Behavioral Interventions Designed Reduce Sleep Difficulties

Abstract The purpose of this study to investigate behavioral interventions designed to reduce sleep difficulties in a child. Positive bedtime routines and sleep restriction were successful in eliminating bedtime disturbances and nighttime awakenings in a five-year-old child sleeping problems. Positive bedtime routines included activities such as brushing teeth, taking a bath, picking out pajamas, and reading a story. Sleep restriction involved reducing the number of hours the child slept. While maintaining a consistent bedtime and Wake-up time. Positive bedtime routines and sleep restriction resulted in improved parental satisfaction. With the child s behavior at bedtime, the child s sleep pattern, and the time it takes to put the child to bed at night. Introduction Bedtime problems and night waking’s in infants and young children are established, persistent, and associated with a variety of impairments in youth and their families (Moore, M., 2010). Many parents have struggle with their children to develop appropriate sleep scheduling and bedtime routines. Learning how to sleep soundly is a normal part of development. It is typical for children to wake during the night. However, returning to sleep may be difficult at times for children. Children who get little sleep are more likely to have behavioral problems, be prone to general moodiness, and have difficulties living up to their potential. Having a child that is not getting restful sleepShow MoreRelatedThe Effects Of Autistic Children972 Words   |  4 Pagesact in a manner we conceive as normal. To understand how a proper diet can help an autistic child one must understand the dietary difficulties the child must face, and three of the diets. These diets are known as the Gluten-free, Casein-free, Soy-free Diet (GFCFSF); the Gluten-free, Casein-free Diet (GFCF); and the Specific Carbohydrate Diet (SCD). Dietary Difficulty Many Autistic children have a difficult time with diets, and the health issues they may cause. Many Autistic children are consideredRead MoreSleep Apnea Essay examples1538 Words   |  7 Pages Sleep Apnea nbsp;nbsp;nbsp;nbsp;nbsp;Sleep is essential to life; it is one of several components, including food and water, which keep the living alive. However, a significant percentage of the human population has considerable difficulty reaching and maintaining Stage IV within their sleeping patterns, the stage that allows the mind and body to fall into a deep and restorative sleep, otherwise known as REM sleep. At the core of this difficulty is a condition known as obstructive sleep apneaRead MoreThe Behavioral Center For Suicidal Ideation1536 Words   |  7 PagesJ.F. is a 42-year-old, Hispanic male who was transferred to the behavioral center for suicidal ideation, in which he planned to hang himself with cable wires. He has a history of mental illness in the family. The patient’s mother has a history of bipolar disorder, and passed away when the patient was 37 years old. The patient was emotionally and abused by a family member when he was around 8-10 years old. He had attempted su icide as a teenager by trying to overdose on pills. His medical history includesRead MoreCognitive Behavioral Therapy Essay example1507 Words   |  7 PagesCognitive behavioral therapy (CBT) is among the most extensively tested psychotherapies for depression. Many studies have confirmed the efficacy of cognitive behavioral therapy (CBT) as a treatment for depression. This paper will provide background information about the intervention, address the target population, and describe program structure and key components. It will also provide examples of program implementation, challenges/barriers to implementing the practice, address how the practice supportsRead MoreCancer Diagnosis And Treatment Of Cancer Essay1480 Words   |  6 Pagesnormal body function, as it increases energy demands and alters body systems. There are many factors that can lead to the development of cancers, including genetic, behavioral, and environmental influences. The presence of disease is not always obvio us; therefore, it is imperative for individuals to participate in screening interventions to promote early detection. Cancer diagnosis and treatment requires a patient-centered, multidisciplinary approach to care, which is inclusive of definitive diagnosisRead MoreSymptoms And Symptoms Of Generalized Anxiety Disorder1591 Words   |  7 Pagesabout a number of events (work, friends, health). Mary reported that it is difficult to control the worry. The anxiety and worry are associated with the following symptoms, which are present for more days than not: difficulty concentrating or mind going blank, irritability, and sleep disturbance. The anxiety, worry, or physical symptoms cause significant distress or impairment in Mary’s social and occupational areas of functioning. The disturbance is not attributable to the physiological effectsRead MoreBeyond Blue Is An Australian1300 Words   |  6 Pagesprofessional to discuss reasons to stay alive, then moves on to coping strategies such as rediscovering things that the person finds most enjoyable in life. To further develop this strategy, Beyond blue have designed the ‘Beyond Now’ app, which is an effective tool used by clinicians to support interventions with their suicidal patients. The app is intended to provide a platform for people to develop their own personalised safety plan and allows users to access a range of coping strategies, social supportRead MoreAssessment And Treatment Of Combat Related Posttraumatic Stress Disorder Essay1598 Words   |  7 Pagesposttraumatic stress disorder (PTSD), address the symptoms linked to PTSD, and the methods used in the assessment of posttraumatic stress disorder with emphasis on military combat-related PTSD. In addition, the literature review will identify the interventions by social work, if any, when addressing PTSD and the role social workers may play when assisting those with combat-related posttraumatic stress disorder. Assessment Posttraumatic stress disorder is caused by exposure to a traumatic stressor orRead MoreDepth Look At Autism Spectrum Disorder3112 Words   |  13 PagesZapata Columbia Basin College In Depth look at Autism Spectrum Disorder Autism Spectrum Disorder, or ASD, is a complex developmental disorder which is usually diagnosed during the first 3 years of life. The disorder is characterized by severe difficulty or inability in communicating, socializing, forming relationships with others, and responding appropriately to the environment. According to the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, ASD was one of the diagnosis coveredRead MoreArtificial Sentience Essay1045 Words   |  5 PagesThe use of computers has pervaded the life of every human being. At every street corner there are machines to be found that have been designed to simplify our lives and take over the mundane jobs that no longer require human intervention. One only needs to think of automated teller machines replacing bank tellers, vending machines phasing out street vendors, or near-infallible CCTV watching over us as policemen and sheriffs once did, to realise the extent that technology has enhanced and improved

Teen Pregnancy Is A Serious Issue - 982 Words

The social issue I will be addressing throughout my paper is teen pregnancy. The term teen pregnancy is referring to teens between the ages of 13-19 who become pregnant (Akella Jordan, 2015). Despite the fact that teen pregnancy rates have dropped within the past twenty years, United States continues to have the highest rates of teen pregnancy in comparison to all other developed nations ( Akella Jordan, 2015). Teen pregnancy is a serious issue for a multiplicity of reasons. A teenager who has a baby is more susceptible to face many social issues in their future such as poverty, poor education, bad behaviors, health issues, and child welfare (Akella Jordan, 2015). A multitude of persons throughout the United States are continuously questioning what can we do to reduce the rates and negative affects of teen pregnancy within our country. Many continue to also question whether or not our present-day social policies regarding teen pregnancy are practical. Within the United States ap proximately one million adolescents become pregnant each year and teens who become pregnant are considered to be an immensely susceptible population (March Cabrera,2015).†¨ The social issue of teen pregnancy frightens many because teens are still babies themselves yet have to begin raising their own baby as well. The majority of teens who become pregnant lack readiness to raise a child,are in denial of the pregnancy as a whole, do not receive appropriate prenatal care, lack healthcare, areShow MoreRelatedThe Sociological Viewpoint Toward Social Problems Essay1077 Words   |  5 Pagessociety places more significance on some issues rather than others that â€Å"They (the issues) become real only when they are subjectively defined or perceived as problematic (Leon-Guerrero, 2010). 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These reasons consist of family related problems, the lack of being taught about safe sex in school and by parents at homeRead MoreTeenage Pregnancy in City of Los Angeles644 Words   |  3 Pagesï » ¿Teenage Pregnancy 2 Running head: Teenage Pregnancy 1 Teenage Pregnancy in City of Los Angeles Teenage Pregnancy in City of Los Angeles This paper casts light upon the health issues related to teenage pregnancy in the city of Los Angeles. Teenage pregnancy is an important issue as it affects multiple aspects of population growth, women health and economic conditions. Los Angeles is situated in the south of state of California, USA. It enjoys significant portion of eminence when rated inRead MoreEssay on Teen Pregnancy: More Education is Needed1174 Words   |  5 PagesTeenage pregnancy is a rising factor throughout the world that’s caused by many unfortunate actions. Teenagers feel the need to engage in sexual activities due to peer pressure, violence and statutory rape. 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The baby’s father wanted nothing to do with theRead MoreTeen Pregnancy Essay1121 Words   |  5 Pages5/6 11/20/2017 Teen Pregnancy The fearless of all parents who have teenagers is pregnancy. Nowadays, teen pregnancy is a serious problem. Teenage have a lack of skills to handle a pregnancy. So that impact strongly on the future of a young woman. Teen pregnancy is associated with negative consequences for adolescents for three reasons: lack of education, medical complication, uncertainty about the future, and financial difficulties. First, the main causes of teenage pregnancy are the lack of educationRead MoreThe Effects Of Teenagers Being Sexually Active1082 Words   |  5 Pageshave had sexual intercourse in the past three months, are at an extremely high and immediate risk of unintended pregnancy and sexually transmitted infections (STIs). (DiClemente) Teens who take part in sexual behaviors that do not use contraceptives, use contraceptives inconsistently, or have multiple sex partners have an even greater risk. (Kirby) The cause and effect of this issue can be difficult to disentangle, but there are many correlations that can be found in connection with sexually activeRead MoreThe Age Of The Pill1530 Words   |  7 Pageswere made available. By the 20th Century, teen pregnancy was the norm. The prevention of unintended adolescent pregnancy has become an important goal of our society. Although adolescent pregnancy and birth rates have been steadily decreasing, many adolescents still become pregnant. Th e purpose of this research paper is to review the history, current status, programs and the future of teen pregnancy. History In the early 20th Century, teen pregnancy was the norm. Women were lucky to get an educationRead MoreEffects Of Teenage Society Essay740 Words   |  3 Pagesyears our teen society has made drastic changes. The teen society has made many positive attributes in the past years. Recently there have been a couple of problems surfacing into the world. These issues has caused the teen society to deteriorate slowly. I believe that teen pregnancy is a leading cause to many negative things. Being a teen parent is a significant factor that affects almost everyone close to them. In some cases this could be a positive situation but in most cases it’s not. Teen parentsRead MoreTeen Pregnancy And Birth Rates861 Words   |  4 PagesThe increase of pregnancy that ranged from 30 percent to 50 percent between 1971 and 1979 was due to the large increase in premarital sexual activity for young white girls(Kohli, 1995). Studies found an increase in contraceptive use among sexually active teens from 50 percent to 70 percent users between 1971 through 1979 (Kohli, 1995). This increase in contraceptive use was not enough to outweigh the increase in premarital sexual activity. This only increased the rate of pregnancies in teenage girls

Janice free essay sample

Nothing in my life prepared me for Janice. She was frail, sporting only two teeth. Her shirt, covered in shades of red, yellow and green, was dirty and stained. Her light brown hair was greasy and slicked back into a ponytail toward the bottom of her head. Her armpits were full of hair. She was wearing no makeup, and her eyes were wet. Through her tears, she trembled; telling her story†¦ and in a moment, the pain of Hurricane Katrina became real to me. Three days earlier, I sat listening to a flight attendant review safety procedures of the plane. I was nervous. New Orleans was a whole new world for me, and I had no idea what to expect. I rested my head back hoping my mind would take a reprieve from the race of fear it had been running, but it did not stop. I was anxious and desperately wanted to land, but it was time for me to stop worrying about what lay ahead that week. We will write a custom essay sample on Janice or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page I needed to put my fears aside and let God’s plans happen. Stepping out of the airport the overwhelming heat made it hard to breathe. My team and I were wearing bright tie-dyed shirts adorned with a large blue cross on the back. The quote above the cross read, â€Å"It is more blessed to give than to receive. Acts 20:35.† Walking through the airport, strangers put out their hands, thanking us for being in New Orleans to help. I didn’t understand at that point, why we were so important. At the start of our third day of work, our van pulled up on the curb in a small, typical, New Orleans neighborhood. We were going to be pulling weeds for a woman named Janice. Like most others in New Orleans, her lawn was engulfed in â€Å"Katrina Weeds†. There was a rusty colored water line around the perimeter of the empty house, and in the driveway sat a lonely FEMA trailer. Seeing this, it hit me. These people had lost everything and this was the reason people in the airport had thanked us. I knelt on the ground pulling weeds for a long time. Slowly, the weeds that once overtook the front lawn like a jungle seemed to disappear. Filling trash bag after trash bag, we worked to make her house look somewhat presentable; even if just from the outside. Packing up our work tools, our team discussed what it would be like to live through something as horrific as this. A leader brought up how hot it must have been in the Superdome and how bad it must have smelt with all of the people crammed inside but Janice’s voice interrupted our conversation. Janice had heard a part of our conversation. Her words were quiet and hard to understand through the tears flowing down her cheeks. â€Å"The stench was horrific†. â€Å"There were dead bodies everywhere. They floated in the water and once the water was gone from the city, they simply lay on the road. â€Å"I have not showered since the hurricane. I wash my clothes in the bathtub and my body with a wash cloth. I can not shave And I refuse to look in the mirror†. Images flooded my mind. I couldn’t imagine. Saying goodbye, we gathered around her in prayer and soon after, we loaded into the vans with Janice’s story permanently imprinted on our hearts. A week after I had first arrived in New Orleans, I found myself listening once again to a flight attendant review safety procedures. My eyes were wet. A week before, I had been on the verge of tears because I was scared for this trip. Now, I was crying because I didn’t want to leave. At least 1,836 people died in Hurricane Katrina and thousands more were displaced and affected but was the one face that made the wrath of Katrina real.

Influence of Religion on Politics

Introduction It is desirable to separate religion and politics at all cost. However, absolute separation of the two spheres of influence to a human being is not possible as the two institutions have their subjects in the same locality anywhere in the world (Johnstone 147). In other words, some people in the government are followers of established religions and in the same way, members of the religions are members of the government in various levels. This essay seeks to investigate the influence of religion on politics.Advertising We will write a custom essay sample on Influence of Religion on Politics specifically for you for only $16.05 $11/page Learn More Influence of Religion Every one strives to satisfy their wants and desires. It is apparent that resources are limited and no one can ever gather enough resources so as not to want more (Johnstone). Resources, other than being limited, are finite (Johnstone 146). As such, there exists a discrepancy bet ween supply and demand, which generates competition among people for the scarce resources. Politics is near synonymous with government and are institutions that are concerned with regulation and allocation of resources (Johnstone 146). Religion has profound influence on politics and government (Johnstone 146). Religious groups, movements and alliances have at times influenced the political path. For instance, the civil rights crusade in the 1960s, the anti communism movement are some of the activities that had the backing of religion (Johnstone 146). It is quite hard for a government to pass abortion laws where the Roman Catholic Church is quite strong. The church is influential in various aspects discussed below. Religion has influenced voting patterns and behavior throughout history. It is evident during political campaigns as leaders seek the support of various religious groupings. Consequently, one will hear of ‘Catholic vote’, ‘Jewish vote’, and the Ba ptist vote ’as well as ‘the Evangelical votes (Johnstone 149). In America, it is commonplace knowledge that Anglicans support the Republican Party while the Roman Catholic and Jews favor Democrats (Johnstone 149). Concerning legislation and morality, religion has influence politics surrounding issues like birth control, same sex unions, and abortions (Johnstone 155). In addition, blue laws are evidence of religious influence on politics. Such laws include those that prohibit doing business on Sunday, regulations dictating the distance of restaurants from churches and schools, laws that restrict the sale of intoxicants as well as laws regulating sale of and distribution of contraceptives (Johnstone 155). The ratification of the Eighteenth Amendment of 1919 prohibits the selling of most alcoholic drinks in the United States of America (Johnstone 155). The Anti-Saloon League, which fought for this ratification. The league began in the Calvary Baptist Church (Johnstone 155) . Religious Fundamentalism Introduction Some people are willing to die for their religion beliefs and are very ready to defend and propagate such beliefs in the face of any opposition. Religious fundamentalism is a religious outlook and movement that began around 1900 courtesy of American Protestants (Johnstone 179).Advertising Looking for essay on social sciences? Let's see if we can help you! Get your first paper with 15% OFF Learn More Their primary aim was to curb the spread of liberalization within religion and secularization in the American society. By and by, the term has found its way into other religious movements found in other religions like Islam, Buddhism, Hinduism and Judaism as well (Johnstone 179). The Concept of Fundamentalism, Its Utilization and Source The term first appeared in a publication in 1910 written by the Evangelicals titled ‘The Fundamentals’ (Johnstone 180). It was a culmination of a series of religious seminars and workshops for around a decade prior to the publication (Johnstone 180). The Fundamentals consisted of the primary (fundamental) doctrines pertaining to Christianity (Johnstone 180). One had to receive the fundamentals and believe them. Currently, the term designates Jews, Hindus, Muslims, among others (Johnstone 180). Fundamentalism is a reaction towards modernity. Its chief aim is to recover what has been lost over the years through modernization (Johnstone 181). It is a contradiction since fundamentalists live in modern times yet want to go back to former times (Johnstone 181). The realization that the good old days are gone and gone for good does not seem to sink into them (Johnstone 181). Further, the so-called modernity is a result of rapid technological innovations like the radio, cellular phones, television, the internet as well as the magic of modern medicine, which involves marvels like organ transplants (Johnstone 181). Fundamentalists live and rely on such modern innovations and a s such, they do change with times like anyone else (Johnstone 181). In a sense, therefore, they are moderns. Why is Modernity a Threat to Fundamentalism? Berger identified five characteristics of modernity that affect fundamentalism (Johnstone 182). First, modernity brings about abstraction, which involves forgoing solidarity, and the sense of relationships with others (Johnstone 182). Secondly, fundamentalists are present and backward looking and that is why they talk of the ‘good old days’ (Johnstone 182). Modernism introduces and emphasizes on the future. Fundamentalists see this as going against faith in God as future lies in the hands of God. Deeds like booking of appointments and keeping diaries amounts to anticipating the future (Johnstone 182). Modernity has led to severe individualistic lives (Johnstone 182). The fundamentalists feel this is weakening of the society and decreases the sense of belonging. Liberalization and secularization are the other aspects of modernism as discussed earlier. Liberalization encourages getting into other options other than God alone while secularization brings in other explanations for different phenomenon other than God alone (Johnstone 182). These are the aspects that fundamentalists react to and constantly strive to oppose and overcome.Advertising We will write a custom essay sample on Influence of Religion on Politics specifically for you for only $16.05 $11/page Learn More This essay on Influence of Religion on Politics was written and submitted by user Susan Warren to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Essay on Wwii World War Ii and Czech States

Essay on Wwii World War Ii and Czech States Essay on Wwii: World War Ii and Czech States WWIl Being the most destructive war in history, World War II was responsible for killing about 55 million men. The war made a difference in the way the world was scene. There were many causes for the war. These causes include the following; the end of World War I, appeasement policy, expansion of Japanese military and Hitler with his policies of expansionism. World War I caused massive destruction and the world became alert to another major war evolving. This led to the formation of the League of Nations and Britain’s appeasement policy. Then end of WWI was proclaimed with the signing of the Treaty of Versailles. The treaty placed guilt and responsibility of World War I on Germany and included territorial clauses that ordered Germany to give up African Colonies and forayed annexation of German Austria. The treaty also ordered Germany to repay 226 billion for the damages caused by the war. This treaty was a major cause for WWII because it wasn’t harsh enough to prevent German y from becoming a world force again. This treaty also managed to upset all Germans. They saw it as unfair. ( pg 751- 752) The Appeasement policy was another cause of WWII. This policy was set in place by France and Britain. It allowed Nazi Germany to have anything it wanted in hopes that Hitler would be appeased and disregard his aggressive policies. Germany entered Rhineland under the Versailles treaty in 1936 and Hitler was forbidden not to. In 1938, German armies entered into Austria and annexed the country. Germany violated the treaty of Versailles in more than one way. Britain and France did not protest the violations in hopes that another war would not occur. Lastly, Hitler and his armies entered the Czech states to take Sudetenland back and France and Britain raised their objections. Hitler proceeded and implied that war was in the making. WWII would not have occurred if Hitler didn’t have chance to construct a great arm Lastly, Hitler and his armies entered the Czech states to take Sudetenland back and France and Britain raised their objections. Hitler proceeded and implied that war was in the making. WWII would not have occurred if Hitler didn’t have chance to construct a great army.(pg. 838-839 The major root cause of WWII was the expansion of Japanese militarism. The war in the pacific was not avoidable. The US and Japan didn’t agree on

Manometer Definition and Purpose

Manometer Definition and Purpose A manometer is a scientific instrument used to measure gas pressures. Open manometers measure gas pressure relative to atmospheric pressure. A mercury or oil manometer measures gas pressure as the height of a fluid column of mercury or oil that the gas sample supports. How this works is, a column of mercury (or oil) is open at one end to the atmosphere and exposed to the pressure to be measured at the other end. Before use, the column is calibrated so that markings to indicate height correspond to known pressures. If atmospheric pressure is greater than the pressure on the other side of the fluid, air pressure pushes the column toward the other vapor. If the opposing vapor pressure is greater than atmospheric pressure, the column is pushed toward the side open to air. Common Misspellings: mannometer, manameter Example of a Manometer Probably the most familiar example of a manometer is a sphygmomanometer, which is used to measure blood pressure. The device consists of an inflatable cuff that collapses and releases the artery beneath it. A mercury or mechanical (anaeroid) manometer is attached to the cuff to measure a change in pressure. While aneroid sphygmomanometers are considered safer because they dont utilize toxic mercury and are less expensive, they are less accurate and require frequent calibration checks. Mercury sphygmomanometers display changes in blood pressure by changing the height of a mercury column. A stethoscope is used with the manometer for auscultation. Other Devices for Pressure Measurement In addition to the manometer, there are other techniques to measure pressure and vacuum. These include the McLeod gauge, the Bourdon gauge, and electronic pressure sensors.

Additional Reading #2 Assignment Example | Topics and Well Written Essays - 1250 words

Additional Reading #2 - Assignment Example ction of an important good thereby leading to a problem whereby no one pays for the good and thus no one gets it despite the product having a higher value compared to the expenses that would be incurred in its production. However, in real sense, the world is never rigid since there are many individuals who are not perfectly selfish thus making it possible to charge consumers for part of the benefit they enjoy. This is because not every individual act or behave in the same way thereby causing variations and differences. Thus, the small percentage of individuals that does not conform to the group behavior brings the small benefit. However, the small benefit constitutes the externality causing underproduction and not the non-existence of a product (Harris, 34). It is of crucial significance to note that there are several forms of externalities. In relation to this, it is important to highlight that externalities may always have several effects. Some of the effects of the externalities may be beneficial (Harris, 68). However, it is of critical to note that some externalities have negative effects on the parties involved. In connection to the above case, it is of critical significance to note that whatever the effects of externalities on the surrounding environments, there are several factors to which such effects are based. Externalities that result to positive influences in the lives of people, as well as, to their surrounding are closely associated with positive externalities (Harris, 73). However, it is prudent to acknowledge the fact that externalities that are associated with bad or negative impacts on the lives of human beings, as well as their surroundings are results of negative externalities. Based on the above, it is of critical s ignificance to know some of the examples of externalities. In addition, it is prudent to understand the nature as well as effects associated with each form of externality. In relation to this, it is prudent to note that one of the

The Emergence of a Unique Cultural Life in the South America Essay

The Emergence of a Unique Cultural Life in the South America - Essay Example The number of the people who migrated was in terms of millions. For the Asians and the Europeans who moved to South America had to go across the ocean. Many of those who migrated to America preferred residing in the Western side of America and some parts of the North Eastern side. However, others felt more attracted to move to the Southern side of America (Cobb 75). These people include; Greeks, Italians, Cubans, Jews, and Asians among many others. However, the number of the immigrants to South America was less than the number of Southern African Americans who lived in poverty. In South America, there was a lot of poverty and the wages were too low to attract immigrants. There were very few opportunities for the immigrants since black Americans and a few of the local whites are the once who worked in the agricultural sectors as laborers and employees in the textile industry respectively. By 1860, only five percent of the population was made of the immigrants unlike in the North and E ast parts of America whereby the percentage of the population made up by the immigrants was fourteen. Actually, to the South American government, that was very disappointing considering that the government tried as much as possible to attract more foreigners (Cobb 99). After the coming of foreigners to South America, several factors influenced the culture of the region in an impacting way. One of the factors is racism. Amongst the Asian foreigners, the highest number was made of Chinese people. There were few Chinese women as compared to Chinese men. Eventually, most of the Chinese men married black American women who were black in complexion. In some few cases, Chinese men married the local whites in South America. The children born as a result of the intermarriage were neither white nor black. White schools could not enroll the Chinese children to their schools because they did not know the best way to classify the children (Edward 97). As a result of intermarriages, new groups of people came up who were more different in their way of life. Language is another factor that leads to the unique culture in South America. Converging of different cultures and different lifestyles in the region made the culture unique. Though others tried to copy and cope with different cultures, new cultures were developed. The blacks were able to grow foodstuffs such as corn and cassava. Asians came up with a way of getting rid of the poisonous parts found in the foodstuffs. The blacks had to adapt the culture of the Asians in a way to benefit them (Edward 101). Normally, when different types of people occupy a place, it occurs that one is not confined in his or her culture. Therefore, there was a lot of evolving in different cultures in order to make life better. Different religions, which existed in South America, caused a lot in the culture. Since there were religions, which worked well with a certain group of people, this affected the culture of the people. Some groups of peo ple did not value others depending on their religions and many denominations. This lead to conflicts because different churches had their own way of doing and showing their here was a time that protestants could not mind the church to attend since the protestant churches had common practices. Eventually, there being sub division in the churches and different faiths, disparities arose thus different churches were meant for different groups (Edward 185). By the late 19th century, indiscipline in churches started because the worshippers started being against each other. This caused internal indiscipline in the region. Each church believed that its faith was the most correct and

Self Awareness Essay Example for Free

Self Awareness Essay 1. Introduction How you access yourself in order to become more self-aware and how you reflect on your career on an ongoing basis is of utmost importance to ensure a successful personal development plan is followed continuously. In the current day and age most managers find it very difficult to set time aside for proper reflection and to spend some quality time putting development plans in place to ensure constant personal growth and development. Some of the key questions a typical manager will have to answer is how to find a balance between work, family life and personal development, or what would be the best models and tools currently available to assist him or herself to enable optimum personal growth. Another question would be how to apply these tools optimally based on your current circumstances. In this assessment I will attempt to address some of these questions, however, I do think that some of the proposals that I will put forward will have to be reviewed on an ongoing bases. This is to ensure it stays aligned with my ever evolving understanding of self-development. 2. Reflection and the way forward 2.1 Reflecting on personal development If I have to reflect back on my career it is clear that I have reached a key moment in my life about three years ago when I hit a ceiling as a subject matter expert. I also realised that I do not have sufficient management experience to make a smooth transition from a subject matter expert to a senior manager. I have reached this ceiling because I have exhausted all possible promotion options. The only way ‘forward’ for me was sidewards. The first question that came to mind was how do I change this conundrum and where do I go from here? I embarked on an MBA at Henley business school without a scientific approach in the hope that it will provide some answers. Fortunately we were exposed early on to tools and models to assist us. I used the Strategic Analysis diagram developed by Prof. Marc Day (2013) to determine which model will be the best suited for my current situation. I decided that the Force Field Analysis model developed by Lewin, K (1952) was the best fit. The reason is because I mainly need to improve my capability to become a better manager, or rather to refine my capabilities, to become a better manager. It also lies close to the Competition quadrant within a firm. This is also very applicable because of the severe competition when it comes to climbing the corporate ladder. Refer to figure 2.1 for details. The first question that now comes to mind is how do I eliminate the opposing forces in order to move from my current state to my desired state. Another question would be how can I best utilise my learning style to speed up the transition? I evaluated these opposing forces and have identified some of them that are more tangible and easier to manage. * Is an MBA the right vehicle or choice for me? I have the highest preference for the Monitor Evaluator team role according to the Belbin Team Role Report (Belbin, 2012) compiled by Henley Business School (2013). This, in short, means that I can often judge accurately, however, I sometimes lack drive. I currently have more confidence that the MBA is probably the right decision because I have the ability to judge accurately, according to Belbin, however, it will remain an open ended question that will only be answered in due time. The MBA is also a formal program. This will hopefully provide the drive I lack from time to time and the motivation I need to complete my studies. I am also Pragmatist (AE) according to Kolb (1985). Honey Mumford (2000) commented that Pragmatists like to see how learning is put into practice in the real world. This also supports my decision to join the formal Henley MBA program because all the case studies are real and theory will thus be applied into practice in real world scenarios. I therefore think that I have made the right decision to decide on an MBA as my education vehicle of choice. In doing so I have definitely weakened one of the opposing forces. * Impact on my personal life, my career and my family I realise that completing an MBA will require serious commitment and will definitely impact my family, my career and my personal life. My wife and children realise that I have reached a dead end in my career and that I will have to do something extra ordinary to change direction. They have also committed to support me from day one because they know that my despondency about my work will eventually rub off on our marriage and family life. We also realise that it is still early days and that the real challenges lie ahead. I am, therefore, convinced that this is an opposing force that I can manage down in order to weaken it. These two are also the most prominent opposing forces, so it will have a major effect on the outcome if they are managed properly. * Financial Constraints This constraint is one of the few that are not really manageable, however, I have arranged with Henley Business School to pay the tuition fees in payments. This will definitely assist me and it will also weaken the opposing force. * Networking ability My ability to network is still an ongoing constraint. I will address this developing need in the next sessions. 2.2 Reflect on recent career I used the Henley Team Working Questionnaire (2010) to reflect on my recent career in order to establish a fit (or lack thereof) between me as a manager / team leader and my role within my organization. I realize that this is not an assessment tool of my current job, but rather a tool to be used to asses my current need of learning in going forward. This has highlighted a few areas that require development. These areas might also be the reason for the misalignment/misfit between my current career expectation and my progression within my organization. I have always realized that I have areas in need of development, hence my decision to start my Henley MBA. The Henley Team Working Questionnaire has assisted me a great deal in identifying those areas. I have used the Henley Star (Henley Business School, 2011), as part of this assignment, to assist me in analysing my most important development areas. The area that has come out on top was my development need to demonstrate impact and to influence others. I currently have a lot of questions that are still unanswered. I hope to get a better understanding of exactly how to approach it and how to address them in order to ensure a successful outcome. I will spend more time on how I plan to address these questions in the next section. For now it is important that I have a starting point for my own personal development in order to improve my current fit. I have also completed chapter 5 of the textbook provided, A Manager’s Guide to Self Development (Pedler, M, Burgoyne, J Boydell, T, 2007: 27). This has also indicated that I need to develop my creativity as well as my command of the basic facts in my company. 2.3 Planning ahead The key question at this stage is how would I go about addressing these areas of development over the next twelve months? I will need to balance three main areas, my life and family, my working career as well as my time spend studying for my MBA. In addition, I will also have to constantly focus on my areas of development in order to try and approve them. Doing this should improve my management capabilities. It will also align me with the correct individuals in my current company to ensure improved opportunities in growing my career. Pedler, M, Burgoyne, J Boydell, T (2007:37) gave a list of activities to do for each area that requires development in their book A Manager’s Guide to Self Development. I have highlighted some of these activities and have drawn up a plan to do it over the next 12 months. Refer to appendix A. I will also have to make sure I spend more time in our office and with top management in order to gain access to valuable information, insights and data. This will assist in improving my impact and my influence with other people. I will also have to manage my time with my client more efficiently in order to attend all the ‘open days’ and information sessions at our company so that I can achieve my goal. I put a schedule together to ensure I manage all areas of development. I know this is premature, however, it is a start. Refer to Appendix B. I intend recording my progress as well as my learning journals in a tool called Evernote. This tool is available across all platforms and it syncs seamlessly between all my devices. This makes it an ideal tool for my requirements. Conclusion I have tried various approaches in the past to improve my managerial capabilities to move from a subject matter expert orientated environment to top management. I realise now that I will have to change my approach because I tend to favour the Monitor Evaluator team role and I am a pragmatist. The key question that still remains is exactly how? This assignment has assisted me in identifying three main areas where development is needed, namely the ability to demonstrate impact and to influence other, creativity and a command of the basic facts. I have put an activity plan together (Appendix A) to assist me improving my areas in need of development. The main issue to keep in mind is that I continuously will have to be self-aware. I will also have to reflect on each and every move I make from now on. My activity plan should also be revaluated on an ongoing basis to ensure it is still the best fit for my current needs. The finer detail is still missing. My hope is that I will be able to i mprove it by applying the models, tools and exercises available during the course of the MBA and to get more clarity in moving forward.

Market Composition Essay -- Global Finance, Investments

Over the past two decades, a panoply of behavioral finance research has been devoted to exploring the trading patterns of behavior and trading performance of individual and institutional investor categories over time and across exchanges. In fact, this intriguing research topic is of considerable interest to academic scholars and market practitioners alike, because it has great academic value and practical implications for industry. Specifically, capturing the trading pattern and investment performance of each investor group within a particular country can cast light on some worthwhile issues such as market composition, information transmission, asset price formation, and market efficiency and liquidity. Due, in part, to the information asymmetry evidenced between institutional investors and individual investors (e.g., Alangar et al., 1999; Lin et al., 2007; Duong et al., 2009), each group is more likely to have its unique characteristics. In their 2008 study, Kaniel et al. point out that institutional investors are by and large perceived to be better-informed rational traders, and to have a rather long-term investment perspective. In contrast, individual investors are generally viewed as unsophisticated traders, who prefer short-term investment horizons and are deeply involved in making sentiment-driven investment decisions based on their own cognitive biases. On the other hand, researchers working in the area of behavioral finance distinguish between two acknowledged trading patterns premised on investors' reactions to the past price movements of stocks. The first pattern of behavior is labeled as momentum investing or positive feedback trading, in which investors purchase (sell) a stock in anticipation of a further rise (d... ...kes (2011) report significant evidence that all three investor types – especially insurers – are more contrarian when selling than buying, which suggests that investors are reluctant to realize losses, in conformity with the evidence presented by Grinblatt and Keloharju (2001) and Odean (1998). More recently, Phansatan et al. (2012) examine the Stock Exchange of Thailand (SET) and find that individual and institutional investors appear to be contrarian traders as opposed to foreign investors who are shown to be positive feedback traders. Interestingly, the trading strategies of institutions in the Thai stock market lead to very inferior security section, and thus very poor overall trading performance. On the other hand, the trading behavior of individual investors brings about gains from security section, but their poor market timing counterbalances these gains.

An Analysis of Advertisement Essay

In the Hunter/Gatherer section of Omnivore’s Dilemma, Pollan talks about what it takes to accomplish the task of developing a meal on his own; consequently, the people of today’s society are so used to the abundance of food that they have no idea what all is involved in establishing a full meal. Americans take this great abundance of food for granted, which causes an increased craving for more. This is where the world of advertisement has been the strongest. One of the easiest ways to reach people is through their food; therefore, major food industries try to lure people in at all costs just to buy their products. The Fast food industry is the ringleader of all this trickery. They try their best to make people believe that their food is the best on the market, and in this process they hide several of their flaws with a beautiful or very appealing advertisement. The creation of an advertisement has been broken down into a specific science where the creator of the advertisement can specifically pinpoint the targeted audience’s interests. The advertisement of industrial foods has become a major weakness in the American culture; consequently, the factors of this weakness come from the inability for omnivores to make the right decision on what to eat, whether or not the food is good for them, the lack of courtesy for others and themselves, and the failure to see through the pretty colors and the attractive facade advertisements display. One example of this corruption of food culture can be viewed in a simple Carl’s Jr. ad. In this advertisement, there is depicted a hamburger and few lines of text, but the simplicity of this ad is what makes it all the more deceiving. The creator of this ad uses several pictorial techniques in order to captivate anyone that may see it. First of all, the colors in the hamburger are brilliant and eye-catching such as: the perfect golden color of the sesame seed bun; the bright yellow of the cheese between two layers of perfectly charbroiled beef patties; the vibrant red of the ketchup; and the perfectly fresh look of the tomatoes, onions, and lettuce. This ad rives its viewers to believe that this hamburger is ideal and seems almost tangible. As though the brilliant colors of the hamburger was not enough, the creator of this ad uses a black background in order to illuminate all the hamburger’s superlative attributes. As the ad is further examined, the three line of white, bolded text is inescapable, especially on the black background. Another way the advertiser att racts the viewer is through the positioning of the ad on the poster, billboard, etc. Here in this particular ad, the picture has almost perfect axial balance. This means that the main focus of the ad, the burger, is the central item of the whole ad, and this is definitely the first thing the advertiser wants his viewers to see. Another thing about the orientation of the picture is almost looks three-dimensional. The advertiser does this so that the viewer can get as close to the burger without smelling it or tasting it as possible. The next biggest thing on the advertisement is the catchy phrase that is in a special font and size that is the next thing that catches the eye. The ambience in the Carl’s Jr. dvertisement is that of a bold hunger and also casually crude. This mood is set not only by the picture but also by what the words imply. The phrase printed on the ad, â€Å" She’ll tell you size doesn’t matter. She’s lying† is an old joke that is crude and degrading for women. Here, in an underlying way, women are itemized and they are seen as some kind of prize instead of a human being. Not only does th e text degrade women but also men. It degrades men in that the creator of this advertisement thinks that all men walk around thinking about sex all the time. Unfortunately, this is probably true, and it is a pretty â€Å"low blow† to take advantage of such a serious weakness. Pollan states that one of the omnivore’s frequently asked question is â€Å"What should we do for dinner† (1). When searching for the answer, people will seek it anywhere, and sadly, many fall into the vulgarity of this ad. Pollan explains this notion when he says, â€Å"When you can eat just about anything nature has to offer, deciding what you should eat will inevitably stir anxiety, especially when some of the potential foods on offer are liable to kill you† (3). Although a hamburger may not kill someone, the insinuation of sex in the ad can drag people down to the nasty greasy level of the burger. Although this ad is crude and misleading, the creator of it uses pathos, ethos and logos very well in order to reach a future consumer. The pathos, or emotion, that the advertiser sets through his ad is that of sex and pride. Both of these are not actually stated in the ad, but these are the emotions that take place when the ad is comprehended. The creator of this ad has a certain target, and that target is any man over the age of thirteen. He uses their greatest weakness, their sex drive, to lure them I to wanting one of those burgers. This use of sexual reference is a very good example of logos because the creator uses the tactic of testing men’s pride. A great amount of a man’s pride comes from his sexual endowments. Here in this article those endowments are being tested from the standpoint of almost saying, â€Å"Are you man enough to eat this burger? † The ethos of this ad though is low. Usually it is not right to take advantage of someone’s greatest weakness, which is done here to men. But, because of the ongoing battle between fast food chains today, it is important to take advantage of any weakness the consumer may have in order to win their business. The role of this Carl’s Jr. advertisement is an excellent example of how the world views food and the lack of respect for it. The statement made in the text is a crude, humorous, cliche joke that has been a little over used. The advertiser shows not only his level of maturity, but also the maturity of the consumers that fall for this trick. It is not just what the words say on the ad that makes it wrong, but what the words imply. This underlying reference towards sex is probably the lowest advertisers could reach to appeal to their targeted consumers. Where in a hamburger does someone get sexual aspirations? There is nothing sexy or in any way appealing of someone eating a giant, messy hamburger. For people to be satisfied in their food because it is advertised in this way is absurd and disrespectful not only to the food itself, but also the people who prepared it. In this particular Carl’s Jr. ad, all that is shown is the glorious end product of a long line of â€Å"dirty work†, and the middleman who did that work is forgotten. If people had to go back to the days when the meal had to provided without the help industry, there would be a whole new level of respect for those who work to produce those foods. The hunter/ gatherer group was allowed to see a small portion of what steps it takes to get a meal on the table from the very beginning. The greatest dilemma that they faced was finding enough food, and in the beginning, having food at all. Although this was a great obstacle, it also gave the group a sense of accomplishment when they had conquered the task producing a complete meal without the help of anything but nature. This way of life is how people had to do it before there were any industrial food chains. It has almost become a lost art. Pollan explains this when he says, â€Å"Now there are some people (though not all that many of them anymore) for whom such a radically self-made meal exists firmly in the realm of possibility. I am not one of them† (277). He uses himself as an example of this loss of culture and heritage. In this advertisement of the Carl’s Jr. Super Star with cheese, many things can be taken from the simple picture of the burger and the text. The fast food industry has ruined people because they have all the food they need at a quick cheap price, and unfortunately this has caused people to take the life necessity of food for granted. People have perverted the food industry with their lack of respect for food and themselves through the food they eat and the way that food is sometimes advertised. Industrial food chains make their ads look so perfect and tasty, but unfortunately, the real thing is nowhere near what is advertised. Fast food is a trick that everyone is falling for. This quick food blinds people to the hard work it takes to get the meal from the field to the table.

Health in Comminities

# 2008 University of South Africa All rights reserved Printed and published by the University of South Africa Muckleneuk, Pretoria CMH2602/1/2009 ±2011 98316532 (iii) __________________________________ __________________________________ Contents WELCOME AND INTRODUCTION (vii) PART 1: THEORETICAL FOUNDATIONS IN COMMUNITY HEALTH 1 LEARNING UNIT 1: 2 1. 1 1. 2 1. 3 1. 4 1. 5 1. 6 1. 7 1. 8 1. 9 CONCEPTS AND THEORIES/MODELS IN COMMUNITY HEALTH Introduction Theoretical thinking as a language Choosing a theory/model to apply to community health The dimensions model of community health nursing Orem's self-care deficit theory of nursingNeuman's systems model/theory Pender's health promotion model Gordon's functional health pattern framework Conclusion 2 2 3 4 5 8 9 10 11 PART 2: THE INDIVIDUAL AND FAMILY AS CLIENT 13 LEARNING UNIT 2: 14 2. 1 2. 2 2. 3 2. 4 2. 5 2. 6 2. 7 2. 8 2. 9 2. 10 Introduction Defining the concept of family Structure of the family Types of families Stages of family d evelopment The family as social system Cultural values in the family Family functions Roles of the family Conclusion LEARNING UNIT 3: 3. 1 3. 2 3. 3 3. 4 3. 5 3. 6 3. 7 3. 8 3. 9 3. 10 3. 11 THE FAMILY AS CLIENT ASSESSING FAMILY HEALTH IntroductionAssessment of the family The biophysical dimension The psychological considerations The physical environmental considerations The socio-cultural dimension The behavioural considerations The health system considerations Diagnostic reasoning and the family as a client Planning, implementation and evaluation Conclusion 14 14 15 16 17 19 20 21 21 21 23 23 23 25 25 27 28 30 31 31 31 32 (iv) LEARNING UNIT 4: INFANTS FROM BIRTH TO 18 MONTHS 4. 1 Introduction 4. 2 Definition of child health 4. 3 Growth and development during infancy 4. 4 Developmental tasks 4. 5 Infant nutrition 4. 6 Cognitive-perceptual patterns . 7 Child abuse 4. 8 Stress in infancy 4. 9 Pathological processes 4. 10 Immunisation 4. 11 Conclusion 34 34 34 34 35 36 37 37 38 38 38 41 LEARNING UNIT 5: THE TODDLER (18 ±36 MONTHS) 5. 1 Introduction 5. 2 Age and physical changes 5. 3 Nutrition in toddlers 5. 4 Elimination and exercise patterns 5. 5 Sleep and rest pattern 5. 6 Cognitive-perceptual pattern 5. 7 Self-perception-self-concept pattern, roles-relationships pattern, child abuse, sexuality-reproductive pattern, coping with stress, and values and beliefs 5. 8 Pathological processes 5. 9 Social processes 5. 10 Conclusion 43 43 43 44 44 44 45LEARNING UNIT 6: THE PRE-SCHOOL CHILD 6. 1 Introduction 6. 2 Age and physical changes 6. 3 Cognitive-perceptual patterns 6. 4 Self-perception-self-concept pattern, roles-relationships pattern, sexuality-reproductive pattern, coping-stress pattern and values-beliefs pattern 6. 5 Pathological processes 6. 6 Social processes 6. 7 Conclusion 48 48 48 49 LEARNING UNIT 7: THE SCHOOL-AGE CHILD 7. 1 Introduction 7. 2 Age and physical changes 7. 3 Cognitive-perceptual pattern 7. 4 Self-perception-self-concept pattern, roles-rel ationships pattern, sexuality-reproductive pattern, coping-stress pattern and values-beliefs pattern 7. Pathological processes and social processes 7. 6 Conclusion 52 52 52 53 LEARNING UNIT 8: THE ADOLESCENT 8. 1 Introduction 8. 2 Age and physical changes: Gordon's functional health patterns 8. 3 Gordon's functional health patterns in adolescents 8. 4 Pathological processes in the adolescent 8. 5 Social processes 8. 6 Conclusion 56 56 56 57 58 59 59 45 46 46 46 49 50 50 51 54 55 55 (v) LEARNING UNIT 9: GENDER HEALTH 9. 1 9. 2 9. 3 9. 4 9. 5 9. 6 9. 7 Introduction The status of women Women's health status The lesbian/gay, bisexual and transgender (LGBT) client Men's health statusThe epidemiology of health for gay, bisexual and transgender men Conclusion LEARNING UNIT 10: CARE OF THE CLIENT IN THE WORK SETTING 10. 1 10. 2 10. 3 10. 4 10. 5 Introduction The objectives of occupational health The occupational health nurse's scope of practice Nursing care of working populations Conclusion LEARNING UNIT 11: THE OLDER ADULT 11. 1 11. 2 11. 3 11. 4 11. 5 11. 6 11. 7 11. 8 11. 9 11. 10 11. 11 11. 12 11. 13 11. 14 11. 15 11. 16 Introduction Age and physical changes Goals of health promotion Pattern of health perception-health management Nutritional metabolic patternElimination pattern Activity-exercise pattern Sleep-rest pattern Cognitive-perceptual pattern Self-perception-self-concept pattern Roles-relationships pattern Sexuality-reproductive pattern Coping-stress tolerance pattern and values-beliefs pattern Pathological processes Social processes Conclusion 60 60 61 62 63 63 64 64 65 65 66 66 66 67 68 68 69 70 70 70 70 70 70 71 71 71 71 71 71 72 72 PART 3: THE COMMUNITY AS CLIENT 75 LEARNING UNIT 12: HEALTH PROMOTION IN THE COMMUNITY 76 12. 1 12. 2 12. 3 12. 4 12. 5 12. 6 12. 7 12. 8 12. 9 12. 10 12. 11 12. 12 Introduction Definition of a communityDefining the term community health The community as a client Goals of community-oriented practice Strategies for improving community health Community partnerships Community-focused nursing process Planning Implementation Evaluation Conclusion 76 76 77 77 77 79 79 79 80 81 83 83 (vi) LEARNING UNIT 13: INTERVENTIONS FOR HEALTH PROMOTION IN THE FAMILY 13. 1 13. 2 13. 3 13. 4 13. 5 13. 6 13. 7 13. 8 13. 9 Introduction Definitions of health promotion Interventions for health promotion The purpose of health education The health educator Principles for health education Implementation of the educational planEvaluation of the educational process Conclusion LEARNING UNIT 14: ISSUES IN COMMUNITY HEALTH 14. 1 14. 2 14. 3 14. 4 14. 5 14. 6 14. 7 14. 8 Introduction Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (Aids) Tuberculosis (TB) Poverty Homelessness Violence Community resources Conclusion 84 84 84 85 85 86 88 89 89 90 92 92 92 93 94 94 95 95 97 BIBLIOGRAPHY 98 ANNEXURE A: FEEDBACK FOR SCENARIO IN LEARNING UNIT 3 ? LEARNING UNITS 4 ±12 99 ANNEXURE B: FACTS ABOUT IMMUNISATION 106 ANNEXUR E C: THE REVISED EXPANDED PROGRAMME ON IMMUNISATION IN SOUTH AFRICA (EPI-SA) SCHEDULE 08 ANNEXURE D: PLANS TO ADD TWO NEW VACCINES TO PREVENT PNEUMONIA AND DIARRHOEA IN BABIES 110 ANNEXURE E: PRIVATE VACCINES SCHEDULE 111 (vii) Welcome and ____________________________ introduction ____________________________ Welcome to this second-level module on health in communities. You will learn about the concepts and theories/models involved in community health to equip you with a theoretical foundation for this module. The aim of this module is to equip you with knowledge about the life span of the individual in order to give you skills to work with families in the community.You will also gain a holistic approach towards critical issues in the community. You should grow and develop into a competent and skilful practitioner who can identify needs and problems relating to family health and respond to them in an innovative way. Working through this module will enrich your life not only professi onally, but also personally. The nature of this study guide This study guide has been designed in an interactive way with the aim of guiding you through two prescribed books. As you work through this study guide you should integrate the information in the study guide with the information in your prescribed books.The Internet has a wealth of information and you are advised to use the Internet as often as possible to broaden your knowledge on certain topics. Prescribed books You are expected to purchase the following prescribed books for this module: Clark, MJ. 2008. Community health nursing: advocacy for population health. 5th edition. Englewood Cliffs, NJ: Prentice-Hall. Edelman, CL & Mandle, CL. 2006. Health promotion through the lifespan. 5th edition. St Louis: Mosby. Edelman and Mandle (2006) has very valuable information on health promotion and covers the entire life span, from birth to death.In addition to your study guide, this book is very important: you will find a wealth of information. Clark (2008) is a book on community health nursing that emphasises the dimensions model of community health nursing right through. This is a very valuable model which will help you to gain a holistic and systematic approach towards the individual, family and community. (viii) The information in these two books is complementary. Together with the study guide it will help you to gain the knowledge and skills you will need to supply health care to individuals, families and communities.Activities The activities are planned to either reinforce content, to guide you to tackle upcoming content, or to motivate you to think about issues. You will note that in part 2 of the study guide there is only one activity at the end of each learning unit: here we want you to apply the dimensions model of community health to a member of the family. Feedback on all these activities will be given in annexure A. This CMH2602 module runs parallel with the practice module for Community Health, CMH2126. The theory cannot be separated from the practice. IconsYou will find a series of icons in the text to guide you as you progress with your studies. Activity When you see this icon, you will know that you must complete an activity. We may ask you to read a specific section in the prescribed literature, apply given information, think about topics that have not been introduced, find your own information or ask other people for information. Please read the instructions carefully. Assessment criteria This icon indicates the questions that you can use to assess your own understanding of the work. These questions are adapted from the outcomes.You are told what you should do to prove that you have met the learning outcomes. Prescribed reading When you see this icon, study or read the prescribed book as indicated, before continuing with the next section. Learning outcome This icon tells you how you will benefit in the field of practice if you know the content of the specific learning unit. The outcomes tell you what you will be able to do after you have studied the work. h Feedback This icon tells you what was expected from you when you did the activity. It will not necessarily give you all the facts but will give you guidelines on how to answer the question.Not all of the activities will have feedback because many of the answers are given in your prescribed books. (ix) Conclusion This module is designed to enable you to work with families in the community. It is based on the needs and problems of the family. It covers individuals who are part of the family and the family as part of the community. After completion of this module, together with the practice module, you will be able to take responsibility for practising as an independent community nurse in any community setting. PART 1 THEORETICAL FOUNDATIONS IN COMMUNITY HEALTH 2 Learning unit 1Concepts and theories/ models in community health Outcomes Since theories/models provide you with the knowledge you nee d to practise community health in a scientific way, it is essential for you to be familiar with the various theories/models in the field to be able to apply them to community health. When you have worked through this learning unit you will be able to: * * * * 1. 1 describe various concepts in theoretical thinking explain selected theories/models in detail describe the key concepts and themes of the selected theories/models apply the theories/models to community healthIntroduction While we will discuss theories/models in general in this learning unit, we will also deal with several selected theories in more depth in order to indicate how they can be applied to community health. It is currently accepted that theories form the basis of community health. Since theories provide us with the knowledge we need to practise community health in a scientific way, it is essential for the community nurse to be familiar with the various theories/models in the field and to be able to apply them to community health. 1. 2 Theoretical thinking as a languageThe terms theory, model, conceptual framework, conceptual model are often used synonymously in literature. The literature reflects various conflicting opinions about the terms, their usage and meaning. According to Polit and Beck (2008:141) a conceptual model or a conceptual framework represents a more informal mechanism for organising and discussing phenomena or concepts, while theories are more formal in nature. Conceptual theories, frameworks and models are composed of concepts or constructs. These concepts or constructs are interdependent because they systematically demonstrate the relationship between variables.A model is a symbolic representation of concepts or variables with an interrelationship. A phenomenon is the abstract concept under study, often 3 used by qualitative researchers, while a concept is a description of the objects or events that form the basis of a theory. Both models and theories can describe and pre dict the relationship between phenomena. Models and theories are terms that are often used interchangeably in literature. The term theory is often used to refer to the subject content that student nurses must be taught in the lecture room to acquire the information they need to perform the nursing tasks in practice.Researchers such as Polit and Beck (2008:768) define theory as â€Å"an abstract generalisation that presents a systematic explanation about the relationships among phenomena†. Theories include principles for explaining, predicting and controlling phenomena. In all disciplines theories serve the same purpose. This purpose is to make scientific findings meaningful, and to make it possible to generalise. A theory is composed of concepts and constructs that are systematically related and that are also goal-oriented (Stanhope & Lancaster 2006:196). Types of traditional theories include grand theories and middle-range theories.Grand theories describe and explain large s egments of the human experience which are very broad. Middle-range theories explain more specific phenomena such as stress, self-care, health promotion and infant attachment. Metatheory is a term used to label theory about the theoretical process and theory development (Polit & Beck 2008:141). Metaparadigm refers to the main concepts that identify the phenomena or ideas of interest to a discipline, in this case the discipline of nursing. They provide the boundaries for the subject matter of the discipline.The metaparadigm concepts for nursing include person, environment, health and nursing (Clark 2008:67). However, current literature suggests that a four-concept metaparadigm for the discipline of nursing is too limited and suggests additional concepts such as transitions, interaction, nursing process, nursing therapeutics, self-care, adaptation, interpersonal relationships, goal attainment, caring, energy fields, human becoming and other concepts. The best-known and most used concep ts are however the first four: person, environment, health and nursing. 1. 3 Choosing a theory/model to apply to community ealth Choosing a suitable theory or model is not always an easy task ? especially when most theories are geared towards the care of individuals and were never designed to apply to groups or communities. The theory or model that is chosen must be flexible enough to be adapted to the community health situation and its aim must be to provide guidance for those who practise community health. The importance of the family or community network and the social network must both be clearly reflected, and the theory or model must be realistic and simple enough to understand and apply.In addition, the theory/model should harmonise with the community nurse's views about the individual, the environment, personal health and community health. You may find that the theory that is chosen may not always fulfil all your expectations and that it may also not be applicable to all cir cumstances. You may often be required to make adjustments or to develop your own personal model on the basis of existing theories. 4 Activity Explain why community health nursing should be based on a model or theory. h Feedback You should have considered the following points: * * * * * 1. 4A systematic approach is needed. Theories/models assist community nurses to evaluate health status and to plan, implement and evaluate effective nursing care. The model/theory used directs attention to relevant aspects of the client situation and to appropriate interventions. Epidemiologic models help in examining factors that influence health and illness. Nursing models suggest interventions to protect, improve and restore health. The dimensions model of community health nursing Clark's (2008:69) dimensions model of community health nursing is one of the few models designed for community health.This model is described in detail in your prescribed book (Clark 2008) and will therefore only be summa rised here. This model is a revision of the previously titled Epidemiologic Prevention Process Model. The dimensions model incorporates the nursing process and the levels of prevention as well as an epidemiologic perspective on the factors influencing health and illness. The dimensions model consists of three elements: the dimensions of health, the dimensions of health care and the dimensions of nursing. The dimensions of health include: * * * * * * the the the the the he biophysical dimension psychological dimension physical environmental dimension socio-cultural dimension behavioural dimension health system dimension The dimensions of health care include: * * * primary prevention secondary prevention tertiary prevention The dimensions of nursing include: * * * * cognitive dimension interpersonal dimension ethical dimension skills dimension 5 * * process dimension reflective dimension You should study this model to enable you to assess the health status of individuals, families or communities and to guide your nursing interventions.Prescribed book Study chapter 4 in Clark (2008, or later editions), on the dimensions model of community health nursing. Activity (1) Name the three elements of the dimensions model of community health nursing. (2) List the dimensions included in each element. (3) Give an example related to the dimensions in each element that addresses the health of a population group. 1. 5 Orem's self-care deficit theory of nursing Orem proposes a general theory of nursing which she calls the theory of self-care deficit. Orem's theory focuses on people's ability to practise self-care.The dominant theme of her philosophy of health is that people should be empowered and encouraged to practise their own self-care by means of their own efforts or with the help of significant others. Orem's self-care deficit theory of nursing consists of three interrelated theories: the theory of selfcare, the theory of self-care deficit and the theory of nursing syste ms. This theory is consistent with community health, based on the following premises: * * * Individuals and groups must accept responsibility for their own health and consequently care for themselves.The community nurse should provide the necessary training and support that will enable individuals or communities to do this. The community nurse should intervene only when a deficit or need arises in the selfcare framework. The World Health Organization (WHO) also strongly emphasises that self-care and selfresponsibility play an important role in achieving the goal of optimal health. 1. 5. 1 Theory of self-care In order to understand the theory of self-care, one must first understand the concepts of self-care, self-care agency, basic conditioning factors and therapeutic self-care demand.Self-care include those activities and decisions which a person undertakes in order to maintain life, health and well-being. These activities are acquired by learning, and they contribute to the mainten ance of human development and functioning. 6 Self-care agency refers to the ability of a person to exercise self-care in daily life. The ability to care for oneself is affected by basic conditioning factors: age, gender, developmental state, health state, socio-cultural factors, health care system factors, family system factors, patterns of living, environmental factors and resource adequacy and availability.Therapeutic self-care demand is the sum total of the measures which are called for at a particular time for the promotion and maintenance of health, development and general well-being. In the case of self-care, purposeful actions and steps are taken. Although selfcare should benefit an individual's health, his or her perception of self-care may not always promote good health, as is the case with a person who smokes in the belief that it reduces his or her stress levels. Self-care requisites refer to the reasons for which self-care is undertaken.The three categories of self-care requisites include universal, developmental, and health deviation. Universal self-care requirements include those processes which are essential for the normal functioning and maintenance of health and life, such as the following processes: * * * * * * having and maintaining sufficient fresh air/oxygen, water and food intake finding the balance between exercise and rest, and having social interaction avoiding dangers and obstacles that can compromise human functioning and well-being promoting human functioning and development in a group roviding care associated with elimination processes and personal hygiene keeping a balance between being alone and social interaction Developmental self-care requisites are divided into two categories: * * The first concerns the maintenance of those conditions which are favourable to a person's normal growth and development. The second is concerned with the prevention of those negative conditions, forces, influences and factors which can hinder and ob struct normal development. Awareness of such requirements reflects a person's level of development and his or her general capacity for self-care.Health deviation self-care is necessary for preventing illness, injury and retardation. It involves taking whatever steps are necessary for preventing or treating illness or disability effectively. The requisites for health deviation self-care include: * * * * * * seeking and securing appropriate medical assistance being conscious of and attending to the effects and results of pathologic conditions conducting medically prescribed diagnostic, therapeutic and rehabilitative measures attending to or controlling the negative effects of prescribed medical treatment effectively ccepting oneself as being in a specific state of health and in need of particular forms of health care developing and sustaining health-optimising lifestyles 1. 5. 2 Theory of self-care deficit The theory of self-care deficit forms the core of Orem's general theory of nurs ing. According to this theory, an adult who is unable to practise self-care requires dependent care; this refers to an adult who does not have the ability to meet his or her own needs or 7 only has partial ability to take care of himself or herself. This may happen or example when a person falls ill and this illness generates new demands, requiring the implementation of complex measures and specialised knowledge. Orem cites the following examples of support or help which can be offered in such circumstances: * * * * * acting on behalf of a person or undertaking certain activities for this person until he or she can once again care for himself or herself more independently providing guidance and direction in the new situation providing physical and psychological support creating and maintaining a new environment which supports personal development providing appropriate relevant instructionsA self-care deficit occurs where there is a discrepancy between the need for self-care and the ability to manage this self-care. In such circumstances the individual needs to be assisted and educated to administer whatever self-care he or she may need. In short, a self-care deficit occurs when a person is unable to practise appropriate self-care on his or her own or without external assistance. 1. 5. 3 Theory of nursing systems The theory of nursing systems consists of two components: the nursing agency, and nursing systems.The nursing agency refers to the characteristics of people who are trained as nurses that enable them to act, to know and to help others meet their therapeutic self-care demands by developing their own self-care agency. Nursing systems are created when nurses use their knowledge and skills to plan and implement nursing care where there are deficiencies in self-care. The aim of intervention by the nurse is to compensate for the self-care activities which the individual, family or community cannot maintain at an optimal level. These compensatory activities a re classified into: * * *The wholly compensatory system where the community nurse becomes the self-care agent to compensate for the client's inability to maintain his or her own self-care. The community nurse cares for and supports the client wholly. For example, this would happen where a person is in a coma and cannot consciously look after himself or herself. The partly compensatory system where the client is capable of certain self-care measures but only to a limited degree. The aim of health care intervention is to lend support and carry out certain activities on behalf of the client until he or she is able to resume them again.The supportive/educational system where the client can manage self-care but needs the support and guidance of the community nurse. The community nurse regulates the selfcare agent's performance and development so that he or she can function more independently (George 2002:126). Activity (1) Describe the different components of the self-care deficit theory of nursing. 8 (2) Explain what is meant by a self-care deficit. (3) A mother and her two-month-old baby visit your clinic. The baby is not gaining sufficient weight and the mother appears tired and stressed. Identify the self-care deficit in this particular case. h FeedbackYou should have covered the following points in your answer: (1) The mother is not able to care for herself with the demands of a new baby. (2) She therefore needs health education and advice on how to handle the situation. 1. 6 Neuman's systems model/theory According to Neuman, her personal philosophy of helping each other live contributed to development of the holistic systems perspective of the her systems model. Neuman's theory is based on: * * the two main components of stress and the individual or his or her body's reaction to that stress the community's reaction to certain stress factors (stressors) in the environmentNeuman based her systems model on a general systems theory and regards the client as an op en system which reacts to stressors in the environment. Stressors may be intra-personal, inter-personal or extra-personal. Intra-personal stressors occur within the client system boundary and correlate with the internal environment (eg feelings such as anxiety or anger within a person). Inter-personal stressors occur outside the client system boundary and have an impact on the system (eg stimuli between people such as role expectations). Extrapersonal stressors also occur outside the ystem boundaries, but are further away from the system than the inter-personal stressors (eg work or finances). Environment includes all the external and internal influences that surround the client system. The external environment exists outside the client system and the internal environment exists within the client system: * * * * The client system contains a basic structure or core construct (individual, family community) which is protected by lines of resistance. The basic structure includes system variables such as physiological, psychological, socio-cultural, developmental and spiritual variables.Penetration of the basic structure results in death. The normal level of health is identified as the normal line of defence which refers to the client's usual state of wellness and represents stability over time. When the normal line of defence is invaded or penetrated, the client system reacts, for example with symptoms of illness. The flexible line of defence prevents stressors from invading the system and is a dynamic state of wellness that changes over time. It can for example be altered in a relatively short period of time by factors such as inadequate sleep or food.The lines of resistance protect the basic structure and become activated when the normal line of defence is penetrated by environmental stressors. If sufficient energy is 9 * available, the normal line of defence is restored; but if the lines of resistance are not effective, death may follow. Reconstitution involves stabilisation of the system and movement backwards to the normal line of defence. Health care intervention takes place in the prevention modalities, that is the primary, secondary and tertiary levels of prevention. (Clark (2008:67)) Prescribed reading Study Neuman's model in Clark (2008, or later editions).Activity (1) (2) (3) (4) Explain what Neuman means by client variables. Describe the concepts of line of resistance and normal line of defence. Describe Neuman's view on health. Define the term stressor. This theory/model can also be applied to community health because a preventive approach is followed and because of its flexibility. 1. 7 Pender's health promotion model Pender described a model which is applicable to community health in particular. This model is based on principles of health promotion and, to a certain extent, corresponds with the Health Belief Model.Pender's health promotion model comprises three basic concepts, namely individual perceptions, variables which can influence healthy behaviour and the probability that actions will be taken to promote health: * * * Individual perceptions include factors such as how important health is seen to be, perceptions on control and effectiveness, the definition of health, the state of health, the advantages inherent in preventive measures, and possible obstacles. Variables include factors such as demography, income, literacy, culture and family health patterns.The probability that action will take place includes matters such as ? ? ? ? how highly the person rates or values action any previous experience with health personnel the availability and affordability of preventive services the threat that the condition holds for the individual or family Prescribed reading Study Clark (2008, or later editions), the section on Pender's health promotion model. 10 Activity (1) Name the variables which can affect the preventive actions that a family and a community may take. (2) Write short notes on individual perce ptions and indicate how they can influence health-promoting actions.Pender's model is applicable to community health because the promotion of health is taken as the starting point and factors which influence the measures for promoting health are defined and emphasised. The model can guide and lead the community health nurse in promoting health. On the grounds of the variables and perceptions that are identified, she/he can make decisions on the degree of intervention that is necessary. For example a degree of knowledge and motivation may seem necessary to allow the community to take certain promotive actions, or to decide whether or not the available options are acceptable.The community health nurse's task could then be to give the community the necessary information or to influence them to modify perceptions that are detrimental to their health. Depending on the specific problems or behaviour that deviates from a healthy living pattern, the culture of the community, the level of li teracy and so on, the community health nurse can plan a programme or develop his or her own model based on Pender's promotive model. (Clark 2008:257) 1. 8 Gordon's functional health pattern frameworkHistorically, conceptual models in nursing have employed Gordon's health-related behaviours and developed them into an assessment model with 11 functional health patterns. Your prescribed book (Edelman & Mandle 2006) uses this framework throughout in the assessment of each developmental stage. The 11 functional health patterns include: * * * * * * * * * * * pattern of health perception-health management nutritional-metabolic pattern elimination pattern activity-exercise pattern sleep-rest pattern cognitive-perceptual pattern self-perception-self-concept pattern roles-relationships pattern sexuality-reproductive pattern oping-stress tolerance pattern values-beliefs pattern (Edelman & Mandle 2006:131) Read Edelman and Mandle (2006 or later edition), the section on functional health pattern s: assessment of the individual. 11 1. 9 Conclusion Various theories/models applicable to community health were discussed in this learning unit. It is very important that you as a community health nurse have an understanding of these theories/models and how they could be applied to community health. Assessment criteria (1) Define the following terms: ? ? ? ? ? theory model conceptual framework phenomenon concept (2) (3) (4) (5) 6) Define the different constructs of Orem's theory. Explain the defence mechanism in Neuman's theory. Describe the principles on which Pender's promotion of health model are based. Name the three elements of the dimensions model of community health nursing. Name the dimensions of the dimension of health in the dimensions model of community health nursing. (7) List the functional health patterns in Gordon's functional health pattern framework. Note: Application of selected models/theories will be assessed in part 2 of the study guide. 12 PART 2 THE INDIVIDUAL AND FAMILY AS CLIENT 14 Learning unit 2The family as client Outcomes When you have worked through this learning unit you will be able to: * * * * * * * 2. 1 describe the concept of family describe the structure of the family describe different family types and their characteristic features describe the stages of family development discuss family functions describe the family as a social system discuss cultural values in the family Introduction The family is the basic social unit in any community. Family members usually share living arrangements, responsibilities, goals, the continuity of generations, and a sense of belonging and affection.How well a family works together and meets any crisis depends on the composition of the family (the structure), the activities or roles performed by family members (the functioning) and how well the family is able to organise itself against potential threats. 2. 2 Describing the concept of family Clark (2008:318) states: â€Å"A family is a compo sed of two or more persons who are joined by bonds of sharing and emotional closeness and who identify themselves as being part of the family. Unlike those of other social systems, family relationships are characterized by intimacy, emotional intensity, and persistence over time. ‘ Santrock (2006:216) states: â€Å"[The family is] a social system, a constellation of subsystems defined in terms of generation, gender and role. Divisions of labour among family members define particular sub-units, and attachments define others. Each family member is a participant in several subsystems. Some are dyadic (involving two people) some polyadic (involving more than two people). † Stanhope and Lancaster (2006:322) refer to the following definition: â€Å"A family refers to two or more individuals who depend on one another for emotional, physical, and/or financial support.The members of the family are self-defined. † 15 Activity Ask different members of the multi-disciplinary health team to define family. Analyse the responses for similarities and differences. 2. 3 Structure of the family Family structure is the organised pattern or hierarchy of members that determines how they interact. Components of a family structure include the role of each family member and how they complement each other, the family's value system, communication patterns and power hierarchy. The family structure influences the way that a family functions. Allender & Spradley 2005:526) The genogram shows family information graphically in order to view complex family patterns over a period of time, usually three generations or more. d. 1956 Heart Peg 71 Housewife Al 72 Grocer Sue Housewife John Steelworker d. 1982 Cancer Mark 37 Engineer Jan 36 Housewife Jim 9 Jack 46 Mechanic Mary 16 Pat 41 Waitress Married 1979 Steve 18 Clerk Earl 17 Student Detroit Fig 2. 1 Genogram Source: Allender & Spradley (2005:528) Nan 4 Married 1977 Divorced 1979 Joe 45 Teacher Sam 20 Student Lou 13 Los Ang eles Married 1983 Ann 39 Nurse Pam 11 16 ActivityDraw a genogram of your own family. 2. 4 Types of families There are many family types and a family type may change over time as it is affected by birth, work, death, divorce and the growth of family members. * * * * * * * The nuclear conjugal family. The traditional nuclear family structure consists of a husband, wife and children. Most young people move away from their parents when they marry and form nuclear families (no grandparents, aunts or uncles live in the home). The nuclear family is found in all ethnic and socio-economic groups, and is accepted by most religions.Today the number of nuclear families is declining as a result of the increase in divorce, single parenthood and remarriage, the acceptance of alternative lifestyles, and greater disparity. The extended (multi-generational) family. The extended family includes the nuclear family as well as other family members such as grandmothers, grandfathers, aunts, uncles, cousin s and grandchildren. The advantage of such a family is that it means more people may serve as resources during crises and also provides more role models for behaviour and learning values. The single parent family.Single parent families consist of an adult woman or man and a child or children. Single parent families result from divorce, out-of-wedlock pregnancies, absence or death of a spouse, or adoption by a single person. A health problem in a single parent family is almost always a serious matter, because there is no backup person for childcare when the parent is ill. The blended family. The term blended family refers to a remarriage or a reconstituted family, where a divorced or widowed person with children marries someone who also has children of his or her own.Children of blended families are exposed to different ways of living and also have increased security and resources. They may become more adaptable to new situations. However, rivalry may arise among the children for the attention of a parent or there may be competition with the step-parent for the love of the biological parent. The communal family. The communal family is made up of groups of people who have chosen to live together as an extended family group. Their relationships with each other are motivated by social values or interests rather than by kinship.Because of the number of people present, members may have few set traditional family roles. The values of commune members are often religiously or spiritually based and may be more oriented to freedom and free choice than those of a traditional family structure. The cohabitation family. The cohabiting family consists of two persons who are living together, but remain unmarried. They may be heterosexual or homosexual. Some such relationships are temporary but others are long-lasting. Reasons for cohabitation include the desire for a trial marriage, the increased safety that results from living together and financial factors.The single allianc e family. Many single young adults live together in shared apartments, dormitories or homes for companionship and financial security. Although these relationships are often temporary, they have the same characteristics as cohabitation families. 17 * * The homosexual family. The homosexual family is a form of cohabitation where a same sex couple live together and share a sexual relationship. Such a relationship offers support in times of crisis that is comparable with that offered by a traditional nuclear or cohabitation family. The foster family. Children whose parents are unable to care for them are laced in a foster home by a child protection agency. Foster parents usually receive remuneration for their care. Foster families may also include the parents' own biological or adopted children. Foster care is theoretically temporary until children can be returned to their own parents (Clark 2008:318). Prescribed reading Read Clark (2008, or later edition), types of families. 2. 5 Stage s of family development Stage 1: Beginning family During this first stage of family development, members work to accomplish three specific tasks: * * * to establish a mutually satisfying relationship to learn to relate well to their families of origin f applicable, to engage in reproductive life planning The first stage of family life is a tenuous one, as evidenced by the high rate of divorce or separation of partners at this stage. The time frame for this stage extends from marriage to the birth of the first child. Stage 2: The early child-bearing family The birth or adoption of a first child is usually an exciting yet stressful event in a family. It requires economic and social role changes. The duration of this stage is from the birth or adoption of the first child to 30 months after this date. The following developmental tasks are usually accomplished during this stage: * * * he establishment of a stable family unit the reconciliation of conflict regarding developmental tasks fa cilitating developmental tasks of family members Stage 3: The family with pre-school children A family with pre-school children is a busy family as children at this age demand a great deal of time related to growth and developmental needs and safety: accidents are a major health concern at this stage. The time frame for this stage is when the oldest child is two to five years of age. Developmental tasks during this stage include: * * * integration of second or third child socialisation of children beginning of separation from children 18Stage 4: The family with school-age children Parents of school-age children have the major responsibility of preparing their children to be able to function in a complex world. At the same time they have to maintain their own satisfying marriage relationship ? this can be a difficult time for a family. Many families need the support of tertiary services such as friends, church organisations or counselling. The time frame for the family with school-ag e children is when the oldest child is 6 to 13 years old. Developmental tasks during this stage include: * * * separation from children to a greater degree fostering education and socialisation aintenance of marriage Stage 5: The family with teenage/adolescent children The primary goal for parents with teenagers differs considerably from that of the previous developmental stages. Family ties must now be loosened to allow adolescents more freedom and prepare them for life on their own. Rapid technological advances have increased the gap between generations ? this can make stage 5 a trying time for both parents and children. Violence, accidents, homicide and suicide are the major causes of death in adolescents ? and death rates from HIV are growing. This places a still greater responsibility on the family.The time frame for this stage is when the eldest child is 13 to 20 years of age. Developmental tasks of this stage include the following: * * * maintenance of marriage development of new communication channels maintenance of standards Stage 6: The launching centre family For many parents this stage when children leave to establish their own households is the most difficult. It appears as though the family is breaking up and parental roles change from those of mother and father to guideposts. The parents may experience a loss of self-esteem as they feel themselves replaced by other people.For the first time they may start feeling old and less able to cope with responsibilities. The time frame for this stage is from the time the first child leaves home to the time the last child leaves home. The following developmental tasks should be accomplished during stage 6: * * * * * promotion of independence integration of in-law children restoring of marital relationship developing of outside interests assisting own aging parents Stage 7: The family of middle years At this stage a family returns to a two-partner nuclear family, as before childbearing.Some partners see thi s stage as the prime time of their lives with the opportunity to do things they never had time or finances for, such as travelling and hobbies. Others may experience this time as a period of gradual decline without the constant activity and stimulation of children in the home and may experience the â€Å"empty nest† syndrome. Support people may 19 also not be as plentiful as earlier in the parents' lives. The time frame for this stage is from the time the last child leaves to retirement. Developmental tasks for this stage include: * * * developing leisure activities provision of a healthy environment ustaining a satisfying relationship with children and grandchildren Stage 8: The family in retirement or older age The number of families of retirement age is increasing rapidly, with people living longer as a result of advanced technology, medical research and increasing health consciousness. Family members of this group are, however, more apt to suffer from chronic and disablin g conditions than people in the younger age groups. The time frame for this stage lasts from retirement to death. Developmental tasks include the following (Clark 2008:323): * * * maintaining satisfying living arrangements adjusting to reduced income djusting to loss of spouse Prescribed reading Study Duvall's and Carter and McGoldrick's stages of family development in Clark (2008, or later editions). 2. 6 The family as social system All families share certain characteristics. Every family is a social system with its own cultural values, specific roles, functions and structure and each family moves through recognisable developmental stages. A social system consists of a group of people who share common characteristics and who are mutually dependent. What affects one member affects the whole family, and vice versa. Families have certain features that differ from other social systems: * * * Families last longer than many other social systems. Families are inter-generational social sys tems consisting of three or sometimes four generations. Family systems include both biological and affinal relationships (relationships created by law or interest). Biological aspects of family relationships create links to a larger kin group that are not found in other social systems. A social network support map gives a detailed display of the quality and quantity of social connections. The community nurse can use this to help the family understand its support systems and to form a basis for nursing interventions. 20 Fig 2. Social network support map Source: Allender & Spradley (2005:528) 2. 7 Cultural values in the family The cultural values in a family can have a major influence on how a family views health and health care systems. Each new generation takes on the values of the previous generation, passing traditions and cultures from generation to generation. A family's cultural values and behaviours can either facilitate or impede the promotion of health and prevention of dise ase. Prescribed reading Read Clark (2008, or later editions), the chapter on the cultural context. Activity (1) Apply the four principles of cultural assessment to the family. 2) Discuss culturally competent care. h Feedback Note the following points: 21 (1) You needed to view the culture in the context in which it developed, examine the underlying premise of culturally determined behaviour and the meaning of behaviour in the cultural context. There is a need to recognise intercultural variation. (2) You needed to define cultural competence, consider the characteristics and challenges of cultural competence and the modes of culturally competent care. 2. 8 Family functions Family functions are the activities that a family performs to meet the needs of its members.These needs include basic needs such as food, clothes, housing, emotional support and guidance. All families ? regardless of the type of family ? have in common these basic needs that require a family to function in certain ways to ensure family survival. As the social system changes, the family system has to adapt if it is to meet individual needs and equip its members to participate in the social system. The family is a hierarchical system which is usually built on kinship, power, status and privileged relationships that may be related to age, gender, personality and health. All family functions can be reduced to two basic ones: * *