Child Behavioural Problem Programmes Analysis

Child Behavioural Problem Programmes Analysis Antisocial behaviour Aggression and fighting are part of normal child development and can help children to assert and defend themselves. Persistent, poorly controlled antisocial behaviour, however, is socially handicapping and often leads to poor adjustment in adults (Scott 1998). It occurs in 5% of children (Meltzer et al 2000), and its prevalence is rising (Rutter et al 1998). The children live with high levels of criticism and hostility from their parents and are often rejected by their peers.3 Truancy is common, most leave school with no qualifications, and over a third become recurrent juvenile offenders (Farrington 1995). In adulthood, offending usually continues, relationships are limited and unsatisfactory, and the employment pattern is poor. Thelon term public cost from childhood for individuals with this behaviour is up to ten times higher than for controls and involves many agencies (Scott et al 2001b) Antisocial behaviour accounts for 30-40% of referrals to child mental health services (Audit Commission 1999). Most referrals meet general clinical diagnostic guidelines for conduct disorder from ICD-10(international classification of diseases, 10th revision), which require at least one type of antisocial behaviour to be marked and persistent. Rather fewer meet the diagnostic criteria for research, which for the oppositional defiant type of conduct disorder seen in younger children require at least four specific behaviours to be present (World Health Organisation 1993). The early onset pattern typically beginning at the age of 2 or 3 years is associated with comorbid psychopathology such as hyperactivity and emotional problems(Taylor et al 1996, language disorders, neuropsychological deficits such as poor attention and lower IQ, high heritability (Solberg et al1996), and lifelong antisocial behaviours (Moffitt 1993). As a result of its prevalence and significant consequences, the management of these childhood behavioural problems has received an increasing level of attention, research and theory over recent years. Two of the more prominent interventions for the behavioural management of children are health visitors and Group Parenting Programmes. Each of these approaches will now be outlined and will be the focus of the systematic literature review to be discussed. 1.1 Health Visitors and behaviour management The health visitors first task is to identify health care needs. Together with general practitioners, they provide the child health surveillance programme of immunisations, screening, and advice. They aim to identify those important conditions that parents might overlook and, for the rest, to help parents access professional expertise, voluntary agencies, and local facilities (NHS Executive 1996). Health visitors make key contributions regarding immunisation, breast-feeding, good nutrition and depression. This role can extend to help make appropriate interventions regarding the management of child behavioural problems through home visits. Health visitors can help to identify problem situations and refer the parent/child to the right agency. Furthermore, they can advise the parent and help to equip them with the skills needed to effectively manage and reduce the behavioural problems. If the health visitor can meet the parent when the child is under 10 days old, or even at the ante-natal stage, then a trusting and effective relationship can be formed (Beecham 1997) which can have positive effects. It has been suggested that this is of particular relevance to subgroups such as single parents. They have been shown tube less likely to attend health care environments for immunisations and their children appear to have more accidents around the home (Flemmingand Charlton 1998). These are clearly key issues within community service provision (Hall 1996). The health visitors can provide much needed support, particularly with the more vulnerable groups. This social support can have significant benefits during pregnancy/labour(Match and Sims 1992), after birth (Kumar et al 1993) and in reducing the probability that the mother will experience post-natal depression(Ray and Hornet 2000). The health visitor can therefore have a range of benefits for the parent and the child and the extent to which these benefits extend to the child’s behavioural problems merits consideration. 1.2 Group Parental Programmes Harsh, inconsistent parenting is strongly associated with antisocial behaviour in children (Rutter et al 1998), but whether this is a cause or consequence or is due to a common genetic predisposition has been less clear (Farrington 1995). The pioneering work of Patterson and colleagues showed that parents had a causal role in maintaining antisocial behaviour by giving it attention and in extinguishing desirable behaviour by ignoring it (Patterson 1982). Such findings have facilitated the development of group parenting programmes which aim to reduce children’s anti-social behaviour by working with parents. These programmes include the Webster-Stratton programme (Webster-Stratton and Hancock 1998) and the Solihull approach. They generally involve group sessions with parents of children who have behavioural problems. Sessions take place over a few months and involve the discussion of topics such as play, praise, limit setting, rewards and the handling of misbehaviour. The children do not attend the sessions. Video tapes aroused to provide examples of good and bad parenting behaviour and encourage the parents to talk about their experiences. This approach provides an alternative way of managing child behavioural problems rather than the need for health visitors to attend the parents’ homes. 1.3 Evaluating Health Interventions Before selecting any health-related intervention it is vital that theyare assessed on a number of grounds through empirical research which investigates their effectiveness and efficacy. Within the NHS, cost restraints pose a significant issue and hence any intervention needs to provide value for money relative to other potential options (Royal College of Paediatric and Child Health 1997). The Audit Commission(1997) reported that the annual maternity costs in England and Wales are  £1.1 billion. Hence, any savings, or more cost-effective approaches, could have significant impacts on the financial performance of the NHS. Both group parenting programmes and health visiting have been evaluated within empirical research. Most of this research has taken place within America (Deal 1994). The following review will consider this research in order to evaluate the use of group parenting programmes and home visits by health visitors with regards to their effectiveness and efficacy for managing child behavioural problems. The methodology employed within this research will now be outlined before ten relevant research studies are discussed and critically analysed. These findings will then be related to the research discussed in this introduction to the review before overall conclusions are drawn regarding the research question. 1.4 Method and search history A systematic review aims to integrate existing information from comprehensive range of sources, utilising a scientific replicable approach, which gives a balanced view, hence minimising bias (Clarke Oman 2001). In other words, a scientific approach will help to ensure that research evidence is either included or excluded based upon well-defined and standardised criteria. This should ensure that the possible effects of researcher bias should be kept to a minimum. Berkley and Glenn (1999) also states that systematic reviews provide a means of integrating valid information from the research literature to provide a basis for rational decision making concerning the provision of healthcare. Literature reviews are important as they can help to consolidate the knowledge which is available on a given topic. The main themes and findings can be highlighted and this information can inform the design, implementation and evaluation of future research. In this instance, the research evidence can be used to make recommendations and decisions regarding the use of health visitors and Group Parenting Programmes for behaviour management in children. 1.5 Reviewing process Whenever one reviews or compares research reports, it is important that clear set of criteria are established upon which the evaluations can be made. Table 1 below outlines the global process which was used to conduct the literature review. This process was based upon that employed by Berkley et al (1999) It is important that such a framework is identified and used to structure a literature review so that all of the relevant stages are addressed and that limitations which could be associated with the methodology employed can be reduced where ever possible. Table 1: Systematic Review (Summary of Framework)(Adapted from Berkley and Glenn 1999) Identify the need Rationale, background information, existing work Formulate problem and specify objectives Background, problem specification, objectives Develop review protocol Design, resources, refinement Literature search and study retrieval Sources, search strategy, documenting a search strategy Assessing studies for inclusion Defined criteria, minimising reviewer bias, tables of studies included and excluded Assessing and grading studies Appraising checklists, hierarchies of evidence Extracting Data Data collection forms, extraction methodology Synthesizing data Qualitative overview, quantitative synthesis Interpreting results Strength of evidence implications of results Disseminating and implementing results Methods of dissemination and implementation In terms of the process used to review the selected research, the guidelines used by McInnis et al (2004) were adopted. These are displayed in Table 2 below: Table 2: Core Principles Used in Reviewing Selected Research Articles (adapted from McInnis et al 2004) Systematic reviews Adequate search strategy Inclusion criteria appropriate Quality assessment of included studies undertaken Characteristics and results of included studies appropriately summarized Methods for pooling data Sources of heterogeneity explored Randomised controlled trials Study blinded, if possible Method used to generate randomisation schedule adequate Allocation to treatment groups concealed All randomised participants included in the analysis (intention to treat) Withdrawal/dropout reasons given for each group Cohort All eligible subjects (free of disease/outcome of interested) selected or random sample 80% agreed to participate Subjects free of outcomes on interest at study inception If groups used: comparable at baseline Potential confounders controlled for Measurement of outcomes unbiased (blinded to group) Follow-up sufficient duration Follow-up complete and exclusions accounted for ( 80% included in final analysis) Case control Eligible subjects diagnosed as cases over a defined period of time or defined catchment area or a random sample of such cases Case and control definitions adequate and validated Controls selected from same population as cases Controls representative (individually matched) 80% agreed to participate Exposure status ascertained objectively Potential confounders controlled for Measurement of exposure unbiased (blinded to group) Groups comparable with respect to potential confounders Outcome status ascertained objectively 80% selected subjects included in analysis Cross-sectional/survey Selected subjects are representative (all eligible or a random sample) 80% Subjects agreed to participate Exposure/outcome status ascertained standardized way Qualitative Authors position clearly stated Criteria for selecting sample clearly described Methods of data collection adequately described Analysis method used rigorous (i.e., conceptualised in terms of themes/typologies rather than loose collection of descriptive material) Respondent validation (feedback of data/researchers interpretation to participants) Claims made for generalizability of data Interpretations supported by data The results of this analysis will be presented via the CAST tool. Thesis available in two formats. The first concerns the evaluation of qualitative research studies and the second provides a framework forth evaluation of studies which have used a randomised and controlled approach within their methodology. The use of such a framework can provide structure within the results section and ensure that the data is presented in a way which is easily read and understood by the reader. 1.6 Sources of data The methodology employed within the research will involve obtaining data from three key sources: Computerised searches, Manual searches, and the Internet. Each of these data sources will now be considered in more detail. 1.6.1 Computer-based searches The methods used in this research will include a detailed computerised literature search. Multiple databases, both online and CD–Rom will be accessed to retrieve literature because they cite the majority of relevant texts. (Ford and Miller 1999) The computerised bibliographic databases are:- †¢ MEDLINE †¢ EMBASE †¢ CINAHL †¢ PSYCHINFO †¢ British Nursing Info BNI †¢ Cochrane †¢ Science Direct (All Sciences Electronic Journals) †¢ Asia †¢ DETOC †¢ HMIC However because articles may not be correctly indexed within the computerised databases, other strategies will be applied in order to achieve comprehensive search (Sindh Dickson 1997). 1.6.2 Manual searches A manual search will be performed to ensure that all relevant literature is accessed. The manual searches will include:- †¢ Books relevant to the topics from university libraries and web sites †¢ Inverse searching- by locating index terms of relevant journal articles and texts †¢ Systematically searching reference lists and bibliographies of relevant journal articles and texts 1.6.3 The Internet The internet will provide a global perspective of the research topic and a searchable database of Internet files collected by a computer. Sites accessed will include:- †¢ Department of Health †¢ National Institute of Clinical Excellence †¢ Google †¢ The British Medical Journal website (www.bmj.com) 1.7 Identification of key words Databases use a controlled vocabulary of key words, in each citation. To assist direct retrieval of citations techniques Boolean logic will be applied using subject indexing, field searching and truncation to narrow the topic focus (Hicks 1996, Goodman 1993). As part of this approach, key words will be based on the components of the review question. An imaginative and resourceful technique of searching electronic databases will be used including recognising the inherent faults in the indexing of articles. Misclassification and misspelling will be included in the searches with searches utilising keywords and the subheadings, (Hicks 1996). Based on these principles, the following search terms will be used in different combinations: †¢ Behaviour Management †¢ Children †¢ Anti-Social Behaviour †¢ Health Visitors †¢ Group Parenting Programmes †¢ Webster-Stratton †¢ Solihull †¢ Evaluation Further search terms may be used within the methodology if they are identified within some of the initial search items. Whenever one is searching literature ‘sensitivity’ and ‘’specificity’ are important issues when conducting searches of research on a database. The searches need to be as ‘sensitive’ as is possible to ensure that as many of the relevant articles are located. This may be a particularly salient issue with regards to the evaluation of behavioural management techniques for children as the number of appropriate entries may be limited. Thus an attempt to locate as many of these articles as possible becomes a more relevant and important objective. Furthermore, the search needs to be ‘specific’. In other words, it needs to be efficient where appropriates that a higher number of the articles identified through a database search can be included and hence the time allocated to reviewing articles which are ultimately of no relevance, can be kept at inacceptable level. 1.8 Inclusion/Exclusion criteria In order that a manageable quantity of pertinent literature is included in this study, it is essential that inclusion and exclusion criteria are applied. In order that a diverse perspective of the topic is examined broad criteria will be used. (Benignant 1997). However, it is important to note that a balance needs to be achieved through which the scope of the inclusion criteria is sufficiently wide to include relevant articles whilst also being sufficiently specific such that the retrieval of an unmanageable set of articles is avoided. 1.8.1 Inclusion criteria: The articles which are highlighted within the proposed searches will be assessed in terms of whether or not they meet the following criteria. Each article will need to be viewed as appropriate with regards to all of these constraints if they are to be included in the final analysis. †¢ A literature review encompassing all methodologies will be applied ( Pettigrew 2003) †¢ International studies will be included †¢ Available in English †¢ Relate to the evaluation of Health Visitors and/or Group Parenting Programmes †¢ Focus on the behaviour of young children 1.8.2 Exclusion criteria The articles highlighted by the searches will also be assessed in terms of whether or not they fulfil the following exclusion criteria. If a potential relevant article meets one or more of these criteria then they will be immediately excluded from the data set and will not be included within the analysis stage of the methodology. †¢ It is not the purpose of this review to discuss the development of behavioural management interventions so studies focusing on this will be excluded †¢ Literature in a foreign language will be excluded because of the cost and difficulties in obtaining translation. †¢ Research reported prior to 1990 will not be included within this review. 1.9 Consideration of ethical issues Any research involving NHS patients/service users, carers, NHS data, organs or tissues, NHS staff, or premises requires the approval of ankhs research ethics committee (REC).(DH 2001) A literature review involves commenting on the work of others, work that is primarily published or in the public domain. This research methodology does not require access to confidential case records, staff, patients or clients so permission from an ethics committee is not required to carry out there view. However, it is essential to ensure that all direct quotes are correctly referenced. Permission must be sought from the correspondent before any personal communication may be used. All copyrights need tube acknowledged and referenced. The researcher will also act professionally when completing this report and ensure that research is identified, reviewed and reported accurately and on a scientific basis. The analyses of the ten selected articles will now be summarised. 2.0 Results and CAST tool Based on the inclusion and exclusion criteria for this literature review, a set of ten research studies were selected. They will now be analysed using the CAST Tool. Article 1: Morrell and Walters (2000) TITLE Costs and effectiveness of community post-natal support workers: Randomised controlled trial AUTHORS Morrell CJ and Walters PS SOURCE British Medical Journal, 2000: 321, 593-598 QUESTION 1: FOCUS This research was sufficiently focussed on assessing the cost effectiveness of a series of home visits by a health visitor. It aimed to determine the cost of this intervention compared to that which would be normally incurred through the maternity process. It also aimed to investigate the health benefits of these individual home visits for the mothers and children involved. QUESTION 2: APPROPRIATENESS A randomised controlled trial was employed within the methodology of this research as it provided a group with which the results of the women in the intervention group could be compared. Therefore the progress of women who had recently given birth could be monitored and analysed to see if there were any significant differences as a result of the attendance of a Community post-natal suppor t worker. QUESTION 3: ALLOCATION A total of 623 women who had recently given birth were recruited for the study at a university teaching hospital. They were randomly allocated to either the intervention group (N = 311)or the control group (N = 312). The only requirement for inclusion in the study was that the participants were giving birth. Participants were not matched for factors such as their age, marital status or whether or not it was their first child. It was presumed that such individual differences would be controlled for by the random allocation of the participants within the relatively large sample. Subsequent analysis of the characteristics of those in the sample revealed that there was no significant differences in terms of age between the intervention and the control group. Neither did they differ on a set of88 socio-economic details. QUESTION 4: BLINDED The intervention participants were not blind to the fact that they were receiving help from a support worker. No de tailed information is given of the control group and of what their perception and knowledge of the research was. Inevitably the support workers themselves knew that they were in the intervention group. The potential, however, for observational bias was relatively small as the dependent variables were provided by the participant. As they had nuclear interest in demonstrating that the intervention had made appositive effect when it actually had not, this should have helped to ensure that the data given were accurate accounts of what had actually happened. . QUESTION 5: ACCOUNTED FOR Of the 623 participants who were recruited for the original study, a total of 551 participants completed the whole study through to the follow up stage. The cases of drop out were due tithe participants not wanting to complete the course of home visits or because they did not return the questionnaires at the follow up stage. QUESTION 6: FOLLOW-UP A range of questionnaires were completed by the participan ts at the six week and six month follow up stages. It would have been interesting to combine this approach with a more qualitative method, such as a focus group, such that a more in-depth data set could be gained to supplement the quantitative data. QUESTION 7: CHANCE The study employed a relatively large sample of 551 participants. QUESTION 8: FINDINGS Therefore were no significant health benefits associated with the intervention at the six week or six month follow up periods. The cost of the intervention to the NHS was  £815 for the intervention group and  £639 for the control group. There were no differences between the groups in terms of their use of the social services and in personal costs. QUESTION 9: PRECISE The study provides p values which indicates that there are no significant benefits associated with this intervention despite it being significantly more expensive. QUESTION 10: OUTCOMES As a result of the relatively large sample it would appear that these results co uld be generalised to other simple hospital situations in the UK. Based on the statistics provided, one would not recommend this intervention in terms of the health benefits. Having said this, it was a popular intervention with the women who received it and this may have value in itself. Article 2: Scott et al (2001a) TITLE Multi-centre controlled trial of parenting groups for childhood anti-social behaviour in clinical practice. AUTHORS Scott S, Spender Q, Dolan M, Jacobs B and Ashland H SOURCE British Medical Journal, 2001, 323, 194 QUESTION 1: FOCUS This research was sufficiently focused on the evaluation of a specific programme for a specific age group and set of behaviours. QUESTION 2: APPROPRIATENESS A sample of 141 3-8 year olds were allocated to either receive the intervention or to go on a waiting list(control group). Allocation was based on the date of referral This was an appropriate approach for this research study as it enabled the effects of the intervention programme to be evaluated. QUESTION 3: ALLOCATION The controlled trial approach was used as the allocation procedure should help to ensure that the children in the intervention and control groups exhibited equivalent anti-social behaviour and hence individual differences could be controlled for. QUESTION 4: BLINDED The particip ants were blind to the allocation stage of the methodology. The participants were aware that they were taking part in an evaluation study. The people who rated video tapes on the parent participants and their children was blind to whether the participant had been in the intervention group or in the control group. Therefore the ratters were blind to treatment and condition. QUESTION 5: ACCOUNTED FOR A total of 31 participants dropped out of the study as they did not attend a sufficient number of the intervention sessions. QUESTION 6: FOLLOW-UP Participants were followed up five to seven months after the base line stage. Six measures of child behaviour were taken as well as one measure of parenting behaviour. This is inacceptable follow up period for this form of study. A long term follow-up, however, would have helped to establish the permanence of any significant changes which result from the intervention. QUESTION 7: CHANCE A power calculation was reported in this study and the s ample size exceeds that which is recommended. Thus it could be argued that sufficient steps have been taken to minimise the possible influence of chance. QUESTION 8: FINDINGS The referred children who took part in the study were highly anti-social. A significant reduction was observed in taint-social behaviour of those within the intervention group. The behaviour of those within the control group was found to remain constant. The praise given by parents was found to increase three fold by those in the intervention group and to decrease by a third for those in the control group. QUESTION 9: PRECISE Confidence levels are provided within the statistical section of the study. Based on these it could be concluded that the parental group behavioural programme does have a significant impact on serious anti-social behaviour among children. QUESTION 10: OUTCOMES The large sample and sound methodology employed within this research would lead one to conclude that these results could be gene ralised to children of similar ages and with similar levels of anti-social behaviour. Article 3: Harrington et al (2000) TITLE Randomised comparison of the effectiveness and costs of community and hospital based mental health services for children with behavioural disorders. AUTHORS Harrington R, Peters S, Green J, Byford S, Woods J and McGowan R. SOURCE British Medical Journal, 2000, 321, 1047-1050 QUESTION 1: FOCUS The research focused on the evaluation of a community based versus a hospital based delivery of mental health services for children with behavioural disorders. The question set was relatively broad including both the costs and effectiveness of the approaches but it was sufficiently focused on specific programmes. QUESTION 2: APPROPRIATENESS The parent/child participant pairing were randomly allocated to receive the behavioural programme either at community location or at the hospital. This allocation was performed bay researcher who was independent of the study. The allocation was performed using stratified sampling between the two different health authorities involved in the research. Q UESTION 3: ALLOCATION This randomisation was performed such that no bias within the allocation procedure could have an influence on the results. The potential of parental expectations as a confounding variable was also acknowledged and assessed. No significant difference was found between the two groups on this variable. QUESTION 4: BLINDED At the observational stage of the research theatre was blind to the treatment group of the participants. This was demonstrated when they tried to identify the location which different participants had received the intervention. Their performance on this task was no better than chance. QUESTION 5: ACCOUNTED FOR A full set of data was available for 115 out of the 141 participants who took part in the research. The drop outs occurred through non-attendance to the programme sessions or no data being provided at the follow up stage. QUESTION 6: FOLLOW-UP The participants were followed up one year after the base line stage. QUESTION 7: CHANCE The sa mple size was selected based on the size of the effect which was required by the purchaser and the provider’s agreements regarding whether the programme would be accepted for wider implementation. QUESTION 8: FINDINGS It was reported that there were no significant differences between the intervention groups in terms of the parents’/teachers reports of the child’s behaviours, the parents ‘criticisms of the child and the impact of the child’s behaviour on the family. Parental depression was identified as a significant problem and variable which predicted the outcome of the child’s behaviour assessments. QUESTION 9: PRECISE The ultimate finding of this research was fairly specific in suggesting that the location in which a parental behavioural management programme was delivered did not have significant impact on the child’s behaviour. It appears more important that a range of services are made available, including those which address par ental depression. QUESTION 10: OUTCOMES The large sample and the use of two different health care authorities would lead one to conclude that these findings could be generalised to other areas of the UK. Article 4: Buts et al (2001) TITLE Effectiveness of home intervention for perceived child behavioural problems and parental stress in children with utero drug exposure AUTHORS Buts AM, Pulpier M, Marino N, Belcher M, Leers M and Royall R. SOURCE Archives of Paediatric and Adolescent Medicine, 2001, 155, 1029-1037 QUESTION 1: FOCUS This research project was specifically focused on evaluating a home intervention programme which aimed to educate and provide support for parents of children with perceived behavioural problems. QUESTION 2: APPROPRIATENESS Participants were mothers who had recently given birth at one of two urban based hospitals in Baltimore, USA. They were randomly allocated to either receive the home visits or to be given the standard care package which would usually be given. QUESTION 3: ALLOCATION Random allocation was used to overcome any potential bias which could have been present if the researchers had allocated the participants. This enabled an assessment of the relative benefits of the home intervention to be determined over and above that which would be associated with standard care. QUESTION 4: BLINDED The data obtained within the study was via questionnaires completed by the parental participants. They were blind at the allocation stage of the study but clearly they knew that they had been either exposed or not exposed to the home visit intervention. The child behaviour ratings were given by an independent observer. QUESTION 5: ACCOUNTED FOR A total of 100 participants took part in the study. A sample of 51 participants comprised the standard care control group with 49 being in the intervention group. The details of the dropout rates were not clear. QUESTION 6: FOLL

Comparison between Because I Could Not Stop For Death and Come Up From the Fields Father :: Emily Dickinson Walt Whitman Poetry Essays

Comparison between Because I Could Not Stop For Death and Come Up From the Fields Father Emily Dickinson and Walt Whitman were two of the best poets in America, during the nineteenth century. They were both rebellious each in his own way. The shared some features, especially their abandonment of the usual form of poetry and their use of free verse instead. In comparing the poems â€Å"Because I Could Not Stop For Death† by Dickinson and â€Å"Come Up From the Fields Father† by Whitman, we can notice some similarities. Both poems have some kind of music though there is no rhyme scheme, due to the use of free verse. They both use repetition of some words. Dickinson repeated the words â€Å"we passed†. While Whitman repeated several words such as â€Å"waking†, â€Å"longing†, â€Å"withdraw† and â€Å"better†. They both used descriptive language. Dickinson described the â€Å"Dews† that â€Å"drew quivering and chill†, her â€Å"gown† which was made of â€Å"Gossamer†, her â€Å"Tippet† which was â€Å"only Tulle†. She also gave us a description of the house of death, which was â€Å"A swelling of the ground, The roof was scarcely visible, The Cornice in the ground†. Yet Whitman used more descriptions in his poem. He described the fields of Ohio’s villages in autumn and their beauty. He described the â€Å"apples ripe†, the â€Å"grapes on the trellis’d vines†, â€Å"the sky so calm, so transparent after the rain†. He made us feel as if we were smelling the grapes, the buckwheat and touching them. He made us hear the buzzing of the bees. He also made us experience the awe and misery of the mother by describing her â€Å"trembling steps† when she went to read the letter, her â€Å"sickly white face and dull in the head†. In addition to her state after her son’s death, she was â€Å"presently drest in black†, â€Å"her meals untouched†, â€Å"fitfully sleeping often waking† and her â€Å"deep longing†¦to be with her dead son†. Dickinson uses imaginative and somehow figurative language. She personifies death as a gentleman who kindly takes her for a journey in his carriage. She also personifies immortality as a person riding with them in the carriage. She uses paradox â€Å"The Cornice in the ground†. Whereas Whitman’s language is poetic and realistic. Both poems discuss the view of death, but from different perspectives. Dickinson gives us a joyous and happy view of death, which is like a kind gentleman that takes her for a journey. He is so civil, therefore she willingly gives him her â€Å"labor† and â€Å"leisure too†. She is not afraid of death, she instead receives it calmly. Whereas Whitman’s view is the contrary. For him death is a horrible

Ethics

Ethics 101 1. 1 background and development of theoretical ethical approaches Deontological Theory The deontological theory state that the consequences or outcomes of actions are not important, what actually matter is that the actions are morally Justified. For example drunken driving is wrong, now if a person argues that he safely navigated his way back home and for that reason he/she should not be held accountable by law, they are wrong because their action was wrong in the first place and was breaking the basic principle for morally correct behaviour that a person should not drive while being drunk.The contribution of Immanuel Kant towards development of Deontological theory Immanuel Kant proposes that in taking a decision â€Å"Duty' carries the foremost importance. Kant is of the view that a person's actions will only be regarded as morally and ethically correct when they are taken keeping in mind the sense of duty and responsibility in mind. Teleological Ethical Theory The tele ological ethical theory put the primary focus on the â€Å"Consequences† i. e. â€Å"What are those actions that produce the best possible results†?Along with attaching importance to the consequences the teleological theory also suggests that the ecisions framework that is developed for achieving the desired consequences should also be managed with care. Consequentialist Theory According to the â€Å"Consequentiality Theory', the basis for determining how moral a person's actions are the consequences. The consequences of actions can be good or bad, and they can be damaging or favourable. The contribution of Jeremy Bentham towards development of a person's actions can be a classified as good or bad depending on what consequences the action has produced.According to Bentham's opinion the good things are classified as â€Å"pleasure† and the bad ones as pain†. (http://www. studymode. com/) 1. 2 Absolute ethics has only two sides: Something is good or bad, bl ack or white. Some examples in police ethics would be unethical behaviours such as bribery, extortion, excessive force, and perjury, which nearly everyone would agree are unacceptable behaviours by the police. Relative ethics is more complicated and can nave a multitude ot sides witn varying shades ot gray . What is considered ethical behaviour by one person may be deemed highly unethical by someone else.The Absolutist theory is the theory that certain things are right or wrong from an bjective point of view and cannot change according to culture. Certain actions are intrinsically right or wrong, which means they are right or wrong in themselves. This is also known as deontological. The relativist theory is the theory that there are no universally valid moral principles. All principles and values are relative toa particular culture or age. Ethical relativism means that there is no such thing as good â€Å"in itself†, but if and action seems good to you and bad to me, that is it, and there is no objective basis for us to discover the truth.This theory is also known as teleological. An example of an absolutist ethical system would be if a single mother with a very young child had no money and therefore no food to feed the child, and she stole some food from the shop and the mother was caught and had a trial, an absolutist would argue that its morally wrong to steal and should suffer the consequences of the crime. They don't take into account the situation the person might be in and use an absolute law. However, this is in contrast to the alternative ethical system, called â€Å"relativist†, because this system is really the complete opposite.Again I'll use the same example s I did for absolutist. If a relativist was looking at this they would take into consideration the situation the woman might be in and empathize with her and try to find an outcome that is the most fair. One reason to support the absolutist approach as the only defensible approac h is that it provides Justification for acting which means that morality seems to demand some sort of obligation. If there's a fixed moral code then there is no obligation to act in a way. Another strength is that it gives clear guidelines, which basically means the rules are fixed and clear to apply. () 1. 3 Ethics refers to a prescribed or accepted code of conduct. Ethical issues are a set of moral values that need to be addressed while carrying out business. Businesses operate in a society that is structured around moral values. Therefore, when conducting its operations, a business has certain responsibilities which are to provide the society with quality goods and services that will improve the people's living standards. In order to survive, a business needs to maintain its customers. Product packaging is one way of ensuring a business maintains its existing customers and also acquire ew customers.Some companies are known to allow underweight packaging of products which are then highly priced and this is a rude way of increasing profits. However this negative trend will affect the business in the long run as customers will eventually come to learn that they are being swindled. In an attempt to boost sales, some businessmen adapt promotional method mislead customers as the message conveyed may not give the exact details of the product. Businesses should desist from increasing prices without valid reasons. In doing so, they will be taking advantage of the customer and this is unethical.Businessmen should also desist from taking part in corrupt practices such as selling low standard goods while bribing government officials in order to continue operating. Entrepreneurs should consider the effects of their activities on the society they serve. In the long run, wrong dealings and corruption will tarnish the image of the business and have a negative effect on sales. Business people ought to comply with the law requirements and observe laid down principles of mora lity in their dealings. They should seriously consider expectations of the community they serve. (    Ethics Table of Contents Therapeutic Patient Relationships Overview Since the sass, ethics has been incorporated into virtually every aspect of the health care system. Because of such a small time window, the study of ethics in a medical perspective continues to change and improve for the benefit of the patient. Studies of doctor-patient relationships Indicate the need of greater ethical study and intervention.Studies show that although many physicians are aware that a romantic r sexual relationship Is unethical, as many as nine percent believe that the ethics depends on the situation (Reese, 2012). Often, an abuse in the doctor-patient relationship does not occur because of a lack in educational skills. Rather, abuse in the doctor/patient is attributed to flaws, or loopholes, in the rules of ethics and law (Subplots et al, 2010). Continued research of the most recent ethical framework can begin lowering any chance of unprofessional.In order to have a successful patient relationship, a phys ician must understand and respect the barriers in place. This session will take a look at ethics. Participants will assess their own ethical principles and apply the concepts they've learned to problems in ethical communication and/or conduct in the workplace. Behavioral Objectives Intended to inform the physician on the definition of ethics Clarify the nature of the ethical responsibilities held in common by current and prospective physicians. Identifies ethical considerations relevant to physicians Recognize different situations containing unethical conduct.Gain the knowledge on how to respond to in situations that require ethical decision-making. Apply the incept of good ethical behavior in their current practice. Outline of Training Session I. Introduction:What is ethics? Ethics refers to a framework of discipline from a branch of philosophy, in which ideas of right and wrong, virtue and vice, and good and evil, are all examined systematically (salvoes & Meyer, 1990). II. Compon ents of Ethics Participants will know basic history, definition, and examples of ethics. A.Ethical Framework – before we can manage ethical dilemmas in the health care setting, we must understand examples of ethical principle, as well as our own, to avoid any conflict of interest. . Self-Assessment Culture Values Beliefs Ideas 2. Continuous Regulation Self-control Trustworthiness Professionalism Education Intervention B. Understand the Significance of Ethics 1. Factors That Improve Ethical Conduct a. Public view c. School curriculum d. Government regulations 2. Factors That Require Ethical Behavior a. Provide company guideline for ethical behavior b.Teach the company's guidelines importance c. Describe punishments for unethical conduct C. Review Examples of Unethical/Ethical Conduct IV. Class Activity – Ethics Assessment V. Effectively practice effective ethical communication A. Understand the needs of the recipient D. Ensuring the message considers the common good E. Continue to interpret for conflicts of interest F. Consider the consequences of each message 1. Is this message mutually valuable? 2. Is this message violating confidentiality of another person? Is this message questionable to your professionalism? . VI. Class Discussion VII Summary of Training Session VIII Conclusion Literature Review: Where the Patient Relationship Ends Dry A, a 49 year-old gynecologist, was treating a 36 year-old female patient, Ms B, for chronic vaginal yeast infections. He described her as being seductive during the husband. Dry A found himself feeling very sympathetic towards her and began scheduling longer patient appointments so he could provide some therapy for her as well as assessing and treating the vaginal complaints for which she ostensibly saw him.He would hold her hand while she talked about her difficult situation at home. This decent down the ‘slippery slope' progressed into hugging, and then kissing at the end of the session. He recognized t hat he was feeling lonely and not having regular sexual relations with his wife. Dry A even noted that his wife was inorganic as though her condition was in some way an excuse to progress to a sexual relation with the patient) (Gabbed & Hobby, 2012). The first time that Dry A and Ms B had sexual relations was after hours in his office.This sexual encounter consisted of mutual oral sex. The meetings were set up during appointments in the office, usually at the end of the day. He finally ended these contacts when he felt the encounters were no longer gratifying to him. In addition, he was worried about being caught and that others would not understand his reasons for departing from the usual procedures (Gabbed & Hobby, 2012). Following the filing of a complaint by the patient, Dry A was sent for evaluation.When asked directly he thought he had harmed the patient, Dry A responded that he felt he had actually helped her by his sexual involvement with her (Gabbed & Hobby, 2012). Introduc tion This physician, Dry A, failed to recognize the unethical conduct he was committing in the obvious power differential with the patient, Ms B. Dry A failed to recognize that a patient is paying for his expertise for the treatment of a disease or ailment, and not a relationship of conscious feelings.If Dry A had greater understanding regarding the ethical principle of the doctor/patient relationship, Dry A may have been able to make a more rational decision so this situation never occurred; likewise, if Ms B had more understanding of the ethical principle prior to her first appointment, Ms B may have had the knowledge to evade Dry Ass advances. In summary, the doctor and the patient should be educated on ethical conduct before the doctor-patient relationship is formed to avoid situations, like the example.Studies show that although many physicians are aware that a romantic or sexual relationship is unethical, as many as nine percent believe that the ethics depends on he situation (Reese, 2012). The American Medical Association (AMA) states that prior doctor/patient relationships can influence the patient's treatment and that such a relationship is unethical if the doctor â€Å"uses or exploits trust, knowledge, emotions or influence derived from the previous professional relationship† (American Code of Medical Ethics, 2012).The Mama's use of â€Å"prior relationship† leaves wiggle room for the â€Å"it's complicated† answer, which over one third of the physicians had answered to the question, â€Å"Is it acceptable to become involved romantic or sexual relationship with a patient? In Medicare's 2012 ethics survey (Reese, 2012). Could it be that the and Ms B are aware of the rules but chose in proceeding to break the barriers of the doctor/patient relationship because â€Å"it's complicated? † The â€Å"it's complicated† answer may originate from feelings from the physician to do anything possible to treat the patient.One s tudy on therapists, explains that the therapists would get sexually involved relationships with suicidal borderline patients in order to save the patient from suicide (Gabbed & Hobby, 2012). This ration is flawed, however, because the physician, like Dry A, should have continued to worked to attain the nature of the intended relationship as clearly therapeutic with any potential unexpected circumstances, which is the idea behind the entire therapeutic process (Crower, Belly & Subplots, 2010).A professional needs to self-regulate their internal drives and thoughts in the absence of clear standards or unexpected circumstances, such as that of a suicidal patient whom is not responding to evidence- based treatment (Crower, Belly & Subplots, 2010). This is critical because usually a patient will give up his or her own autonomy to respect the decision of a paternalistic physician (Shari, Samara, Arachnids, 2013).Not to say this approach to a doctor/ patient is unethical, but it can leave room for unethical conduct if the physician cannot control his or her internal drives or thoughts. Patients, like Miss B, need doctors that are competent in all areas of their profession. The study of ethics in undergraduate courses and medical school curriculum is still improving; consequently, it should continuously be assessed in terms of content, educational methods, and change in behavior, and be revised accordingly (Shari, Samara, Arachnids, 2013).Within only the past 20 years or so, medical schools have gun incorporating ethics as its own respective subject (Houghton, Sparks & Chadwick, 2010). The introduction of ethics in to medical undergraduate curriculum has met resistance, however, because it is evolving constantly and some believe ethical topics are redundant or impossible to be taught (Houghton, Sparks & Chadwick, 2010).Once a few generations of physicians are educated, they can begin teaching newer generations from first hand experience to ensure they are fully compet ent, rather than trainers teaching the instructors (Shari, Samara, Arachnids, 2013). Ethics, according to James S. Recourse (2003), â€Å"refers to a field of inquiry, or discipline, in which matters of right and wrong, good and evil, virtue and vice, are systemically examined (p. 49).Professional ethics is described by Craven & Hiring (2009) as involving â€Å"principles and values universal application and standards of conduct to be upheld in all situations (p. 76). The traditional principles that provided the moral grounding for the protection on human subjects in the United States began forming in the sass (Faded, Sass, ethical concern has been to protect patients from injury, risk, abuse, and unjust orders of medical research (Faded, Sass, Goodman, Provosts, Tunis & Bà ©chamel, 2013).There has been an importance in our society of forming a Just health care system, which is guided by principles of healthcare ethics that include benefice, non- maleficent, respect for autonomy, and Justice (Craven & Hiring, 2008). Physicians, nurses, and other members of the health care team have been developing codes of ethics in order to sustain a Just health care system.Faded, Sass, Goodman, Provosts, Tunis & Bà ©chamel (2013) propose a framework that consists of seven ethical obligations, they include: ) to respect the rights and dignity of patients; 2) to respect the clinical Judgment of clinicians; 3) to provide optimal care to each patient; 4) to avoid imposing monomaniacal risks and burdens on patients; 5) to reduce health inequalities among populations; 6) to conduct responsible activities that foster learning from clinical care and clinical information; and 7) to contribute to the common purpose of improving and quality and value of clinical care and health systems (p. ). Most frameworks regarding medical ethics loosely follow these seven steps. Frameworks in ethics provide a systematic way to decide what's right from wrong in a rarity of assigned priorities th at are goal emphasized (Craven & Hiring, 2008). All members of the health care team have a framework, and they can find it resembles this model. Several issues of unethical conduct in the health care setting can arise if ethical principle is ignored.The following are a few debated matters of medical ethical principle that occurs in the health care setting: physician-assisted suicide (Glover, 2010), clinical trials (Barton & Ugly, 2009), bribes/gifts from patients (Sash & Fug- Barman, 2013), patient abuse, sexual comments/actions toward patient (Crower, Belly & Subplots, 2010), confidentiality (Craven & Hiring), and financial interests (Reed, Mueller, & Brenna, 2013). While some subjects such as euthanasia (physician- assisted suicide) may have different labels of good or bad from different people, other subjects such as sexual patient abuse is generally discovered by most of society.While ethical principle of that society on certain principles might change at the about the same rate medical technology changes, it is still important for any health care worker to keep these principles in mind. Since the implementation of medical ethics is relatively new, changes are rapidly occurring in medical education curriculum as well as the workforce. Evidence shows, the effects of the teaching of medical ethics causes greater ethical sensitivity in the clinical setting (Crower, Belly & Subplots, 2010). However, there are still many cases in which medical ethics education does not have an impact.As the progression of ethics continues in the health care setting, evaluation of medical ethics teaching is vital. Research by Shari, Samara, and Arachnids (2013) finds that matching education is successful, and not a waste of human or financial resources. The Institute of Medical Ethics recommends a pyramid of increasing levels of education, they include: knowledge, habituation, and action (Crower, Belly & Subplots, 2010). The idea is to have medical students think critically abou t historical precedents and future situations involving ethical dilemmas, then put into practice the best consideration.The most important thing teaching ethics gives to medical students is awareness (Crower, Belly & Subplots). With practicing physicians, it is important to continue education on professionalism because doing so shows its significance as a competency (Reed, Mueller, & Brenna, 2013). As introductory and continuing teaching methods are evaluated and improved, future medical students can become more ethically sensitive in their communication and actions. References AMA Code of Medical Ethics. Opinion 8. 14 sexual misconduct in the practice of medicine. Http://www. AMA-assn. Org/AMA/pub/physician-resources/medical-ethics/ code-medical-ethics/opinion. Page Accessed November 3, 2012. Shari, F. , Samara A. & Arachnids, A. (2013). Medical ethics course for undergraduate medical students: A needs assessment study. Journal Of Medical Ethics & History Of Medicine, 6(1) Barton, E. , & Ugly, S. 2009) Ethical or unethical persuasion? The rhetoric of offers to participate in clinical trials. Written Communication, 26(3), 295-310 Craven, R. F. & Hiring C. J. (2008). Fundamentals of nursing: Human health and function, 6th. Liposuction Williams & Wilkins Inc.Philadelphia, PA. 76-77. Crower, M. , Belly, S. , & Subplots F. (2010) Abuse of the doctor-patient relationship. London: Royal College of Psychiatrists. Faded, R. , Sass, N. , Goodman, S. , Provosts, P. , Tunis, S. , & Beach, T. (2013). An ethics framework for a learning health care system: A departure from traditional research ethics and clinical ethics. The Hastings Center Report, Spec Noses-ASS Gabbed, G. 0. , & Hobby, G. S. (2012). A psychoanalytic perspective on ethics, self- deception and the corrupt physician. British Journal Of Psychotherapy, 28(2), 235-248. Glover, P.C. (2010) Physician-assisted suicide is unethical. Greengages Press. Recourse, J. S. (2003). Communication ethics. Management Communic ation: A Case- Analysis Approach. 2nd. New Jersey: Pearson Education. Professionalism challenges and opportunities. Minnesota Medicine, 96(1 1), 44-47 Reese, S. (2012). When is it okay to date a patient? Netscape ethics report 2012. Netscape, http://www. Educate. Com/vertically/774295. Sash, S. & Fug-Barman, A (2013 Physicians under the influence: Social psychology and industry marketing strategies. Journal Of Law, Medicine & Ethics. 41 (3), 665-672.Attachment: Principles of Medical Ethics Revised and adopted by the AMA House of Delegates (June 17, 2001) l. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or impotence, or engaging in fraud or deception, to appropriate entities. Ill. A physician shall respect the law and also recognize a responsibil ity to seek changes in those requirements, which are contrary to the best interests of the patient. ‘ IV.A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard within the constraints of the law. V. A physician shall continue to study, apply, and advance scientific knowledge; maintain a commitment to medical education; make relevant information available to tenets, colleagues, and the public; obtain consultation; and use the talents of other health professionals when indicated. VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care VI'.A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. As paramount. ‘X. A physician shall support access to medical care for all peo ple. Source: Code of Medical Ethics: In-Hand Activity: Ethics Self-Assessment The American College of Healthcare Executives (ACHE) made this survey so you can identify areas of ethical practice in which you are weak or strong. For each question, identify one of the five answers that is best suited to you.The ACHE does not believe in a numbered final score, because it is not a tool for evaluating ethical behavior of others. The number that corresponds with each response simply helps you uncover any areas of concern that may require the need for enhancement in some of your current ethical practice. Almost Never Occasionally Usually 4 5 Always Not Applicable 2 I. Leadership 3 I take courageous, consistent and appropriate management actions to overcome barriers to achieving my organization's mission. I place community/patient benefit over my personal gain.I strive to be a role model for ethical behavior. I work to ensure that decisions about access to care are based primarily on medical necessity, not only on the ability to pay. My statements and actions are consistent with professional ethical standards, including the ACHE Code of Ethics. Circumstances would allow me to confuse the issues I advocate ethical decision making by the board, management team and medical staff. I use an ethical approach to conflict resolution. I initiate and encourage discussion of the ethical aspects of management/financial issues.I initiate and promote discussion of controversial issues affecting community/patient health (e. G. , domestic and community violence and decisions near the end of life). I promptly and candidly explain to internal and external stakeholders negative economic trends and encourage appropriate action. I use my authority solely to fulfill my responsibilities and not for self-interest or to further the interests of family, friends or associates. When an ethical conflict confronts my organization r me, I am successful in finding an effective resolution process and ensure it is followed.I demonstrate respect for my colleagues, superiors and staff. I demonstrate my organization's vision, mission and value statements in my actions. I make timely decisions rather than delaying them to avoid difficult or politically risky choices. I seek the advice of the ethics committee when making ethically challenging decisions. My personal expense reports are accurate and are only billed to a single organization. I openly support establishing and monitoring internal mechanisms (e. G. , an ethics committee or program) to Ethics Ethics 101 1. 1 background and development of theoretical ethical approaches Deontological Theory The deontological theory state that the consequences or outcomes of actions are not important, what actually matter is that the actions are morally Justified. For example drunken driving is wrong, now if a person argues that he safely navigated his way back home and for that reason he/she should not be held accountable by law, they are wrong because their action was wrong in the first place and was breaking the basic principle for morally correct behaviour that a person should not drive while being drunk.The contribution of Immanuel Kant towards development of Deontological theory Immanuel Kant proposes that in taking a decision â€Å"Duty' carries the foremost importance. Kant is of the view that a person's actions will only be regarded as morally and ethically correct when they are taken keeping in mind the sense of duty and responsibility in mind. Teleological Ethical Theory The tele ological ethical theory put the primary focus on the â€Å"Consequences† i. e. â€Å"What are those actions that produce the best possible results†?Along with attaching importance to the consequences the teleological theory also suggests that the ecisions framework that is developed for achieving the desired consequences should also be managed with care. Consequentialist Theory According to the â€Å"Consequentiality Theory', the basis for determining how moral a person's actions are the consequences. The consequences of actions can be good or bad, and they can be damaging or favourable. The contribution of Jeremy Bentham towards development of a person's actions can be a classified as good or bad depending on what consequences the action has produced.According to Bentham's opinion the good things are classified as â€Å"pleasure† and the bad ones as pain†. (http://www. studymode. com/) 1. 2 Absolute ethics has only two sides: Something is good or bad, bl ack or white. Some examples in police ethics would be unethical behaviours such as bribery, extortion, excessive force, and perjury, which nearly everyone would agree are unacceptable behaviours by the police. Relative ethics is more complicated and can nave a multitude ot sides witn varying shades ot gray . What is considered ethical behaviour by one person may be deemed highly unethical by someone else.The Absolutist theory is the theory that certain things are right or wrong from an bjective point of view and cannot change according to culture. Certain actions are intrinsically right or wrong, which means they are right or wrong in themselves. This is also known as deontological. The relativist theory is the theory that there are no universally valid moral principles. All principles and values are relative toa particular culture or age. Ethical relativism means that there is no such thing as good â€Å"in itself†, but if and action seems good to you and bad to me, that is it, and there is no objective basis for us to discover the truth.This theory is also known as teleological. An example of an absolutist ethical system would be if a single mother with a very young child had no money and therefore no food to feed the child, and she stole some food from the shop and the mother was caught and had a trial, an absolutist would argue that its morally wrong to steal and should suffer the consequences of the crime. They don't take into account the situation the person might be in and use an absolute law. However, this is in contrast to the alternative ethical system, called â€Å"relativist†, because this system is really the complete opposite.Again I'll use the same example s I did for absolutist. If a relativist was looking at this they would take into consideration the situation the woman might be in and empathize with her and try to find an outcome that is the most fair. One reason to support the absolutist approach as the only defensible approac h is that it provides Justification for acting which means that morality seems to demand some sort of obligation. If there's a fixed moral code then there is no obligation to act in a way. Another strength is that it gives clear guidelines, which basically means the rules are fixed and clear to apply. () 1. 3 Ethics refers to a prescribed or accepted code of conduct. Ethical issues are a set of moral values that need to be addressed while carrying out business. Businesses operate in a society that is structured around moral values. Therefore, when conducting its operations, a business has certain responsibilities which are to provide the society with quality goods and services that will improve the people's living standards. In order to survive, a business needs to maintain its customers. Product packaging is one way of ensuring a business maintains its existing customers and also acquire ew customers.Some companies are known to allow underweight packaging of products which are then highly priced and this is a rude way of increasing profits. However this negative trend will affect the business in the long run as customers will eventually come to learn that they are being swindled. In an attempt to boost sales, some businessmen adapt promotional method mislead customers as the message conveyed may not give the exact details of the product. Businesses should desist from increasing prices without valid reasons. In doing so, they will be taking advantage of the customer and this is unethical.Businessmen should also desist from taking part in corrupt practices such as selling low standard goods while bribing government officials in order to continue operating. Entrepreneurs should consider the effects of their activities on the society they serve. In the long run, wrong dealings and corruption will tarnish the image of the business and have a negative effect on sales. Business people ought to comply with the law requirements and observe laid down principles of mora lity in their dealings. They should seriously consider expectations of the community they serve. (    Ethics Table of Contents Therapeutic Patient Relationships Overview Since the sass, ethics has been incorporated into virtually every aspect of the health care system. Because of such a small time window, the study of ethics in a medical perspective continues to change and improve for the benefit of the patient. Studies of doctor-patient relationships Indicate the need of greater ethical study and intervention.Studies show that although many physicians are aware that a romantic r sexual relationship Is unethical, as many as nine percent believe that the ethics depends on the situation (Reese, 2012). Often, an abuse in the doctor-patient relationship does not occur because of a lack in educational skills. Rather, abuse in the doctor/patient is attributed to flaws, or loopholes, in the rules of ethics and law (Subplots et al, 2010). Continued research of the most recent ethical framework can begin lowering any chance of unprofessional.In order to have a successful patient relationship, a phys ician must understand and respect the barriers in place. This session will take a look at ethics. Participants will assess their own ethical principles and apply the concepts they've learned to problems in ethical communication and/or conduct in the workplace. Behavioral Objectives Intended to inform the physician on the definition of ethics Clarify the nature of the ethical responsibilities held in common by current and prospective physicians. Identifies ethical considerations relevant to physicians Recognize different situations containing unethical conduct.Gain the knowledge on how to respond to in situations that require ethical decision-making. Apply the incept of good ethical behavior in their current practice. Outline of Training Session I. Introduction:What is ethics? Ethics refers to a framework of discipline from a branch of philosophy, in which ideas of right and wrong, virtue and vice, and good and evil, are all examined systematically (salvoes & Meyer, 1990). II. Compon ents of Ethics Participants will know basic history, definition, and examples of ethics. A.Ethical Framework – before we can manage ethical dilemmas in the health care setting, we must understand examples of ethical principle, as well as our own, to avoid any conflict of interest. . Self-Assessment Culture Values Beliefs Ideas 2. Continuous Regulation Self-control Trustworthiness Professionalism Education Intervention B. Understand the Significance of Ethics 1. Factors That Improve Ethical Conduct a. Public view c. School curriculum d. Government regulations 2. Factors That Require Ethical Behavior a. Provide company guideline for ethical behavior b.Teach the company's guidelines importance c. Describe punishments for unethical conduct C. Review Examples of Unethical/Ethical Conduct IV. Class Activity – Ethics Assessment V. Effectively practice effective ethical communication A. Understand the needs of the recipient D. Ensuring the message considers the common good E. Continue to interpret for conflicts of interest F. Consider the consequences of each message 1. Is this message mutually valuable? 2. Is this message violating confidentiality of another person? Is this message questionable to your professionalism? . VI. Class Discussion VII Summary of Training Session VIII Conclusion Literature Review: Where the Patient Relationship Ends Dry A, a 49 year-old gynecologist, was treating a 36 year-old female patient, Ms B, for chronic vaginal yeast infections. He described her as being seductive during the husband. Dry A found himself feeling very sympathetic towards her and began scheduling longer patient appointments so he could provide some therapy for her as well as assessing and treating the vaginal complaints for which she ostensibly saw him.He would hold her hand while she talked about her difficult situation at home. This decent down the ‘slippery slope' progressed into hugging, and then kissing at the end of the session. He recognized t hat he was feeling lonely and not having regular sexual relations with his wife. Dry A even noted that his wife was inorganic as though her condition was in some way an excuse to progress to a sexual relation with the patient) (Gabbed & Hobby, 2012). The first time that Dry A and Ms B had sexual relations was after hours in his office.This sexual encounter consisted of mutual oral sex. The meetings were set up during appointments in the office, usually at the end of the day. He finally ended these contacts when he felt the encounters were no longer gratifying to him. In addition, he was worried about being caught and that others would not understand his reasons for departing from the usual procedures (Gabbed & Hobby, 2012). Following the filing of a complaint by the patient, Dry A was sent for evaluation.When asked directly he thought he had harmed the patient, Dry A responded that he felt he had actually helped her by his sexual involvement with her (Gabbed & Hobby, 2012). Introduc tion This physician, Dry A, failed to recognize the unethical conduct he was committing in the obvious power differential with the patient, Ms B. Dry A failed to recognize that a patient is paying for his expertise for the treatment of a disease or ailment, and not a relationship of conscious feelings.If Dry A had greater understanding regarding the ethical principle of the doctor/patient relationship, Dry A may have been able to make a more rational decision so this situation never occurred; likewise, if Ms B had more understanding of the ethical principle prior to her first appointment, Ms B may have had the knowledge to evade Dry Ass advances. In summary, the doctor and the patient should be educated on ethical conduct before the doctor-patient relationship is formed to avoid situations, like the example.Studies show that although many physicians are aware that a romantic or sexual relationship is unethical, as many as nine percent believe that the ethics depends on he situation (Reese, 2012). The American Medical Association (AMA) states that prior doctor/patient relationships can influence the patient's treatment and that such a relationship is unethical if the doctor â€Å"uses or exploits trust, knowledge, emotions or influence derived from the previous professional relationship† (American Code of Medical Ethics, 2012).The Mama's use of â€Å"prior relationship† leaves wiggle room for the â€Å"it's complicated† answer, which over one third of the physicians had answered to the question, â€Å"Is it acceptable to become involved romantic or sexual relationship with a patient? In Medicare's 2012 ethics survey (Reese, 2012). Could it be that the and Ms B are aware of the rules but chose in proceeding to break the barriers of the doctor/patient relationship because â€Å"it's complicated? † The â€Å"it's complicated† answer may originate from feelings from the physician to do anything possible to treat the patient.One s tudy on therapists, explains that the therapists would get sexually involved relationships with suicidal borderline patients in order to save the patient from suicide (Gabbed & Hobby, 2012). This ration is flawed, however, because the physician, like Dry A, should have continued to worked to attain the nature of the intended relationship as clearly therapeutic with any potential unexpected circumstances, which is the idea behind the entire therapeutic process (Crower, Belly & Subplots, 2010).A professional needs to self-regulate their internal drives and thoughts in the absence of clear standards or unexpected circumstances, such as that of a suicidal patient whom is not responding to evidence- based treatment (Crower, Belly & Subplots, 2010). This is critical because usually a patient will give up his or her own autonomy to respect the decision of a paternalistic physician (Shari, Samara, Arachnids, 2013).Not to say this approach to a doctor/ patient is unethical, but it can leave room for unethical conduct if the physician cannot control his or her internal drives or thoughts. Patients, like Miss B, need doctors that are competent in all areas of their profession. The study of ethics in undergraduate courses and medical school curriculum is still improving; consequently, it should continuously be assessed in terms of content, educational methods, and change in behavior, and be revised accordingly (Shari, Samara, Arachnids, 2013).Within only the past 20 years or so, medical schools have gun incorporating ethics as its own respective subject (Houghton, Sparks & Chadwick, 2010). The introduction of ethics in to medical undergraduate curriculum has met resistance, however, because it is evolving constantly and some believe ethical topics are redundant or impossible to be taught (Houghton, Sparks & Chadwick, 2010).Once a few generations of physicians are educated, they can begin teaching newer generations from first hand experience to ensure they are fully compet ent, rather than trainers teaching the instructors (Shari, Samara, Arachnids, 2013). Ethics, according to James S. Recourse (2003), â€Å"refers to a field of inquiry, or discipline, in which matters of right and wrong, good and evil, virtue and vice, are systemically examined (p. 49).Professional ethics is described by Craven & Hiring (2009) as involving â€Å"principles and values universal application and standards of conduct to be upheld in all situations (p. 76). The traditional principles that provided the moral grounding for the protection on human subjects in the United States began forming in the sass (Faded, Sass, ethical concern has been to protect patients from injury, risk, abuse, and unjust orders of medical research (Faded, Sass, Goodman, Provosts, Tunis & Bà ©chamel, 2013).There has been an importance in our society of forming a Just health care system, which is guided by principles of healthcare ethics that include benefice, non- maleficent, respect for autonomy, and Justice (Craven & Hiring, 2008). Physicians, nurses, and other members of the health care team have been developing codes of ethics in order to sustain a Just health care system.Faded, Sass, Goodman, Provosts, Tunis & Bà ©chamel (2013) propose a framework that consists of seven ethical obligations, they include: ) to respect the rights and dignity of patients; 2) to respect the clinical Judgment of clinicians; 3) to provide optimal care to each patient; 4) to avoid imposing monomaniacal risks and burdens on patients; 5) to reduce health inequalities among populations; 6) to conduct responsible activities that foster learning from clinical care and clinical information; and 7) to contribute to the common purpose of improving and quality and value of clinical care and health systems (p. ). Most frameworks regarding medical ethics loosely follow these seven steps. Frameworks in ethics provide a systematic way to decide what's right from wrong in a rarity of assigned priorities th at are goal emphasized (Craven & Hiring, 2008). All members of the health care team have a framework, and they can find it resembles this model. Several issues of unethical conduct in the health care setting can arise if ethical principle is ignored.The following are a few debated matters of medical ethical principle that occurs in the health care setting: physician-assisted suicide (Glover, 2010), clinical trials (Barton & Ugly, 2009), bribes/gifts from patients (Sash & Fug- Barman, 2013), patient abuse, sexual comments/actions toward patient (Crower, Belly & Subplots, 2010), confidentiality (Craven & Hiring), and financial interests (Reed, Mueller, & Brenna, 2013). While some subjects such as euthanasia (physician- assisted suicide) may have different labels of good or bad from different people, other subjects such as sexual patient abuse is generally discovered by most of society.While ethical principle of that society on certain principles might change at the about the same rate medical technology changes, it is still important for any health care worker to keep these principles in mind. Since the implementation of medical ethics is relatively new, changes are rapidly occurring in medical education curriculum as well as the workforce. Evidence shows, the effects of the teaching of medical ethics causes greater ethical sensitivity in the clinical setting (Crower, Belly & Subplots, 2010). However, there are still many cases in which medical ethics education does not have an impact.As the progression of ethics continues in the health care setting, evaluation of medical ethics teaching is vital. Research by Shari, Samara, and Arachnids (2013) finds that matching education is successful, and not a waste of human or financial resources. The Institute of Medical Ethics recommends a pyramid of increasing levels of education, they include: knowledge, habituation, and action (Crower, Belly & Subplots, 2010). The idea is to have medical students think critically abou t historical precedents and future situations involving ethical dilemmas, then put into practice the best consideration.The most important thing teaching ethics gives to medical students is awareness (Crower, Belly & Subplots). With practicing physicians, it is important to continue education on professionalism because doing so shows its significance as a competency (Reed, Mueller, & Brenna, 2013). As introductory and continuing teaching methods are evaluated and improved, future medical students can become more ethically sensitive in their communication and actions. References AMA Code of Medical Ethics. Opinion 8. 14 sexual misconduct in the practice of medicine. Http://www. AMA-assn. Org/AMA/pub/physician-resources/medical-ethics/ code-medical-ethics/opinion. Page Accessed November 3, 2012. Shari, F. , Samara A. & Arachnids, A. (2013). Medical ethics course for undergraduate medical students: A needs assessment study. Journal Of Medical Ethics & History Of Medicine, 6(1) Barton, E. , & Ugly, S. 2009) Ethical or unethical persuasion? The rhetoric of offers to participate in clinical trials. Written Communication, 26(3), 295-310 Craven, R. F. & Hiring C. J. (2008). Fundamentals of nursing: Human health and function, 6th. Liposuction Williams & Wilkins Inc.Philadelphia, PA. 76-77. Crower, M. , Belly, S. , & Subplots F. (2010) Abuse of the doctor-patient relationship. London: Royal College of Psychiatrists. Faded, R. , Sass, N. , Goodman, S. , Provosts, P. , Tunis, S. , & Beach, T. (2013). An ethics framework for a learning health care system: A departure from traditional research ethics and clinical ethics. The Hastings Center Report, Spec Noses-ASS Gabbed, G. 0. , & Hobby, G. S. (2012). A psychoanalytic perspective on ethics, self- deception and the corrupt physician. British Journal Of Psychotherapy, 28(2), 235-248. Glover, P.C. (2010) Physician-assisted suicide is unethical. Greengages Press. Recourse, J. S. (2003). Communication ethics. Management Communic ation: A Case- Analysis Approach. 2nd. New Jersey: Pearson Education. Professionalism challenges and opportunities. Minnesota Medicine, 96(1 1), 44-47 Reese, S. (2012). When is it okay to date a patient? Netscape ethics report 2012. Netscape, http://www. Educate. Com/vertically/774295. Sash, S. & Fug-Barman, A (2013 Physicians under the influence: Social psychology and industry marketing strategies. Journal Of Law, Medicine & Ethics. 41 (3), 665-672.Attachment: Principles of Medical Ethics Revised and adopted by the AMA House of Delegates (June 17, 2001) l. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or impotence, or engaging in fraud or deception, to appropriate entities. Ill. A physician shall respect the law and also recognize a responsibil ity to seek changes in those requirements, which are contrary to the best interests of the patient. ‘ IV.A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard within the constraints of the law. V. A physician shall continue to study, apply, and advance scientific knowledge; maintain a commitment to medical education; make relevant information available to tenets, colleagues, and the public; obtain consultation; and use the talents of other health professionals when indicated. VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care VI'.A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. As paramount. ‘X. A physician shall support access to medical care for all peo ple. Source: Code of Medical Ethics: In-Hand Activity: Ethics Self-Assessment The American College of Healthcare Executives (ACHE) made this survey so you can identify areas of ethical practice in which you are weak or strong. For each question, identify one of the five answers that is best suited to you.The ACHE does not believe in a numbered final score, because it is not a tool for evaluating ethical behavior of others. The number that corresponds with each response simply helps you uncover any areas of concern that may require the need for enhancement in some of your current ethical practice. Almost Never Occasionally Usually 4 5 Always Not Applicable 2 I. Leadership 3 I take courageous, consistent and appropriate management actions to overcome barriers to achieving my organization's mission. I place community/patient benefit over my personal gain.I strive to be a role model for ethical behavior. I work to ensure that decisions about access to care are based primarily on medical necessity, not only on the ability to pay. My statements and actions are consistent with professional ethical standards, including the ACHE Code of Ethics. Circumstances would allow me to confuse the issues I advocate ethical decision making by the board, management team and medical staff. I use an ethical approach to conflict resolution. I initiate and encourage discussion of the ethical aspects of management/financial issues.I initiate and promote discussion of controversial issues affecting community/patient health (e. G. , domestic and community violence and decisions near the end of life). I promptly and candidly explain to internal and external stakeholders negative economic trends and encourage appropriate action. I use my authority solely to fulfill my responsibilities and not for self-interest or to further the interests of family, friends or associates. When an ethical conflict confronts my organization r me, I am successful in finding an effective resolution process and ensure it is followed.I demonstrate respect for my colleagues, superiors and staff. I demonstrate my organization's vision, mission and value statements in my actions. I make timely decisions rather than delaying them to avoid difficult or politically risky choices. I seek the advice of the ethics committee when making ethically challenging decisions. My personal expense reports are accurate and are only billed to a single organization. I openly support establishing and monitoring internal mechanisms (e. G. , an ethics committee or program) to

Beauty Definition Essay - 1156 Words

What is beauty? How do we decide who is attractive and who is not? Society is full of information telling us what is beautiful, but that fact is that information based on? The topic of beauty has been studied, analyzed and controversial for centuries. We all know the feeling you can have when you hear a beautiful song that brings joy to your heart, stands in a field of flowers that excites your eyes, or admires a face that is visually pleasing. As human beings, we are all drawn to beauty, but what is it that makes something beautiful? The controversial issue that surrounds beauty is that some believe that true beauty is defined by someone’s outer appearance, while others believe it is something that is experienced through a person’s†¦show more content†¦The things that make you different are the things that make you beautiful. There are some very unique traits that every single person in the world has that cant be compared to any other person collectively. Sure , we all have our similarities, but there is no way that two people can say that they are exactly identical. This is one of the great beauties that life has to offer us, even though a lot of us choose not to acknowledge this interesting tidbit, as they desire to fit in instead of standing out. Remember that if you ever want somebody to see how truly beautiful that you are, you have to be willing to live your life as yourself. Dont try someone elses life in an effort to impress, because in the end the only person they will be truly impressed with will you in the outfit of another person. Everything has their own unique beauty, you just have to open your eyes and see it yourself. Beauty is everywhere in the world, next time just think before you say that something is ugly. Remember that everything is beautiful, you just have to see it. Confucius (551 BC - 479 BC), â€Å" Everything has beauty, but not everyone sees it†. Here in the U.S., we may value long, flowy hair, bronzed skin and a face free of wrinkles, but in other parts of the world, pale complexions, visible scars and shaved h eads are the enviable traits. Perception of beauty changes from one person to another, one area to another, and one country to another. Beauty is regarded differentlyShow MoreRelatedThe Definition of Beauty Essay905 Words   |  4 PagesSynthesis Essay #2 The definition of beauty is a characteristic of a person, animal, place, object, or idea that provides a perceptual experience of pleasure, meaning, or satisfaction. Beauty has negative and positive influences on mostly people. Beauty is described by the inside and outside of us. Due to beauty, our self-esteem has been hurt dramatically, especially towards girls. Beauty is not always about our outside looks but it’s about our inside personality also. First of all, beauty hasRead MoreBeauty Definition Essay1411 Words   |  6 PagesBeauty The ways people view beauty have changed over time. Beauty has many definitions, and so many people think about it in different ways. Some people like external beauty and some like internal beauty and many people like both together. Beauty controls how people live and think, but it depends on which definition of beauty they choose to believe in. We live in a world that misunderstands the true meanings of pretty much everything. Thousands of years ago people knew and understood what theRead MoreBeauty Definition Essay1126 Words   |  5 Pagestime? Most people judge beauty base on a person’s physical appearance. However, true beauty sis base on a person’s personality and a how a person treat someone else. The hardest thing is to describe beauty because everyone has their own views about beauty. In my opinion beauty has more to with the way someone see portray themselves. The expression â€Å"beauty† was first used in the 14th century as â€Å"physical attractiveness,† and also â€Å"goodness, courtesy.† The meaning of beauty also came from many placesRead MoreThe Definition of Beauty Essay1145 Words   |  5 Pagesadvertising to tell us what is beautiful and what is not. Whether we realize it or not, beauty is ultimately defined for us. Products are advertised all around us, telling us that something in our life is missing because we do not have a certain product in our possession. Ranging from make-up to plastic surgery, most of this advertising is geared toward women. This can be shown through the advertisements analyzed in this essay. Both ads depict women who are approachable. The older ad depicts simplicity andRead MoreDefinition Of Beauty Essay829 Words   |  4 Pagesthe word beauty or beautiful what do you think of? The way a person looks the way they are on the inside, or is it not even a human but things in nature. Th e definition of beauty has a very broad definition everyone has their own meanings their own thoughts on the subject. After a lot of research and interviewing two people getting the perspective of a male who I am very close to and a female who is just a girl in my class I have finally come to some kind of idea of what the word beauty really meansRead MoreDefinition Of Beauty Essay749 Words   |  3 PagesBeauty is commonly defined as the combination of qualities that pleases our senses, mostly our sight. Despite this, throughout many years, the concept of beauty has been considered one of the hardest riddles to solve. This happens not only because of all of what it covers, but also because of society’s beauty patterns. Society has been in charge in making people, mostly girls, to feel inferior because they do not complete this â€Å"beauty standards† in order to be considered beautiful. We need to beRead MoreBeauty Definition Essay858 Words   |  4 PagesWhat is be auty? How do we define who is attractive and who is not? Is it the models posing on the front of magazine, or the confident, bright eyed person sitting across the room? Our society and media is full of advice telling us what beauty is or how to become beautiful. As human beings we are drawn to beauty, but what exactly is beauty? The phrase, â€Å"beauty is in the eyes of the beholder,† is accurate since what one may consider beautiful can vary from what another may consider beautiful. SomeRead MoreDefinition Of Beauty Essay722 Words   |  3 PagesThere is an English quote, â€Å"Everything has beauty, but not everyone sees it.† The quote is correct in some people’s eyes but not everyone’s, because someone may think the individual is exquisite, but others may see the flaws you don’t. In the research of a well-known Philosophy about Plato, he saw that beauty wasn’t how someone introduced themselves, or how they looked on the outside but instead on how they are inside. The true beauty in some perspectives, is what they been through with their ownRead MoreAn Extended Definition of Beauty Essay1056 Words   |  5 PagesThe subjective element of beauty involves judgment, not opinion. Many people feel beauty is only something seen by the eyes. St. Thomas Aquinas views beauty in both the supernatural and natural orders. Aquinas lists the attributes of beauty to be found in nature. These are; unity, proportion, and clarity. We will see how these attributes of beauty are seen through the eye and felt by the heart. To begin, the concept of unity follows the Aristotelian proposition that nothing can be added to or takenRead MoreBeauty Extended Definition Essay792 Words   |  4 PagesBeauty is something that can be interpreted completely different from person to person. A famous quote that goes along with this perfectly is â€Å"beauty is in the eye of the beholder.† I think a person’s inner beauty should be taken into account when deciding whether or not a person is beautiful. Wikipedia’s definition of beauty is, â€Å"a characteristic of a person, animal, place, object, or idea that provides a perceptual experience of pleasure or satisfaction† while Oxford Dictionary states, â€Å"beauty