The Application Of Clinical Effectiveness In Physiotherapy

The Application Of Clinical Effectiveness In Physiotherapy SCIPS (2006) defined Physiotherapy as a science-based health care profession which emphasises the use of physical approaches in the promotion, maintenance and restoration of an individuals physical, psychological and social well-being through various interventions, supported and influenced by evidence of clinical effectiveness and practitioners may work independently or as members of the health care team. Physiotherapy and rehabilitation services in Oman is still in the young phases where most of our practices follows the traditional method, and evidence based approach involves reading international journals, research papers and attendance to seminars, conferences and postgraduate courses. The services have not been accompanied by a comparable increase in systematic evidence. Few practices have been evaluated either for their efficacy in carefully controlled circumstances or for their effectiveness in typical clinical situations, however to keep abreast with our clinical approach and to attain clinical effectiveness in our services, we need to develop strategies and audits to identify areas of improvement and ways of implementing effective and evidence based care. The essay will demonstrate the action plan by using the quotes of Graham (1996) on clinical effectiveness. The impact of guidelines, auditing and cost- effectiveness will also be discussed within sections of this essay. Clinical Effectiveness NHS Quality Improvement Scotland (NHS QIS 2005) described clinical effectiveness as the extent to which specific clinical interventions do what they are intended to do, i.e. maintain and improve the health of patients securing the greatest possible health gain from the available resources. They further described clinical effectiveness as critical thinking about actions, questioning whether it has the desired result, and about making positive changes to practice. They also continued to describe clinical effectiveness by using the same quotes as Graham 1996. National Health Service (2009) aimed to achieve clinical effectiveness strategy by developing a culture where clinical effectiveness is seen as being integral to the day-to-day provision of clinical care. Furthermore, through the development of an integrated work programme, setting out the structures, priorities, and implementing and monitoring national guidance, standards and policy. Evidence -Based Practice. Evidence-Based Medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients (Belsey J, Snell T(2009). Hospital management.net (2005) in their review of rehabilitating physiotherapy stated that evidence-based practice is currently becoming a basic ethical stand in physiotherapy and other fields of healthcare. The purpose of evidence-based practice is to make any decision-making on diagnosis and treatment proceeds from proven knowledge in the field concerned. Herbert R et al (2005) in their review of practical evidence-based physiotherapy pointed out that research alone is not enough, it is most effective when patients, health professionals and policy makers bring to their decisions a range of values, preferences, experiences and knowledge. Clinical effectiveness as quoted by Graham (1996) the right persons, doing the right thing, the right way, in the right place, at the right time with the right result The philosophy in this essay involves team members collecting knowledge of the available service, and then using evidence from a wide range of sources to inform the outcome, linked to the priorities facing the profession. Also develop frameworks to guide ongoing development such as competency framework, and an integrated care pathway, through implementation of patient care knowledge. The process for development will be timely and detailed, and will be actively disseminated using strategic planning to promote implementation and later will be evaluated. Success for the development of clinical effectiveness and evidence-based care would be for the team to experience a constructive and enabling process that contributes to their continuing professional development and progression of research knowledge and skills. The following sections will apply the parameters of Grahams quote to the practice of physiotherapy and rehabilitation through clinical effectiveness. The right persons-(competence) Epstein and Hundert (2002) defined professional competence as the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served The therapist has to be fully qualified and competent to be able to make decisions for therapeutic interventions, identify and analyse the patients condition, a particular clinical problem, should be able to identify and define standards relevant to clinical work, and have the knowledge of the subsequent intervention that might improve outcome. The right thing (evidence based practice resources) Graham (1996) quoted that evidence-based practice is about doing the right things right, and Muir Gray (1997) supported the emphasis on the process rather than on the result. Evidence can be gathered from a range of resources including published guidelines, journals articles, conferences, books, peer reviews, client feedbacks and other recourses from libraries. In order to attain the evidence based practice resources the social value must be identified and the impact of provider values on access to services and quality of care should be understood. Rebecca Broughton (2001) stated that clinical guidelines are systematically developed statements designed to help practitioners and patients decide on appropriate healthcare. It stated that guidelines reduce unacceptable or undesirable variations in practice and provide a focus for discussion among health professionals and patients. Furthermore, Van der Wees P and Mead J(2004) in their study on framework for clinical guideline development in physiotherapy concluded that clinical guidelines are a valuable resource for effective clinical practice and are important tools for clinical effectiveness and evidence based practice, and has the potential to improve the quality of patient care. The right way (skills and competence) The team will work collaboratively to deliver a new policy as per the needs through an evidence based approach system and evaluate new policy in the context of local and national priorities and critically review the nature of evidence in the context of the working environment. The right way to develop skills and competence and the necessary step will be observed such as; time to develop the services, required post training for the therapists, duration of training and resources such as current equipment, the evidence based researched journals and the financial implication. Protocols or specification must be developed and updated by ensuring staff development such as participation in Continuing Medical Education (CMEs) and ensuring confidence of current knowledge and skills through evidence based practice. Patients dignity and privacy must be equally maintained in all contexts of intervention. The right place (location of treatment/services) This will involve team work to audit and identify the geographical regions that need developing and observe the clinical practice, thus includes identifying priority areas of work to deliver the strategy, The performance will be audited to measure the quality of care the patient experienced including the effectiveness of implementing the best available evidence and then benchmarked against pre-set standards, changes will then be implemented where needed. The clinical audit process seeks to identify areas for service improvement, develop and carry out action plans to rectify or improve service provision and then to re-audit to ensure that these changes have an effect. (Wikipedia). The right time (provision of treatment/services) The team will determine and assess the clinical needs of care and interventions so as to develop the appropriate delivery of services as per the requirements and assess the cost effectiveness of the service delivery. The status of the current services, the type of patients, clinical intervention, time process, duration of treatment and location should be reviewed. Hurley et al (2009) in their study on effectiveness and clinical applicability of integrated rehabilitation programs for knee osteoarthritis showed that correct integrated rehabilitation programmes involving exercise and self-management are more clinically and cost effective and may be the best way of managing the large and increasing number of people suffering chronic knee pain. Another example from Santos et al (2004) in their project implementing clinical evidence in the management of coronary care provided a foundation for the development of a management strategy by using a multidisciplinary team approach, involving updating guidelines and resources. A positive outcome of the project was a reduction in hospital admission. An example in our local services was seen in a study of rehabilitation and management of elderly individuals following stroke which required an integrated approach from a multidisciplinary team. This minimised readmission of chronic cases and proved cost effective. Cost-effectiveness analysis should be done to address and ensure the efficient use of recourses and compare the financial costs of therapies whose outcomes can be measured purely in terms of health effect. (Alan Haycox 2009). Ceri. P. (2001) stated that one such method for measuring the extent of health gains is the quantity adjustment life year (QALY). The right result (clinical effectiveness/ maximising health gain) The results should be identified and reported to assess the benefits and patients satisfaction. The appraised research has to have valid and relevant information in the overall results that could be of clinical benefit safe, effective, cost beneficial and when used on the general population will make a difference. Hence health care authorities should develop appropriate use of evidence-based, standardized processes and centers of excellence to support easy reach of health care through a multidisciplinary care team of physiotherapy and rehabilitation. CONCLUSION This essay has discussed the mechanism of clinical effectiveness and evidence based practice in the context of physiotherapy and rehabilitation service. The essay has reflected on the needs and future expectations in the provision of a safe and effective care on a national scale. It has been found that in the context of providing effective rehabilitation, the implementation of up-to-date guidelines, auditing and cost evaluation are all paramount for the assessment of clinical effectiveness. In conclusion, clinical effectiveness in physiotherapy and rehabilitation services uses an integrated approach and can be thought of as the sum of the right person; as being the competent skilled therapist, backed with the right evidence, protocols and guidelines (the right way). In addition, an efficient well equipped environment. An ongoing review of such intervention and approach is required to evaluate and further improve the results of the provided service.

A Worn Path VS A Rose For Emily Essay

In the pages of the short stories, A Worn Path and A Rose For Emily we are able to see a similar side and connection between the two. As we look at the theme, tone, and morals we are able to better grasp the conflict in these two stories, while detecting whether the two protagonists, Miss Emily and Phoenix Jackson are mentally crazy. The main moral in A Worn Path is the love, and life of Phoenix Jackson. The path she travels across interrupts her life. Her love is the love and affection she has for her grandson. If we read the story closer then it may lead us to the conclusion that Phoenix really does not have a Grandson. Phoenix complains to the doctor that her Grandson has had a sore throat for an extremely long time. This may cause the reader to believe that she used to have a Grandson but he became so sick he died. Yet, at the same time Phoenix also shows her intellect by seeing the money fall out of the hunter’s jacket from a far off distance. In A Rose For Emily the main moral is that some people will do anything not to be alone when they feel scared, and afraid of being left again. Miss Emily’s father used to chase away all of her boyfriends or men she had feelings for. She became adapted to this life of only having her father and when he dies then she feels alone and doesn’t want to ever be alone again and she has not the knowledge to maintain her own boyfriend or husband. So she decides to kill her current crush and she keeps him in a locked room until the day she dies. When you compare the two books they have a very similar tone. Though the locations different they still connect through the same tone. Phoenix Jackson is on a trail walking to town to buy some medicine for her Grandson, while Miss Emily is locked up in her house with a dead man. If you were to not focus as much on the location and put your attention to their state of mind then you can see that they are in the same atmosphere. The tone in A Worn Path is for Phoenix to accomplish the task of getting medicine for her grandchild, while the reader can look at the path as the challenges of her life. Miss Emily on the other hand is just looking to not be so alone. They both know that if they set their mind to their goal then they can  accomplish anything they wish to. The theme is slightly different however. Miss Emily and Phoenix both have goals, but in A Worn Path Phoenix’s life is portrayed so much by the path itself. The path in the story tells the life of Phoenix. While Miss Emily is just a woman who sits at home and does not go out in public too often, she just wants to have company. Phoenix on the other hand had her mindset to go to town and socialize while purchasing the medicine. The conflict in A Rose For Emily is the conflict of human vs. human. However the story is told in a third person point of view, which does not gives us any insight to exactly what Emily, was thinking. The same goes for Phoenix, maybe if the story was told in a first person point of view we would know if they are crazy or sane, because we could get into their mind and tell what it is they were thinking. For example, we don’t know what Phoenix was thinking as she walked down the path, fell in the hole, and reached town. For Emily we could tell clearly if she was insane when she killed the man in her house by her thoughts and emotions. The conflict in A Worn Path is the battle between not only human vs. human but also human vs. nature. The battle of human vs. human lives in the mind of Phoenix but we have little insight of that because how the story is told in a third person not her mind. The next is human vs. nature because of the trials Phoenix has on the trail with the bumps, rocks, ditches, hunters, dogs, and etcetera. Therefore in the stories of A Worn Path and A Rose For Emily we see the similarities that linger in the mind of humans and they way they act to the observing eye. There are several things that are the same such as the tone, conflict, and they have relative morals. Yet they have a different theme to make the reader compare and contrast these two books and their differences.

Buddhism Essay Essay

One of the Buddha’s most significant teachings is that everyone is different, and hence each individual’s path to enlightenment is unique. For this reason, Buddhists acknowledge that they must take inspiration from a variety of sources to complete their individual journey to Nirvana. Belief in the concept of enlightenment is therefore important within Buddhism with different branches and schools giving varying emphasis to the many teachings of Buddha and his close followers, while some believe in Bodhisattvas, from whom they take motivation, all believe in shaping their individual effort to achieve enlightenment. Throughout this essay, the Buddha’s teachings on belief and enlightenment, how the four Noble Truths and Buddhist practices relate to belief and enlightenment, and the positions of the two major branches of Buddhism – Theravada and Mahayana – will all be analysed to determine the role of belief in Buddhism, and hence prove or disprove the a bove comments on enlightenment and belief for Buddhists. Enlightenment or _Nirvana_ is a supreme state; free from suffering, individual existence and all worldly concerns; such as greed, hate and ignorance. It is the ultimate goal of all Buddhists, breaking the otherwise endless cycle of death and rebirth known as samsara. Theravada Buddhism (â€Å"Doctrine of the Elders†) teaches that by refraining from all kinds of evil, purifying the mind and having a deep thirst for knowledge, â€Å"†¦ a Theravada Buddhist can reach the state of perfection and enter Nirvana.† (Oracle ThinkQuest, 2012) This knowledge comes almost entirely from the Tipitaka, meaning â€Å"three baskets†. This collection of scriptures contains slightly different versions between the two schools, but is considered to comprise of the most accurate accounts of the Buddha and his close disciples. It is important to note that Theravada Buddhists believe that due to the requirements for enlightenment, monks and nuns are significantly more likely to achieve Nirvana than lay people who should therefore focus on gaining good karma enabling them to be a monk or nun in their next rebirth. Mahayana Buddhism has a variety of scriptures, many of which have been written by high ranking monks since the time of the Buddha, in order to keep the teachings up to date with the culture of the period. Notably, they also  believe that all people have the capability to become enlightened. Apart from the different scripture emphasis, Mahayana Buddism is significantly diverse to Theravada due to the belief in multiple Buddhas and Boddhisattvas. Boddhisattvas are people of deep compassion who are said to delay entering Nirvana in order to help guide others to enlightenment. As such, Mahayana Buddhism adds to the Theravadan definition of Nirvana being the absence of self-centeredness (and therefore the absence of suffering) and the state of spiritual perfection, displayed by total compassion and concern for others. Two well-known Buddhist quotes which summarise the Buddha’s position on beliefs and enlightenment are: â€Å"Don’t blindly believe what I say. Don’t believe me because others convince you of my words. Don’t believe anything you see, read, or hear from others, whether of authority, religious teachers or texts. Don’t rely on logic alone, nor speculation. Don’t infer or be deceived by appearances.† â€Å"Find out for yourself what is truth, what is real. Discover that there are virtuous things and there are non-virtuous things. Once you have discovered for yourself give up the bad and embrace the good.† The above quotes help explain why Buddhists dislike teachings being referred to as beliefs. The first quote highlights the need for scepticism when reading the teachings. The second quote goes further by explaining the individuality of Nirvana, and the idea that not all teachings apply to everyone. Because followers of Buddhism are encouraged to challenge ideas presented and ascertain their own understanding of the major teachings, it is offensive to refer to this knowledge as belief, since `belief’ often refers to faith or trust in an idea(s) which has not been personally experienced. Hence Buddhists only believe in Nirvana, and the basic principles to reach their goal. Theravada and Mahayana both agree with the Buddha’s view that anyone can attain Nirvana, and one can do it within one’s present life if the Buddha’s instructions are followed carefully and applied sincerely. The two main branches of Buddhism have the same Four Noble Truths and interpret these  teachings in a similar manner. The only relevant difference is that Mahayana Buddhists have Bodhisattvas to aid in follower’s quests for Nirvana, whereas Theravada Buddhists believe that since this path is unique, it is the individual’s task to determine how to incorporate the Buddha’s teachings in their own lives. As stated on BuddhaNet, _†Theravada Buddhism places great emphasis on the clergy (Sangha) as the only ones capable of attaining Nirvana__.†_ (Lyall, 2008). As such, the role of the laity (lay people: normal householders) in Theravada Buddhism is to support the clergy and lead a good life according to the Buddha, in the hope of a better rebirth. Whilst it is not taught that a lay person cannot reach enlightenment, as this would be going against a popular teaching of the Buddha, it is perceived as highly unlikely. In return for the lay people’s support, it is common for the monks to teach the laity, provide advice and conduct ceremonies such as marriages. In contrast, the Mahayana Teachings encourage both the laity and the clergy to become Boddhisattvas and attain enlightenment in their current life. Especially in the case of the laity, belief in the possibility of enlightenment at some stage in the many rebirths a person can undergo, is vitally important and an integral part of not only the religion, but the various cultures the religion exists within. The Four Noble Truths are the essence of the Buddha’s teachings. Similar to a doctor’s method for analysing a health issue, the Buddha has diagnosed the problem (suffering) and identified the cause (of the suffering) within the first and second Noble Truths. The third Noble Truth is the description of a cure, while the fourth is the prescription and instructions to recover. Buddhists believe in the Four Noble Truths in the hope of getting closer to enlightenment and find these teachings realistic and hopeful, rather than pessimistic. The first Noble Truth, suffering (Dukkha), describes suffering as presenting itself in many forms of which some are obvious, such as old age, sickness and death (which Buddha encountered immediately after leaving his palace), and others more subliminal. Buddha explained the problem in a more profound way, teaching that all human beings are subject to desires and cravings but acquiring satisfaction from these desires and pleasure is temporar y and will not last without becoming monotonous. The origin of suffering (Samudaya) is the second Noble Truth, and consists of Buddha’s  claims to have found the cause of all suffering – desire (tanha) – which comes in three forms (which have had various names including the Three Roots of Evil, the Three Fires and the Three Poisons). These forms are the ultimate source of suffering, and are; greed and desire, ignorance or delusion, and hatred and destructive urges. The way to extinguish desire is to liberate oneself from attachment, as is explained in the third Noble Truth – Cessation of Suffering (Nirodha). This truth states that attaining enlightenment involves extinguishing the three fires of greed, delusion and hatred and could be considered as a `definition’ for Nirvana. The path to the cessation of suffering (Magga) is the fourth Noble Truth and is often referred to as the Eightfold Path because Buddha outlined a set of eight principles to follow. These are the right understanding, intenti on, speech, action, livelihood, effort, mindfulness, and concentration. Theravada Buddhism, being the more traditionalist branch, follows the practices that have been passed down by senior monks since the Buddha’s time. These traditions or practices include living in forests and performing both sitting and walking meditation. As part of their early training, Theravadan monks and nuns generally live in huts called `kutis’ situated in forests. These huts are built on stilts to keep animals and insects out and have a path for walking meditation. Older monks and nuns are not required to live in the forest, often residing in monasteries. Early each morning and evening, the monks and nuns from a particular school meet together for meditation and recitation. After these ceremonies, which are called _pujas_, they are required to study the Dharma. An important ritual carried out by people entering the temples is to wash their feet with water which has been carried up to the monastery from a stream, generally found below in the forest. The goal of the monks and nuns is to become an _Arhat_, a person free of suffering, through the meditation. Once free of suffering they can continue on their path to Nirvana. Different forms of Mahayana Buddhism have different religious practices. These practices are often heavily influenced by the culture of the society the Buddhist school(s) resides in. Tibetan Buddhist temples are heavily â€Å"†¦decorated with many kinds of Buddha images and wall hangings called  _thankas_.† Big prayer wheels, containing mantras written on strips of rice paper, are set into the walls of the temple while smaller, handheld versions are also common. Tibetan monks generally live in these temples and in between turning the prayer wheels and studying the various teachings, they hold various festivals. These festivals incorporate an array of prayer flags and other colourful decorations to celebrate significant periods. Japanese and Chinese monasteries are very similar to the Tibetan’s, but often with less vibrant, colourful decorations and less festivals. The monks and nuns recite Sutras and sit in meditation together regularly, akin to their Tibetan counterparts. The idea of studying, reciting and meditation in Mahayana Buddhism is to endeavour to accelerate the monks and nuns journey’s to enlightenment, in order that they can become Bodhisattvas and assist others as they near their journey’s end. Theravada and Mahayana Buddhism are very similar with regard to the fundamental teachings. They both accept Buddha (Siddhartha Gautama) as the Teacher, have identical Four Noble Truths (and therefore Eightfold Path), share ideas on the origins of the world, practice their faith similarly and accept many comparable Buddhist concepts. The only outright difference is the scriptures they most value and consider authoritative, which affect the general path members of each branch follow to attain Nirvana. Belief in the concept of enlightenment is therefore important within Buddhism with different branches and schools giving varying emphasis to the many teachings of Buddha and his close followers, while some believe in Bodhisattvas, from whom they take motivation, all believe in shaping their individual effort to achieve enlightenment. BIBLIOGRAPHY BBC, 2009a. BBC – Religions – Buddhism: Meditation [WWW Document]. BBC Religions. URL http://www.bbc.co.uk/religion/religions/buddhism/customs/meditation_1.shtml BBC, 2009b. BBC – Religions – Buddhism: The Four Noble Truths [WWW Document]. BBC Religions. URL http://www.bbc.co.uk/religion/religions/buddhism/beliefs/fournobletruths_1.shtml Dr. C. George Boeree, 2000. Buddhist Meditation [WWW Document]. Shippensburg University. URL http://webspace.ship.edu/cgboer/meditation.html GCSE RE site, 2011. Revision: Buddhism [WWW Document]. GCSE RE Site. URL http://www.mmiweb.org.uk/gcsere/revision/buddhism/keybeliefs/6_theravada.html Goldburg, P., Blundell, P., Jordan, T., 2009. Investigating religion. Cambridge University Press, Port Melbourne, Vic. Gunasekara, V., 2012. Basic Buddhism [WWW Document]. URL http://www.vgweb.org/bsq/basbud.htm#ch5 Gursam, L., 2009. The Importance of Meditation [WWW Document]. URL http://www.lamagursam.org/importance_of_meditation.html Harderwijk, R., 2011. The Four Noble Truths [WWW Document]. View on Buddhism. URL http://viewonbuddhism.org/4_noble_truths.html Heckert, L., 2012. An Overview of Buddhist Meditation [WWW Document]. Johansson, R., Tillekeratna, A., De Silva, L., 2012. Buddhist Studies: Nirvana [WWW Document]. URL http://www.buddhanet.net/e-learning/dharmadata/fdd43.htm Lyall, G., 2008. Buddhist Studies: The Rise of the Mahayana [WWW Document]. BuddhaNet. URL http://www.buddhanet.net/e-learning/buddhistworld/maha2.htm Nikaya, S., 2012. The Fourth Noble Truth [WWW Document]. BuddhaNet. URL http://www.buddhanet.net/cmdsg/truths5.htm Oracle ThinkQuest, 2012. Buddhism: Buddha [WWW Document]. Oracle ThinkQuest Library: Projects by Students for Students. URL

Ch 1 Need for Ethics - 8650 Words

Thinking Critically About Ethical Issues, Seventh Edition By: Ruggiero  © The McGraw−Hill Companies, 2008 I THE CONTEXT CHAPTER ONE THE NEED FOR ETHICS Why do we need ethics? We have laws to protect people’s rights. If the laws are enforced, what need have we of further rules? Ethics is the study of the choices people make regarding right and wrong. Each of us makes dozens of moral choices daily. Will we go to work or call in sick? Follow the research protocol or violate it? Put quotes around borrowed phrasing or pretend the words are our own? Answer a colleague’s question truthfully or lie? Obey the speed laws or drive as fast as our vehicles will go? Pay our bills or spend our money on entertainment? Keep our marriage vows or break†¦show more content†¦Speaking of one student who refused to say such sacrifice was wrong, the professor writes, â€Å"I was stunned. This was the [same] woman who wrote so passionately of saving the whales, of concern for the rain forests, of her rescue and tender care of a stray dog.†1 As almost any ethics instructor will confirm, when it comes to more subtle issues—such as unauthorized copying of computer programs or plagiarism—the number of people who cannot bring themselves to make a moral judgment increases significantly. Such individuals may regard ethics as intrusive. WHY DOWE NEED ETHICS IF WE HAVE LAWS? Many people reason that we don’t need ethics because our system of laws, when consistently enforced, provides sufficient protection of our rights. In order to assess this idea we must understand who makes laws and how they make them. Who makes them is easy to answer: local, state, and national legislators. How they are made is somewhat more difficult. We know that legislators must get together to talk about a particular behavior and then vote on whether they want to criminalize it. 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