Study Of Post Traumatic Stress - Free Essay Example

Sample details Pages: 22 Words: 6539 Downloads: 6 Date added: 2017/06/26 Category Psychology Essay Type Essay any type Did you like this example? CHAPTER I INTRODUCTION Background of the Study à ¢Ã¢â€š ¬Ã‹Å"Stress is not what happens to us. Its our response to what happens and response is something we can choose. Maureen Killoran Road traffic accidents are global problems affecting all sections of the society. In India about 250 people die everyday which is equivalent to plane crash having no survivors. Don’t waste time! Our writers will create an original "Study Of Post Traumatic Stress" essay for you Create order In 2007, the number of motor vehicle accidents in main metropolitan cities of India were 89,826 and number of persons injured were 57,713. The highest number of people died in road traffic accidents in India till date on 2007 was 1,14,540.(Vidya Venkat,2007) The global annual cost of RTA is almost 230 billion dollars. 1.2 million people die every year due to Road Traffic Accidents. Every day, there are 3300 deaths and 6600 serious injuries on the road in the world. Trauma related death occurs in India every 1.9 minutes,1.27 million people in India sustain serious injuries, 1,20,000 people die on the road every year. A majority of major accident survivors are either confined to bed or wheel chair bound due to brain injury or spinal cord injury or being in psychiatric stress.(www.medindia.net,2010,May 07). Despite the improvement in road condition, vehicle safety and driver education over 3 million persons are injured in motor vehicle accident each year. Many of these persons dev elop post traumatic stress disorder that can become chronic. Patient typically experience distress related to the alteration in their physical and emotional health status, changes in their level of daily functioning and decreased social support or the loss of significant others.( Brunner 2004) Most survivors of trauma, especially those with adequate coping mechanisms can adjust to the incident and having no lingering effects However, some persons have stress reactions that do not abate and may worsen overtime. These reactions can develop into post traumatic stress disorder, which may be severe enough to have significant impact as their daily life as well as that of their spouses, family and significant others. It has demonstrated that witnessing is sufficiently stressful to cause post traumatic stress disorder. Any trauma, especially, when prolonged or repeated, may convert ordinary adaptive response of à ¢Ã¢â€š ¬Ã‹Å"flight or fright into pathologic reaction.(Allen 2005) à ¢ â‚ ¬Ã‹Å"Silent Killer is the best term applicable for stress. The meaning of post traumatic stress disorder is to à ¢Ã¢â€š ¬Ã‹Å"Press tight. It became known in the 70s due to adjustment problems of some vietnam veterans. It has been known by the other name such as à ¢Ã¢â€š ¬Ã‹Å"shell shock in world war I, and à ¢Ã¢â€š ¬Ã‹Å"Battle fatigue in world war II. Post Traumatic stress Disorder(PTSD) was first listed as a diagnostic category by the American Psychiatric Association in 1980. It can affect both children and adult, on various causes. (www.medicinenet.com,2010 ,June06) Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that occur after a person has experienced or witnessed life threatening events such as military combat, natural disaster, terrorist incidents, serious motor accidents or violent personal assaults. It can be acute (2 weeks-3months), chronic(3 months and longer) or delayed (after 6 months). Person perceive, experienced event as traumatic, night mare s of event, inability to recall an important event, exaggerated started response, hyper arousal and hyper vigilant.(National centre for PTSD, 2006) Following a traumatic event, almost every one experiences at least some of the symptoms of Post Traumatic Stress Disorder. The symptoms of Post Traumatic Stress Disorder can arise suddenly gradually or come and go overtime. Everyone experiences Post Traumatic Stress Disorder differently , there are three main types of symptoms: Re-experiencing the traumatic event: Intrussive upsetting memories of the event, Flashbacks, Night mares, Feeling of intense distress when reminded of trauma and Intense physical reactions to reminders of the event (pounding heart, rapid breathing, nausea, sweating) Avoidence and emotional numbing: Avoiding activities; places; thoughts or feelings that remind of trauma, Inability to remember important aspects of trauma, Loss of interest in activities and life in general, Feeling detached from others and emotion ally numb and Sense of a limited future. Hyper arousal: Difficulty falling or staying asleep, Irritability or outbursts of anger, Difficulty concentrating, Hyper vigilance (on constant red alert) and Feeling jumpy and easily startled. Other common symptoms: Anger and irritability, Substance abuse, Suicidal thoughts and Feelings of mistrust and betrayal.(National center for PTSD, 2006) There are good treatments available for Post Traumatic Stress Disorder . Cognitive Behavioural therapy (CBT) is one type of counseling. It appears to be most effective type of counseling for Post Traumatic Stress Disorder .In cognitive therapy, therapist helps the person to understand and thought about trauma and its aftermath. Cognitive behavioural therapy includes four individual sessions involving psycho education, muscle relaxation training, imaginal exposure and invivo exposure and finally cognitive restructuring. Each sessions may last from 30 to 75 minutes. CBT begins with education about the problems and how the treatment can help. Patient will learn about the specific symptoms and experiences. After becoming more aware of thought and beliefs, patient will learn about the common changes in beliefs that occur after going through trauma. Psychotherapy provide ways to cope with intense feelings about the past, and raise self esteem. Family therapy is provided involving whole family, which cope with tough emotions and maintain good relationships.(National center for PTSD, 2007) For trauma patients, psycho education helps to use of healthy coping strategies such as relaxation and mobilization of social support, about physiological basis for psychological phenomena such as mood instability, flash backs, memory problems, depression and allows them to see these as symptoms and not as personal failings.(Wessley et al 2008) Bisson, Mifarlane and Rose(2005) stated that psycho education is a way of providing traumatized individuals with a psychological map to understand thei r reactions. These may be adjuncts to other interventions, given in the review large from provision of brochures and face to face sessions. Elizabeth Scott (2005) stated that progressive muscle relaxation is a great technique for reducing overall body tension and stress by alternatively tensing and relaxing the muscles. With practice, the participant learns to completely release the body within seconds and keep from storing up tension and stress in the body. The goal of relaxation training is to produce a response that counters the stress response when this goal is achieved the action of hypothalamus adjusts and decreases the activity of sympathetic and parasympathetic nervous system. Progressive muscle relaxation entails physical and mental components involves the tensing and relaxing of muscle groups in sequential pattern. Tensing and relaxing various muscle groups throughout the body produces deep state of relaxation which found capable of relieving a variety of conditions, from high blood pressure to ulcerative colitis. The mental component focuses on the difference between the feelings of tension and relaxation. Thus, with practice patient learns how to effectively relax and deter stress when it becomes an unhealthy level.(www.wikipedia.com, 2010, Nov28) According to Neeraja (2008) the role of nurse for post traumatic stress disorder should be empathetic, sincere honest, trustworthy with effective communication skills and interaction skills. Directing the client in psycho education process allow the client to ventilate his feelings outwardly, motivate to discuss job and methods (plan of activities) to attain it, enhance the functioning levels, independence level of achievement. Promote clients interaction with group members and family members to enhance coping strategies. Assist client to divert mind from traumatic memory to useful activities. Train up the client in deep breathing exercises, relaxation excercises, healthy lifestyle.So educating t he client is the utilization of alternative coping strategies to come out from post traumatic stress disorder. Significance and Need for the Study Even to much sunshine can be devasting, while only with rain can growth occur. Accept both as part of the growing process in the garden of life. Donald S. Neviaser Every day, there are 3300 deaths and 6600 serious injuries on the road in the world. Trauma related death occurs in India sustain serious injuries. 1,20,000 people die on the road every year. (www.medindia.com, 2010,June 4) A motor vehicle is a human made calamity. It angers and it raises question of blame. It can turn survivors into while knuckled drivers who live in fear of another accident. Accident phobia and post traumatic stress disorder frequently disabling. (Klaus Kuch et al;2006) The National centre for PTSD(2006) has described that the Post Traumatic stress disorder is an anxiety disorder that occurs after a person has experienced or witnessed life threatening events such as military, combat, natural disaster, terrorist incidents, serious motor accidents in violent personal assaults. The development of Post Traumatic Stress Disorder may be delayed from 1 week to 3 years and it is divided in to two stages. Stage 1 is associated with an adrenergic surge that occurs ac utely, but persons rarely dwell long-term on the incident. It may last up to 1 month .Stage 2 is that if symptoms lasts for more than 6 weeks. The patient is considered to have entered stage characterized by sense of helplessness and loss of self control. Autonomic and somatic manifestations dominate in their stage moreover, It is accompanied by lifestyle personality changes. Post traumatic stress disorder is believed to be caused by either physical trauma or psychological trauma, or more frequently a combination of both. Post traumatic stress disorder symptoms may result when a traumatic event causes an overactive adrenaline response, which creates deep neurological patterns in the brain. Three areas of the brain whose function may be altered in Post traumatic stress disorder have been identified: the prefrontal cortex, amygdala and hippocampus. Cognitive Behavioural Therapy (CBT) have been proven to be an effective treatment for Post traumatic stress disorder , and is currently considered the standard of care for Post traumatic stress disorder by the United States Department of Defense(www.wikipedia.com.2010,Nov 25). Post traumatic stress disorder is assumed to be an equivalent syndrome regardless of the type of traumatic event. When comparing the clinical profiles among civilian trauma: sexual assault, motor vehicle accident, and sudden loss of loved one;it may differ in trauma types which may lead to unique variants of the post traumatic stress disorder ,which may result from different etiological factors. So it may require different treatment approaches.(Kelley et al;2009) According to Maria Pease(2011)the prognosis for Post traumatic stress disorder depends upon the severity and length of time a person has suffered from the disorder. The majority of patients with Post traumatic stress disorder respond to psychotherapy. There are often residual symptoms, however, and we cannot yet predict who will respond best. There are significant risks to a pe rson with Post traumatic stress disorder if they do not receive treatment. They may stay in a hyper aroused state, further damaging their brain. They may lose their job and/or family due to their irritability. Suicide is also a risk with untreated Post traumatic stress disorder. Moddern (2004) stated that cognitive behavioural therapy including sessions of psycho education, relaxation training, exposure therapy and cognitive restructuring is an effective treatment of choice for clients with post traumatic stress disorder. Benham (2005) stated that psycho education is crucial in the initial safe and stabilization stage because this is when problems related to trauma history are identified, expectations for future treatment are defined and coping skills that are necessary for delaying with painful memories or changing risky behavior are taught. Phoenix(2007) stated that the goal of psycho education in the aftermath of traumatic event are to help people understand the range of normal responses to such events, use coping strategies, and identify responses that warrant more intensive intervention. Relaxation therapies include a range of techniques such as autogenic training, deep breathing exercises, progressive muscle relaxation. The goal of progressive muscle relaxation is overall relaxation and stress reduction. Practice can produce a set of physiologic changes mat can result in showed respiration, lowered pulse and blood pressure and increase in alpha brain activity and possibly even reduction in the bodys inflammatory response (www.mentalhealthwiki.org,2010.June 13) George and Lalitha (2006) stated that skill of relaxing using Jacobsons progressive muscle relaxation procedure is probably the easiest method to teach the client to use, sufficient instructions and practice proficiency can be acquired by any one. The focus on physical tension and relaxation gives excellent proper reception feedback and helps to focus the attention. Deborah Brause r(2010) conducted a small, phase pilot study on effectiveness of Methlylenedioxymethamphetamine (MDMA), also known as ecstasy, added to psychotherapy in reduction of symptoms of posttraumatic stress disorder (PTSD) in patients who are resistant to other treatments. The study demonstrates that MDMA-assisted psychotherapy with close follow-up monitoring and support can be used with acceptable and short-lived side effects in a carefully screened group of subjects with chronic, treatment-resistant PTSD. They quoted that MDMA was found to be effective ,even though have a long way to go and dont have any clinical conclusions yet. Nursing care of patients with post-traumatic stress disorder becomes very difficult if the patient shows an extremely apprehensive response to the particular care procedure or treatment. So the nurse has to communicate with the patient in a clear and concise manner. Assume a consistent, non-judgmental, honest, and a positive attitude while providing nursing ca re to establish sense of trust and security and remove guilt in patients mind. (wwwmedicinetips.com,2011,Jan 06) The nurses efforts for post trauma patients are directed to life supporting interventions and to the inclusion of approaches aimed at the reduction of additional stressors like sleep deprivation. Nurses are in a unique position to assist individuals in identifying adaptive coping strategies. By this, patient will develop a sense of control with an increase in self esteem as the practices are incorporated into daily activities. Specific stress reducing activities include relaxation training, cognitive appraisal, music therapy, exercise, decision control, massage and humour. So the knowledge of stress and coping theories, provides the nurse with useful concept that are applicable to all phases of nursing process (Luckmann). Keegan (2003) stated that successful use of alternative and complementary therapies provided by nurse will help to decrease stress for critical ca re patients. The therapies included are aromatherapy, hydrotherapy, humour, music massage, imagery, relaxation therapy. Hence the investigator felt the need to perform experimental study to assess effectiveness of psycho education and progressive muscle relaxation training in reducing Post traumatic stress disorder. STATEMENT OF THE PROBLEM A quasi experimental study to assess the effectiveness of selected nursing interventions in reducing the level of post traumatic stress disorder among patients met with motor vehicle accidents admitted in Madurai Institute of Orthopedics and Traumatology Hospitals, Madurai. OBJECTIVES To assess the level of post traumatic stress disorder before and after selected nursing intervention in the experimental group. To assess the level of post traumatic stress disorder before and after routine treatment in the control group. To compare the level of post traumatic stress disorder between the experimental and control group after the nursing interventions. To assess the effectiveness of selected nursing interventions in reducing the level of post traumatic stress disorder. To determine the association between the level of post traumatic stress is experimental group with selected variables (age, educational status, marital status, marital status, occupational status, nature of accident, loss of body part and loss of family member during accident). HYPHOTHESIS All hypotheses were tested at 0.05 level of significance H1 The mean post test level of post traumatic stress disorder in experimental group will be significantly lower than mean post test level of PTSD in control group H2 The mean post test level post traumatic stress disorder in the experimental group will be lower than mean pretest level of post traumatic stress disorder after selected nursing interventions. H3 There will be significant association between experimental group post test level of post traumatic stress disorder and with selected variables (age, educational status, marital status, nature of accident, loss of family member and loss of body part). OPERATIONAL DEFINITION Effectiveness : It is the most outcome of selected nursing intervention in producing reduction of post traumatic stress disorder in patients net with motor vehicle accident. It will be measured by the score obtained by the subjects in the PTSD Checklist Civilian version (PCL-C) Scale. Post traumatic stress disorder à ¢Ã¢â€š ¬Ã¢â‚¬Å" It is an anxietic disorder that may develop with the patient after threatened death, assault, serious injury, motor vehicle accidents as meant to physical integrity of oneself or others, numbing of emotional response or hyper arousal. Hereafter it will be termed as PTSD. In this study, subjects who met with motor vehicle accidents were selected based on the Diagnostic and Statistical Manual of Mental Disorders(DSM)IV Criteria for PTSD. Selected nursing interventions: They are actions undertaken by a nurse to further the course of treatment for a patient In this study following interventions are taken to reduce post traumatic stress disorder. P sycho education : Education of subjects with psychological disturbance, regarding, common reaction have been found among those exposed to trauma and coping strategies, reestablish routines, avoidance of intrusive thoughts and relaxation techniques. It was provided for 20 minutes. Progressive muscle relaxation training- It refers to programme of relaxation with eyes closed, the muscles are tensed (10 seconds) are relaxed (20 seconds) in sequence and progressive pattern. This was provided for 30 minutes. Patients met with accidents- It refers to conscious patients admitted after motor vehicle accident with minimum hospital duration of 14 days,admitted in selected hospital during data collection period. ASSUMPTIONS Patients who have met with motor vehicle accidents will experience post traumatic stress disorder symptoms Progressive muscle relaxation training will have no adverse effects on patients who are practicing it. Patients who have received progressive muscle relaxation will not have difficulty in practicing it. Hospitalized patients will suffer from some sorte of stress. DELIMITATIONS The following delimitations were set for the study: Patients who have met with accidents with in a duration of one month, admitted in Madurai Institute of Orthopedics and Traumatology, Madurai. Patients with high level of post traumatic stress disorder during the period of data collection Data collection period is limited to six weeks. Progressive muscle relaxation training was administered for 30 minutes and psycho education for 20 minutes for 14 days. PROJECTED OUTCOME Research study findings will be very useful to the nursing practice because nurses can teach these simple intervention to their patients to reduce post traumatic stress disorder. Psycho education will enhance acceptance of symptoms and reduce level of post traumatic stress disorder among patients met with motor vehicle accidents. Progressive muscle relaxation will reduce the level of post traumatic stress disorder among patients met with motor vehicle accidents. CONCEPTUAL FRAMEWORK The conceptual framework of this study was based on Sister Callista Roys Adaptation Model (1934), which involves four concepts-person,environment,nurses and health. The adaptive system has four components-Input (stimuli which may come from the environment) which can be focal (immediately confronting) contexual (all other stimuli that are present) or residual (non specific such as cultural beliefs):Throughput (which includes processes that a person uses as an adaptive system and effectors as physiologic function, self concept and role function) and Output ( positive or negative outcome of the adaptive system-persons behavior).. In this study,persons were patients with post traumatic stress disorder, reduction in the level of severity of post traumatic stress as the goal of nursing, health is considered an adaptation to post traumatic stress disorder and environment was defined as all the conditions affecting the development and behavior of person.Selected nursing interventions(ps ycho education and progressive muscle relaxation training) were considered to be regulator coping mecahanism.Factors in the environment that affect were categorized as focal,contextual and residual stimuli.In this study focal stimuli was refered to the physiological(heart pounding,trouble breathing,sweating,sleep disturbance,irritability) and psychological(memories.hyperarousal,numbing,poor concentration);contextual stimuli were age, sex, educational status, occupational status, marital status, loss of body part, loss of family member.Selected nursing interventions(psycho education and progressive muscle relaxation training) were considered to be regulator coping mecahanism.Output is the absence or reduction in the level of post traumatic stress disorder(Adaptive response) in both groups or no reduction in level of post traumatic stress disorder (ineffective response) is both groups which need to be given feedback by re-assessment process. CHAPTER II REVIEW OF LITERATURE According to Polit and Hungler(1999) researchers often undertake a literature review to familiarize themselves with that knowledge base. The term literature review refers to the activities involved in identifying and searching for the information on a topic and developing an understanding of the state of knowledge on that topic. Related literature was reviewed in depth, so as to broaden the understanding of the selected problem. The idea was to develop a deeper insight into the problem area and to identify the level of post traumatic stress disorder among patients met with motor vehicle accidents and to evaluate effectiveness of psycho education and Progressive muscle relaxation training to reduce post traumatic stress disorder. The review of literature is organized under following headings: Studies related to post traumatic stress disorder Effects of psycho education on post traumatic stress disorder Effects of progressive muscle relaxation training on post traumati c stress disorder Studies related to post traumatic stress disorder Andresen (2010) investigated on post traumatic stress disorder: a history and a critique. The study explained that the history of PTSD has often been linked to the history of war, but the disorder has been frequently described in civilian settings involving natural disasters, mass catastrophes and serious accidental injuries. The diagnosis first appeared in the official nomenclature when Diagnostic and Statistical Manual of Mental Disorder (DSM I) was published in 1957 under the name gross stress reaction. When DSM III was developed in the mid 1980s the recent occurrence of the Vietnam war provoked a more thorough examination of the disorder. Post Traumatic Stress Disorder was defined as a stress disorder that is a final common pathway occurring as a consequence of many different types of stress including both combat and civilian stress. Barayani et al;(2010) has conducted a study to assess the relationship between post traumatic stress disorder, quality of life, social support and affective and dissociative status in severely injured trauma victims. The study was carried out in 52 severely injured accident victims 12 months after trauma. Respondents were given a questionnaire and structured clinical interviews. One fourth of respondents met all criteria for post traumatic stress disorder and another 21.2% had sub syndromal Post Traumatic Stress Disorder. Patients with Post Traumatic Stress Disorder showed higher severity of dissociative and depressive symptoms and major impairments in some dimensions of quality of life. Severely injured accidents victims seem to face a major risk of Post Traumatic Stress Disorder and impairments in health related quality of life. Frommberger et al;(2008) had conducted a prospective study on prediction of post traumatic stress disorder by immediate reactions to trauma among 179 unselected consecutively admitted road traffic victims were assessed a few days after the accident for psychiatric diagnoses and psycho patholog y. At 6 months follow up assessment, 152(85%) of patients were interviewed again of the patients, 18.4% fulfilled the criteria for post traumatic stress disorder (DSM III R) within 6 months after the accident. Patients with PTSD were injured more severely, stayed significantly longer in the hospital than other patients.A regression analysis revealed that the length of hospitalization was mainly due to diversity of factors such as severity of injury, severity of accidents and premorbid personality. Chen, Liu and Zheng (2006) conducted a study on Post Traumatic stress Disorder after road traffic accidents in forensic medicine. 156 victims of road traffic accidents were recruited, who applied to court for cost order. The victims were examined for psychiatric diagnosis by psychiatrists and for rank of impairment by experts in forensic clinical medicine. 51.92% fulfilled criteria for PTSD (ICD 10). Morbidity difference in male and female were significant . The scores in World Health O rganization Quality of life were higher in PTSD group than in non PTSD group. Acquirement of awarded costs could obviously prevent Post Traumatic Stress Disorder, and higher incidence of Post Traumatic Stress Disorder existed in road traffic accidents victims who applied to court for costs order. Watts (2006) had assessed the prevalence of post traumatic stress disorder caused by surviving serious road accidents, 29 people were selected. Their high vulnerability was clearly established 41% had PTSD and 52% with severe intrusion or avoidance phenomena, which included 31% who had both the occurrence of psychological sequelae was not associated with being currently distressed by another event, not with age, gender or acquaintance with people killed in the accident. Stretch et al;(2006) had assessed the prevalence of risk for development of post traumatic stress disorder symptoms among active duty and reserve veterans from Pennsylvania and Hawaii who either deployed (N-1,524) or d id not deploy (N-2727) to the Persian Gulf as a result of Operational Desert Storm. All participants anonymously completed a survey questionnaire but included the impact of event scale and brief symptom inventory. Results indicate the likelihood of post traumatic stress disorder symptoms in appropriately 8.0% of active duty verterans and 9.3% of reserve veterans who deployed to the Persian Gulf. Cairo et al; (2010) had investigated the prevalence of post traumatic disorder among adult earthquake survivors in Peru(magnitude 80). The cross-sectional study was conducted using demographic questions, PTSD checklists and a translated version of Harward Trauma Questionnaire.298 adult earthquake survivors were interviewed and detected 75 cases of PTSD (Prevalence 25.52%;95% confidence interval,20.2%-30.1%).In the bivarial analysis,PTSD was significantly associated with female sex, loss of relative, food and water shortages joblessness,lack of clean drinking water or appropriate sleeping conditions. Thavichachart et al;(2009) conducted a cross-sectional community survey on Post traumatic stress disorder prevalence among Tsunami survivors in Thailand.3,133 samples had been conducted in two phases from the same sampling group. The first phase was concerned with prevalence of PTSD, depression and related factors. The second phase included 2,573 samples from first phase and focused on Post traumatic stress disorder and other mental disorders. The 3,133 samples used in the first phase showed that 33.6% suffered from Post traumatic stress disorder, 14 .27% with depression and 11.27% suffered from both. Elkit and Christiansen (2010) had investigated the prediction of post traumatic stress disorder through the presence of acute stress disorder in a population of 148 female rape victims who visited a center shortly after the rape or attempted rape regardless of whether cases were classified according to full Post traumatic stress disorder status or accessing to meeting the criteria for the three Post traumatic stress disorder core symptoms clusters, the classification was correct in approximately two thirds of cases. A regression analysis based on Acute Stress Disorder severity and sexual problems following the rape accounted for 48% of post traumatic stress disorder severity variance. Susan et al;(2009) had done study on analysis of symptoms presentation and sampling for post traumatic stress after childbirth. 1423 women after birth were selected via the community (n=502) or internet (n=921). Demographic, obstetric and trauma history variables were also measured.Full post traumatic stress disorder diagnostic criteria were endorsed by 2.5% of women from the community and 21% of women on the internet. Factor analysis found two post traumatic stress disorder symptom clusters of re experiencing and avoidance and numbing and arousal 60% of post traumatic stress disorder cases were correctly identified by parity, delivery type and the interaction b etween sexual trauma and delivery type. Dao et al;(2010) performed a retrospective survey to assess the effect of clinical depression, post traumatic stress disorder as risk factors for in hospital mortality after Coronary Artery Bypass Grafting surgery. Nationwide inpatient sample database providing information on 8 million US inpatient stays from about 1000 hospitals. Patients were more likely to have had depression (alive, 24.8% deceased,60.3%, P0.0001) post traumatic stress disorder (alive 13.4%; deceased 56.1%, P0.001) and comorbid depression and post traumatic stress disorder (alive 7.8%, deceased 48.5%, P 0.001) Two findings were note worthy. First,depression,post traumatic stress disorder are prevalent is patients undergoing coronary artery bypass grafting procedures. Second, depression and post traumatic stress disorder increase the risk of death by magnitudes comparable with well established physical health risk factors after CABG. Schelling (2008) stated that Post t raumatic stress disorder has been described in patients after multiple trauma,burns or myocardial infarction, ARDS or septic shock.Studies in long term survivors of ICU treatment demonstrated clear and vivid recall of different categories of traumatic memory.A high number of these traumatic memories from the ICU has been shown to be a significant risk factor for the later development of Post traumatic stress disorder is long term survivors. II STUDIES AND LITERATURE RELATED TO THE EFFECTS OF PSYCHO EDUCATION ON POST TRAUMATIC STRESS DISORDER Bethany (2007) stated that psycho education about the persistent effects of trauma help survivors to better understand their stress responses and knowledge of coping strategies which provides a sense of control over these responses. Trauma education for providers can minimizes negative counter transference and prevent vicarious traumatization. Advanced practice nurses may provide psychological and behavioural disturbances related to severe and persistent abuse or trauma, especially early in life. It provides a cognitive framework for their experience and helps minimize adverse responses. For persons with persistant symptomatology, education about physiological basis for psychological phenomena such as mood instability, flash backs, memory problems and depression allows them to see these symptoms and not as personal failings. Psycho education also need to address immediate needs for safety and self care. Oflaz, Halipoglu and Aydin (2006) conducted a quasi experimental study to ex amine the effectiveness of psycho education intervention on post traumatic stress disorder and coping styles of trauma survivors. 51 survivors of motor vehicle accidents who met diagnostic criteria for PTSD. Comparison groups were made up as psycho education only and medication only. Six semi structured psycho education session were conducted. Clinician Administered PTSD scale, Hamilton depression scale and coping strategies scale were used for me measurements. The result showed, that there was significant difference between à ¢Ã¢â€š ¬Ã‹Å"psycho education only group and à ¢Ã¢â€š ¬Ã‹Å"medication only group. Avoidance as a copying strategy had significant positive correlations with Post traumatic stress disorder. Kim et al; (2005) conducted randomized controlled trial at University of California Medical Center, USA to evaluate the effectiveness of psycho educational programme in reducing post traumatic stress disorder among patients following motor vehicle accidents. The study wa s done in seven out patients with post traumatic stress disorder. Following randomization, into psycho education group, patients completed the Clinician Assisted PTSD scale prior to and at the completion of intervention.The scores increased significantly is psycho education group (21%) when compared to standard care group 0.5% thus the results curtained up that there was significant difference between psycho education group and standard care group of patients. Pratt et al; 2005 conducted study for the evaluation of PTSD psycho educational program for trauma patients. 70 inpatient participants who met criteria for Post traumatic stress disorder attended three sessions of psycho educational programme using group format of video and discussion. The participants completed a knowledge of Post traumatic stress disorder questionnaire before and after the education programme. Participants, demonstrated significant increase in knowledge about trauma and Post traumatic stress disorder and reported high levels of satisfaction with the program. Findings supported the use of this intervention as a first step in increasing knowledge about Post traumatic stress disorder and stimulating motivation to seek future treatment. According to Gromisch (2010) treatment for Post traumatic stress disorder may include psycho therapy,medication or a combination of the two treatments. Another types of treatment that can be done along with psycho therapy is psycho education and trauma victims can often receive more information about their particular type of trauma through psycho education.Psycho education explores psychological responses to trauma, future symptoms. It needs to be individualized for that trauma victim. While information as the commonness of interpersonal violence may reduce the clients sense of being the only one who has be victimized, it may also reinforce the clients over estimation of the amount of danger in the interpersonal environment leading to increased fear a nd avoidance of others. Wessley et al;(2008) noted that psycho education covers the provision of information can occur following trauma exposure immediately which covers the provision of information about nature of stress, post traumatic and other symptoms and what to do about them. The aim of providing psycho education was to ameliorate the effects of exposure to extreme situations. Krupnick and Green (2008) quoted that psycho education for Post traumatic stress disorder is explaining to individuals or groups what common reactions have been found among those who have been exposed to traumatic stress. It includes a delineation of the symptoms of Post traumatic stress disorder, description of common reactions that occur, in addition to symptoms it might include indications of when to seek professional help. Hoslbuk (2004) conducted a study to explore the use of psycho education in the treatment of post traumatic stress disorder with military personnel.80 military personnel w ere selected who met the criteria for Post traumatic stress disorder as per DSM IV. Results from exploring the meaning and understanding of psycho education. The effectiveness in the treatment of Post traumatic stress disorder revealed subjective results due to time frame and situation of use with the treatment technique. Douglas and Yeomans (2008) conducted a study to examine the effect of psycho education on the nature and severity of traumatic stress symptoms in a Burundian sample.They used an experimental design to examine the influence of PTSD psycho education. Participants were randomized to three condition : A reconciliation workshop with psycho education, without psycho education and a waitlist control. Results showed that participants in the psycho education condition experienced a reduction of Post traumatic stress disorder symptoms and relative to other conditions. There was no differential effect by condition on more general symptoms of anxiety, depression and somatiz ation symptoms. Secondary hypothesis predicting relationships at baseline between prior to exposure to trauma models developed in industrial societies and nature of severity of Post traumatic stress disorder symptoms were not supported. Gould, Greenberg and Hetherton(2007) conducted a study for the evaluation of PTSD psycho educational programme : stigma and military psycho educational management strategy based on peer group risk assessment developed by UK Royal Navy was used. Psycho education seeks to modify attitudes about Post traumatic stress disorder, and help seeking and trains military personnel to identify at risk individuals and refer them for early intervention. The quasi experimental study found that psycho education significantly improved attitudes about Post traumatic stress disorder, stress and copying. Blanchard et al; (2007) conducted randomized controlled trial comparing cognitive behavioural therapy with psychotherapy and waitlist control condition. 78 trauma survivors who were atleast 6 months past their motor vehicle accident completed treatment.Of this sample 81%(n=63) met diagnostic criteria for PTSD. Individuals receiving cognitive behavioural therapy including (muscle relaxation, exposure therapy, psycho education,desentization) showed significantly greater reduction than those in the waist list condition of those with diagnosable criteria at post treatment, compared to 48% of those treated by- supportive therapy and 24% of individuals in the waist list condition. III.STUDIES RELATED TO EFFECT OF PROGRESSIVE MUSCLE RELAXATION THERAPY ON POST TRAUMATIC STRESS DISORDER: Emery et al;(2006) conducted a randomized clinical trial to evaluate the effectiveness of progressive muscle relaxation training on post, traumatic stress after motor vehicle accident. In the study 55 trauma survivors were selected who met PTSD diagnostic criteria. Participants were then randomly assigned to 25 minutes progressive muscle relaxation condition.Following the brief intervention, participants completed self report questionnaire. Result indicated a significant time, with participants in the progressive muscle relaxation condition experiencing a significant decrease in post traumatic stress while participants is the no à ¢Ã¢â€š ¬Ã¢â‚¬Å"treatment condition experienced no change is post traumatic stress disorder. Result supported the efficacy of progressive muscle relaxation in reducing post traumatic stress disorder and provide further evidence of the utility of behavioural stress management strategies. Blythe and Erdahl (2006) in a single case study found the effectiv eness of progressive muscle relaxation intervention in reducing post traumatic stress disorder. Brown, Sterling and Hanley (2006) conducted randomised controlled trial of progressive muscle relaxation training is management of post traumatic stress disorder. Training in relaxation technique was provided to 69 patients among earthquake survivors for a period of six weeks. Level of post traumatic stress was measured by detailed assessment of Post traumatic stress disorder. Results showed that there was significant reduction in post traumatic stress symptoms (p=0.001) Hayes (2007) conducted a comparative study in Sydney to compare the effectiveness of progressive muscle relaxation and guided imagery on post traumatic stress and quality of life. In this study 56 people following a natural calamity who were experiencing anxiety and post traumatic stress disorder symptoms, were to one of four treatment conditions:(i)Progressive muscle relaxation training,(ii)Guided imagery training( iii)Both of these treatments (iv)Control groups. Subjects were tested before and after learning muscle relaxation and guided imagery techniques for anxiety, post traumatic stress and quality of life using the hospital Anxiety and Depression scale and Brief Interview for Post traumatic Disorder (BIPD). There was no significant improvement for anxiety, however significant positive changes occurred for post traumatic stress disorder and quality of life in the third group. Fecteau and Nicki (2008) reported the first controlled treatment trial with motor vehicle accident survivors diagnosed with Post traumatic stress disorder. Treatment included three individual cognitive behavioural therapy (CBT) sessions involving psycho education, progressive muscle relaxation and cognitive interventions, individuals who received treatment showed significant improvement on clinician and self reported Post traumatic stress disorder symptoms. Four of 10 individuals who received CBT were free of Post traumatic stress disorder diagnoses after treatment. Thus even with relative short individual format treatment of six weeks CBT appeared effective for reducing the symptoms of motor vehicle accident related Post traumatic stress disorder. Blanchard, et al (2008) completed randomized controlled trial comparing cognitive behavioural therapy with supportive psychotherapy, both concluded in an individual treatment format and a wait list control condition. 78 survivors who were at least 6 months past their motor vehicle accident completed treatment. Of thin sample 81% (n=63) met diagnostic criteria for PTSD and the remainder had severely symptomatic subsyndromal forms of the disorder. CBT included 12 sessions of muscle relaxation, training, exposure therapy, psycho education, cognitive restructuring and desensitisation. Individuals received cognitive behavioural therapy showed significantly greater reduction in clinician rated Post traumatic stress disorder severity relative to those in the supportive psychotherapy condition than those in waitlist control condition. Hinkling, Sison and Vanderploeg (2009) investigated the use of bio-feed back and relaxation training as a treatment of post traumatic stress disorder. Subjects received between 8 and 14 sessions of training overall as well as concurrent individual and group therapy. Measures used to assess treatment outcome include pre and post Multidimensional Health Focus of Control scores as well as electromyographic and subjective measures of tension with each session. Additionally an overall post treatment clinical rating of change and 1-2 years follow up data were obtained for each subject. Improvements were demonstrated for each subject, an evidenced by a decrease is overall Multidimensional Health Focus Control scores, lowered EMG and subjective tension rating for all participants. Results suggest that use of relaxation training and biofeedback was a particularly useful component within a comprehensive tre atment program for Post traumatic stress disorder. Parendeh et al;(2010) had conducted a clinical trial quasi experimental study to evaluate the effect of progressive muscle relaxation training on quality of life among Post traumatic stress disorder veterans wives.28 war veterans wives in Tehran city were selected and divided into interventional and control groups randomly. Educational program was performed for intervention group at 3 sessions, each lasted 2 hours during a week. The quality of life in both groups was determined before 6 weeks and 12 weeks after training, by SF36 questionnaire. The results revealed significant difference between quality of life mean score before and after in intervention group (P0.001),and showed promoting their life quality.

Autism Spectrum Disorders Prevalence - 766 Words

Autism Prevalence Autism Spectrum Disorders (ASD) refers to a group of developmental brain disorders that affect a child’s cognitive, behavioral, and social abilities (American Psychiatric Association, 2013). There are several forms of ASD that have different impairments and levels of severity. Recent research has been looking at the increased prevalence of ASD and possible causes of this increase. In attempts to determine reasons for the increased prevalence of ASD, Schieve et al. examined the relationship between the risk factors of pregnancy and the increase in ASD. A mathematical model was created to identify and measure if such a relationship existed. In the model, the research looked at each risk factor of pregnancy, individually and in combination, and if there was any evidence that these risk factors impacted an ASD (Schieve et al., 2011). If there was an impact found, they looked at how much of an impact it made. The pregnancy data is from the U.S population-based sur veillance datasets. Although the different pregnancy risk factors were associated with ASDs, Schieve et al. determined that the increase in ASD due to pregnancy risk factors is minimal (2011). Another study looked into a different explanation for the increased prevalence of ASD in the population. As compared to the Schieve et al. (2011) study, Kogan et al. (2009) conducted research by using randomly dialed telephone surveys. The research participants consisted children between the ages of 3-17Show MoreRelatedThe Prevalence Of Autism Spectrum Disorder Essay1786 Words   |  8 Pagesapparent increase in the prevalence of Autism Spectrum Disorder in the United States has been a growing public concern. The lifelong condition can cause severe neurodevelopmental problems characterized by symptoms such as impaired communication, diminished social interaction, and unusual ritualistic behaviors (Johnson, Handen, Zimmer, Sacco, Turner, 2010). Unfortunately, doctors and researchers have not been able to agree on the direct cause for Autism Spectrum Disorder (ASD) or ways to treat theRead MorePrevalence Of Depression And Autism Spectrum Disorder1334 Words   |  6 Pages Prevalence of Depression in Individuals with Low to High Functioning Autism Spectrum Disorder Kelvin Davis PSY 1022 Monday, October 14, 2013 Wednesday 8:00 am Word Countâ€Æ' Abstract Individuals with Autism Spectrum Disorder (ASD) are quite vulnerable to anxiety and depression, especially in late adolescence and early adult life (Tantum Prestwood, 1999). In accordance with a study sampling children between 7 and 13 years of age (Vickerstaff, Heriot, Wong, Lopes Dossetor,Read MoreIn Recent Years, The Prevalence Of Autism Spectrum Disorder1357 Words   |  6 Pagesrecent years, the prevalence of autism spectrum disorder (ASD) has increased greatly (Nevison 2014). For example, in 2000 the Autism and Developmental Disabilities Monitoring (ADDM) Network estimated about 1 in 150 children had ASD. Six years later in 2006, the prevalence increased to about 1 in every 110 children and then most recently in 2012 to 1 in 68 children. According to the CDC (2008) autism is the fastest-growing developmental disability. With the growing prevalence of autism, the society hasRead MoreThe Increasing Prevalence in Autism Spectrum Disorders1155 Words   |  5 Pages Autism is a mental condition that can occur in children from birth but is diagnosed in early infancy or early childhood. It is a complex neurobiological disorder that typically lasts throughout the lifetime of a person. It can be considered as a spectrum of disorders characterized by severe developmental deficiencies that can affect socialization, communication, emotional development and can cause repetitive or unusual behaviors. The ranges of the symptoms are mild to severe. There is a milder formRead MoreAutism Is A Matter Of Passionate National Debate1197 Words   |  5 Pages Introduction: †¢ In the past two decades or so, autism has changed from being a condition nobody had even heard about to widely recognized mental health condition. Due to widespread use of internet, social media and smartphones everybody knows something about autism. Just searching for autism in Google brings up more than 68 million results. Autism has become a matter of passionate national debate among different stake holders such as government, public health agencies, mental health associationsRead MoreAutism And Childhood Of Autism Essay1382 Words   |  6 Pagesexplored of all youth psychiatric disorders, Autism continues to be a captivating condition. The conception and description of the disorder has evolved significantly over time leaving some philosophies once held with principle to later verify to be unproven. Scientists and clinicians have provided the highest influences to the understanding of the illness, however, history does illustrate countless teachings and initial interpreta tions of a possible genesis of autism to be uncertain. The socio-politicalRead MoreInside Autism Spectrum Disorder Essay1715 Words   |  7 PagesAutism Spectrum Disorder is a neurodevelopmental disorder that is characterized by a number of deficits in verbal and non-verbal communication, social interaction with others, and other behaviors. Usually diagnosed in early infancy, this disorder is the most impairing and severe of the neurodevelopmental disorders. Before the publishing and release of the Diagnostic Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013), Autism Spectrum disorder could be diagnosedRead MoreIntroduction To Autism Spectrum Disorder ( Asd )931 Words   |  4 PagesIntroduction to Autism Spectrum Disorder (ASD) Autism have been recognized as in existence since the 1940s but only in recent years it has been recognised under the standardized psychiatric diagnostic classification schemes. It is not unusual for people with ASD to be at risk of displaying challenging behaviours which could lead to offending behaviours, however, on the other hand they can also be at lower risk as they find rules helpful in surviving in the social world. This paper will look at whatRead MoreAutism Spectrum Disorder And Autism1492 Words   |  6 Pageslife there are several different disorders that have been well known from many years ago. There is one disorder that was diagnosed in the early 1800’s but it wasn’t until a few years ago that it gained lots of attention. What used to be known as Autism was later renamed in the DSM to Autism Spectrum Disorder meaning, a neurodevelopmental disorder rather than a pervasive developmental disorder (Gargiulo, 2015). Autism spectrum disorder is a development al disorder characterized by abnormal or impairedRead MorePrevalence Of Autism Essay949 Words   |  4 Pages The Increasing Prevalence of Autism Autism, or autism spectrum disorders (ASD), is a neurodevelopmental disability that is characterized by deficits in two behavioral areas: communication and social, and restrictive and repetitive behaviors. The Center for Disease Control and Prevention (CDC) reported that 1 in 88 children had an ASD in 2008 (CDC 2012), and in 2010 the prevalence increased to 1 in 68 children (McCarthy). Could the increase in prevalence of ASD be attributed to environmental factors;

Electric Field Free Essays

Name ____________________________________Electric Fields Go to http://phet. colorado. edu/simulations/sims. We will write a custom essay sample on Electric Field or any similar topic only for you Order Now php? sim=Electric_Field_Hockey and click on Run Now. 1. You rub balloons in your hair and then hang them like in the picture below. Explain why you think they move apart and what might affect how far apart they get. A balloon becomes negatively charged when it is rubbed on a person’s hair. This occurs because all the protons and neutrons leave the balloon and attach to other objects such as the hair. If two balloons both have negative charges then both balloons will repel each other because same charges repel while opposites attract. 2. Test your ideas using Electric Field Hockey in the Practice mode. Make a table to record your observations about what affects the direction and speed of the puck. Your table should demonstrate that you have run controlled tests with all the variables. Charges introduced |Effects on positive charge repulsion | |Positive |Repel | |Negative |Attract | Charges introduced |Effects on positive charge speed | |Positive |Close to charge=Increasing repulsion speed | | |Far from charge= decreasing repulsion speed | |Negative |Close to charge=Increasing attraction speed | | Far from charge= decreasing attraction speed | 3. Reflect on your ideas from question #1 and your data from question #2. How do your observations support, dispute or ad d to your ideas about what affects how charged bodies interact? The data collected helps support my claims that like charges repel each other while opposites attract. In the case of the balloons both balloons are negative there for repelling each other. 4. As you put charges onto the playing area, arrows appear on the puck. †¢ What do you think the arrows on the puck are illustrating? The arrows illustrate the movement of the pucks as well as velocity. †¢ How do the arrows from the positive charges compare and contrast to the ones from the negative balls? The positive charges seem to repel the puck while the negatives attract. †¢ Investigate how you can use the arrows to predict the motion of the puck. 5. Write an explanation of how you can predict the motion of a charged hockey puck that is moved by other charged pucks. Explain using examples and drawings that include: †¢ How to use free body diagrams and vector addition. †¢ How negative and positive charges compare and contrast. How to cite Electric Field, Essay examples

Provisions of Australian Contract Law

Question: Discuss about the Provisions of Australian Contract Law. Answer: Introduction This question consists of three different cases where we need to comment that whether consideration is present and whether it has an enforceable agreement. All three cases are almost similar with slight difference in the price which is offered for the Lotus Super 7 Sports Car. Before commenting on all three cases we should understand the meaning of Consideration and Enforceable Agreement/Contract. (Lawyerie, 2016) Consideration: it is a value which a promisor receives from a promisee in return for his promise. It is concerned with the bargain of the contract. It must have a value in the eyes of law and excludes promises of love and affection, betting gaming etc. A promise which is only from one side is not a consideration, instead it is a gift. There are various rules which are governing the law of consideration. The rules are given below:(Ilovelibrariesorg, 2016) Consideration should not be past. It should move from the promise. It must be sufficient and should not be adequate. Any part payment made should not be considered as a valid consideration for a promise to forgone the balance. Any existing public duty and contractual duty should not be regarded as valid consideration.(E-lawresourcescouk, 2016) Enforceable Agreement/Contract: There are certain provisions which needs to be fulfilled to called a contract or an agreement is enforceable. The basic requirements which need to be there for a contract to be enforceable are:(Lawscom, 2016) 1. Consideration must be present. 2. There must be an offer by a party 3. Acceptance must be given by the other party. 4. Relevant parties must have the legal capacity to the contract. 5. The matter on which the discussion is there must be legal in law. 6. There must be a mutual obligation between both the parties If all the above mentioned conditions are present then a contract or an agreement is considered as enforceable.(Lawcom, 2016) There are two parties involved in this case named as Jane and Jack. Jane is giving an offer to Jack to give her Lotus Super 7 sports car. Nothing is mentioned regarding the price at which the car is offered. The price of the same vehicle in a very good condition in the market was $25,000. In this case only Jane has given promise to give her sports car to Jack but there is no promise from the side of Jack. For a consideration to be present promise should be there from both sides, but here promise is given only from one side. Jack has not given any promise to Jane, so there is no consideration. In such cases it is called as gift. Jane has gifted her Sports car to jack without any consideration. Jack has even accepted the offer which is given by Jane. Now since consideration is not present then this contract would be enforceable by law. Any contract can be enforceable only when a consideration is present in it, but in this case consideration is not there. Hence this case neither has any consideration nor is the contract enforceable by law. The second case is also very similar to the first one but the only difference is the price which is given for the sports car. Jane has promised to give her sports car to Jack at a price of $25,000. The market price of the same vehicle in a very good condition would also cost $25,000. This means the price which is offered by Jane is same as the price which is offered in the market. In this case both Jane and Jack promised each other. Jane has promised to give her car to Jack while Jack has promised to give $25,000 to Jane. $25,000 paid by Jack to Jane is the consideration paid. The said contract between Jane and Jack is enforceable since all the elements of a contract are present in it. The elements fulfilled in this case are:(Rocketlawyercom, 2016) Jane has offered her Sports car to Jack. Hence the offer condition is fulfilled. Jack has accepted the offer which was offered by Jane. Hence the acceptance condition is also fulfilled. Jack has paid $25,000 to Jane for the car which is same as the price which is offered in the market. Consideration condition is also fulfilled. Both the person involved has the obligation. Jane has an obligation to give her Sports car to Jack and Jack has an obligation to give money to Jane. Hence Mutuality of obligation condition is also fulfilled. Both Jack and Jane have the legal capacity to the contract.(Thefreedictionarycom, 2016) Hence in this case consideration is present and even the contract is enforceable by law. The third case is also very similar to the first two cases except the price which was given by Jack. Even here Jane has offered her Sports Car to Jack but at a price which is very low than the price offered in the market. Price offered in the market was $25,000 while the price offered by Jane to Jack was only $2,500. The price offered was only 10% of the price offered in the market. Consideration is present in this case but it is not legally enforceable because the price offered is very low. For a consideration to be present certain rules needs to be fulfilled. The rules are explained below:(Wwwuiono,, 2016) Consideration paid here does not belong to past. It was a promise given by Jack to Jane in return for the Sports Car. The consideration paid was not sufficient because it was only 10% of the price which was offered in the market. The amount paid is not a part payment. $2,500 is the full payment which was paid by Jack to Jane. There are not contractual and public duty included in the consideration. All the conditions regarding consideration have been fulfilled except the third condition. Consideration paid by Jack was not sufficient enough. Now since consideration is not present then the contract would also be not enforceable by law. Hence in this case neither the consideration is present nor is the contract enforceable by law.(Findlawcom, 2016) Issue: This case also highlights the provisions of contract law. With the help of this case we would understand about the breaches in a contract. Two parties are involved in this contract. A shipbuilder has taken a contract to build a tanker for North Ocean Tankers. The terms and conditions of the contract were: 1. Amount paid to the shipbuilder would be in U.S. Dollars. 2. If there is any change in the currency then price paid would not get affected. It does not contain provisions for currency fluctuations. When fifty percentage of the contract was completed U.S. had devalued Dollar by 10%. Now since the contract didnt contain provisions regarding currency fluctuations, shipbuilder suffered losses. Due to the loss suffered shipbuilder demanded an extra amount of $3 million and if the amount is not paid then the construction would be stopped. Buyer didnt want the construction to be stopped since they had a charter for the tanker and it was essential that it should be delivered on time. Buyer agreed to pay the demanded extra amount under protest. Buyer decided not to take any action until the entire construction is completed. As soon as the construction was completed buyer wanted to recover the extra money which was paid. We need to see that whether buyer would be successful in claiming back the extra amount which was paid by them or not.(Wordpresscom, 2016) Rule: when an agreement between two parties is legally enforceable then it is called a contract. But there are certain elements which need to be present in a contract to make it legally enforceable. The elements are discussed below:(Contractstandardscom, 2016) Acceptance and offer Agreement should be legal as per the respective State Laws. Both the parties must have the intention to create binding relations. Consideration must be paid for the promise, which is made by the party. Both the parties must have the genuine consent. Legal capacity of the parties to act. If all the above-mentioned elements are present in a contract then it is considered as a contract.(Lsuconca, 2016) Breach of a contract is a legal cause of action in which one of the parties did not performed its promise as per the terms and conditions of the contract. If a party was unable to perform his duty as mentioned then it is considered as a breach. There are various kinds of breaches in a contract which are discussed below:(Ideaint, 2016) Minor Breach: in such kind of a breach non-breaching party could not sue the breaching party for specific performance but can sue for actual damages. Material Breach: in such kind of a breach party to the contract can either compel performance or collect damages because of the breach. Fundamental Breach: In such kind of breaches aggrieved party can terminate the performance of a contract and the party can sue for damages as well. Anticipatory Breach: under this breach party will not perform his duty when the performance is due. It is a situation where future non-performance is inevitable.(Adamsdraftingcom, 2016) Application: first we need to check that whether the contract entered between the shipbuilder and North Ocean Tankers is legally enforceable by law or not. The elements of a contract are discussed below in detail: North Ocean Tankers is a company which has given an offer to the shipbuilder to construct a tanker for them. Offer is present in this contract. Shipbuilder has accepted the contract which was offered by the buyer. Acceptance is also present in the contract. For the work done by the shipbuilder, amount is paid by the buyer in U.S. Dollars. Hence consideration is also present in this case. Both the parties have obligation to perform. Shipbuilder has the obligation to build the tanker and North Ocean Tankers has the obligation to pay them. The terms and conditions of the contract are legally enforceable. As per the terms payment will be made to the shipbuilder only in U.S. Dollars and it will not contain any provisions regarding currency fluctuations.(Dlapipercom, 2016) Since all the elements of a contract are present in this case, the said contract is legally enforceable by law. But since shipbuilder was suffering losses, it had asked for extra $3 million to be paid. This was not as per the terms and conditions of the contract. It was clearly mentioned that provisions of currency fluctuations should not be there. Inspite of knowing this shipbuilder had asked for extra amount. This is a breach of a contract committed by the shipbuilder. If he was not happy with the terms of the contract then he should have requested for a change in the terms. But unfortunately there was no such request by the shipbuilder and hence it was assumed that he has agreed with the terms and conditions of the contract. This breach is considered as a minor breach which was committed by the shipbuilder. Though buyer had paid an extra amount to the shipbuilder, it has an option to recover the amount from him. Nine months after when the contract was completed buyer wanted to recover the excess payment which was paid under protest. As per Australian law buyer has the complete right to reco ver the amount which was earlier paid by the buyer under protest. Conclusion: The shipbuilder should have raised an objection when terms and conditions of a contract were made but no objections were raised. So now he cannot change the terms of the contract. Payment terms were fixed so buyer has the right to recover the excess amount, which was paid to the builder. Hence Buyer would be successful in recovering the excess amount paid to the builder. References Adamsdraftingcom.2007.Adams on Contract Drafting.[Online].[19 August 2016].Available from: https://www.adamsdrafting.com/material-breach Contractstandardscom.2016.Contractstandardscom.[Online].[19 August 2016].Available from: https://www.contractstandards.com/clauses/termination-upon-breach Dlapipercom.2016.DLA Piper.[Online].[19 August 2016].Available from: https://www.dlapiper.com/en/uk/insights/publications/2016/03/termination-of-commercial-contracts E-lawresourcescouk.2016.E-lawresourcescouk.[Online].[19 August 2016].Available from: https://e-lawresources.co.uk/Consideration.php Findlawcom.2016.Findlaw.[Online].[19 August 2016].Available from: https://smallbusiness.findlaw.com/business-contracts-forms/what-is-consideration-and-how-much-is-required.html Ideaint.2016.Ideaint.[Online].[19 August 2016].Available from: https://www.idea.int/about/vacancies/upload/General-Conditions-for-Contract-for-Provisn-of-Services.pdf Ilovelibrariesorg.2016.Ilovelibrariesorg.[Online].[19 August 2016].Available from: https://www.ilovelibraries.org/article/nuts-and-bolts-enforceable-contract Lawcom.2016.Lawcom Legal Dictionary.[Online].[19 August 2016].Available from: https://dictionary.law.com/Default.aspx?selected=305 Lawscom.2016.Lawscom.[Online].[19 August 2016].Available from: https://contract-law.laws.com/enforcing-contracts Lawyerie.2016.Lawyerie.[Online].[19 August 2016].Available from: https://www.lawyer.ie/company-law/creating-a-legally-enforceably-contract Lsuconca.2016.Lsuconca.[Online].[19 August 2016].Available from: https://www.lsuc.on.ca/For-Lawyers/About-Your-Licence/Audits-and-Reviews/The-Contract--Potential-Issues-and-Sample-Clauses Rocketlawyercom.2016.Rocketlawyercom.[Online].[19 August 2016].Available from: https://www.rocketlawyer.com/article/what-is-consideration-cb.rl Thefreedictionarycom.2016.TheFreeDictionarycom.[Online].[19 August 2016].Available from: https://legal-dictionary.thefreedictionary.com/consideration Wordpresscom.2006.LAW INFORMATION .[Online].[19 August 2016].Available from: https://legalcatch.wordpress.com/2006/10/24/consideration-law-definition Wwwuiono.2016.Wwwuiono.[Online].[19 August 2016].Available from: https://www.uio.no/studier/emner/jus/jus/JUS5260/v12/undervisningsmateriale/Consideration.pdf

Apa Reference Examples Essays

Apa Reference Examples Essays Apa Reference Examples Essay Apa Reference Examples Essay Bosshardt, W. , Van Der Klaauw, W. , Watts, M. (2011). Economics coursework and long-term behavior and experiences of college graduates in labor markets and personal finance. Economic Inquiry, 49(3), 771-794. Atkinson, B. , Heath, A. , Chenail, R. (1991). Qualitative research and the legitimization of knowledge. Journal of Marital and Family Therapy, 17(2), 175-18. Battistelli, A. , Galletta, M. , Portoghese, I. (2012). Mindsets of commitment and motivation: interrelationships and contribution to work outcomes. The Journal of Psychology, 147(1), 17-48. Benjamin, B. O’Reilly, C. (2011). Becoming a Leader: Early career challenges faced by MBA graduates. Academy of management learning education, 10(3), 452-472. Brewer, K. L. , Brewer, P. D. (2012). Influencing variables and perceptions regarding MBA degree programs. Academy of Educational Leadership Journal, 16(4), 27-38. Brown, D. J. , Cober, R. T. , Kane, K. , Levy, P. E. , Shalhoop,J. (2006). Proactive personality and the successful job search: A field investigation with college graduates. Journal of Applied Psychology, 91(3), 717-726. Brown, S. D. , Fischer, A. , Nord, D. Solberg, V. S. (1995). Career Decision-Making and career Search Activities: Relative effects of career search self-efficacy and human agency. Journal of Counseling Psychology, 42(4), 448-455. Bruce, G. (2010). Exploring the value of MBA degrees: Students’ experiences in full- time, part-time, and executive MBA programs. Journal of Education for Business, 85, 38-44. Corner, J. (1991). In search of m ore complete answers to research questions: Quantitative versus qualitative research methods is there a way forward? Journal of Research, 16, 3, 718-727. Crant, J. M. (2000). Proactive behavior in Organizational. Journal of Management, 26, 435-462. Crede, M. , Kuncel, N. (2008). Study habits, skills, and attitudes: The third pillar supporting collegiate academic performance. Perspectives on Psychological Science, 3, 425-453. de Leeuw, E. D. (2008). Choosing the method of data collection. In E. D. de Leeuw, J. J. Hox, D. A. Dillman (Eds. ), International handbook of survey methodology (pp. 113-135). Mahwah, NJ: Lawrence Erlbaum. Duffy , M. E. (1985). Designing research the qualitative –quantitative debate. Journal of Advanced Nursing, 11, 3, 225-232. Eisner, S. (2010). Grave new world? Workplace skills for today’s college graduates. American Journal of Business Education, 24-27. Fink, A (2009). How to conduct Survey; a step by step guide. Thousand Oaks, California: SAGE. Griffin, R. , MacKewn, A. , Moser, E. , Van Vuren, K. W. (2012). Learning skills and motivation: correlates to superior academic performance. Business Education Accreditation 5(1). Howard, C. M. , Schnusenberg, O. (2012). Student preparation and personality traits in the job market. Academy of Educational Leadership Journal, 16, 35-53. Kardam, B. L. Rangnekar, S. (2012). Job satisfaction: Investigating the role of experience education. Journal of Arts, Science Commerce, 4(1), 16-22. Khan, N. S. , Riaz, A. , Rashid, M. (2011). The impact of work content, working conditions, career growth on employee motivation. Interdisciplinary Journal of contemporary research in business, 3(3), 1428-1434. Meila, K. M. (1982). Qualitative methodology. Journal of Advanc ed Nursing, 7, 4, 327-335. Meyer, J. P. , Becker, T. E. , Vandenberghe, C. (2004). Employee commitment and motivation: A conceptual analysis and integrative model. Journal of Applied Psychology, 89, 991-1007. Putman, D. B. (2002). Job satisfaction and performance viewed from a two dimensional model, The Journal of Defense Software Engineering, 26-28. Ridgell, S. , Lounsbury, J. (2004). Predicting academic success: general intelligence, â€Å"Big Five† personality traits, and work drive. College Student Journal, 38(4), 607-618. Rowden, R. W. (2002). The relationship between workplace learning and job satisfaction in US small midsize businesses, Human Resource Development Quarterly, 13(4), 407-25. Swaminathan, S. , Jawahar, P. D. (2013). Job satisfaction as a predictor of organizational citizenship behavior: An empirical study. Global Journal of Business Research, 7(1) 71-80. Tantiverdi, H. (2008). â€Å"Worker’s job satisfaction and organizational commitment: Mediator variable relationship of organizational commitment factors’, The Journal of American Academy of Business, 14. Tanyel, F. , Mitchell, M. A. , McAlum, H. G. (1999). The skill set for success of new business school graduates: Do prospective employers and university faculty agree? Journal of Education for business, 35.

Free Essays on Collaborative Groups

Social Control In Collaborative Groups One of the best skills collaborative groups in schools can teach children is the responsibility for their actions. Extra-curricular activities provide wonderful opportunities for children to be involved in events that offer both positive and negative sanctions. Most extra-curricular activities require regular attendance and mandatory involvement in the selected events. Failure to adhere to the rules and regulations of the group results in negative sanctions. Different activities offer different sanctions, however all have both positive and negative along with formal and informal sanctions. In high school Drama Departments there are many positive and negative sanctions that can be placed in order to maintain the group. These sanctions can be put in place by both instrumental leaders and expressive leaders. One of the most common informal positive sanctions is the applause of the audience after a performance, The applause is the audiences way of showing their gratitude, approval and acceptance of the performance. The applause encourages those involved with the performance to continue to use their talent for more performances. However, positive sanctions occur other places than during a performance. For instance, if a person is doing well, memorizing their lines, attending practice regularly, supporting others involved, and meeting deadlines, the individual may be commended by the sponsor, or another instrumental or expressive leader of the group. People who are behind-the-scenes may be given positive informal sanctions by members of the cast, sponsor, or other individuals who they are working with. There are many formal sanctions that take place in a Drama Department as well. Often, selected individuals will be awarded at different ceremonies throughout the school year. These selected individuals may be sanctioned in the school newspaper, or at events outside of school. These individuals may ... Free Essays on Collaborative Groups Free Essays on Collaborative Groups Social Control In Collaborative Groups One of the best skills collaborative groups in schools can teach children is the responsibility for their actions. Extra-curricular activities provide wonderful opportunities for children to be involved in events that offer both positive and negative sanctions. Most extra-curricular activities require regular attendance and mandatory involvement in the selected events. Failure to adhere to the rules and regulations of the group results in negative sanctions. Different activities offer different sanctions, however all have both positive and negative along with formal and informal sanctions. In high school Drama Departments there are many positive and negative sanctions that can be placed in order to maintain the group. These sanctions can be put in place by both instrumental leaders and expressive leaders. One of the most common informal positive sanctions is the applause of the audience after a performance, The applause is the audiences way of showing their gratitude, approval and acceptance of the performance. The applause encourages those involved with the performance to continue to use their talent for more performances. However, positive sanctions occur other places than during a performance. For instance, if a person is doing well, memorizing their lines, attending practice regularly, supporting others involved, and meeting deadlines, the individual may be commended by the sponsor, or another instrumental or expressive leader of the group. People who are behind-the-scenes may be given positive informal sanctions by members of the cast, sponsor, or other individuals who they are working with. There are many formal sanctions that take place in a Drama Department as well. Often, selected individuals will be awarded at different ceremonies throughout the school year. These selected individuals may be sanctioned in the school newspaper, or at events outside of school. These individuals may ...

Focussing on public transport, what have been the positive and Essay

Focussing on public transport, what have been the positive and negative implications of public-private partnership - Essay Example As well, travelling a bike or else a motorbike allows shunning the traffic on the streets, given that in the gigantic cities there are unique biking lane which doesn’t permit buses or cars (Steiner 2004). Alternatively, employing means of public transportation as well has its benefits; at the outset, it’s actually low-cost, at the present time you could buy a extraordinary IP card, and after that blow it all time you obtain on and descend the bus and store up supplementary currency on price of transportation (Moos and Sommers 2006). Analysis To get better the condition on the streets of the large cities, the government must obtain a variety of processes; for example, attempt to transfer some of the organizations hooked on the outer edge so as to create the hub of the city fewer packed. This restructuring of a thickly occupied region can be one of the vital explanation to the traffic overcrowding issue. The executives must also believe of making novel projects to build l atest subway lines, bus routes furthermore biking lanes with the intention that the ways of public transportation are more interesting to the public. ... The public transportation organizations have extremely deprived services for city’s publics which provided as their faithful clients. If the service has been overhauled, it would draw more kindness from the novel and possible clients who for no reason employ it earlier than. Consequently from the enlargement of public transportations practices, the rush-hour traffic would be reduced. As an example, City has a lot of alternatives for public transportations. Even though reassess as a urban city, the situation of the public transportation service is a disastrous. Tarnished iron seat, non air conditioner practical, impure passenger’s region, and elevated lists of criminalities â€Å"executed† in the services demonstrate the trustworthiness of City’s public transportation representation. Improvements Transportations as well as roads are not available for all medium and all communities. Transportations and roads access are not open-minded to those who merely hav e two-wheel force. They would not obtain the similar amenities so as to the government provided for those who have supplementary than two-wheel constrain. In addition, the charge for employing transportations and roads are expensive for centre to stumpy group society (Rudy 2010). Because a picture, from the primary time three years before, Bus method has prejudiced the utmost respect from the City public since Bus way provides relieve, security, and the competence of time to arrive at differ purpose in City with reasonable costs that fits into every society. Getting better roads and transportations could persuade the community to employ individual transportations. When the building of the transportations is enhancing, the public are confined

A short review of Nancy Folbre, Valuing Domestic Product New York Term Paper - 2

A short review of Nancy Folbre, Valuing Domestic Product New York Times, May 28, 2012 - Term Paper Example In her New York Times article titled â€Å"Valuing Domestic Product,† eminent economics professor Nancy Folbre lamented how domestic work or housework, is excluded from the usual computation of gross domestic product, which is the total value of all products and services that are produced within an economy in a given period. This is quite ironic because household work, if actually given a monetary value by computing the total amount of hours devoted to household chores and multiplied by the domestic workers supposed current market wages, is really a big amount of money and therefore constitutes a very significant portion of any gross domestic product. The economists have excluded or omitted this home sector of mostly unpaid services. An implication of the said article is that women who form the vast majority of the house workers suffer from gender inequality (Folbre, 2012, p. 1), an invisible workforce that over the years contributed greatly to improving living standards. This unpaid work has been exchanged in recent years with paid work due to globalization fostered by neoliberalism, which is more of a social and moral concept than just a mere economics idea, as more women join the workforce. A consequence of the neoliberalism fostered by the globalization concepts of free trade, privatization of public institutions, economic liberalization and open markets is an uptrend in the exploitation of labor, mostly women who now joined the paid labor force, and the degradation of the processes in social reproduction and a diminution of the social contract under a regime of the liberal democracy government. The home or family as a basic social unit has been weakened due to more women leaving the home in search of paid work outside, but at wages considerably less. Brown argues neoliberalism is a political project because it enforces the existence and operations of a free market by a state that can either promote or suppress it, but primarily to enhance it. This means

Interpretation of The Rich Brother by Tobias Wolff Essay

Interpretation of The Rich Brother by Tobias Wolff - Essay Example Much as he behaves in the story, I conjured up the image of a selfish, mean, and rude guy with a lot of money for Pete. The facts of the story that led me to draw this image of Pete in my mind were his distaste for Donald’s act of giving away his $100 that he expressed by throwing Donald out of the car and not even realizing how bad he has behaved. Instead, Pete says to Donald, â€Å"you’d better go† (Wolff 12), thus deceiving himself that he does not need Donald. Pete has the audacity to nod to the music in his car after throwing his brother out of it. While the overall impression of Donald was that of a good guy without money, I missed out some of the most important underlying messages in the story like the real meaning of being rich unless I had discussion about this story with my friends. After discussing the story’s interpretation with my friends and listening to theirs, I reached the conclusion that the story contains some very important messages tha t make it more meaningful and sophisticated than I had presumed. My friends came up with their own opinions and conclusions they had drawn from the story, all of which sparked a number of questions in my mind; who of the two brothers is really rich; the one with more money or the one with the better character? Does Donald really need Pete to make a living or is Pete really in need of somebody with a high character like Donald? Is money so powerful that it deprives man of all sensitivity, sensibility, and humanity? Does money do that to everybody or there was something very wrong about Pete that it did that to him? These and many more questions were discussed with the peers. Comparison of the two interpretations has led me to the conclusion that when we read something and interpret it by ourselves without consulting anybody, we are likely to adopt a biased approach toward interpreting it so as to draw the meaning that we want out of it. We approach the reading in a certain way and th ings seem to make sense that way. While we definitely have a viewpoint, we tend to overlook, if not completely ignore, various other meanings that can be derived from the same reading. The state of mind in which we read a story plays a decisive role in what conclusions we draw from it. In order to get the most out of a reading, it is advisable to discuss the story with peers so as to get their opinion. While the best results can be achieved if all peers have personally read the story at least once, the reader should at least summarize the story to the peers so as to ensure that everybody gets to know about it even if he/she has not personally read it. When I discussed the story and my interpretation of it with my peers, not only that practice exposed me to a variety of themes, ideas, moral lessons, and conclusions hidden in the opinions of my peers, but I also noticed a widening of the horizon of my own thoughts. The practice opened my mind and I also came up with new conclusions th at I might not have been able to do alone. The strengths of personal interpretation include surfacing of a well-defined opinion of the reader that might be unique, sharpening of mind as one ponders over the facts of the story alone without anybody’s guidance or help, and maximization of learning as no other activity is as strong as building memory and interpretation skills as personal interpre

Interprofessional Working in Nursing

Interprofessional Working in Nursing Mr Alfred Robinson is 85- year-old and lived happily with his wife for 50 years in a London inner city borough. They had no children but got on well and socialised with friends and neighbours. Mr Robinsons wife, Lucy, recently passed away. Alfred seems to carry on with his life as usual, going to bingo, having lunch twice a week with friends and doing gardening. Six months after the wifes death, he seemed less communicative, unkempt and frail. He confided in Susan, a family friend, that he was missing his wife, having no appetite, and feeling tired all time. After discussion, Susan volunteered to accompany Alfred to his GP for a check up. Mr Robinson was diagnosed with chest infection and admitted to hospital. Within a short time he had two further admissions, one with dehydration, and weight loss, and the other with a fall which affected his self-caring ability and confidence to walk. Three hospital admission, Mr Robinson needs were met holistically by different health and social care professionals through an inter-professional working teamwork and he always made good progress. Using relevant literature, observations made and experiences gained during my clinical placements, this essay will discuss the case of an 85-year old frail and widowed man, Mr Alfred Robinson, who appears to be grieving from the loss of his wife, has suffered a chest infection, suffering from loss of appetite and weight and has had a fall which has affected his self-caring ability and confidence to walk. In addition to discussing interprofessional working, this essay will identify three health and social care professionals, and their roles within the interprofessional working team in their quest to restore Alfreds health. The essay will next focus, in greater detail, on one of the professionals and will cover issues such as accountability, responsibility, legal, moral, ethical and statutory regulation of the professional body to which the individual belongs. The essay will then reflect on how engaging in group discussion and presentation helped in writing this piece, and then conclud e with a summary of the main points raised. Interprofessional working, simply put, means working and learning together and sharing knowledge to achieve a common goal in relation to a patient care. As specialization grows in all the healthcare professions, so too does the need for the simultaneous development of practice that encourages working together. As Bleakley et al (2006, p467) have pointed out, there is a growing body of evidence to suggest that interprofessional practice offers greater benefits for patient care and safety than multi-professionalism. Hutchings et al (2003) opined that it is impossible for one professional to possess all the skills, knowledge and resources needed to meet the total healthcare needs of the society. Quality care and effectives services are the product of good team and these aspirations should be central in clinical guidelines, position statements or standard of practice. In spite of the apparent benefits of interprofessional practice, there are obstacles to interprofessional working. Headri ck et al (1998, p773) have identified some barriers to interprofessional working. These include: differences in history and culture, historical interprofessional and intra-professional rivalries, differences in language and jargon, varying levels of preparation, qualifications and status, fears of diluted professional identity and accountability, as well as concerns regarding clinical responsibility. Three health and social care professionals this essay has chosen to collaborate in order to restore Mr Alfred Robinsons health are: a bereavement counsellor, a dietitian and a physiotherapist. The bereavement counsellors role is to help Alfred to adapt to the death of Lucy, his wife for 50 years. Alfreds response and reaction to the loss (grief) of his wife includes physical, psychological, social and spiritual components. Alfred appears to be experiencing more complicated grief reactions to his bereavement and loss (Doka, 2006) and lack of progress towards psychical assimilation after passage of time and appears to be exhibiting the presence of maladaptive behaviours (Freud, 1917). The bereavement counsellor will assist in healing of Alfreds grief psychically in order that he experiences a less psychologically painful living without Lucy. The counsellor will also assist Alfred to have within the self an inner awareness of movement through his grief and towards a more adaptive relationship with Lucy (Fenn, 2011). A dietitian is a healthcare professional who focuses on proper food and nutrition in order to promote good health (WHO, 2010). Dietitians assess, diagnose and treat diet and nutrition problems at individual and wider public level. Uniquely, dietitians use public health and scientific research on food, health and disease which they translate into practical guidance to enable people make appropriate lifestyle and food choices (The British Dietetic Association, 2011). Working in consultation with other health care givers, a dietitian was involved in the diagnosis and dietary treatment of Mr Robinson. As Mr Robertson had poor appetite and had lost weight, the dietitian would have advised and provided a nutritional plan based on a comprehensive needs assessment of Mr Robinson, against which progress was monitored and outcomes evaluated in order to optimise his nutritional status and prevent re-infection and further weight loss. For instance the dietitian would have prescribed special diet , and nutritional supplement and Mr Robinsons weight reviewed regularly to ensure that the desired progress was being made. The rest of the essay will focus on physiotherapist, statutory regulatory of the physiotherapy practice, professional body of physiotherapy and the roles of physiotherapist. The rationale for the choice of a physiotherapist is that Mr. Robinson had had a chest infection and a fall which had affected his self-caring ability and confidence to walk. The physiotherapist would have helped restore Mr Robinsons movement ability and confidence to walk. The physiotherapist would have, in addition, helped treat his chest infection through the removal the excess secretion in Mr Robinsons lungs, assisted cough, and tried to improve ventilation of the lungs by physical means. All physiotherapists in the United Kingdom have received training on dealing with chest diseases and infections. (The Jennifer Trust, 2009). As a student nurse, I had the opportunity to observe, explore, interact and collaborate with physiotherapists in delivering quality care to patients during my clinical placement. I was once placed in a stroke rehabilitation unit where I worked closely with other health and social care professionals. These include doctors, nurses, dieticians, physiotherapist, clinical psychologists, occupational therapist, speech and language therapist, healthcare assistants and others. During the placement I had the chance to observe the physiotherapist helping an elderly patient in maintaining his mobility and independence after a fall. I also had a unique chance to assist a stroke patient to walk around under the supervision of a physiotherapist. I also observed a speech therapist helping the same patient to re-discover his speech while a dietitian offer advice on nutrition and diet to the same patient who happened to be a diabetic as well. The World Congress of Physical Therapy in1999 described the nature of physiotherapy as providing services to people and populations to develop maintain and restore maximum movement and functional ability throughout the lifespan. Besides, physical therapy is concerned with identifying and maximising movement potential within the spheres of promotion, prevention, treatment and rehabilitation, (cited in Hammond and Wheeler, 2008, p3). The Chartered Society of Physiotherapy (CSP) (2002b) defines physiotherapy as a health profession concerned with human function and movement and maximising potential. Physiotherapy uses physical approaches to promote, maintain and restore physical, psychological and social well-being, taking into account of variations in health status. Physiotherapy is science- based, committed to extending, applying, evaluating and reviewing the evidence that underpins and informs its practice and delivery. The exercise of clinical judgement and informed interpretation is at its core (Hammond and Wheeler, 2008 p3). In the CSP revised Scope Professional Practice (2008), the definition of scope of physiotherapy practice is based on four pillars of massage, exercise, electrotherapy and kindred forms of treatment (cited in Dimond, 2009, p4). With its root in massaging, the therapeutic touching of patients sets physiotherapy aside from other professions. Physiotherapists continue to use massage therapeutically in addition to manual techniques such as manipulation and reflex therapy. Therapeutic handling underpins many aspects of rehabilitation, requiring the touching of patients to facilitate movements (Hammond and Wheeler, 2008, p3). To practise in the profession of physiotherapy in the UK, one is required by law to be registered with the Health Professions Council (HPC), UKs statutory regulator for health professions. The titles physiotherapist and physical therapist are protected by the powers of Health Profession Order 2001 and may only be used by persons who are on HPCs statutory register. The essence of this is to protect patients from unqualified or inadequately skilled healthcare providers. HPC keeps a register for health professional that meets its standards and it takes action if registered health professionals do not meet those standards. The HPC sets the standards of professional training, performance and conduct for fifteen professions including physiotherapist (HPC 2011). The HPC has since 2006 put in place a system, requiring re-registration at intervals of two years and that all physiotherapists provide evidence that they have been developing and are continuing to develop their skills and knowledge while they are registered. The Continuing Professional Development (CPD) standards require physiotherapist to supply a profile on request demonstrating fulfilment of the CPD standards (tested through sample audit). The standard requires all registrants to maintain a continuous, up-to-date and accurate record of their CPD activities. This is to ensure that registrants CPD has contributed to the quality of practice, service delivery and benefits the service user. All registrants are expected to able to demonstrate that their CPD is a blend of learning activities relevant to current and future practice. Physiotherapists are fully autonomous practitioners and do not require a medical referral in order to see a patient. Patients may access a physiotherapist directly themselves, or may be referred to a physiotherapist by other health professionals. The Chartered Society of Physiotherapy (CSP) is a professional body for physiotherapist. The CSP provides a framework for curriculum of physiotherapy education and approves those physiotherapy programmes that meet the requirements of the framework on behalf of the profession. Additionally the CSP publishes rules of professional conduct and standards of physiotherapy practice derived from within the profession and are in harmony with those of the HPC. Anyone on the HPC physiotherapist register may call themselves a physiotherapist, however, only those who are also members of the CSP, may call themselves as chartered physiotherapist. It is worthy to note that relationship with the HPC is one of registrant; with the CSP it is one of membership. The breadth of activity and resources that the CSP undertakes and provides seek to establish a level of excellence for the physiotherapy profession. Its education and professional activity is centred on leading and supporting its members delivery of high-quality, evidence-based patience care. The CSP is the primary holder and shaper of physiotherapy practice in the UK and works on behalf of the profession to protect the chartered status of physiotherapists standing, which is the one denoting excellence (Hammond and Wheeler, 2008, p2). The CSP sets standard and ideals of behaviours for its members. The CSPs Rules of Professional Conduct was first endorsed in 1895 (Barclay, 1994) and has been revised and updated periodically since that time. A new Code of Professional Values and Behaviour which will supersede the Rules of Professional Conduct (still valid) is being piloted with members (CSP, 2011). The Rules of Professional Conduct (the Rules) defines the professional behaviour expected of chartered physiotherapists which are intended to safeguard patients. The Rules require chartered physiotherapist to: respect and uphold the rights, dignity and individual sensibilities of every patient; ensure the confidentiality and security of patient information; work safely and competently; not exploit patients; and act in a way which reflects credit on the profession and does not cause offence to patient and carer (CSP, 2002a). The CSP has since 1990, periodically published CSP Standards of Physiotherapy Practice (the Standards), the fourth edition was in 2005 and currently being revised (CSP, 2011). The Standards describes the professional consensus on the practise of physiotherapy and reflect the collective judgement of the profession. The Standards provides statements about the practical application of the ethical principles set in the Rules. The core standards provide a framework within which all chartered physiotherapist and associate members are required to practise. The core standards play a central role in the delivery of safe and effective physiotherapy to patients. For instance, the Core Standards 2 (CSP, 2005a) states Patients are given the relevant information about the proposed physiotherapy procedure, taking into account their age, emotional state and cognitive ability, to allow for informed consent. The expected measurable performance or activity set out for this standard include: the patient s consent is obtained before starting any examination/ treatment; treatment options, including significant benefits, risks, and side-effects, are discussed with the patient; the patient is given the opportunity to ask questions; the patient is informed of the right to decline physiotherapy at any stage without that prejudicing future care; the patients consent to the treatment plan is documented in the patients records. The Standards include clinical audit tools for measurable performance or activity to be assessed against. The clinical audit tool consists of a template for physiotherapist to assess both core and service standards so as to identify areas of good practice and also areas for development work. The essay will now consider some of the roles physiotherapists play in the health delivery system. Physiotherapists work in outpatients department of healthcare institution where they treat spinal and joint problems, accidents and sports injuries. In caring for the elderly like Mr Robinson, physiotherapists help maintain mobility and independence, rehabilitation after falls, treat arthritis and chest infection. In neurology, physiotherapists help restore normal movement and function in stroke and multiple sclerosis in patients. Physiotherapists play important roles in mental healthcare delivery by giving classes in relaxation, improving confidence and self-esteem through exercising. Physiotherapists work in hospice where they treat terminally ill people suffering from ailments such as AIDS and cancer. In paediatrics care, physiotherapists treat injured and sick children as well as those with severe mental diseases and physical deformities and conditions such as cerebral palsy and spi na bifida. This essay was facilitated by the feedback received during the group presentation. It helped me to research more to understand the topic in general and also to plan and structure the essay. In conclusion this essay has taken a cursory look at interprofessional working, its benefits and challenges in general and specifically how a dietitian, bereavement counsellor and physiotherapist collaborated in restoring Mr Robinson to good health. The essay explored the HPC as statutory regulators of physiotherapy to ensure high standards and to protect patients from unqualified or inadequately skilled healthcare providers. The CSP is the primary holder and shaper of physiotherapy practice in the UK and works on behalf of the profession to protect the chartered status of physiotherapists standing, which is the one denoting excellence.