychological needs when compare to individual with lung cancer (Core et al., 2000; Edmonds et al., 2001; Skilbeck et al., 1998; Tranmer et al, 2003). Why family members? When there is progression of diseases it imposes negative impacts on psychological health of Care givers (Daniela Figueiredo, 2014). Careers are more likely to suffer from anxiety and depressive symptoms providing continuous care during the advance stage of the disease and end of life care (Abebaw Mengistus Yohannes 2007). Preparation for death should include a realistic appraisal of the prospects for dying peacefully at home. (Hansen –Flaschen J .2004) Most of the patients are willing to be housebound at the end stage of life so its responsibility of family cares to provide continuous care and support them White P (2011) stated 45% were housebound, 75% had a career in end stage of COPD . despite no studies have been conducted qualitatively on family care givers perception on End of life care on COPD in Asian countries . Review of literature: â€Å"Palliative care in COPD† search in PUBMED extracted only 285 titles from 1991 to 2011. ( Anirban Hom Choudhuri 2012) .The absence of palliative care services highlights the need for research into appropriate models of care to address uncontrolled symptoms, information provision and end of life planning. (Jones et al 2014). Synthesis of findings: The literature review showed that the family care givers suffer from intense conflict, emotions such as helplessness, guilt, anger, anxiety and frustration. These suffering are due to deterioration of the health of the loved one and cumulative losses over time that the patient illeness affect the care givers the most. The key findings of each study were identified and supplemented based on a review of the full article. Then, categories were derived by grouping the key findings thematically. Lack of support: Most of the family care givers reported they were unaware of the facilities for COPD patient. There was no social or psychological support. If the support is received also this is inadequate or sporadic. They learnt most of the things by their experience regarding prognosis, treatment signs and symptoms, illness. They faced the financial constraint in addition too. They are expecting support from the health care professionals. â€Å"Well, the care from Father’s doctors was extremely basic and, I felt, on the most part extremely uncaring†¦ The doctors really had an attitude of ‘You were a smoker, you’re dying of lung disease, and what do you want us to do about it?’ The way they spoke to him, and the fact that they really weren’t concerned, and they didn’t doo very much for him; anything they did for him, I was disappointed in† – participant from Hasson et al. (2009) Burden of care givers: Burden of care givers are noted in all the studies. Most of the care giver said they are exhausted and need to perform multi task. They need to spend most of time in caring the patient. The involvement in social life is reduced, change of relationship with patient. Mostly they are anxious and frustrated. Sometimes care givers are helpless when they patient are suffering from breathing difficulties. â€Å"It is very frustrating, and you know I don’t know if the government realizes how hard it is for carers..It’s a full-time job. It’s work isn’t it? It’s not something you do because you like it. I mean I care for my Dad, I love him and I want to look after him, but I also need my own time.†- participant from Philip et al. (2014) End of life care and support of Bereavement Mostly family career are involved end of life decision making which lead to a peaceful death and die with dignity for the patient. â€Å"I think the situation was the way is should have been. I think if there had been any external help, it would have been a bit of an intrusion. [Father] did not want to leave the house and that was fine but also whenever he was like that and he was not feeling the best, it was just best to leave him alone† – participant from Hasson et al. (2009) Some said the hospital policy did not allowed us to care for the patient in home during end stage of life. No adequate bereavement support for the family careers after the death. Some had counselling in later part of life. Rewards, meaning, and coping: However, some caregivers described their experiences as positive. Identified positive features include sense of pride, esteem, and mastery as a caregiver a sense of normalcy; being able to demonstrate love and fulfill satisfaction and sense of accomplishment ability to be with and help the patient life-enriching experiences closer relationships a sense that it is important. Some care givers felt that their loved one died with dignity and respect. They were able to provide good care and that provided them a sense of accomplishment. Conclusion: The COPD has a great impact on Family care givers. All the studies stated that there is a lack of support and facilities, unmet needs. There was a lack of knowledge about the available facilities and lack of emotional support .There is a need for supportive and education regarding the palliative and end of life care. Mostly of the careers reported they are helpless when patient suffering from breathlessness and guilt of not doing enough. Caregiver’s involvement in providing care and feeling able to provide quality care, will enhance the coping among the care givers. These four studies were conducted in European countries and thus there is a lack of ethnic diversity which may have an additional impact on caregiving culturally. Many recommendations were made for further research relating to the care givers perspectives. The studies did not discuss if there were any difference in the care provided by spouse/children or by ethnicity. Thus, further research can be done to study the cultural influences on care giving of COPD patients. Research Objectives What are the experiences of Family care givers on end of life care of patient with COPD in ICU? What are the needs of family care givers on end of life care of patient with COPD? What are the barriers of caring family care givers Details of Research Proposal: Aims To explore the needs of Primary family care givers or bereaved careers on end of life care of ICU COPD patient To explore the perspectives of Primary family care givers or bereaved careers on end of life care of ICU COPD Patient. Operational definition: End of life care: The care provided to alleviate the symptoms of patient during the end stage of COPD. Family care givers: Care provided by the Family members other than the health care professionals. Bereaved careers: Bereaved careers are one who suffered from the death family members due to COPD. Research Methodology: Study design: A Phenomenological Descriptive approach will be adopted to explore the perspectives of Family care givers on End of life care. Interviews will be conducted. Sampling: The study will use purposive sampling method to select the participant for the interview. Samples: Primary Family care givers COPD patient who have died in ICU Inclusion criteria: Participant Speak English Participant over 18 years of age Bereaved careers of COPD patient within a year. Exclusion criteria: Bereaved careers of other diseases. Family care givers of other diseases Bereaved and Family care givers of More than one year of COPD patient Sample size planning: Approximately 10-15 primary bereaved careers of COPD patient until the data saturation is obtained Ethical Consideration: The DSRB approval will be obtained before data collection. The purpose of the study will be explained to the participant before informed consents are obtained. The participant will be ensured that the information collected will be kept confidential and it will be used only for research purpose. Data collection: The researcher will get access to the COPD Program coordinator and get permission to conduct a study. After Permission is granted, the COPD patient died in ICU will be identified through the register. The eligible participant will be selected who meet the inclusion criteria. Then the family members will be contacted through telephone by the researcher and if the participant is willing to participate in the research.. The research process will be first explained to the selected participants in an appropriate manner without hurting their sentiments and understanding their difficult situation’s as well. Face to face semi structured interviews will be conducted with the Family care givers. In that interview, a set of general and open ended questions would be asked. And the entire conversation will be audiotaped. Each conversation is assumed to last for 40 to 60 minutes. When the participant become too emotional, the interview will be stopped and reassured by the researcher. Again the interview will be conducted when normality is retained. After the interview, basic demographic data will be collected and the same will be kept confidential. A pilot study will be conducted based on the interview guidelines prepared with 2-3 participants to assess the feasibility of this study. Interview guidelines: Introduction 🙠 2 minutes) Good morning .Thank you for participating in our Research. I Arunadevi graduate student from Alice Lee Center of nursing Studies, National University of Singapore. As a Part of my program I am conducting this Interview. The interviews will be carried out for 45 minutes to an hour. The Questions will be open ended questions. The answers will be audiotaped. Objectives :(1 Minute) To identify the perspectives of primary Family care givers on End of Life care Interview Questions: 45 minutes to One hour) How did you become a Primary care giver? What you understand your role as a care giver? What do you understand about end of life care? How do you experience providing care to family members at the end stage? What helped with the care? What do you felt as lacking while providing the care? What could be improved? Ending session: (5 minutes) Would you like to say anything further? Thanks for sharing your thoughts and views. It would surely help others and provide support when others are facing the same problem. Data analysis: The analysis of the data is based on Colaizzi (1978) which includes various steps such as read and acquire the meaning, organize it into meaningful themes, integrate results, send it to the participant as final validating steps. The recorded interviews will be listened repetitively and transcribed to verbatim by the researcher. The initial impression and reflection will be noted in a separate note book. The themes will be emerged from the transcript. The clustering of the themes with similar context will be made .The thematic analysis will be used to analyses the data. Whenever possible the transcript will be send to the participant to know the meaning or to validate the information. Gaps will be identified as well based on the expectations of the family care givers. Then certain recommendations/suggestions will be generated for the group based on the findings, in addition to the current facilities available. Rigour /Validity: The four essential criteria highlighted by Lincoln and Guba (1985) are as follows: Credibility, Transferability, Dependability and Conà ¯Ã‚ ¬Ã‚ rmability. Credibility refers to the confidence in the truth and interpretation of Data. After transcribing the transcription will be send to the participant when possible to validate the information. To ensure the findings are not modified by the researcher. Reflective Questioning will also be used to ensure the credibility. Transferability of the results generated in the study will be achieved through ‘thick description’, (Lincoln Guba 1985). The study findings will be useful to all the health care professionals family care givers of COPD patient on End of life care. Conformability and dependability rest on the consistency, objectivity and accuracy of the data findings chiefly depends on the data consistency and accuracy and (Richard Morse 2007). Audio recording and supervisor member check in will be done for conformability and dependability.

Racial Ideologies in Frederick Douglass and Linda Brents Narratives Es

Racial Ideologies in Frederick Douglass and Linda Brent's Narratives 4) Slavery was justified by racial ideology. Consider three texts, including one that was written by a former slave. How do the authors either replicate or refute racial ideologies common in the nineteenth century? I am going to focus on the narratives of Frederick Douglass and Linda Brent as examples of a refusal of racial ideologies and Harriet Beecher Stowe’s Uncle Tom’s Cabin as an example of replicating (although attempting to refute) racial ideologies of the day. Douglass’s Narrative and Brent’s Incidents follow them from ignorance to knowledge; knowledge and freedom gained through their own doing. I think that Stowe is in a way both trying to write an anti-slavery novel, however, I can’t see her as anti-racist because Romantic Racialism is what grounds her arguments. In all three, I am going to prove that the relationship between and the representations of the body and the mind are what either refuse or support racial ideologies of the nineteenth century. First, Frederick Douglass’s Narrative introduces the reader to a young Douglass who is ignorant in terms of book knowledge and also lacks practical life experience. He even lacks the knowledge of his own age. But the fact that Douglass is able to educate himself refutes the idea of the time that African Americans were intellectually inferior. By the end of the narrative, he is more educated than someone like Covey, one of his former masters. Kimberly Drake claims that [t]he ability to utilize language, especially written language or literacy, is also portrayed by many ex-slaves as crucial to their quest for freedom, a freedom which in large part is the ability to allow ... ...impulse. All three of these books have really helped me to gain an understanding of what the racial ideologies of the period in which they were written were: Douglass and Brent, through their refusal of these ideologies and Stowe through her inadvertent reinforcement of them. Bibliography: Works Cited Brent, Linda. Incidents in the Life of a Slave Girl. Ed. L. Maria Child. San Diego: Harcourt Brace & Company, 1973. Douglass, Frederick. Narrative of the Life of Frederick Douglass. New York: Dover Publications, Inc., 1995. Drake, Kimberly. â€Å"Rewriting the American Self: Race, Gender, and Identity in the Autobiographies of Frederick Douglass and Harriet Jacobs.† MELUS 22 (Winter 97): 91-109. MacFarlane, Lisa Watt. â€Å"’If Ever I Get to Where I Can’: The Competing Rhetorics of Social Reform in Uncle Tom’s Cabin.† ATQ 2 (June 90): 135-148. Racial Ideologies in Frederick Douglass and Linda Brent's Narratives Es Racial Ideologies in Frederick Douglass and Linda Brent's Narratives 4) Slavery was justified by racial ideology. Consider three texts, including one that was written by a former slave. How do the authors either replicate or refute racial ideologies common in the nineteenth century? I am going to focus on the narratives of Frederick Douglass and Linda Brent as examples of a refusal of racial ideologies and Harriet Beecher Stowe’s Uncle Tom’s Cabin as an example of replicating (although attempting to refute) racial ideologies of the day. Douglass’s Narrative and Brent’s Incidents follow them from ignorance to knowledge; knowledge and freedom gained through their own doing. I think that Stowe is in a way both trying to write an anti-slavery novel, however, I can’t see her as anti-racist because Romantic Racialism is what grounds her arguments. In all three, I am going to prove that the relationship between and the representations of the body and the mind are what either refuse or support racial ideologies of the nineteenth century. First, Frederick Douglass’s Narrative introduces the reader to a young Douglass who is ignorant in terms of book knowledge and also lacks practical life experience. He even lacks the knowledge of his own age. But the fact that Douglass is able to educate himself refutes the idea of the time that African Americans were intellectually inferior. By the end of the narrative, he is more educated than someone like Covey, one of his former masters. Kimberly Drake claims that [t]he ability to utilize language, especially written language or literacy, is also portrayed by many ex-slaves as crucial to their quest for freedom, a freedom which in large part is the ability to allow ... ...impulse. All three of these books have really helped me to gain an understanding of what the racial ideologies of the period in which they were written were: Douglass and Brent, through their refusal of these ideologies and Stowe through her inadvertent reinforcement of them. Bibliography: Works Cited Brent, Linda. Incidents in the Life of a Slave Girl. Ed. L. Maria Child. San Diego: Harcourt Brace & Company, 1973. Douglass, Frederick. Narrative of the Life of Frederick Douglass. New York: Dover Publications, Inc., 1995. Drake, Kimberly. â€Å"Rewriting the American Self: Race, Gender, and Identity in the Autobiographies of Frederick Douglass and Harriet Jacobs.† MELUS 22 (Winter 97): 91-109. MacFarlane, Lisa Watt. â€Å"’If Ever I Get to Where I Can’: The Competing Rhetorics of Social Reform in Uncle Tom’s Cabin.† ATQ 2 (June 90): 135-148.

Timeline of Education

Time Line of Education History of American Education Edu 324 Hernandez Karen Lane 4 March 2013 1647 The General Court of the Massachusetts Bay Colony decrees that every town of fifty families should have an elementary school and that every town of 100 families should have a Latin school. The goal is to ensure that Puritan children learn to read the Bible and receive basic information about their Calvinist religion. 1779 Thomas Jefferson proposes a two-track educational system, with different tracks in his words for â€Å"the laboring and the learned. Scholarship would allow a very few of the laboring class to advance, Jefferson says, by â€Å"raking a few geniuses from the rubbish. † 1785 The Continental Congress passes a law calling for a survey of the â€Å"Northwest Territory† which included what was to become the state of Ohio. The law created â€Å"townships,† reserving a portion of each township for a local school. From these â€Å"land grants† even tually came the U. S. system of â€Å"land grant universities,† the state public universities that exist today. 1790Pennsylvania state constitution calls for free public education but only for poor children. It is expected that rich people will pay for their children's schooling. 1805 New York Public School Society formed by wealthy businessmen to provide education for poor children. Schools are run on the â€Å"Lancasterian† model, in which one â€Å"master† can teach hundreds of students in a single room. The master gives a rote lesson to the older students, who then pass it down to the younger students. These schools emphasize discipline and obedience qualities that factory owners want in their workers. 817 A petition presented in the Boston Town Meeting calls for establishing of a system of free public primary schools. Main support comes from local merchants, businessmen and wealthier artisans. Many wage earners oppose it, because they don't want to pay the taxes. 1820 First public high school in the U. S. , Boston English, opens. 1827 Massachusetts passes a law making all grades of public school open to all pupils free of charge. 1830s By this time, most southern states have laws forbidding teaching people in slavery to read.Even so, around 5 percent become literate at great personal risk. 1820-1860 3. 1 million immigrants arrive a number equal to one eighth of the entire U. S. population. Owners of industry needed a docile, obedient workforce and look to public schools to provide it. 1837 Horace Mann becomes head of the newly formed Massachusetts State Board of Education. Edmund Dwight, a major industrialist, thinks a state board of education was so important to factory owners that he offered to supplement the state salary with extra money of his own. 840s Over a million Irish immigrants arrive in the United States. Irish Catholics in New York City struggle for local neighborhood control of schools as a way of preventing their childr en from being force-fed a Protestant curriculum. 1848 Massachusetts Reform School at Westboro opens, where children who have refused to attend public schools are sent. This begins a long tradition of â€Å"reform schools,† which combine the education and juvenile justice systems. 1851 State of Massachusetts passes first its compulsory education law.The goal is to make sure that the children of poor immigrants get â€Å"civilized† and learn obedience and restraint, so they make good workers and don't contribute to social upheaval. 1865-1877 African Americans mobilize to bring public education to the South for the first time. After the Civil War, and with the legal end of slavery, African Americans in the South make alliances with white Republicans to push for many political changes, including for the first time rewriting state constitutions to guarantee free public education.In practice, white children benefit more than Black children. 1893-1913 Size of school boards in the country's 28 biggest cities is cut in half. Most local district (or â€Å"ward†) based positions are eliminated, in favor of city-wide elections. This means that local immigrant communities lose control of their local schools. Makeup of school boards changes from small local businessmen and some wage earners to professionals (like doctors and lawyers), big businessmen and other members of the richest classes. 1896 Plessy v.Ferguson decision. The U. S. Supreme Court rules that the state of Louisiana has the right to require â€Å"separate but equal† railroad cars for Blacks and whites. This decision means that the federal government officially recognizes segregation as legal. One result is that southern states pass laws requiring racial segregation in public schools. 1905 The U. S. Supreme Court requires California to extend public education to the children of Chinese immigrants. 1917 Smith-Hughes Act passes, providing federal funding for vocational education.Big m anufacturing corporations push this, because they want to remove job skill training from the apprenticeship programs of trade unions and bring it under their own control. 1924 An act of Congress makes Native Americans U. S. citizens for the first time. 1930-1950 The NAACP brings a series of suits over unequal teachers' pay for Blacks and whites in southern states. At the same time, southern states realize they are losing African American labor to the northern cities. These two sources of pressure resulted in some increase of spending on Black schools in the South. 1932A survey of 150 school districts reveals that three quarters of them are using so-called intelligence testing to place students in different academic tracks. 1945 At the end of World War 2, the G. I. Bill of Rights gives thousands of working class men college scholarships for the first time in U. S. history. 1948 Educational Testing Service is formed, merging the College Entrance Examination Board, the Cooperative Test Service, the Graduate Records Office, the National Committee on Teachers Examinations and others, with huge grants from the Rockefeller and Carnegie foundations.These testing services continued the work of eugenicists like Carl Brigham (originator of the SAT) who did research â€Å"proving† that immigrants were feeble-minded. 1954 Brown v. Board of Education of Topeka. The Supreme Court unanimously agrees that segregated schools are â€Å"inherently unequal† and must be abolished. Almost 45 years later in 1998, schools, especially in the north, are as segregated as ever. 1957 A federal court orders integration of Little Rock, Arkansas public schools. Governor Orval Faubus sends his National Guard to physically prevent nine African American students from enrolling at all-white Central High School.Reluctantly, President Eisenhower sends federal troops to enforce the court order not because he supports desegregation, but because he can't let a state governor use military power to defy the U. S. federal government. 1968 African American parents and white teachers clash in the Ocean Hill-Brownsville area of New York City, over the issue of community control of the schools. Teachers go on strike, and the community organizes freedom schools while the public schools are closed. 1974 Milliken v. Bradley. A Supreme Court made up of Richard Nixon‘s appointees rules that schools may not be desegregated across school districts.This effectively legally segregates students of color in inner-city districts from white students in wealthier white suburban districts. Late 1970s The so-called â€Å"taxpayers' revolt† leads to the passage of Proposition 13 in California, and copy-cat measures like Proposition 2-1/2 in Massachusetts. These propositions freeze property taxes, which are a major source of funding for public schools. As a result, in twenty years California drops from first in the nation in per-student spending in 1978 to number 43 in 1998. 1 980sThe federal Tribal Colleges Act establishes a community college on every Indian reservation, which allows young people to go to college without leaving their families. 1994 Proposition 187 passes in California, making it illegal for children of undocumented immigrants to attend public school. Federal courts hold Proposition 187 unconstitutional, but anti-immigrant feeling spreads across the country. Resources: Applied Research Center 2012, Historical Timeline of Public Education in the US Retrieved from: http://www. arc. rg/content/view/100/217/ Gaither, M. 2011 History of American Education Chapters two through eight of book Retrieved from https://content. ashford. edu/books/AUHIS324. 11. 1/ Morgan A Time Rime, Influential Events in the History of American Education Retrieved from: http://timerime. com/en/event/1386863/Latin+Grammar+School/ Sass, Edmund @ College of Saint Benedict/Saint John's University American Educational History: A Hypertext Timeline 2013 Retrieved from: ht tp://www. eds-resources. com/educationhistorytimeline. html

Essay on Analysis of Nonverbal Cues In The Workplace

To be successful in business, one must be able to perceive and use nonverbal cues to one’s advantage. It has been noted by communication experts that when two people have face-to-face communication only a small percentage of the message is delivered through the words they use. The majority of the message is understood and received through nonverbal communication behaviors. These behaviors include gestures, postures, facial expressions, and even clothing; all of which can interfere with the verbal messages that a person is trying to deliver. Although, the importance of nonverbal cues has not been examined extensively in the workplace, it makes sense that they would have a strong impact on any communication both in and out of the realm†¦show more content†¦Eye contact has long been a sign of a man’s good word. The customer would feel important, would feel that his or her time was being valued and that he or she had the full attention of the sales agent. Whe n all of these feelings are put together, there is a good probability that a sale will be made and a satisfied customer will leave with a feeling of good customer service by the sales agent. Posture Posture plays another important role in the workplace as a nonverbal cue. Besides the obvious sloppy, lazy image that poor posture can give off, it also demonstrates one’s confidence or lack thereof. When an individual is standing in a hunched over droopy posture, a vibe is felt by others that the person is either unhappy or insecure. Neither of those qualities makes for a successful person in a business workplace. Additionally, posture holds differently levels of importance in international business dealings as it can be a sign of disrespect and be rather offensive to people of other cultures. Take for instance having your hands in your pockets, this is seen as disrespectful in Turkey (Tidwell). Sitting with your legs crossed is offensive in Ghana and Turkey, while sitting in a way that shoes the soles of your feet is offensive in Thailand and Saudi Arabia (Tidwell). So posture is a highly important nonverbal cue that can have serious implications ifShow MoreRelatedCom munication Is A Fundamental Element Of Any Organization1849 Words   |  8 PagesCommunication in any workplace is a vital skill. In many career fields it is a necessary trait and if done well, can excel a person s carer towards new heights. I have found that communication is a fundamental element of any organization. With communication we are able to achieve our current goals, while planning accordingly for our future goals. This all aligns with a company s overall mission. I have found this to be true when interviewing Chris Coomer a analytics manager from 22Squared. 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