Reducing Adverse Drug Events in Older Adults

Reducing Adverse Drug Events in Older Adults Gabrielle S. Buma With age comes the prospect of multiple health problems that may require treatment with several medications and multiple prescribers. The likelihood of morbidities and comorbidities such as, heart disease, arthritis, diabetes, and hypertension increases with age. Many older adults also take over the counter medications, vitamins, and other supplements along with their prescribed medications. The use of these multiple kinds of medications is called polypharmacy, and if done so correctly the use of multiple medications can have positive results in the treatment and maintenance of disease but if not used correctly the drugs could be less effective and result in expensive drug-related morbidity and mortality. The Agency for Healthcare Research and Quality claim that more than 770,000 people are injured or die each year from Adverse Drug Effects (ADEs) (Lynn, 2012). What makes this even more of a concern is that many experts believe that ADEs are significantly underreported. According to the Journal of the American Geriatrics Society, the annual cost associated with drug-related morbidity and mortality has been estimated to be at around $177 billion (Roth, Weinberger Campbell, 2009). Many factors play a role in the quality medication use in older adults; these factors can be considered overuse, underuse, and misuse. The misuse of medication that leads to adverse drug effects in older adults can be greatly reduced by improving health literacy and prescribing physician and patient communication. According to the Institute of Medicine, health literacy is considered an individual’s capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Martin, Kripalani, DuRapau, 2013). Currently in the United States, the older adults that are 65 years and older represent the largest group with the lowest general literacy and health literacy skills in the country (Bennett, Chen, Soroui White, 2009). This means that there is a large portion of the older adults over 65 that are making health decisions with the likelihood of not fully understanding them. Older adults over 65 years of age also have the highest rate of chronic illness of any other age group. The combination of low levels of literacy and high prevalence of multiple chronic conditions with multiple medications are major contributing factors to the high rate of ADEs in older adults. The article, Preventing Medication Errors, in the Institute of Medicine c ited that poor patient comprehension and unintentional misuse of prescription drugs as a significant cause for medication error and worse health outcomes (Martin, Kripalani, DuRapau, 2013). Many older adults are simply accidentally misusing prescribed medications due to a low level of health literacy. Low literacy in older adults and Medicare recipients affects their understanding of complex medication labels, instructions, and regimens (Martin, Kripalani, DuRapau, 2013). A way to improve older adult’s understanding of prescription drugs especially among those with limited literacy is greatly needed to prevent unintentional use that lead to AEDs, before the improvement can be made we need to first understand the factors associated with patients understanding of prescription drugs and their labeling. According to the National Assessment of Adult Literacy, adults who are socioeconomically disadvantaged that are a part of minority groups are more likely to be in poorer health (Davis, Wolf, Bass, Middlebrooks, Kennen, Baker, . . . . Parker, 2006 ). In the study, Low Literacy Impairs Comprehension of Prescription Drug Warning Labels, the authors measured a group of 251 adult’s ability to correctly interpret commonly used prescription medication labels. They measured the participant’s health literacy by having an expert panel evaluating the patient’s interpretation of the commonly used prescription medication labels. The results showed that one-third of patients were reading at or below a 6th grade level and that a patient’s comprehension of warning labels was associated with their level of literacy. The result that low literacy is associated with low comprehension and a difficulty understanding of warning labels on prescription medications is not a surpris e because the labels use terminology about a 6th grade reading level (Davis, Wolf, Bass, Middlebrooks, Kennen, Baker, . . . . Parker, 2006 ). The multistep instructions were found difficult for patients across all literacy levels. I found it surprising that the multistep instructions were difficult for all reading levels, but the study explains that the more steps a labels has the less concise and clear it tends to be to the patient. If the multistep instructions are a challenge for all literacy levels to understand then I would assume that it is quite challenging for a large population of the older adults who tend to have the lowest levels of literacy and so many different medications to keep track of with each having multistep directions. The study did offer recommendations that would help the understanding of medication labels for all literacy levels. These recommendations include; warning labels being developed with consumer participation, especially with lower literate populations, attempt to keep the steps short, clear and concise with familiar words and recognizable icons. After reading this study, I was surprised to learn that more prescription drug labels are not developed with the use of consumer participation, one would assume the in the developing of the instructions that it would be a priority to develop the instructions with consumer participation. It seems that more consumer participation with all health literacy levels would help create more user friendly labels that could result in a significant decrease in misuse of prescription drugs. The study, Improving Medication Management among At-risk Older Adults, evaluates health literacy but also medication self-efficacy and medication adherence. One reference in the study shows an alarming 54.3% of Medicare enrollees with limited health literacy were unable to understand what is considered simple medication instructions such as. â€Å"take on an empty stomach, † (Martin, Kripalani, DuRapau, 2013). The study describes a quality improvement pilot project where they provide at-risk older adults with illustrated medication instructions as an approach to improve medication understating use. In the quality improvement pilot project they evaluated the effect of their intervention on the older adult’s confidence in managing their medication and their self-reported adherence. This study, Improving Medication Management among At-risk Older Adults, took place at an adult day center were medication errors and misunderstanding medication instructions were identified as a problem. The authors and staff provided the adult day care center’s participants with illustrated depiction of their daily schedule PictureRxâ„ ¢ with the goal to improve the older adult’s understanding of medication instructions and improve medication safety. The illustrated aid shows the older adult’s medications pictorially, uses what they consider plain language for the instructions, and uses icons to aid patients in understanding the purpose and the dosing schedule (Martin, Kripalani, DuRapau, 2013). The PictureRx cards were used for six weeks and then the participants were surveyed along with reassessing their self-efficacy and adherence, as well as their perception on the PictureRx cards. The results showed that after the use of the PictureRx cards the participants reported much less forms of non-adherence and confidence significantly improved in areas of self-efficacy, such as correctly taking medications and following a routine. This article provides a valuable assessment of older adult’s health literacy and applies an intervention that resulted in an improved adherence and self-efficacy in older adults. When comparing the participant assessment before for the use of PictureRx and then the reassessment after shows a notably significant improvement. This pilot study shows an efficient way to improve older adult’s various health literacy levels and provides them with a way to better understand their overall medication regimens. I think something very similar to the PictureRx would be a great tool to implement for pharmacists when filling medications for older adults at the pharmacy and can provide a good reference for doctors when explaining medications to patients especially since doctors are so limited on the amount of time they can spend with a patient. Proper patient provider communication plays a huge role in a patient’s ability to understand their medications and ability to properly follow their medication regimes. Good communication about health history and medications with a provider and a patient could prevent the misuse of medication and an ADE. Before prescribing a new medication, the prescribing doctor is supposed to review the patient’s current medications, including over the counter medications, vitamins, supplements, and the patient’s health history. The article, Physician Communication When Prescribing New Medications from the Archives of Internal Medicine recommends that prescribing physicians should educate their patients about their medication’s purpose, how and when to take it, and the medications expected adverse effects. The patient and physician interaction is an opportunity for the physician to educate the patient on these topics which may reduce nonadherence that can be a result from poor understanding about medication use. The article also describes and assesses the quality of physician communication with patients about newly prescribed medications. The authors assess the provider’s communication through an observational study that combined patient and physician surveys and audiotaped 860 of the 909 participating patients while 270 new medications were prescribed (Tarn, Heritage, Hays Kravitz, 2006). During these visits the authors measured the quality of physician communication when prescribing new medications. The study by Tarn, Heritage, Hays, and Kravitz found that physicians stated full medication dosing directions for less than 60% of all of the medications that had been prescribed and informed the patients about the duration intake and ADEs for one third of the time. The study shares that ADEs were addressed for 35% of the medications and how long to take the medication was addressed at 34%. Although patients may be able to find information about their medications from different sources such as, a pharmacists and medication package inserts, information from their visits with the prescribing physician is inadequate to meet the patient’s needs. Conclusion The study found that the use of precise wording on prescription drug label instructions can improve patient understanding of how to take the medication patients with limited literacy were more likely to misinterpret instructions despite use of more explicit language Patients that have a limited literacy rate and those who are taking more medications are at a greater risk for misuse. Reference Page Davis, T. C., Federman, A. D., Wolf, M. S. (2009). Improving patient understanding of prescription drug label instructions. Journal of General Internal Medicine, 24(1), 57- Davis, T., Wolf, M., Bass, P., Middlebrooks, M., Kennen, E., Baker, D., . . . . Parker, R. (2006). Low literacy impairs comprehension of prescription drug warning labels. Journal of General Internal Medicine, 21(8), 847-851. Martin, D., Kripalani, S., DuRapau, J. (2012). Improving medication management among at-risk older adults. Journal of Gerontological Nursing, 38(6), 24-34. Roth, M., Weinberger, M., Campbell, W. (2009). Measuring the quality of medication use in older adults.Journal of the American Geriatrics Society,57(6), 1096-1102. Tarn, D. M., Heritage, J., Paterniti, D. A., Hays, R. D., Kravitz, R. L. (2006). Physician communication when prescribing new medications . Archive of Internal Medicine, 166(17), 1855-1862.

Women in Nation Building

Women’s participation in nation-building is an important ingredient in achieving an equitable, peaceful and more prosperous society. Gender equity and women’s inclusion play a central role both as a litmus test and as an active variable shaping a more democratic, stabilized and developed society. To enhance the results of nation-building, the study suggests that nations should place a greater emphasis on the broader concept of human security from the earliest phase of nation-building efforts. In addition, leaders should establish governance based on principles of equity and consistent rule of law, and should include women in the earliest economic reconstruction activities. Women play a special role in the overall development of the country. â€Å"There is no chance for the welfare of the world unless the condition of women is improved. It is not possible for a bird to fly on only one wing. † â€Å"woman is the builder and moulder of a nation’s destiny, though delicate and soft as lily, she has a heart, stronger and bolder than that of man, she is the supreme inspiration for man’s onward march. Today the educated women have come out of their inferiority complex and are shouldering all kinds of responsibilities, as Managers, officers, TV and radio news reader, pilots, Ministers, Anchors, Musicians, Clerks, Stenographers, and what not? state is a â€Å"union of families and villages†. Family is the basic unit of society, which is the foundation o f state itself. Happy families create a healthy society and healthy society is a pre-requisite of strong political order in democratic societies. A woman is an architect of society. She establishes the institution of family life, builds the home, brings up the children and makes them good citizens. Her strength in totality contributes in the making of an ideal family, ideal society and an ideal state. It has become essential for women to be politically empowered to achieve socio-economic justice. It has rightly been said who holds the purse holds the nation. As the women are better half of the nation, they deserve better share in political power. The male-dominated political parties and legislatures in the country do not bear with their equal number in epresentative institutions. What we lack is â€Å"political will† to understand the importance of women's role in nation building and all avenues open to them to get political power. MEN Should realize the power of women,And women should also realize their power too,what they can do for them,for their family,for their nation. They are the building blocks of nation building,In the words of Martin Luthar KIng ,†A mother's place is inside her home,But she should also make certain,she gets outside that home enough to help worth while crusades and actively mould the country her children will live in. She therefore holds a key position and her role in shaping the fate of the nation must be recognized and respected. This we see that a woman occupies a vital position in family,society and it is time we recognised and respected her ability. They should not search for the role models but try themselves to be role models in politics. It would be of no use giving equal share in parental property unless the social set-up is changed. That can be changed only by sincere implementation of laws made for women. A woman is shakti, the natural energy. The most ancient scriptures say that without the female power, it is not possible for humankind to survive. The female power has been the force behind all the great leaders of the world. Therefore, they must be politically empowered. The writing is on the wall – the hand that rocks the cradle is the hand that rules the world. OUR WOMEN have a great part to play in the progress of our country, as the mental and physical contact of women with life is much more lasting and comprehensive than that of men. For nothing was it said, â€Å"The hand that rocks the cradle rules the world†. In the apron string of women is hidden the revolutionary energy, which can establish paradise on this earth. Woman is the magnificent creation of god, a multi faceted personality with the power of benevolence, adjustability, integrity and tolerance. She is companion of man, gifted with equal mental faculty, a protector and provider, the embodiment of love and affection. The role given to women in a society is a measuring rod and true index of its civilisation and cultural attainment.

Essay about Book Review on “Where We Stand Class Matters”

Akiba-zemi (GSP490 F12-S13) Book Review 1 Yukimi Ouchi January 7, 2013 Book Review on â€Å"Where We Stand: Class Matters† In her book Where We Stand: Class Matters, Bell Hooks address the issues of classism interlocking with racism, white supremacist ideology and sexism in contemporary American culture. Her arguments in this book are greatly tied to her personal experience that she moved up from working class to the upper class as she succeeds in academic life and writing many books. Through this book, the most important point she puts emphasis on is the acknowledgment of the complex interlocking of classism, racism and sexism. Bell Hooks is not a poor working-class any more,†¦show more content†¦As far as she describes, she just enjoyed living with grandparents and she says that the lure of life was everywhere and in everything, but no one in the crowded house had a regular job or social security number, and no one talked about class even if they were open about money. Hooks personal memories tell me that poor people ar e afraid to talk about class because to be poor in the U.S. was to be an object of shame and ridicule, and because they were afraid to face the reality that makes them feel miserable, unpleasant, and unsecured. And the most importantly, most of them are not really conscious about how classism affects and exploits them. On the other hand, according to Hooks privileged (mostly white) people do not want to talk about class because they do not really want to change. Hooks says Citizens in the middle who live comfortable lives, luxurious lives in relation to the rest of the world, often fear that challenging classism will be their downfall, that simply by expressing concern for the poor they will end up like them, lacking the necessities of life. We can see the widening gap between rich and poor and more and more class-segregated society in the U.S. today, but this appears rather favorable circumstance for the privileged people with class power. I came to realize that whites of all class backgrounds seek to keep underprivileged non-white people in subordination to maintain their own class status. Hooks interprets it the victimsShow MoreRelatedAnalysis Of Christopher Doob s The First Edition Of Social Inequality And Social Stratification 1119 Words   |  5 PagesThe author structures this book in the direction towards a theoretical concept that attracts the reality of social inequality and stratification as a whole. Doob dissects this books into eleven chapters given that each chapter examines the inequality of stratification. Also during the readings of this book Doob used plenty of data to show the socioeconomic strata revolved around the history of America. 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homosexuality a mental disorder - 4366 Words

HOMOSEXUALITY: A MENTAL DISORDER? A Term Paper Presented to Trexie O. Alawi College of Arts and Sciences SURIGAO DEL SUR STATE UNIVERSITY Tandag City, Surigao del Sur In Partial Fulfilment Of the Requirements of the Course English 102 (Writing in the Discipline): TTH 7:30 – 9:00 a.m. 2nd Semester, AY 2013-2014 By Bruce Franklyn G. Aliguay February 2014 Homosexuality: a mental disorder? Thesis Statement: People should know that, homosexuality is a normal aspect of human sexuality and should not be considered a mental disorder. OUTLINE I. What is homosexuality? II. Origin and nature of homosexuality A. Glandular disturbance B. Genetic causes C.†¦show more content†¦The term gay is used predominantly to refer to self-identified homosexuals of either sex. Lesbian is a gender-specific term that is only used for self-identified homosexual females. Dr. Vincent Berger added that, Gay in modern usage usually refers to homosexual men or women. Gay sometimes also refers to the culture of homosexual men and women (as in gay history), to things perceived by others to be typical of gay people (as in gay music), or to same-sex more generally (as in gay marriage). Most people consider gay and homosexual to be synonyms. Note that while Gay applies to men and women equally, the term lesbian is gender-specific and is used exclusively to describe homosexual women. There is no corresponding word for gay men. According to Sanchez and Agpaoa, (2009) homosexuality on the other hand is the generic term used to denote sexual responsiveness to members of the same sex. Although more often used to describe erotic attachment among men, it is also technically encompasses female-female or lesbian relationships. While homosexuality is practiced in a variety of ways, it is not the activity itself that earns the label of deviance but the choice of sexual objects. Based on Salcedo, et al., (1999) Many common terms are used to designate the homosexuals like gays, queer, queenie, becky, bakla, bayot for males and for women, tomboy, binalalaki, T-boom, Tumbalats, and lesbian, etc. Origin and Nature ofShow MoreRelatedIs Homosexuality A Mental Disorder?1500 Words   |  6 PagesHomosexuality has been one of the most controversial subjects around the world for thousands of years. Being a homosexual has been seen as taboo, morally wrong, and just abnormal. Scientists have questioned the mental health status of those who proclaim themselves as being homosexual, and have even gone as far to say that homosexuality is a mental disorder. Until 1974, being homosexual was deemed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a mental illness, and classifiedRead MoreHomosexuality As A Mental Disorder1325 Words   |  6 Pagesorientation. 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Essay about Animal Rights Working to Help Reduce the...

Working to Help Reduce the Numbers Not many people can resist a puppy or kitten, how cute and cuddley they are. Everytime I see one I just want to take it home with me. I have 3 cats, all rescues, 2 from adoption event sponsored by PetSmart and the othe was only with me until I could find her a good home. That was almost 3 years ago. Not every animal is lucky enough to have nice, warm, loving home or get adopted into one. The numbers are staggering. Having recently moving almost directly in middle of what I learned to be an undocumented feral cat colony, it breaks my heart seeing so many hungry and scared cat and kittens every night living in such heartbreaking conditions. With kitten season rapidly approaching, the numbers again are†¦show more content†¦Female cats can deliver up to four litters per year, for an annual average of 20 kittens per cat -- or 3 million valleywide, doing the math not only gave me a headache, it also made me realize that this is becoming an epidemic and started doing some research into this. With the overpopulation and overcrowding at our Las Vegas Animal Shelters, ordinances were adopted in November of 2009 and went into effect in April of 2010 requiring most dogs and cats be spayed or nuertered by 4-6 months old. Within just a year of its passing into law, 520 animals were spayed or nuetered and returned to their owners compared to just 9 animals the year prior. That is a 5700% increase. With other ordinances being passed as one in 2012, allowing feral cat care-taking to be allowed by outside agencies and community care-takers, allowing for these organizations to step in and start making a difference in reducing the numbers, not just for the sad fact of so many strays without homes but for the safety and health issues it causes within the cat as well as human community. The usual method adopted by these organizations is to trap and release, which traps strays within the colony and nueters the males, tags the ears and releases them back into their area. Sponsors of feral cat communities are in effort responsible for the care and feeding of these colonies.Show MoreRelatedAnimal Rights : Animal Or Its Organs And Tissues Are Used1335 Words   |  6 Pagesthe experimental procedures, either a whole animal or its organs and tissues are used. For this purpose animals are euthanized (killed) by established methods. Many times, the animals surviving the clinical testing are euthanized at the end of an experiment to avoid the later pain and distress (Rusche, 2003). In some cases (for example in LD 50 analysis) animals die as a result of the experiment. The pain, distress and death experienced by the animals during scientific experiments have been a debatingRead MoreNo-Kill Shelter Essay1748 Words   |  7 Pagesoverpopulation, it right to kill animals simply because they are not wanted? Or is it ever right thing to do? The United States is faced with the problem of what should be done with the excess of stray animals. This is a complex thing to solve, but that doesn’t mean killing the animals for space is right. Stray dogs and cats have just as much right to a good home as pets that already have owners. No-Kill shelters are beneficial, they provide a safe, pet-friendly environment that would help solve the problemsRead MoreThe Nonhuman Animal Rights Movement1588 Words   |  7 Pagessee themselves in the nonhuman animal rights movement, namely as donors and consumers of PETA, its tactics, and its selection of â€Å"cruelty-free† products. The recurrent discourse has also fostered and contributed to a particularly n eoliberal ideological composition of the nonhuman animal rights movement that encourages competition with other non-profits and defines â€Å"success† by the number of single issue campaigns it wins, the amount of media coverage it gets, the number â€Å"likes† it receives on socialRead MoreAnimal Testing And The Scientific Field1305 Words   |  6 Pagesthat help with diseases and technology. During the developments and discoveries in the scientific field, people find that the richest discoveries in health or medicine generally depend on animal testing. 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This day was first observed on the 15th March 1983, twenty one (21) years after the declaration of consumer rights by John F. Kennedy who was the President of the United States of America then. Botswana started commemorating this

Constructivist Theory as the Framework for Student Strategies Free Essays

string(46) " as cited in Brush A ; Saye, 2000 \) \." This chapter provides a reappraisal of the literature used to inform the little research undertaking described in this study. To roll up literature for my thesis, I accessed the web sites for Zunia, ERIC, UNICEF, MoEYS, UNESCO, and the e-journal aggregation at James Cook University. There were troubles in deriving entree to some beginnings because many were password protected. We will write a custom essay sample on Constructivist Theory as the Framework for Student Strategies or any similar topic only for you Order Now Besides a challenge was turn uping articles written for the Kampuchean context, which has limited the range of the literature reappraisal for the local Cambodian context. Furthermore, many of the articles I searched were secondary informations beginnings, so it was sometimes hard to mention or cite because some secondary beginnings did non supply elaborate information. At times it was a description of a survey written by person other than the individual who conducted it. I besides had problem in finding which articles were related straight to my subject to be included ( Gay, Mills, A ; Airasian, 2009 ) . Besides utilizing assorted databases, I besides read books about the student-centered theory and old surveies conducted by UNICEF ( United Nation Children ‘s Fund ) every bit good the Cambodian-based undertaking rating written by VVOB. The cardinal words used to turn up literature were: student-centered, learner-centered, constructivism, societal constructivism, the zone of proximal development, scaffolding, student-centered instruction, and student-centered schoolroom. The mention subdivisions of relevant articles were besides used for placing other surveies that would be relevant to this reappraisal. The chapter has been structured following several subjects that emerged as literature was reviewed. It will depict the relevant literature focused on the issues environing the research aim. This chapter has been classified into several sub subdivisions based on the subjects that emerged during reading. 2. 1 Constructivist Theory as the Framework for Student-Centered Schemes Within the past two decennaries, the construct of â€Å" constructivism † A has been pulling attending from pedagogues ( Airasian A ; Walsh, 1997 ) . Since constructivist theory is an epistemology and doctrine and non a theory of acquisition, constructivist teaching method has been developed by pedagogues influenced by the thoughts of cognition building found within constructivist theory ( Yilmaz, 2008 ) . â€Å" Constructivist teaching method is informed by the thoughts of John Dewey and William James ; the latter work of Jean Piaget ; and the sociohistorical work of Lew Vygotsky, Jerome Bruner, and Ernst von Glasersfeld † ( p. 165 ) . Harmonizing to Dewey, the relationship of the person to his or her environment and the edifice of experience through action are really of import. This importance has besides been recognized by constructivism, particularly societal constructivism ( Brush A ; Saye, 2000 ) . Piaget ‘s work dealt with the phases of development which people go through and the importance of find in acquisition ( Alexander, 2006 ) . Vygotsky ‘s work focused on societal interaction as an agent of acquisition every bit good as the importance of a pupil ‘s bing experience and cognition ( Alexander, 2006 ; Yilmaz, 2008 ) . Among constructivism ‘s three foundational bookmans, Dewey, Piaget, and Vygotsky, Vygotsky ‘s work has had a clear influence on the construct of societal constructivism and played an of import function in modern constructivist idea because two of his four key rules are ; collaborative acquisition and student-centeredness ( Yilmaz, 2008 ) . His first cardinal con struct focuses on the societal nature of larning hence the term ‘social constructivism ‘ and the 2nd is that kids learn best the constructs that are within their zone of proximal development ( ZPD ) . The ZPD is a construct used to depict how a kid ‘s acquisition and kid ‘s cognitive development degrees develop together in societal state of affairss ( Vygotsky, 1978 ) . The ZPD is considered among the most utile both theoretically and practically ; of all the constructs that are created by Vygotsky ( Chenyne A ; Tarulli, 1999 ) . The construct of ZPD, which focuses on the relation between human larning and development, is the 2nd foundation for scaffolding schoolroom direction ( Stuyf, 2002 ) . The ZPD is defined as â€Å" the distance between the existent developmental degree as determined by independent job resolution and the degree of possible development as determined through job work outing under grownup counsel or in coaction with more capable equals † ( Vygotsky, 1978, p. 86 ) . Alexander ( 2006 ) , Shear ( 2007 ) , and Stuyf ( 2002 ) depict the ZPD as the country between what a scholar can carry through mentally and make independently by themselves, and what the scholar can carry through with the aid or the support of a more knowing other grownup or equal. The peer portions knowledge with the scholar to construct the spread between what is known and what is non known ( Shear, 2007 ) . The construct of ZPD is now widely applied in instruction and larning in many subject-matter countries ( Willis, 1996 ) . The thought of the ZPD informs teacher staging of larning to make effectual learning environments. It means effectual larning takes topographic point within the kid ‘s ZPD. Vygotsky stated that: A Learning awakens a assortment of internal developmental procedures that are able to run merely when the kid is interacting with people in his environment and in cooperation with his equals. When these procedures are internalized, they become portion of the kid ‘s independent developmental accomplishment. ( Vygotsky, 1978, p. 90 ) . Similarly, Wilhelm, Baker A ; Dube ( 2001 ) argued that the ZPD is the cognitive country in which effectual direction and acquisition can go on. Teacher, equals, and instructional environment are the aid and support which pupils can larn with and this lies within the ZPD. â€Å" A kid ‘s new capacities can merely be developed in the ZPD through coaction in existent, concrete, located activities with an grownup or more capable equal † ( Wilhelm, Baker A ; Dube, 2001, p. 3 ) For constructivist oriented instructors, the importance of planing an instructional activity is to place a job and supply pupils with resources to assist to work out the jobs thereby supplying chances for pupils to see jobs from a assortment of positions, leting pupils to join forces and negociate solutions to jobs and prove those solutions in a existent universe context ( Bednar et al, Duffy A ; Jonassen, Brown, Collins A ; Duguid as cited in Brush A ; Saye, 2000 ) . You read "Constructivist Theory as the Framework for Student Strategies" in category "Essay examples" Similarly harmonizing to UNESCO ( as cited in Mtika A ; Gates, 2010 ) , student-centered instruction helps to fix pupils to run into society ‘s outlooks, to plan educational experiences to progress pupils ‘ acquisition, and supply chances for pupils to show their success in accomplishing social outlooks. 2. 2 What is Constructivism? Constructivism is non a theory about instruction, but it is a theory about cognition and acquisition ( Haney A ; McArthur, 2001 ) . Harmonizing to Airasian A ; Walsh ( 1997 ) , constructivism is non an instructional attack ; it is a theory about how scholars come to cognize or how people learn. Brady ( 2006 ) A ; Staver ( 1997 ) stated that constructivism comes from traditional epistemology, which offers a philosophical account about the nature of cognition. Constructivists believe that cognition is created from the interaction between bing experiences or cognition of people and new thoughts or state of affairss they encounter. In the constructivist schoolroom, scholars are encouraged to do connexions between their bing cognition and new experience ; this is the procedure of building cognition ( Airasian A ; Walsh, 1997 ) . Furthermore, over the last decennary, constructivism has significantly influenced scientific discipline pedagogues because it links pupils ‘ bing thoughts to new experience and new information ( Haney A ; McArthur, 2001 ; Staver, 1997 ; Yilmaz, 2008 ) . Similarly, Driver, Asoko, Leach, Mortimer, and Scott ( as cited in Hand et al. , 1997 ) stated that societal constructivist attacks in scientific discipline instruction are non new. The execution of constructivist larning theory has helped to develop the interaction between pupils and instructor and supply chances to build scientific discipline cognition in the schoolroom. Similarly, Mtika and Gates ( 2010 ) argued that this pedagogical theory helps to promote pupils ‘ interaction with the topic ‘s contents and with on e another while the instructor facilitates the acquisition procedure. Constructivism has been divided by some theoreticians into three classs ( Alexander, 2006 ; Yilmaz, 2008 ) . They are Cognitive constructivism, Extremist constructivism, and Social constructivism. These three classs emphasize that cognition and significance are constructed by the human head ( Yilmaz, 2008 ) , nevertheless there are differentiations between them ( Hirumi, 2002 ) . Cognitive constructivism focuses on person ‘s interactions with the environment. Extremist constructivism emphasizes the person ‘s cognition building which is based on old cognition and experiences, and societal constructivism dressed ores on persons within groups and their sociocultural contexts ( Alexander, 2006 ; Yilmaz, 2008 ) . Though constructivism has been categorized into three, harmonizing to Staver ( 1997 ) , the two most comprehensive and celebrated classs of constructivism are extremist and societal constructivism. The two trade names have much in common. First, cognition is created by the thought of a individual and a community. Second, societal interactions between and among scholars are cardinal to constructing cognition. Knowledge is built by persons within their communities, societies, and civilizations. Furthermore, the agencies of societal interaction is chiefly linguistic communication because linguistic communication is a manner that worlds communicate and understand each other. Third, the character of knowledge is functional and adaptative, that it is in an active procedure ( Staver, 1997 ; Yilmaz, 2008 ) . Finally, the intent of knowledge is to function the persons ‘ organisation of his or her experiential universe. However, the two trade names are chiefly different. Extremist constr uctivism focuses on knowledge and the person, whereas societal constructivism focuses on linguistic communication and the group. 2. 3 Constructivism in the Classroom Airasian A ; Walsh ( 1997 ) argued that constructivism is accepted in many instruction systems because it helps to advance higher order believing accomplishments of pupils. Similarly, harmonizing to the survey of Hand et al. , ( 1997 ) , engagement of pupils ‘ thoughts or thought is the most of import factor that influences pupils ‘ acquisition. In the survey of a group of junior secondary college pupils in Australia, pupils reported that they enjoyed larning through little group work, category treatment, developing their ain thoughts, less note pickings, and they developed a greater apprehension of constructs. These are all larning schemes that reflect the usage of societal constructivism in the formal acquisition context. Among the classs of constructivism, societal constructivism attacks are utile for pupils because pupils can be required to work in a group or separately and make non necessitate to wait for a instructor to direct their acquisition. â€Å" The vision of the constructivist pupil is one of activity, engagement, creativeness, and the edifice of personal cognition and apprehension † ( Airasian A ; Walsh, 1997, p. 446 ) . Whether societal constructivists emphasize cognitive development or societal interactions, there are several specific things that instructors can make to assist scholars to build their apprehension, structural staging is one of these things ( Killen, 2003 ) . Literally, scaffolding is a structural support that is set up around a edifice under building. In instruction in a metaphorical sense, stagings are the support structures that are provided by others such as parents, equals, and instructors to pupils to enable them to finish a undertaking and experience accomplishment in their acquisition ( Yang A ; Wilson, 2006 ) . Harmonizing to Hammond A ; Gibbons ( as cited in Yang A ; Wilson, 2006 ) , effectual staging is both high challenge and high support. â€Å" Vygotsky stressed that pupils need to prosecute in disputing undertakings that they can successfully finish with appropriate aid † ( Wilhelm, Baker, A ; Dube, 2001, p. 4 ) . Scaffolding is a procedure whereby a instructor or peer gives assistance or support to the pupils in their ZPD as it is necessary and removes this assistance when unneeded ( Killen, 2003 ) . â€Å" Scaffolding must get down from what is close to the pupils ‘ experience and construct to what is farther from their experience † ( Wilhelm, Baker, A ; Dube, 2001, p. 4 ) . Similarly, at the beginning of a new acquisition undertaking, the staging should be fix to be concrete, seeable, and external, so learning can get down from the concrete to the abstract. The construct of staging is closely related to the ZPD because staging was developed by other socio-cultural theoreticians using Vygotsky ‘s construct of ZPD to educational contexts ( Yang A ; Wilson, 2006 ) . In other words, the thought of scaffolding originally came from Vygotsky ‘s socio-cultural theory ( Stuyf, 2002 ) . Mitchell and Myles ( as cited in Yang A ; Wilson, 2006 ) stated that societal constructivism focuses on larning that occurs in socio-cultural environments and scholars become active builders of their ain acquisition environment. Vygotsky ‘s socio-cultural theory proposes that societal interaction plays a cardinal function in the development of knowledge. Learners are non hence stray persons ; they are active scholars because of societal interactions ( Stuyf, 2002 ; Yang A ; Wilson, 2006 ) . How to cite Constructivist Theory as the Framework for Student Strategies, Essay examples

BCBS Tiering Strategy

Question: Discuss about the BCBS Tiering Strategy. Answer: Introduction: The insurance companys strategy to tier physicians seems to be a good platform for development in healthcare provision. Since the classification would be based on performance I still believe that the patient will have the right space to make informed choices on the type of services and the physicians to offer them. However, I have a few reservations and concerns with reference to your strategy. To begin with Brennan and Carrara (2008) note that tiering of physicians might end up affecting the patients loyalty to their already established healthcare providers. The patients are likely to end up making wrong choices by picking on physicians only because they are top tiered but not necessarily because they can adequately meet the clients medical needs. There is a dire need for consistency in healthcare provision hence the patients need to accustom to a definite and more direct approach when it comes to seeing medical intervention. I believe this strategy may have adverse effects on patie nt choices making it a not-so welcome innovation in my opinion. Secondly, due to the fact that the physicians will be tiered based on the quality of performance an external certification, those physicians classified in the lower tiers might be rendered jobless. In a tiered system, the consumer choices are largely based on the quality of service provision in addition to cost effectiveness. This would therefore see most patients opting for the top tiered physicians at the expense of those appearing the lower tiers. I would rather suggest a more liberal system in which all the physicians are given an equal platform for recognition and job opportunities. My third concern would be challenges associated with the process of switching service providers and hospitals. In the current state, the patients are subscribed to specific physicians. The process of tiering would see the physicians classified into different categories comprising low and higher tiers. Patients might subsequently choose to switch to the service providers falling in the higher tiers (Landon, 2012). The process of moving from one provider to another encompasses a cumbersome process which may see the patients lose out on insurance cover. This may happen when the chosen service provider fall out of the insurance companys scope of cover. Despite the fact that the company intends to use a performance based approach in classifying physicians, the transition might be accompanied by various economic implications. The tiering may also be based on cost-effectiveness which in turn affects not only the participants but also the service providers. Patients will most likely go for network tiers characterized by low medical expenses as much as the amount spent is derived from their contributions. Such choices may see patients settling for affordable option at the expense of the need for quality. Lastly, tiering may not only affect individual physicians and patient choices but also the hospitals. Depending on the network in which it is placed, tiering can either cause a hospital to gain or lose revenue (Dranove Sfekas, 2008). In addition to quality service provision, patients would be keen to consider the cost-effectiveness of the service provider choices. Subsequently, the hospitals not included in the narrow networks may lose their clients to the networked hospitals which in turn leads to loss of revenue for the former. It is important to note that your strategy will cover over 50 physicians from my organization and hence all the patients associated with them. The transition involving the implementation of this strategy might be time and resource consuming in addition to the costs involved. Suggestions of a better approach With the eminent challenges associated with this strategy, I would like to make a few suggestions on steps the company could take to make the project more acceptable and applicable to my organizational situation. As noted by (Draper Liebhaber, 2007), there is a vital need for patient empowerment and guidance when it comes to making choices for healthcare providers. This can be achieved may availing as much information as possible about the tiering strategy hence allowing them to make informed choices. The process of awareness and education of patients ought to be one of the insurance companys core objectives. This approach would offer the consumers a concise picture of the implications of their choices. In addition to patient education, the providers can also be educated on the need to uphold quality standards, transparency and integrity in service provision (Scanlon Chernew, 1997). This is because the process of tiering is solely based on performance hence a provider is likely to be tiered highly when they exhibit high standards in quality provision. The third strategy would be to sensitize the hospitals on the need to retain a close and constructive link with the patients and providers. The hospitals therefore ought to install effective network strategies which would ensure that the services provide adequately respond to the demands of the healthcare market place. This could be achieved when the hospital remain transparent with the aspects of pricing and quality. A clear record of the out of pocket of payments ought to be defined within the strategys plan. This approach would be pivotal in generating effective consumer behavior to the changes associated with the new strategy (Goldman Zheng, 2007). There also a need to exercise elasticity with respect to the prices in order to maximize on the benefits of the new projects. With flexible prices, the patients are covered from excessive spending which gives room for savings both by the service providers and participants. When such open ended approaches are used before implementing the strategy, the idea is likely to elicit positive consumer response hence widening the scope of benefits associated with the new idea. Furthermore, BCBS could deploy a strategy which would see all the patients involved in the planning process before the strategy is implementing. Through this approach, their views can be incorporated into the strategys design to minimalize the negative impacts of this implementation on the patients medical needs. The insurance company equally needs to ensure that the components of this strategy are aligned with both the legal environment and local policies. Lastly, the insurance company might consider the need for flexibility, constantly revising the prices, quality ratings as well as the value of the networks. The constant monitoring of the progress would ensure that the strategy positively impacts the patients, physicians, hospitals and other related organizations. References Brennan, A., Carrara, L. (2008). Do Managed Care Plans' Tiered Networks Lead to Inequities in Care for Minority Patients? Health Affairs, 27(4), pp. 11606. Dranove, D., Sfekas, A. (2008). Start Spreading the News: A Structural Estimate of the Effects of New York Hospital Report Cards. Journal of Health Economics, 27 (1), pp. 1201 1207. Draper, D., Liebhaber A. (2007). High-Performance Health Plan Networks: Early Experiences. Center for Studying Health System Change, 2(1), pp. 23-34. Goldman, D., Zheng, Y. (2007). Prescription Drug Cost Sharing: Associations with Medication and Medical Utilization and Spending and Health. Journal of the American Medical Association, 298(1), pp. 619. Landon, E. (2012). Keeping Score under a Global Payment System. New England Journal of Medicine. 366(5), pp. 3935. Scanlon, D., Chernew, M. (1997). Consumer Health Plan Choice: Current Knowledge and Future Directions. Annual Review of Public Health, 18(1), pp. 50728.