Solving Poverty A Widespread Disease - 930 Words

Ravi Parashar Ms. Thompson AP Lang 1B March 12, 2014 Final Draft Steps to Solving Poverty Poverty is a widespread disease, afflicting about 3 billion people around the world, that can be cured by taking effective measures. However, it seems incurable by the sheer amount of people affected by it and the convoluted, multifaceted reasons it is caused. This horrible affliction has perhaps hit developing countries the hardest, where around 98% of the undernourished children reside, creating an atmosphere of melancholy. These developing nations include some big countries like Brazil, India, and China with large populations suffering from low standard of living. It is tragic that so many people have to endure such harsh conditions. It is imperative to find a solution to poverty if we wish to progress as a society. Many politicians claim that poverty is one of the foremost factors hindering economies from progressing. Clearly, for the betterment of humankind we must find a solution, and soon at that. Firstly, we must realize that the definition of poverty is relative, and can be influenced by certain viewpoints and opinions. However, the most common definition of poverty is the condition where people’s basic needs of clothing, food, and shelter are not being met. Some other basic needs include sanitation, water, and health care. This definition is also known as the condition of absolute poverty, and is not up to controversy or impacted by any biases. Poverty has adversely negativeShow MoreRelatedPoverty Essay1390 Words   |  6 PagesPoverty in simple terms is the lack of adequate money to meet basic needs including shelter, food, and clothing. 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Concern in educational attainment between social groups Free Essays

Nelson Mandela grew up in a state divided by apartheid. A black adult male in a state where a white minority ruled, he had a vision for South Africa ; to be one state regardless of race. In 1994 he became the first black president of South Africa – testament, so, that barriers, of any sort, should non be ground for or an apology for deficiency of attainment or accomplishment of any sort and, that barriers can be overcome. We will write a custom essay sample on Concern in educational attainment between social groups or any similar topic only for you Order Now It is widely agreed that there are legion barriers to educational accomplishment and societal inclusion, among them Special Educational Needs ( SEN )[ 1 ]and disablement, Ethnicity and English as an Additional Language, and gender to call but a few. The purpose of this essay nevertheless, is to look at merely one of the barriers faced in this state, poorness, and to look at how students within this societal group are affected and how poverty affects their educational accomplishment, farther, the essay will look briefly at the development of inclusive instruction and what is presently being addressed by this and subsequent authoritiess in order that pupils, irrespective of circumstance can hold equality in instruction. In order to associate poorness with educational accomplishment and attainment spreads, a background to poorness and societal inclusion within instruction will be outlined followed by the first portion of the analysis which will look at the historical overview of inclusive instruction, current policy and counsel and its impact on minority groups ; the 2nd portion of the analysis will analyze the effects of poorness and how, in peculiar, students entitled to FSM ‘s[ 2 ]impact on the spread in educational attainment compared against kids non entitled to FSM ‘s. The concluding degree of the analysis will look at the importance of contracting the spread and the debut of the twenty-first Century School. What is poorness? At this point it is necessary to observe that, through research, it became evident that there is an ill-defined and infinite definition about what ‘poverty ‘ is and how it should be measured. However, most of the research leads to an understanding that poorness is to be related to in footings of ‘typical ‘ life criterions within the UK and the undermentioned definition is widely accepted: ‘Individuals, households and groups in the population can be said to be in poorness when they lack the resources to obtain the types of diet, take part in the activities, and have the life conditions and comfortss which are customary, or are at least widely encouraged and approved, in the societies in which they belong. ‘ P Townsend, Poverty in the United Kingdom: a study of family resources and criterions of life, Penguin, 1979, p31 The most important point made above and which is the chief cause of poorness is ‘resources ‘ ; to underscore more clearly, the chief cause of poorness is deficient income/unemployment which, for grownups with kids straight impacts on them and their well-being. Although the UK has a system of benefits which should protect households with kids from poorness, these excessively are deemed as excessively low. In relation to this, it accepted that whilst grownups do non take for themselves the route of poorness, for kids of parents populating in poorness there is no alternate and they are hence non merely kids but could be described as victims of circumstance. Poverty is non merely about traveling without it is about being deprived of equality in countries such as wellness, lodging and regard and, in the instance of kids, instruction. In concurrence with the definition ( above ) the DCSF ( 2009 ) goes on to depict child poorness entirely as ‘Child poorness agencies turning up in a family with low income. Research has shown that these kids will confront a greater hazard of holding hapless wellness, being exposed to offense and neglecting to make their full potency. It means they miss out on school trips, do non hold equal winter vesture and are n’t able to bask leisure activities with their equals. As a consequence, their instruction suffers – doing it hard to acquire the makings they need to travel on to sustainable, well-paid occupations. This limits their possible to gain the money needed to back up their ain households in ulterior life, and so a rhythm of poorness is created. ‘ www.dcsf.gov.uk/everychildmatters/strategy/parents/childpoverty/childpoverty/ What is Social inclusion? As with poorness, in order to associate societal inclusion with educational accomplishment and attainment spreads, a background and apprehension of the issues refering to societal inclusion demand to be outlined. The term ‘social exclusion ‘ is a term by and large used to depict what can go on to people who are capable to the most terrible jobs, and are hence no longer ‘socially included. ‘ As noted above, kids have no pick of background ; they are born into it and hence find themselves in poorness as a consequence of their birth circumstance. For a kid non to be socially included brings effects above and beyond economic poorness entirely. It is by and large considered that to be ‘socially excluded ‘ as a immature and waxy kid can hold far making effects damaging to both instruction and wellness hence, to surmise, to be socially excluded is to confront exclusion non merely economically but socially and academically excessively. hypertext transfer protocol: //www.cabinetoffice.gov.uk/social_exclusion_task_force/context.aspx Historical development of inclusive policy A ; counsel Bearing in head the old points, it is necessary now focus on how this and old authoritiess have attempted to get the better of some of these issues through inclusive instruction. It should besides be noted that whilst this essay is concentrating, in the chief, on the impact of poorness on educational accomplishment, the roots of inclusive instruction lay preponderantly with another minority group, kids with larning difficulties/special educational demands ( SEN ) . However, as acknowledged above ; through circumstance, students from households who are deemed as in poorness have now been identified as a group who are under accomplishing academically and, hence, as with students with SEN are a recognized minority group for which an inclusive instruction should profit. Inclusion is non a new thought and in fact has its roots at the bend of the last century where educationists, in peculiar kid public assistance innovator Elizabeth Burgwin, saw neither the purpose nor virtuousness in, what was so segregated instruction and that versions could be made to ordinary schools in order to educate all kids, whatever their ability or circumstance, together, nevertheless, there was another sentiment that kids could be ‘categorised ‘ harmonizing to their ability and taught in ‘special ‘ schools. These were kids who, in the words of the School Board for London ( 1904 ) were kids who could non be taught in ‘ordinary ‘ schools. ( Thomas, Walker and Webb, 1998 ) It became accepted that ‘segregated ‘ education/’special schools was the safe and reasonable manner frontward to run into the demands of kids with SEN ; farther, this format of schooling safeguarded the instruction of mainstream students in ‘ordinary ‘ schools, so the 1944 Education Act scripted an highly segregative station war instruction system. It was non until the mid-1960 ‘s when grounds showed deficiency of success in the system that opinions began to alter and instruction looked toward ‘integration ‘ and inclusion ( Thomas et al. , 1998 ) . Given so that the intent of inclusion within instruction is that students with SEN are integrated into mainstream instruction it is of import here to observe the difference between integrating and inclusion. The term ‘Integration ‘ was introduced in 1978 in the Warnock Report and referred to the thought of incorporating kids with SEN into a common educational model. The thought has since progressed to include all kids, non merely those with an identified SEN, but kids from all minority groups irrespective of gender, ethnicity or circumstance [ poorness ] so that a to the full inclusive instruction should be to the full inclusive of all kids and is seen to encompass diverseness. ( Warnock Report ‘special educational demands ‘ 1978 chapter 7 ) ( House of Commons: Select Committee on Education and Skills Third ReportA A 2006 ) Clarification of inclusion policy: Specifying inclusion p58 ) . Inclusive instruction ‘Promoting excellence in instruction and undertaking disadvantage demands we personalise learning and acquisition and back strong, advanced leading in schools ‘ Ed Balls, Secretary of State for Children, Schools and Families July 2007 – nowadays[ 3 ] ECM – Address to the National Children ‘s Bureau, 23rd July, 2007 The rule and patterns of inclusive instruction hence suggests that all students in a school, irrespective of their strengths or failings in any country, go portion of the school community ; that they are included in the feeling of belonging among other students, instructors, and back up staff farther, schools have a legal duty to educate all regardless of gender, ethnicity or circumstance in mainstream schools. Interrupting the nexus ( DSCF, 2009 ) identified that a FSM student is besides more likely to hold been identified with particular educational demands ( SEN ) and will be more likely to hold a CoP[ 4 ]statement or categorised as School Action or SA+ , it is possible that this group will besides be of a group of BEM or BESD[ 5 ]which have besides been identified as an under executing societal group. It is by and large considered that there is a relationship between these factors and intercessions such as individualized acquisition, as identified within the QCA model for inclusion, is critical to adhere to in order for advancement. For these identified groups, inclusion is non needfully merely understanding that every student will non be working on the same larning aims as every other student within that group but that the teaching method will be about recognizing where distinction would be appropriate in order to back up and suit the different acquisition demands and manners of the social/learning group and that a elaborate attack to supervising their betterment is in topographic point in order that marks may be stretched and met. Personalised acquisition ( distinction ) therefore, will be cardinal to raising accomplishment and therefore should be a cardinal constituent to contracting the spread and working towards a civilization where a kid ‘s opportunities of success are non limited by their socio-economic background, gender, ethnicity or any disablement or circumstance. Working within the inclusive model nevertheless should non be viewed as a barrier for either student or staff ; inclusion needs to be viewed as a go oning procedure of interrupting down barriers and contracting the spread to educational attainment for all kids and immature people. There are a figure of Torahs turn toing favoritism in instruction and therefore support inclusive instruction in the UK. Arguably, the most of import piece of statute law passed in recent old ages is the Every Child Matters ( ECM ) policy which, launched in 2003, was published alongside the formal response to the study into the decease of Victoria Climbie[ 6 ]and gave rise to the 2004 Children ‘s act. ECM covers kids and immature grownups up to the age of 19 ( or 24 for those with disablements ) and is the Government ‘s purpose is for every kid, whatever their background or circumstance, to hold the support needed to: Be healthy Stay safe Enjoy and accomplish Make a positive part Achieve economic wellbeing The ECM policy focussed on Inclusive Education A ; Equality of Opportunity and placed high on the docket 3 chief countries: Human Rights – Childs have a right to larn and play together, they should non be discriminated against and inclusion is concerned with bettering schools for both students and staff likewise Equal Opportunities in Education – Children do better in inclusive scenes ( academically and socially ) , they should non necessitate to be separated in order to accomplish equal academic position and inclusive instruction is a more effectual usage of resources Social Opportunities – inclusive instruction is on portion of inclusion in society, kids need to be involved with all their equals. Assuming so that ECM and the 2004 Children ‘s act are back uping and approving inclusion, it is interesting to observe that there is grounds to propose, through the attainment spread, that societal minority groups, despite advancement and the inclusion and integrating advocated in the Warnock Report, are still under accomplishing and, that the construct of inclusive instruction is still discussed as though it applies merely to kids with an identified SEN and is non taking history of all societal minority groups, but as identified in the ‘Index for Inclusion ‘ below, it does, in fact, have a much wider range, inclusion in instruction involves: ( Booth and Ainscow 2000 ) Valuing all pupils and staff every bit. Increasing the engagement of pupils in, and cut downing their exclusion from, the civilizations, course of study and communities of local schools. Restructuring the civilizations, policies and patterns in schools so that they respond to the diverseness of pupils in the vicinity. Reducing barriers to larning and engagement for all pupils, non merely those with damages or those who are categorised as ‘having particular educational demands ‘ . Learning from efforts to get the better of barriers to the entree and engagement of peculiar pupils to do alterations for the benefit of pupils more widely. Sing the difference between pupils as resources to back up acquisition, instead than every bit jobs to be overcome. Admiting the right of pupils to an instruction in their vicinity. Bettering schools for staff every bit good as for pupils. Underscoring the function of schools in edifice community and developing values, every bit good as in increasing accomplishment. Fostering reciprocally prolonging relationships between schools and communities. Poverty and the effects on instruction It is the purpose of this and subsequent authoritiess to raise accomplishment for all students and to interrupt the nexus between disadvantage [ poorness ] and low educational attainment. In 1999, the [ so ] authorities pledged to halve child poorness by 2010 and eliminate it by 2020, in response to this, in 2008 the authorities published a paper: Ending Child Poverty – Making it Happen 2008 underscoring their committedness to guarantee non merely that each consecutive coevals is able to derive better occupations, but that everyone has the opportunity to accomplish their possible, no affair what their background, farther the paper announced that a kid poorness Bill will be introduced in 2009. The Child Poverty Act 2010[ 7 ]ensures that sustained action must be taken to undertake child poorness by this, and hereafter, authoritiess, by devolved disposals, and by local authorities and their spouses. The act sets marks associating to the obliteration of kid poorness, and to do other proviso about child poorness. The Bill provides a statutory footing to the committedness made in 1999 and to make a model in which to supervise advancement at a national and local degree. Relevant to poorness and instruction nevertheless, is section 26 of the act which makes an amendment to the of the Education Act 1996 and gives the Secretary of State an order-making power to widen eligibility for free school repasts ( FSM ‘s ) if the kid meets prescribed conditions and the kid ‘s parent is in reception of a prescribed benefit or allowance. ( Child Poverty Act, 2010 ) Research carried out by the Joseph Rowntree Foundation in 2007 reinforced that the links between poorness and instruction were clear but complicated and that to interrupt the established relationship between poorness and hapless educational results required a alteration to the implicit in constructions ( Raffo, Dyson, Gunter, Hall, Jones, Kalambouka JRF A Review of research on the links between instruction and Poverty, September 2007 ) . Since so and with the coming of the Child Poverty Act and the End Child Poverty Campaign, inroads have been made and some 500,000 kids have been lifted out of poorness[ 8 ]nevertheless, there are still presently 4 million kids in the UK life in poorness, as defined above, which equates to an overpowering 30 % of kids all within the UK, farther, the UK has one of the worst rates of child poorness in the industrialized universe. It could be argued therefore that poorness has the ability to befog the possible and chance of a kid and hence limit the life opportunities of the kid. Evidence suggests that poorness has the capableness of determining a kid ‘s development ; before making the age of 2 ; a kid from a poorer household is more likely to be demoing lower degrees of attainment than that of a kid from a better off household and that kids turning up in poorness are more likely to go forth school at 16 with fewer makings ( End Child Poverty ; 2010 ) . In the preface to Removing Barriers to Achievement ( DfES, 2004 ) a set of specific educational ends were expressed. Chiefly, instruction is targeted as a agency to incorporate persons into society and to learn them the accomplishments necessary to take part contribute and achieve their possible. Therefore it can be assumed that the impression of inclusive instruction is a basic human right of every kid regardless of circumstance. Given so that the chance for full clip instruction is available for all and, that under international human rights jurisprudence ( and, in peculiar, Articles 28 and 29 of the UN Convention on the Rights of the Child ( 1989 ) which cover the right to instruction ) , the UK has an duty to supply [ inclusive ] instruction for all kids. ( UN Convention on the Rights of the Child: 1989 ) If it is the instance so, that ‘the right of the kid to instruction, and with a position to accomplishing this right increasingly on the footing of equal chance ‘ ( Article 28 ) , it is interesting to observe that on mean hapless kids score less good on a scope of educational steps such as reading trials in early old ages and GCSE consequences in secondary instruction, foregrounding the predicament of poorness in instruction. With the statement made in the: Ending Child Poverty papers [ to guarantee non merely that each consecutive coevals is able to derive better occupations, but that everyone has the opportunity to accomplish their possible, no affair what their background ] it must follow, hence, that portion of the reply lies in instruction as the way to a better occupation lies with makings. During the last 10 old ages schools, nationally, have benefited from authorities investing and statistics show that the attainment spread is shuting nevertheless, grounds shows that there is still a nexus between household income and accomplishment. Approximately 15 % of all students are entitled to FSM ‘s but as demonstrated [ below ] , these students are less likely to acquire 5 good ACEM[ 9 ]compared to those students non in reception of FSM. For that ground, poorness and want remain an on-going country of concern. ( DCSF: Interrupting the Link, 2009 ) The importance so of FSM ‘s for eligible students should non be under estimated as a agency to shuting the spread in educational attainment as, to mention back to the UN Convention on the Rights of the Child ( 1989 ) , article 27 provinces that no kid in the UK should travel hungry. Abraham Maslow is known for set uping the theory of a hierarchy of demands, which places, in a pyramid, the order basic demands need for motive. At the underside, are the physical demands which, although basic, we will non work comfortably without. The basic human demand is for nutrient, H2O and slumber. The center of the pyramid trades with the emotion and at the really top is self fulfillment. Using this theory illustrates and reinforces the importance of FSM ‘s for students eligible as without their basic demand met students will non work to the best of their ability as demonstrated below. Assuming so that, a kid is fed, research has shown that there is a important and immediate consequence of diet on behavior, concentration and cognitive ability. Areas straight associating to educational attainment affected by nutrition have been identified as: Developmental upsets e.g. dyslexia and dyspraxia, Memory Concentration Intelligence Attention span Attention-Deficit-Hyperactivity Disorder Aggression Accomplishment ( Sorhaindo, A. A ; Feinstein, L. 2006 ‘What is the relationship between kid nutrition and school outcomes? ‘ Wider Benefits of Learning Research Report No 18. Centre for Research of Wider Benefits of Learning ) p 7, 11. If it is the instance so that nutrition has a clear impact on the public presentation of a student, it must hence be of premier importance to guarantee that all students entitled to FSM are in reception of them. In add-on to the above, nutrition is besides believed to impact upon behavior, which has the potency besides to impact school public presentation and interaction with equals, and compromise self-pride ( Sorhaindo et.al. , 2006 ) However, research carried out for the DCSF by the Key Stage 2 A ; 4: National Indicator Set has shown that where students are in reception of FSM academic attainment is lower at every key phase ( as the focal point group identified is secondary students, relevant statistics merely are identified ) . By the sheer fact that a student is entitled to FSM indicates that they are from a household whose parents or carers are in reception of benefit and are hence are on low income and are entitled to use to their local authorization to claim FSM ‘s. The usage of the Income Deprivation Affecting Children Index ( IDACI ) is used in order to find FSM eligibility. This nevertheless, this is by no means a perfect system, as it misses out kids from households who do non use for all the benefit to which they are entitled ; in so making pushes the household farther into economic pandemonium as tiffins that need non needfully be paid for now become, unnecessarily, portion of the household budget. ( DCSF: Want and Education 2009 ) An attainment spread ( measured by students entitled to FSM ) is measured at each cardinal phase ; it begins at cardinal phase 1 and additions at each key phase through instruction. By the terminal of cardinal phase 4, research has shown that there was a 29 per centum point spread between FSM and non FSM students in English and a 28 per centum point spread in maths. This equates to a non FSM student holding over three times the odds of accomplishing an A*-C class in these topics compared to an FSM student. In 2007 Merely 21 % of FSM students achieved 5 ACEM[ 10 ], compared to 49 % of non FSM students. This figure had narrowed somewhat from the statistics available for 2003, whereby a non FSM student had 3.8 times the odds of accomplishing 5+ACEM, but this ratio has fallen over clip to merely 3.1 in 2007. ( DCSF: Want and Education 2009 ) . With a nexus in educational attainment holding been identified and linked to amongst others, poorness and FSM ‘s it is necessary to look at how this spread can be narrowed ; for every bit long as poorness exists in childhood there will be an addition in the hazard of grownup poorness. Intergenerational rhythms of poorness are non unbreakable or inevitable, but alterations need to be implemented or there will be a hazard that, in future old ages, the spread in attainment will impact on society, as there will be kids go forthing instruction with fewer accomplishments required by employers when come ining into the work force, which will finally impede economic growing. There is grounds to propose that poorness need non be the cause to achievement or attainment. Research carried out by Jason Strelitz, policy adviser on UK kid poorness for Save the Children, showed that with successful fiscal and policy intercession by national authorities ‘poverty ‘ as a cardinal barrier to educational attainment can be eliminated ( Jason Strelitz, The Guardian Newspaper, Thursday 21 August 2008 ) . It has been shown and is acknowledged that FSM ‘s are a clear indexs of public presentation nevertheless, in London in 2007, the mean attainment spread of kids on FSM and non FSM ‘s was 27 per centum points, the spread in public presentation between kids on FSM in the best authorization and the worst was wider still ; 37 per centum points proposing that it is non FSM in isolation entirely that is seen as a barrier but geographics and ZIP code. To exemplify ; two contrasting London boroughs: Kensington and Chelsea, with few kids on FSM, besides Tower Hamlets, who had the highest proportion of kids on FSM anyplace in the state. In 1998 Tower Hamlets ranked as one of lowest-performing governments in the state for educational attainment ; 10 old ages subsequently their consequences were above norm across the board and, for the poorest kids among the really best. It appeared the reply for Tower Hamlets was investing. During the 10 twelvemonth period identified, investing and e ducational enterprises were focused on deprived countries and the consequences were outstanding. With the exclusion of one, all of the 30 local governments that were identified saw betterment in their GCSE attainment since 1998. All, saloon one, had above mean per-pupil support. ( Strelitz, 2008 ) . This clearly demonstrates how investing in instruction can work to contract the spread in attainment and that poorness, is non needfully a barrier to instruction. However, it should be remembered that the investing has been made in the educational system/framework non the person and that the kids themselves, due to household circumstance, are still really in poorness although the chance of a good/better instruction has been afforded them and which will be the key to their hereafter and the chance for them to travel on into higher instruction or employment giving them the chance of interrupting intergenerational rhythms of poorness. It is clear so from the above that jobs within the instruction system have been identified and are being addressed, through statute law thrust and frontward thought as fiscal investing entirely will non work out the job, nevertheless, it does bespeak that the job can be solved. Working on the guidelines for alteration recommended in ECM the authorities has produced a series of documents aimed at sketching the manner frontward to contract the spread for specific groups. June 2009 saw the publication of the current authoritiess ‘ white paper: Building a twenty-first Century School System along with Interrupting the Link. Constructing a twenty-first Century School System proposes the manner forward for instruction. It paperss how this and future authoritiess will construct on the bing school system to make a new system that will supply an instruction that is able to move in response to the challenges of society. Further it looks at and endorses a wholly inclusive educational system taking to interrupt the nexus between want, disadvantage, disablement and low educational attainment and so impacts upon intergenerational poorness as discussed above and where every kid, irrespective of gender, ethnicity or circumstance [ poorness ] will hold the chance to develop and derive the accomplishments necessary to win in the of all time altering planetary clime. ( DCSF: twenty-first Century School System ) One component of the twenty-first Century School is ‘Extended ‘ services within schools. This has now been implemented in 72 % of schools countrywide and it is intended that by the terminal of 2010 all schools will offer ‘extended ‘ school services. The purpose being, to hold integrated wellness and societal attention on site every bit good as kid attention and after school installations ; thereby guaranting that jobs which may potentially stand in the manner of students larning are more easy and readily cover with. However, informations to day of the month shows that whilst consciousness of and satisfaction with services among parents is comparatively high, there remains a engagement spread between FSM eligible students and those non eligible, with non FSM demoing typically a 10 % higher engagement rate. The issue hence is to farther promote the deprived groups and, in peculiar those eligible for FSM, to take part and do usage of the offer. The engagement spr ead indicates that kids from poorer backgrounds are less likely than their equals to hold used to such installations and are hence less likely to province that the service meets their demands on the other manus the information shows clearly that advancement is being been made in enabling deprived kids to take part in quality after school activities, but that more demands to be done to maximize the benefits of these activities to convey this groups battle with acquisition. ( DSCF: Interrupting the Link, 2009 ) Decision It is non poverty entirely that is the barrier to educational accomplishment. Poverty is circumstance. This and subsequent authoritiess can, and should put in instruction in order to give our kids the chance they need to interrupt away from intergenerational poorness and to shut the spread in educational accomplishment and societal inclusion. While kids are denied their basic human right of an instruction – equal for all, no affair their current circumstance, they will stay in poorness. Bettering life opportunities through instruction, for all, is non an unrealistic aspiration but does demand the committedness of policymakers, both national and local, schools, spouse bureaus and parents to work together, to be focused on presenting alteration for all. As Nelson Mandela broke through his barrier and proved that race need non keep back accomplishment, this state excessively can interrupt down barriers ; kids from all backgrounds can accomplish – poorness does non and should non be a barrier to attainment. 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Review of Gastroesophageal Reflux Disease †MyAssignmenthelp.com

Question: Discuss about the Review of Gastroesophageal Reflux Disease. Answer: Introduction: Nursing care for chronic illnesses involves influence from multiple factors. In order to ensure safe and high quality care the nurse must ensure that the patient needs and the clinical needs are met. It can be ensured by the prioritisation of care and it is considered to be the integral part of the daily nursing practice (Harrison et al., 2017). The essay deals with Peter Mitchell presented with the uncontrolled diabetes and obesity. The aim of the essay is to manage the chronic illness integrating various principles. Applying the clinical reasoning cycle the main health issues of Peter will be identified, and two priorities of care will be discussed. According to Levett-Jones, clinical reasoning involves collection of cues, followed by information processing, understanding the health problems of the patient, implementing the interventions, evaluating the outcomes and reflecting on learning process (Barker, Linsley Trueman, 2016). The first step in clinical reasoning process is taking into consideration the patients situation and it involves listing of facts, objects or people (Dalton et al., 2015). Peter Michell, (52 years) is presented to medical ward with poorly controlled diabetes. He is troubled with sleep apnoea and obesity ventilation syndrome. For cues and information, the nurse must review the current information from the exiting handover, and asses for collecting new information (Barker, Linsley Trueman, 2016). On obtaining information from the clinical handover, it was found that patient has history of diabetes since 9 years; he has morbid obesity, hypertension, depression since three months, apnoea and Gastro oesophageal disease reflux disease. The patient is smoking since last 30 years. Social appears to be poor as he lives alone and his children rarely visit him. He is unable to cope up with his weight gain. His diabetes intervention, insulin led him to leave job. He is surviving only on governm ent benefits. He avoids socialization owing to his illness. He appears to be motivated to lose weight and is currently under medication. As per the previous assessment the Peter has HR 102 Bpm, BP 180/92mmHg, RR 23 Bpm, and Sp02 95%, Obesity, blood pressure, hypertension, and diabetes may be interrelated as per knowledge pathophysiology. The vital signs and symptoms demonstrated the risk of heart diseases (Koolhaas et al., 2017). Processing the collected information is important to identify the main heath issue of the patient. This part of the clinical reasoning involves analysing the data to understand the signs and symptoms of the patients and relate with the cues to identify the relationships (Barker, Linsley Trueman, 2016). It will help predict the necessary clinical outcomes in Peter. The patient has weight 145kgs and height 170cms, that can be calculated to have BMI around 50.2. A BMI of 30 or less than 30 is normal and above this range is considered obesity. The patient presenting ventilation syndrome and apnoea may be related to obesity. According to Castro-An et al. (2015) obesity disturbs the breathing process resulting low blood oxygen level and buildup of carbon di-oxide. It may have caused the ventilation syndrome. It affects sleeping process due to episodes of shallow breathing causing apnoea. People with excess weight have soft tissues in mouth and throat that may cause obstruction of airway d uring sleep. Smoking also causes apnoea through airway obstruction (Kent et al., 2015). It requires immediate intervention to prevent further deterioration. Patient history of hypertension is due to both obesity and diabetes. Hypertension is known as high blood pressure. The normal BP should be 120/80 and the patient has 180/92. Increase in fatty tissues in the body with weight gain increases vascular resistance and pressure on arteries. It causes the heart to pump more blood. Obesity is known as the major cause of type 2 diabetes. Obesity increases the insulin production to compensate the blood sugar level. It results in diabetes. Diabetes causes arthrosclerosis, thereby increasing blood pressure. It is the risk factor for stroke, and kidney damage (Koolhaas et al., 2017).The patient has high heart rate that is 102 bpm which is greater than the normal 100 bpm. The respiratory rate of the patient is 23 bpm which is greater than the normal 12-20 bpm. The increased respiratory and heart rate may be due to excess adipose tissues that restricts the movement of chest muscle and diaphragm. The increase in blood pressure, heart rate and respira tory rate, may lead to heart failure. It is also the risk factors for collapsibility of pharyngeal tract (Lycett et al., 2015). Depression in the Peter may be associated with illness and deterioration as well as social isolation. Stresses due to illness, smoking and social isolation are known to elevate depression (Snoek et al., 2015). Further, the gastro oesophageal disease reflux in patient is also associated with obesity. Lower oesophagealsphincterin obese people is displaced due to high intra-abdominal pressure. It results in increased gastro-oesophagealgradient. Obesity with diabetes further worsens this disease by damaging the nerves that is neuropathy. It may be improved by better glycemic control. Diaphoresis is also common to both obesity and diabetes (Punjabi et al., 2015). It can be concluded that obesity and diabetes are the major health issue of the patient. In order to establish the nursing goals, it is important to identify the patient problems by synthesising facts and inferences (Barker, Linsley Trueman, 2016). Based on the above analysis, the main issues identified are obesity due to excess weight and diabetes due to poorly controlled blood glucose level. However, obesity is the root of all the complications. The symptoms presented by Peter such as diaphoresis, shakiness and other deviation in vitals signs are all common to obesity and diabetes. These symptoms require immediate intervention as there is increasing risk of heart failure, liver, kidney damage. Weight gain increases obesity and diabetes, which increases the appetite and further weight gain. The symptoms of both the diseases are interrelated like a vicious cycle. Adequate nursing plan will help decrease the comorbidities and improve the quality of life. Taking action plan to reduce weight and glucose control will help Peter improve his social life and overcome depressio n. It will help him better participate in his activities of daily living. Based on the analysis two health priorities are identified to develop appropriate nursing actions. The two health issues in Peter are obesity due to excess weight gain, and uncontrolled diabetes. Reducing weight and controlling glucose level will eventually improve all the associated complications and are two priorities of care. Appropriate nursing action plan is developed to fulfil the two nursing priorities of care. Actions are based on the evidence and include both pharmacological and non-pharmacological interventions. The non-pharmacological interventions are lifestyle interventions. To fulfil the first priority, the patient may be administered with the orlistat as it effectively decreases the absorption of dietary fat by 30% (Yanovski Yanovski, 2014). It also improves sensitivity to insulin. The patient will be educated to lose weight and engage in exercises. The benefits and implications will be explained to ensure compliance to the treatment. It will be followed by collaboration with dietician to develop effective weight reduction and diet plan for Peter (Sharma Lau, 2013). The plan will include weight loss protocol with weekly target. The patient may be recommended to intake high protein diet and low fat food. It will help decrease cholesterol (Franz et al., 2015). Further, patient will be engaged in weight reduction by exercise program. It may be aerobics or brisk walking, to help manage the sugar level. Peter can participate for five days in a week for 30 minutes in swimming (Koolhaas et al., 2017). To fulfil the second priority, the nurse may administer the glucose lowering tablets such as metaformin. It is a glycosidase inhibitor. It is also helpful to reduce weight as well. Alongside insulin may be administered. The dosage may be adjusted to prevent hyperglycemia. In addition the patient may be administered with the anti-hypertensive medication to control high blood pressure such as metaprolol. It will prevent the risk of heart failure (Yang et al., 2018). The nurse may enhance self care in Peter by educating him about the self care. He may be trained to self monitor glucose. Educating patient about effect of smoking on diabetes, will motivate Peter to accept healthy behaviour (Lycett et al., 2015). He will be better able to manage the diabetes and obesity complications (Franz et al., 2015). Also he has depression, so he will be referred to psychiatrist. It will help Peter stop smoking, cope with weight loos interventions and overcome depression (Baumeister et al., 2014). After action plan, evaluating the efficacy of the clinical outcomes is important part of nursing care that helps achieve desired goals (Dalton Gee Levett-Jones, 2015). The patient may be monitored for any sign of ketoacidosis, as it may lead to death in untreated condition. Peters weight should be monitored regularly along with other vital signs. It includes his blood pressure, respiratory rate and oxygen saturation. Considering the medication, it may be effective to monitor hyperglycaemic condition. The patient will be monitored for diet plan adherence and exercise program to make modifications (American Diabetes Association, 2015). Reflection on the care process seems that it may be challenging for Peter to follow the dietary recommendations. I will support him through motivational therapy and involve in group discussions. It will improve social life and minimise stress (Baumeister, Hutter Bengel, 2014). In conclusion, the case study helped understand the clinical reasoning process. It allows nurses to design goal driven care plan for the chronic condition. Applying clinical reasoning cycle, the care plan for Peter is designed based on evidence. The essay helped gain valuable insights into prioritisation of care by analysing the health issues obesity and diabetes. The interventions were targeted to two priorities of care that are weight reduction and control glucose level. The interventions will help improve peters health related quality of life. References American Diabetes Association. (2015). 3. Initial evaluation and diabetes management planning.Diabetes Care,38(Supplement 1), S17-S19. Barker, J., Linsley, P., Trueman, I. (2016). Clinical judgement and decision making.Evidence-based Practice for Nurses and Healthcare Professionals, 45. Baumeister, H., Hutter, N., Bengel, J. (2014). Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review.Diabetic Medicine,31(7), 773-786. 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