Therapeutic Recreation

Study Rationale The RT practice entails continued improvement of interventions including fitness programs to help improve care for developmentally and intellectually challenged people. This study draws from a research by Wilhite, Biren and Spencer (2012) that examines the impact of a fitness intervention on the disabled and their caregivers.Advertising We will write a custom assessment sample on Therapeutic Recreation specifically for you for only $16.05 $11/page Learn More This study will examine the experiences of disabled adults and caregivers involved in the RT care within clinical settings. In medical practice, patient experiences of an intervention are crucial; they help improve care delivery through patient-focused care and enhanced communication. Often, documentation in RT practice entails a record of the patient’s leisure profile and a quarterly description of the patient’s past experiences in the RT program. The quarterly descript ion has six basic components that guide recreational therapists in providing care and are entered in the patient’s chart: (1) the goal of the treatment/intervention; (2) the intervention plan; (3) the RT practitioner’s views on the patient’s leisure profile; (4) the resident’s views; (5) the patient progress; and (6) future directions regarding the plan of care. The outlined procedure fails to incorporate the findings of Wilhite et al., (2012) study and thus, may not portray an accurate picture of the patient’s actual experiences. Wilhite et al., (2012) establish that RT intervention participants derive such benefits as lower level of stress, improved muscle tone and decreased weight (p.257). Thus, for patients participating in a particular RT activity, their experiences should be incorporated in the intervention planning process. This will help improve the quality of RT care for the disabled. Further, although most recreational therapists particip ate in routine rounding as other professionals, their perceptions regarding RT activities and leisure opportunities in residential care will help align RT practice to medical models. This will enable the RT practitioners to give patient care that not only focuses on recreational leisure but is also patient centered. Purpose of the Study The proposed study aims to provide a framework for intervention planning for adult disabled residents. It will identify appropriate RT activities and leisure opportunities in a geriatric care setting (Shank Coyle, 2002). In this regard, this study has two objectives; first, to find out the perceptions and views of RT professionals about the current organization of RT activities; and second, to explore the participating patients’ experiences regarding RT benefits. It is hoped that the findings will help develop a framework that reflects the patients’ experiences and is consistent with medical models of patient care. The findings will al so enable RT practitioners to describe the leisure opportunities in professional terms and enhance their ability to provide holistic, patient-focused care through improved communication.Advertising Looking for assessment on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More A statement of the problem In healthcare, recreational therapy, which in the context of a care facility is the patients’ plan of care, is essential. It helps improve clinical practice by incorporating the views of caregivers and their patients into the care plan. Medical care plans also function as legal documents in case of a lawsuit, and therefore, should be prepared in all clinical settings (Navar, 1991). Most care plans are based on measurable patient or nursing outcomes of a given clinical intervention. According to Shank and Coyle (2002), a â€Å"systematically organized and process-focused plan is an important basis for quality patient careâ⠂¬  (p. 132). However, patient experiences are often not incorporated most care plans. In RT practice, very few studies have examined the organization/planning of RT interventions. Navar (1991) states that, in clinical settings, patient-focused care is rooted in the RT concept. However, often, RT practitioners offer limited patient-focused services because the RT frameworks employed are largely borrowed from the nursing profession. In the recreational therapy context, the RT activities, when expressed in measurable terms, help practitioners achieve the goals of the intervention. Also, by examining the current TR practices, practitioners will be able to provide quality patient care. Literature Review Modern nursing practice is generally grounded on the concept of human becoming (Shank Coyle, 2002). The concept entails patient involvement in his or her care planning (Richeson, 2003). The same theory has been adapted in TR practice, whereby patients’ views and experiences info rm practice. Based on the human becoming philosophy RT practitioners can develop organized interventions that incorporate patients’ perceptions and experiences (Ross Ashton-Shaeffer, 2003). Most providers have developed patient-focused care (PFC) models to guide the practice. Spring (2007) writes that patient-focused care entails a system of â€Å"health that is defined by the individual and the goal in practice is enhancing quality of life as defined by the person rather than the health provider† (p. 617). In the TR context, the choice of PFC model affects both the organization of care delivery and perspectives within the RT field (Mikhail et al., 2005).Advertising We will write a custom assessment sample on Therapeutic Recreation specifically for you for only $16.05 $11/page Learn More Most providers aim to develop an effective and efficient RT practice simplified documentation in a manner that reflects patient needs by simplifying the documentation process in a manner that reflects patient needs (Mikhail et al., 2005). It also entails a shift in the caregivers’ beliefs and values to promote interaction as a basic tenet of PFC model. This helps to strengthen nurse-patient relationships in the care settings. It is important to note that, though the RT profession is largely patient-centered, evidence on how recreational therapy and leisure contribute to a more patient-focused care is limited (Whitman, Flynn Fritz, 2003). Nevertheless, research findings indicate that RT interventions reduce the level of stress, improve muscle tone, or decrease weight in patient participants (Wilhite et al., 2012, p. 257). Also, the practitioner-patient interactions during RT activities improve the practitioners’ understanding of the patients’ unique needs so that the care plan is organized to reflect the realities of the patients. Clinical planning is a critical element of RT practice; however, the quality and c onsistency of organization often vary from one care facility to another (Shank Coyle, 2002). Various previous studies focus on ways of improving the quality of RT interventions to achieve improved patient outcomes. A study by Townsend, Cox and Li (2010), which involved interviewing of nurses, found that internal factors such as nurses’ perceptions, nursing or medical terminology and unclear theories prevent nurses from using developing nursing care plans for each patient. Also, factors such as clinical charting requirements and organizational values also affect care planning (Carter, Van Andel Robb, 2003). Studies also show that extrinsic factors such as lack of time, redundancy in charting and noise disruptions affect documentation and organization of RT activities. Thus, RT activities the disabled should be organized to reflect the dynamics of the RT field. In addition, evidence-based practice in recreational therapy promotes the quality of services to patients (Donnelly, 2005). Richeson and McCullough (2002) state that relying on research evidence is essential in RT in three ways: (1) research evidence helps in the design, delivery and assessment of the RT program; (2) use of evidence promotes the achievement of desired patient outcomes; and (3) evidence ensures that the care services are quality and up-to-date. Also, evidence can help facilitate accreditation and accountability in the RT field (Buettner Fitzsimmons, 2007). Besides evidence, practitioners should consider the client needs, health outcomes and the recreation activities, when developing an intervention program.Advertising Looking for assessment on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Therefore, it is imperative that RT professionals have relevant skills to help them to select interventions that will result in high patient outcomes (Kinney et al., 2004). Kinney et al., further state that the choice of the physical activities is essential in achieving positive treatment outcomes for a given RT program. Positive client outcomes indicate that the quality of service offered is high. Stumbo (2003) writes that positive patient outcomes are indications of the progress of the client, either mentally or physically, in the course of treatment. To achieve this, measurable outcomes must be identified, documented and disseminated to other health care professionals. RT professionals treat a number of health problems such as neurological impairment, orthopedic problems and psychiatric illnesses. Thus, to enhance treatment efficacy, the choice of the right intervention is important. Though there are a number of interventions used by RT professionals, the type of illness determin es the type of RT intervention to be used. Shank and Coyle (2002) write that RT practitioners can use different interventions for physically handicapped clients. Examples of health interventions in the RT field include; physical activity, self-expression, creative expression, social interaction and educational activities (Shank Coyle, 2002). Mind activities include meditation, aromatherapy, yoga, sensory stimulation and humor. Other RT interventions for the physically disabled involve physical activities such as exercises, swimming and exercise (Cameron et al., 2005). On the other hand, creative interventions include activities such as music, visual arts, dancing and storytelling. Self-expression interventions include reminiscence, spiritual therapy and adventure. A study conducted by Kinney, Kinney, and Witman, which involved a survey of 276 RT practitioners nationally established that the most common forms of interventions used by the respondents within the RT field include exerc ise, music, games, arts and activities of daily living (ADLs). The practitioners employed a number of facilitation approaches including leisure counseling, stress management, group therapy and reminiscence (Kinney et al., 2004). This implies that it is through a combination of RT approaches and activities that the health outcomes of physically handicapped residents can be improved. Hypothesis This study hypothesizes that a multifaceted RT intervention focusing on physical activities and leisure has more benefits to the disabled residents than a single approach. Findings from previous studies indicate that the participants derive such benefits as lower level of stress, improved muscle tone, or decreased weight (Wilhite et al., 2012, p. 257). More importantly, the participants learn to interact with people who might not be closely familiar to them (Wilhite et al., 2012, p. 260). Thus, a multifaceted, patient-focused intervention has the potential of significantly improving the clients ’ health outcomes. Research Questions The analysis of various studies reveals that the organization of RT care or activities should involve various activities. RT care planning frameworks should be evidence-based and must provide for opportunities for leisure (Richeson McCullough, 2002). To meet the study’s objectives, this study will involve the following research questions: How should RT professionals organize recreation activities for the disabled residents, while providing opportunities for leisure? How do the RT practitioners perceive recreation activities in residential care settings? Do recreational therapy activities achieve higher patient outcomes than standard practice? Research Methodology This study will use an action research approach to explore the patients’ experiences and RT practitioners’ perceptions regarding the RT activities and leisure opportunities for the disabled. The action research technique facilitates knowledge development a s it allows the researcher to cooperate with the participants in the course of the research (Domholdt, 2005). Action research is used in studies involving human subjects and in real-life situations. It is cyclical and involves observation, brainstorming and self-reflection. To determine the physical activities and leisure opportunities appropriate for the disabled residents, it is important that the participants and the RT practitioners are involved (Navar, 1991). In this study, the experiences of the patient and the perceptions of the practitioners will be used to develop a care plan for the disabled. Thus, through this approach, the research will identify new activities and frameworks of health care delivery for disabled residents in a Geriatric Hospital. A total of 100 participants will be randomly selected from this residential facility. The sample participants will include patients and registered RT practitioners (certified RT practitioners). Data Collection In the proposed stu dy, the main instruments that will be used in data collection will be questionnaires. The questionnaires will aim to identify the perceptions and attitudes of the participants in the RT practice (Domholdt, 2005). Email notifications will be randomly sent to potential participants. Individuals will be included in the sample upon sending a confirmation email. The study will use two sets of questionnaires: (1) participant survey questionnaires; and (2) practitioner survey questionnaires. The core questions in the practitioner survey questionnaires will include: In your view, which RT activities improve the patient outcomes for the disabled? What leisure opportunities are available for the disabled in the care facility? Which set of activities (physical, spiritual and personality/self-esteem) improve the health outcomes of the participants? Does a multifaceted approach help achieve higher treatment outcomes than a single strategy? What advantages does intervention planning for disabled patients have over standard care? On the other hand, the main questions in the patient questionnaire will include: Do the physical activities with RT help improve your health? (Does not help, slightly, to some extent, very helpful) What are your experiences regarding the RT intervention in this facility? (Less helpful, helpful, very helpful) How can you rate the RT intervention services in this facility? (Very poor, poor, good, very good) How can you rate the effectiveness of the intervention? (Not effective, moderately effective, effective and very effective) This study will use the random sampling technique (Domholdt, 2005). Email notification will be sent to potential participants. Only disabled residents in the Geriatric Hospital will participate in this research. The participants, selected through the inclusion criteria mentioned above, will undergo a multifaceted intervention program conducted by certified RT professionals for a period of one month. Their views and the per ceptions of the practitioners about the intervention will be collected using structured questionnaires. Data analysis will involve a qualitative approach. The participants’ responses will be grouped into common themes (Domholdt, 2005). Sub-themes will be drawn from the major themes to further explain the client’s experiences of the RT intervention. The researcher will further analyze the sub-themes to identify the concerns and pressures related to RT practice in geriatric/special care settings. Techniques for Recording and Reporting the Findings The themes identified from the analysis of the participants’ responses will be compared with the patient-focused care (PFC) framework and the researcher’s notes. The RT activities identified will be recorded in the charts. This will guide future intervention planning for the disabled in long-term care facilities. Also, the themes identified from the patients’ responses will be used to develop a patient-focu sed, evidence-based care model that is specific to the organization (Donnelly, 2005). The new RT model will be published in recreational therapy and medical journals. Suggestions for the Future The proposed research will only focus on the residents’ experiences regarding a multi-faceted RT intervention and the RT practitioners’ perceptions about the intervention. A framework for organizing or planning recreational activities and leisure will be developed from the findings of the study. Future studies should focus on evaluation techniques for the new framework. Peer review of the framework will enable the researchers to assess the quality of the research. As Domholdt (2005) suggests, the participants should be involved in the evaluation of the new framework to ensure that the model reflects the actual experiences of the participants. This approach will also increase the RT practitioners’ ability to offer patient-focused care within the Geriatric Hospital setting. Incorporating the views and experiences of the disabled residents is a core element of the patient-focused care that guides recreational therapy practice in clinical care settings. References Buettner, L., Fitzsimmons, S. (2007). Introduction to evidence based recreation therapy. Annual in Therapeutic Recreation, 15(9), 12-19. Cameron, K., Ballantyne, S., Msot, A., Msot, M., Msot, T., Ludwig, F. (2005). Utilization of evidence-based practice of registered occupational therapists.  Occupational Therapy International, 12(3), 123-136. Carter, M.J, Van Andel, G.E., Robb, G.M (2003). Therapeutic Recreation –A practical  Approach. Long Grove, IL: Waveland Press, Inc. Domholdt, E. (2005). Rehabilitation Research-Principles and Applications. St. Louis, Missouri: Elsevier Saunders. Donnelly, W.J. (2005) Patient-centered medical care requires a patient-centered medical record. Academic medicine, 80(1), 33-38. Kinney, J.S., Kinney, T. Witman, J. (2004). Therapeutic recreation m odalities and facilitation techniques: A national study. Annual in Therapeutic Recreation, 13(2), 59-79 Mikhail, C.,Korner-Bitensky, N., Rossignol, M., Dumas, J. (2005). Physical Therapists’ Use of Interventions with High Evidence of Effectiveness in the Management of a Hypothetical Typical Patient With Acute Low Back Pain.  Physical Therapy, 85(11), 1151-1167 Navar, N. (1991). Advancing Therapeutic Recreation Through Quality  Assurance: A Perspective on the Changing Nature of Quality in Therapeutic Recreation. State College, PA: Ventura Publishing, Inc Parker, M.J. (2000). Evidence based case report: Managing an elderly patient with a fractured femur. British Medical Journal, 320(9), 102-103. Richeson, N. (2003). Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia: an evidence-based therapeutic recreation intervention. American Journal of Recreation Therapy, 2(4), 9-16. Richeson, N.E., McCullough, W.T. (2002). An evidence-based animal-assisted therapy protocol and flow sheet for the geriatric recreation therapy practice.  American Journal of Recreation Therapy, 15(4), 241-251. Ross, J.E., Ashton-Shaeffer, M. (2003). Selecting and Designing Intervention  Programs for Outcomes. State College, PA.: Ventura Publishing, Inc. Shank, J., Coyle, C. (2002) Therapeutic recreation in health promotion and  rehabilitation. State College, PA: Venture Publishing. Spring, B. (2007). Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know. Journal of Clinical Psychology, 63(7), 611-631. Stumbo, N.J. (2003). The Importance of Evidence-Based Practice in Therapeutic Recreation. State College, PA: Ventura Publishing, Inc. Townsend, A., Cox, S., Li, L. (2010). Qualitative Research Ethics: Enhancing Evidence-Based Practice in Physical Therapy. Physical Therapy, 90(4), 615-628 Whitman, J.M., Flynn, T.W., Fritz J.M. (2003). Nonsurgical management of patients wi th lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy. Physical Medicine and Rehabilitation. Clinics of North America 14(3), 77-101. Wilhite, B., Biren, G., Spencer, L. (2012). Fitness intervention for adults with developmental disabilities and their caregivers. Therapeutic Recreation Journal, 46(4), 245-267. This assessment on Therapeutic Recreation was written and submitted by user Lesly F. to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here. Therapeutic Recreation Introduction The prader-Willi syndrome results from the deletion or lack of expression of seven of the genes found on chromosome 15. It is as a result of disruptions in the paternal chromosome 15. Disruptions in similar regions of the maternal chromosome result in the Angelman Syndrome (Eiholzer, 2005).Advertising We will write a custom report sample on Therapeutic Recreation – Prader-Willi Syndrome specifically for you for only $16.05 $11/page Learn More People affected by the syndrome and its prevalence The syndrome’s incidence falls between 1out of 10,000 and 1 out of 25000 births that are live. It affects young children, adolescents and even adults. In some cases, it may affect fetuses developing in their mother’s wombs. Children suffering from the syndrome exhibit lethargy, retarded growth and coordination difficulties. They also sleep a lot and often experience difficulties during feeding. Adolescents may become obese and show slowness in development. Adults suffering from the syndrome also exhibit obesity and have a high tendency of suffering from diabetes mellitus (Whittington, Holland, 2004). Relationship to other medical disorders The chromosomal disruptions affect the hypothalamus’s function of regulating appetite. The patients therefore have an extreme appetite that is insatiable and the result is obesity. Raised ghrelin levels are also found in the patients. The elevated ghrelin levels have a direct relationship with the obesity and appetite. Diabetes mellitus is common in the patients. The patients also suffer from anxiety and psychiatric disorders. In some cases, patients get depression, paranoia and hallucinations which mostly result in hospitalization. A major characteristic of the syndrome is hypogonadism. Males have testes that are undescended. The situation may be self rectifying. If this does not happen, replacement of testosterone or surgery may be applied. Females have an adrenarc he that is premature and benign. The treatment used for this condition is the replacement of hormones. Patients of the syndrome exhibit a deficiency in growth hormones and are therefore short in stature (Whittington, Holland, 2004). Historical information and current research conducted Heinrich Willi, Guido Fanconi, Alexis Labhart, Andrea Prader and Andrew Zielger were the first people to explain the Prader -Willi Syndrome. This was done in the year 1956. It has been found that over 400, 000 people worldwide have the syndrome and this is a significantly large number.Advertising Looking for report on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Research has been extremely useful in the diagnosis of the syndrome. This is done by carrying out tests of a genetic nature on the patients. Research has aided in the prevention of erroneous diagnosis because the symptoms of the Prader – Willi syndrome closely resemble those of Down syndrome. Although there is no known cure for the Prader Willi syndrome, various treatments are being used to deal with the symptoms exhibited by patients of the syndrome. These include therapies for improved speech and muscular tone in infants, injection of growth hormones to support growth and reduce the rate at which the patients gain weight. Research has also shown that machines can be used for proper passage of air in the respiratory tracts of extremely obese patients when they sleep (Eiholzer, 2005). Significance of the syndrome in the recreation and leisure field There are specific programs that have been implemented to ensure that patients suffering from the syndrome are well accommodated in the recreation and leisure field. These programs ensure the safety of patients. They also ensure that the patients are able to live a full life without feeling discriminated against. Such programs create forums for parents to voice their concerns during meetings. Families are ab le to share what they are going through and support each other by encouraging talk and sharing ideas on how to improve the life and health of patients. Where patients have retarded coordination, therapists are availed to assist. These facilities are able to exhibit professionalism as a result of proper management and leadership. The facilities are important as they ensure that the society lives in harmony without discrimination, regardless of the conditions that the various people are suffering from (Whittington, Holland, 2004). Conclusion There is a significant number of people suffering from the Prader – Willi syndrome and it is therefore necessary to ensure that their lives are protected. This is achieved by taking them for treatment and helping them to live as normally as they can (Eiholzer, 2005). References Eiholzer, U. (2005). Prader-willi syndrome: Coping with the disease – Living with those involved. Switzerland, S. Karger AG.Advertising We will write a custom report sample on Therapeutic Recreation – Prader-Willi Syndrome specifically for you for only $16.05 $11/page Learn More Whittington, J., Holland, T. (2004). Prada –willi syndrome: Development and manifestations. New York, Cambridge University Press. This report on Therapeutic Recreation – Prader-Willi Syndrome was written and submitted by user Makhi Steele to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

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Acute upper respiratory infections (ARI) are one among the important causes of death in all age groups especially in children below 1 year of age. It has been estimated that 2.2 million deaths are due to Acute upper respiratory infections (ARI) throughout the world. ARI accounts for 13 -20% mortality during first year of life and in child hood in India (Registrar generals published figures). It is estimated 630,000 deaths occurred due to acute upper respiratory infection annually among pre-school age group. The magnitude of ARI morbidity and its impact on health services can be measured by the proportion of outpatient attendance due to ARI. As high as 20 40% of children brought to outpatient department and 12 -35% of children admitted to hospital have ARI. There is a need to undertake periodic surveys in various parts of the country to determine the incidence of ARI associated morbidity and mortality in children in order to plan organize and evaluate the health services. The government of India in its policy document of health for all by 2000 A.D recommends the ARI control program me to reduce infant and pre-school child mortality. (Tambe MP, Shivaram.C, Chandrashekhar.Y. Acute upper respiratory infection in children a survey I the rural community, 1999). The symptoms of acute upper respiratory tract infection include rhinitis, pharngitis/ tonsillitis often referred to as a common cold and their complications sinusitis, ear infection, laryngitis and sometimes bronchitis. Symptoms of upper respiratory tract infection are cough, sore throat, runny nose, nasal congestion, headache, low grade fever, facial pressure and sneezing. Onset of the symptoms usually begins 1 3 days after the exposure to a microbial pathogen. The duration of illness lasts for 7 -10 days. (WIKipedia, the free encyclopedia 2000). Acute respiratory infections (ARIs) also includes pneumonia, influenza, and respiratory syncytial virus (RSV), causes 4.25 million deaths every year. ARIs accounts for third largest causes of mortality in the world and the top killer in low and middle-income countries. Acute upper respiratory infection causes at least 6 percentages of the worlds disability and death. These deaths occur mainly in the worlds poorest countries, where the drives of acute upper respiratory infection, includes malnutrition, pollution, overcrowding, and tobacco use. The death due to pneumonia is 215 times higher in low-income countries 3 million to 5 million people suffer from flu every year The most common source of respiratory illness in children is Respiratory Syncitial Virus. Acute upper respiratory infection affects people infected with HIV. The main cause for 20 percent to 40 percent of all hospitalizations in childhood is due to Acute Respiratory Infection. Pneumonia causes 20 percent of all pediatric deaths around the world -1.6 million in 2008, and, 732,000 children die from malaria and 200,000 from HIV/ AIDS every year. Respiratory Syncitial Virus kills at least 66,000 children every year. (Acute respiratory infections Atlas 2010). Researchers from the universita delgi reported that bacteria in the mouth offer probiotic potential against upper respiratory tract infections. There is only a minimal understanding of internal communication between human hosts and their microbes is available,it is of an idea that probiotics are live microorganism which promote health within their host. The benefits of probiotics are predominantly explored so far in the intestinal tract; but,few studies suggest probiotics also promote wellness in the stomach, vaginal tract, skin and mouth. The leading cause of visits to the pediatrician is due to upper respiratory infection in children between the ages of 5 and 12. The main cause for upper respiratory infection is Streptococcus pyogenes and the only treatment available at present is antibiotics, where it prescription rates are running up to 90 percent. Bacteria from the mouths of healthy volunteers were isolated and identified two potential probiotic bacterial strains named Streptococcus salivarius RS1 an ST3. The recently developed oral probiotic prototype and these two strains bound to human pharyngeal cells and responsibe for antagonizing of S. Pyogenes adhesion and growth. Additionally, all these strains were sensitive to antibiotics which are used routinely for treating upper respiratory tract infection. Only about 1 percent of development funding was spent on research on Acute Respiratory Infection in 2007, than the amount spent on HIV related research. Some of the low-cost strategies are available which can be implemented immediately whereas,others require longer term efforts. The strategies mentioned are: Effective distribution of nutritional supplements, vaccination programs, Dissemination of knowledge by public awareness campaigns, Tobacco use to be reduced. Identifying efficient ways to produce vaccines and the distribution need to be strengthened. (Acute respiratory infections Atlas 2010). The supportive therapy of sore throat is gargling with lukewarm saline solution, steam in inhalation, not forcing the child to eat and giving frequent small amount of warm liquid. Tulsi or the loly basil is one of the most common herbs used in cough related remedies. It maintains the health of the throat chest and lungs. In fact, it helps to protect the entire respiratory tract. NEED FOR THE STUDY Literature highlights are increasing incidence of ARI as a major health problem for under five children and health experts advocate alternative therapies like lukewarm saline solution, steam inhalation to treat ARI rather than medication alone. A survey conducted in the rural community regarding respiratory tract infections says that the delay in receiving medical care is considered to learn important reason for the high mortality related to acute respiratory infections in the developing countries. Far distance of the hospital was the main reason for not receding treatment followed by ignorance, family problems etc. Those reasons may force the parents to seek treatment from other alternate resources. The rural medical practitioners are often not institutionally qualified and hence are frequently not able to select and use appropriate antibiotics in adequate dosage for proper duration for the treatment of acute respiratory infections, making the outcome unfavorable in many children. Sensitive use of antibiotics can decrease the adverse effects of it and also the costs spent towards it. Decreased antibiotic usage benefits the patient by reducing the rise of drug resistant bacteria, which is now concerned as a problem in the world nowadays. Health authorities are encouraging physicians to reduce the prescription of antibiotic to treat common Upper Respiratory Infection due to above reasons. (National Center for health statistics 2008) Upper respiratory tract infections (URIs) accounts significant health burden among children.An average child suffers from six to eight attacks of colds each year, where, each attack lasts for seven to nine days. While children are frequently given drugs such as antihistamines, cough suppressants and decongestants, to reduce symptoms, there is no such effectiveness by these medications among children younger than 12 years. The drugs which prescribed for respiratory tract infections are antibiotics, all these antibiotics are not providing much protection against respiratory infections which in turn becomes a sign of future asthma. This again becomes difficulty to attribute antibiotic use in case of asthma. (Anita Kozyrskyj, PhD, University of Manitoba, Winnipeg, MB 2010). When young children affected with both respiratory and non respiratory infections, the antibiotic is the one which is being prescribed frequently. (Mark J.Rosen, MD, FCCP, President, American college of chest Physicians 2010).These physicians came with the conclusion that better decisions for treatment option for respiratory infection can be made only if physicians understand clearly the relationship between asthma and antibiotic use. Tulsi has an important role to play in treating the symptoms of respiratory tract diseases. It acts regularly on phlegm hence it works as a good expectorant giving relief from wet cough. It helps to fight the cause of allergy by which our respiratory tract gets inflamed and then resolves the causative agent. It is anti-inflammatory. It promotes optimum respiratory support. It is an excellent remedy for sore throat and fever. The investigator during her clinical exposure in the community observed that 50% of the under five population is suffering from acute upper respiratory infections. The investigator observed that mothers with under five (child affected with AURI) seeking medical treatment only in case when AURI becomes severe. Mothers in this community ignoring treatment when their children affected with mild AURI and also they are unaware about home remedy for treating the symptoms of AURI. The investigator also identified that reason for seeking treatment only in the severe AURI by the mothers with under five is due to far distance of the health care facilities and also due to poor transportation facilities. And even if mothers seek medical treatment, antibiotics are being prescribed and it is not advisable as per study conducted by (National centre for health statistics 2008). So, the investigator found it is useful to a conduct a research in this community to find the effectiveness to Tulsi on upper respiratory tract infection among under five with upper respiratory infection, where this herb is commonly available and is of no cost. STATEMENT OF THE STUDY A study to assess the effectiveness of steam inhalation with Tulsi leaves on signs and symptoms and behavioral responses of children aged 6 months to 2 years with acute upper respiratory infection at home in a rural community, Coimbatore. AIM OF THE STUDY The aim of the study was to assess whether there was a reduction in the signs and symptoms of acute upper respiratory infection and changes in behavioral responses of the children who received steam inhalation compared to children who did not receive steam inhalation. SPECIFIC OBJECTIVES To assess and compare the degree of acute upper respiratory infection in experimental and control group after intervention. To assess and compare the behavioral responses of children with acute upper respiratory infection in experimental and control group after intervention. To find out the mothers views about steam inhalation with Tulsi leaves. To find out the association between the degree of acute upper respiratory infection demographic variables (Age, sex, immunization status, education of mother, total income of the family). HYPOTHESIS H1 There will be a significant difference in the degree of acute upper respiratory infection between the experimental and control group after intervention. H2 there will be a significant difference in the behavioral responses between experimental and control group after intervention. OPERATIONAL DEFINITION Effectiveness Producing the desired or intended result which is the reduction of symptoms of mild and moderate acute upper respiratory infection and duration of the infection. Steam inhalation with Tulsi 1 liter of water is boiled in a wide mounted receptacle and Tulsi leaves are added to it. The steam coming out of it is breathed by the child while mother is sitting in front of the steam holding the child with head covered. Signs Changes which are observed by the researcher with naked eyes. Symptoms Changes that are noticed by the mother and reported on asking Behavioral responses The reaction of the child in terms of activities such as smiling, walking, running, eating and playing. Acute upper respiratory tract infection (AURI) It is inflammation of the upper respiratory tract involving nose, pharynx and tonsils and manifesting signs and symptoms like runny nose, sneezing, tearing eyes, itching of the nose, pink and shiny nasal mucosa, red and swollen throat, cough, fever and fatigue. Based on the signs and symptoms, AURI is classified as mild moderate and severe AURI. In mild AURI. The symptoms are runny nose, sneezing, tearing eyes, itching of the nose, pink and shiny nasal mucosa, and presence of crusts on the nose and fever. In moderate ARUI, the symptoms are red swollen throat, cough along with the symptoms of mild AURI. In severe AURI, the symptoms are inflamed and enlarged tonsils, pus within the fold of the tonsils, pain during swallowing and pain in the symptoms of mild and moderate AURI. ASSUMPTIONS Acute upper respiratory infections are very common among under five children in urban and rural community. Mothers follow certain home remedies like application of Vicks and Camphor over chest, over head and nose and administration of milk with turmeric and pepper and sugar. Caring children with respiratory infection home in the community is influenced by personal and socio-cultural factors. Children with acute upper respiratory infection mostly treated at home with home remedies which varies from one community to another DELIMITATION The study is delimited to children aged 6months to 2 years The study is delimited to children suffering from mild to moderate acute upper respiratory infections. SCOPE OF THE STUDY The degree of AURI, duration of infection and behavioral response are assessed in AURI children before and after intervention. If there is a significant reduction in the degree, duration and changes in the behavioral responses of experimental group of sample, then it is the clear indication effectiveness of steam inhalation with Tulsi leaves. Teaching steam inhalation is very simple and it can be practiced very easily. If the mothers are able to administer the steam inhalation with Tulsi for their infected children without any difficulties, and if this intervention is acceptable it is clearly indicate the utility value of Tulsi leaves for acute upper respiratory tract infection children. The findings will be beneficial to health practices to motivate mothers with AURI infected children and to promote health life. Conceptual framework A conceptual model can be defined as a set of concepts and those assumptions that integrate them into a meaningful configuration (Fewett, 1980). The development of a concept model is a fundamental process required before conducting actual research. The frame work influence each state of research process. The conceptual framework in nursing research can help to provide a clear concise idea of knowledge in the area. Conceptual framework for this study nursing process model based on Dorothy E.Johnsons Behavioral system theory (1980). According to Johnson, nursing views the individual as a set of interconnected or inter-dependent parts functioning as a integrated whole. Johnson identified seven subsystems. The subsystems are affiliation, aggressive, dependency, eliminative, ingestive, restorative, and sexual. The subsystems carry out special function for the system as a whole. Disturbance in any of the subsystem usually affects the other. The steps of the nursing process in incorporated with the Dorothy Johnsons Behavioral system model. Nursing process is a deliberate activity where the proactive of nursing is performed in a systematic order. Dorothy Johnsons presents a three step nursing process, the steps are entitled nursing diagnosis which parallel the assessment and diagnosis phase, the second step nursing goal equal to the implementation and third step is evaluation. This study focused on children and the dependency system which is one among the subsystems which result in approval, attention, recognition, and physical assistance. ASSESSMENT Assessment is the process of collecting data regarding each subsystem. In this study, the assessment was done in the dependency subsystem. Data on demographic profile (age, sex, immunization status, education of the mother, income of the family) was collected. The children were examined for signs and symptoms of acute upper respiratory infection and behavior responses of the children were collected by interviewing the childrens mother. DIAGNOSIS Through assessment from the subsystem problems are identified and diagnosis is made and it provides basis for nursing intervention. In this study the data collected through observation and interview using interview schedule and observation checklist was analyzed the diagnosis is made on acute upper respiratory infection and categorized into mild, moderate and no infection. NURSING GOALS (PLANNING) After diagnosis is made the goal is to maintain or restore the persons behavioral system balance and stability through planning interventions. In this study, the goal was to reduce the degree acute upper respiratory infection and to restore the high level of activity (behavioral responses). In this study the planning occurs when the children and a nurse identify activities and bring about dependency system equilibrium. INTERVENTION Nursing activity as an external regulatory force assists the equilibrium. Based on the diagnosis, nursing actions and intervention can be planned in terms of teaching, external control or providing responses needed by the client. In this study, the nursing activity was the administration of steam inhalation therapy with Tulsi leaves the children in the experimental group for a period of time brings about change in the degree of acute upper respiratory infection. EVALUATION Evaluation refers to checking the subsystems identified as problematic for balance and overall system stability. In this study, the investigator compared the degree of acute upper respiratory infection of the experimental group children with the control group by using criteria and evaluated the effectiveness of the intervention by observing the signs and symptoms of infection and the report given by mothers of the children. Figure 1 Highlights the conceptual framework on modified nursing process based on Dorothy Johnsons Behavioral system model.

Observations on Emersons Self-Reliance :: Emersons Self Reliance Essays

Observations on Self-Reliance "Nothing can bring you peace but yourself. Nothing can bring you peace but the triumph of principles ." This quotation forms the closing two lines of Ralph Waldo Emerson's "Self Reliance". I am greatly enlightened by his ideas in this article. "Trust thyself" was his advice and many Americans listened. They not only listened in Emerson's lifetime, but his individualistic concepts have reverberated up to the present time. After reading the ideas expressed in "Self-Reliance", I have come to believe that self-reliance is the most important factor in my life. Emerson believes that a man should not be what he is not. "There is a time in every man's education when he arrives at the conviction that envy is ignorance; that imitation is suicide." If a man is envious of other people, he will ignore all merits of himself. If a man imitates other people, he will lose his identity - like suicide. It is common to find a woman like me envious of other people. I am jealous if a girl in the class is more beautiful than I. I am jealous if a classmate gets a higher score on tests. I am jealous if my neighbor has a better car. But as I always find out, when I praise the girl, people will say "you are beautiful, too"; when I praise the classmate, people will say "remember you got a higher score last time"; when I praise the car of the neighbor, people will say "he spent money that he did not have". There is always a "the better side" of myself, which I cannot see because it is hindered by my own jealousy. Imitation is the result of jealousy. When I was in high school, I tried to imitate a girl in my class because I thought she was pretty cool. I bought the same dress, the same shoes, had the same hair style, and tried to act the same way. After one month, I was considered the least cool person in the class. I did not get what I wanted, but instead, lost what I had already had. I was born in a Christian Chinese family in Beijing, China. Under the strict rules of my mother, I began learning piano and Kung-fu when I was six, and many other things other children did not learn. From then on, I was always told to be the best, and I always thought I was the best. Observations on Emerson's Self-Reliance :: Emerson's Self Reliance Essays Observations on Self-Reliance "Nothing can bring you peace but yourself. Nothing can bring you peace but the triumph of principles ." This quotation forms the closing two lines of Ralph Waldo Emerson's "Self Reliance". I am greatly enlightened by his ideas in this article. "Trust thyself" was his advice and many Americans listened. They not only listened in Emerson's lifetime, but his individualistic concepts have reverberated up to the present time. After reading the ideas expressed in "Self-Reliance", I have come to believe that self-reliance is the most important factor in my life. Emerson believes that a man should not be what he is not. "There is a time in every man's education when he arrives at the conviction that envy is ignorance; that imitation is suicide." If a man is envious of other people, he will ignore all merits of himself. If a man imitates other people, he will lose his identity - like suicide. It is common to find a woman like me envious of other people. I am jealous if a girl in the class is more beautiful than I. I am jealous if a classmate gets a higher score on tests. I am jealous if my neighbor has a better car. But as I always find out, when I praise the girl, people will say "you are beautiful, too"; when I praise the classmate, people will say "remember you got a higher score last time"; when I praise the car of the neighbor, people will say "he spent money that he did not have". There is always a "the better side" of myself, which I cannot see because it is hindered by my own jealousy. Imitation is the result of jealousy. When I was in high school, I tried to imitate a girl in my class because I thought she was pretty cool. I bought the same dress, the same shoes, had the same hair style, and tried to act the same way. After one month, I was considered the least cool person in the class. I did not get what I wanted, but instead, lost what I had already had. I was born in a Christian Chinese family in Beijing, China. Under the strict rules of my mother, I began learning piano and Kung-fu when I was six, and many other things other children did not learn. From then on, I was always told to be the best, and I always thought I was the best.