Applications of Positivism in Social Research

Applications of Positivism in Social Research Scientific methodology in sociology, the study of the social world, is most often associated with what is known as the positivist approach. In this essay, to determine whether or not it is indeed possible to apply scientific methods to the study of the social world, I will analyse the strengths and weaknesses of positivist sociology. â€Å"As developed by Auguste Comte, positivism is a way of thinking based on the assumption that it is possible to observe social life and establish reliable, valid knowledge about how it works.† (Johnson p231) This established knowledge was then to be used to affect the course of social change and it would help improve humanity. Comte’s work was in part a reaction to the ‘anarchy’ that besieged France in the wake of the revolution. Comte sincerely believed that scientific rationality could temper the raw human emotions that had lead to such chaos. Sociology, in his definition (and others), literally the science of society, co uld apply such scientific rationalism, empiricism and positivism to social life, thus improving it and preventing continued anarchy. â€Å"Comte believed that social life is governed by underlying laws and principles that can be discovered through the use of methods most often associated with the physical sciences.† (Johnson p231) One would identify the methods of positivism thus; careful observation measurement; quantification; formalisation of concepts precision in definition; operationalisation of theoretical questions mathematisation (connects with all of the previous features; logic and systemisation of theory symmetry of explanation prediction; objectivity understood as value neutrality. â€Å"It consists in deliberately investigating phenomena with the expectations derived from the theory in mind and seeing whether or not the facts actually found agree with these expectations.† (Delanty p52) â€Å"If observed facts of undoubted accuracy will not fit any of the alternatives it leaves open, the system is in need of reconstruction.† (Delanty p53) Positivism, â€Å"Is above all a philosophy of science. As such, it stands squarely within the empiricist tradition. Metaphysical speculation is rejected in favour of positive knowledge based upon systematic observation and experiment. The methods of science can give us knowledge of the laws of coexistence.† (Marshall p510) However, as shall hopefully be shown later, these scientific methods can not show us anything about the inner ‘essences’ or ‘nature’ of things. Broadly speaking structuralism is, â€Å"Used loosely in sociology to refer to any approach which regards social structure (apparent or otherwise) as having priority over social action.† (Johnson p646) Positivism and structuralism are generally highly complementary, positivism effectively being the scientific methodology of structuralism. This can be observed in the works of Comte, Marx, Durkheim and the Vienna circle. Later theorists such as Parsons can also be described as both str ucturalist and positivist although in Parson’s case he does consider certain interpretivist sensibilities. Marx, Durkheim, Comte, the Vienna circle and many others all saw sociology as a science and all believed that social structure was the core component of society. â€Å"Perhaps one of the most important traits in naturalistic or positivistic sociology is the belief that social phenomena are patterned and are subject to deterministic laws much as are the laws governing the natural sciences. Sociological theory then becomes a quest for laws similar to the law of gravity or the law of material density in physics† (Poloma p3) The main difference between the social and natural worlds is that the subject of study in the social world is humanity. People, in basic terms, have a consciousness where as the subjects of the natural sciences, rocks or atoms or chemicals, do not. People are aware of themselves and their surroundings in a way that rocks, for example, are not. This, clearly, is a potential problem for positivist sociology. However, this problem is resolved, in positivist science, by arguing that the self-consciousness of human beings (the ability to think, act and feel) is not a significant factor in our ability to understand social behaviour. This, according to positivists, is because peoples behaviour is, at its genesis, always a reaction to some form of stimulation. This stimulation can be from their socialisation (as we shall see in Parsons work), or it can be something more direct like the need to earn a living or a confrontation with another human. This produces one of the criticisms of positiv ist sociology, as we shall see, action and the meaning placed on that action becomes unimportant for study, only the cause of the action, the stimuli, has any sociological value for positivists. The positivist view of sociology, of its aims, of its methods, is certainly a contentious one. Two of the first sociologists to question these methods, and the first that can be labelled as interpretivist, were Weber and Simmel. â€Å"Weber argues that sociology is not concerned with totalising explanations; only individuals have an ontological reality, society does not exist in that real sense, and so sociological explanations must be in terms of individual events and processes.† (Craib 1997 p51) Rickert’s term of Geisteswissenschaften (literally the sciences of the spirit/mind) greatly influenced Weber’s conception of what sociology should be. The ontological reality which Weber speaks of is that humans are very different from other natural beings. We have free will, an inner life, use symbols, possess language, live in culture and act meaningfully. This ontological reality ensures that humanity cannot be studied using positivist scientific methodology, or any other conventional scientific methodology, sociology must use other methods. While the natural sciences wish to explain natural events, sociology, as understood by Weber, Rickert or Simmel, wishes to understand social action. Social scientists should endeavour to understand social action in very much the same way as one attempts to understand other people, by communicating, through empathy, and through argument. These views are also associated with, and expanded upon, by the philosopher Peter Winch. (Winch 1958) As Weber states, â€Å"Even the knowledge of the most certain propositions of our theoretical sciences – e.g., the exact natural sciences or mathematics is, like the cultivation and refinement of the conscience, a product of culture.† (Delanty p110) In many ways the objective ‘fact’ of scientific enquiry is a fallacy. â€Å"Sociology differs from the natural sciences in that it does not deal with a pre given universe of objects. People attribute meaning to their social world and act accordingly.† (Baert p97) Weber, in his Methodology of The Social Sciences, points out that all knowledge of cultural reality is always from a particular point of view. The philosophical idea that there is no truth, only human opinion is prevalent in this argument. Simmel emphasises and expands upon this point, â€Å"In the last resort the content of any science doesn’t rest on simple objective facts, but always involves an interpretation and shaping of them according to categories and rules that are a priori of the science concerned.† (Stones p74) Any scientific conclusion, be it in the field of physics or sociology, has to be interpreted by its author, then represented by that same author and then reinterpreted by those that read it. In these interpretations any ‘truth’ or ‘law ’ is surrendered to human opinion, human meaning, human understanding. This criticism of positivist sociology is probably best illustrated by a discussion of a classic positivist sociological text, Emile Durkheim’s suicide study. In his study, Durkheim analysed the differential distribution of the occurrence of suicide by country and region. Durkheim professed to have found suicidogenic currents (Durkheim 1963) in society; the pressures to commit suicide, the laws of suicide. â€Å"These are called ‘social currents’†¦They come to each one of us from without and can carry us away in spite of ourselves.† (Delanty p28) Through a positivist, scientific methodology, Durkheim identified the pressures to commit suicide were greater in regions where the Protestant faith was dominant, and weaker where Catholicism dominated. Durkheim’s account posits an external force (suicidogenic currents) as the cause of suicide cause and effect. (Durkheim 1963) However why suicide occurs tends not to be the issue. To say that suicide is caused, not entirely obviously but in part, by the following of the Protestant faith is to assume that the term suicide is a simple one, a fixed one, with no room fo r differing meanings. This view is wrong. What is of importance is how a suicide comes to be defined as such by the coroner’s court. One must remember that a suicide is not an objective fact, but a interpretation, an interpretation that can be influenced by the coroner’s own personal feelings. If a ruling of suicide is likely to cause the deceased’s family pain and suffering, as is likely if they are Catholics, then the coroner may be inclined, where ever possible, to not record a suicide verdict, but an accidental death instead This alerts us to the problematic nature of Durkheim’s, and positivist sociology in general, reliance on statistics. For Durkheim takes those statistics as giving a ‘true’ picture of the incidence of suicide. But do they? Are they rather a representation of the interpretation of suicide as opposed to cold hard objective fact? Interactions/ interpretive work on suicide states that suicide statistics are a construction involving police, courts and coroners. Thus for a death to be counted as a suicide involves a complex social process concerning meaning and interpretation, two unquantifiable characteristics of humanity. Thus suicide is not just the effect of a societal cause, but an interpretation of events, thus not a positivist, scientific event. Therefore if sociologists wish a knowledge of social life, they cannot explain social actors’ action in terms of cause and effect. Rather, they must seek out what the social actors themselves say they are up to, wha t they mean. â€Å"Comte’s view shifted in later life, under the influence of Cloitilde de Vaux. He came to see that science alone could not be a binding force for social cohesion as he had earlier supposed. He argued that the intellect must become the servant of the heart, and advocated a new ‘religion of humanity.’† (Marshall p509) Comte, the originator of the positivist sociological methodology shifted his emphasis away from positivism in his later work, thus exposing the inherent problems and weaknesses at its methodological core. â€Å"Positivism has had relatively little influence in contemporary sociology for several reasons. Current views argue that positivism encourages a misleading emphasis on superficial facts without any attention to underlying mechanisms that cannot be observed.† (Johnson p231) For example, we cannot observe human motives or the meaning that people give to behaviour and other aspects of social life, but this does not me an that meaning and motive are nonexistent or irrelevant. The best way to illustrate the above points is to set them within the context of a positivist sociological study, in this case Parson’s work on personality. For society to function, it is logical according to Parsons to deduce that the individual members of society have to agree with society’s rule. â€Å"For Parsons, the social system is†¦made up of the interactions of individuals. Of special concern is†¦ that such interactions are not random but mediated by common standards of evaluation. Most important among these are moral standards which may be called norms.† (Hamilton p155) When people in society interact the interactions themselves, the emotions that seemingly control them, the goals that the individual actors (people) are hoping to obtain, they are all in fact controlled by the norms of society. â€Å"The concept of order is located predominantly at the level of the social system itself and the cultural system becomes a mechanism of the functioning of the social system.† (Hamilton p146) These norms are adopted and agreed by each member of the society for Parsons and this is his consensus theory. Imp ortantly Parsons’ theory suggests that the power of societal expectations, the power of norms, is more pervasive than merely being a moral standard that mediates interaction and personal relationships. They are in fact the organisational foci of personality, of people themselves. â€Å"Socialisation is the process by which we learn to become members of society, both by internalising the norms and values of society, and also learning to perform our social roles (as worker, friend, citizen and so forth.)† (Marshall p624) The family, for instance, is controlled by the same norms as society because it is that society, just it is a smaller component of it. The subsystems of society are analogous to body parts in the Parsonian model, they are all essential, each provide their own unique function and all interrelate, interpenetrate and are dependent upon one another. Analogous to the human body where each body part has a specific function to perform, and all of those parts work in unison to keep the structure going, so society is organised. Immersion within these subsystems, such as the family leads to internalisations of norms and objects, and this in turn creates personality. Because personality is internalised from society, â€Å"The foci of organisation of both types of system lies in†¦the value systems.† (Parsons p357) The values of society are the values of people, or personality. People are not just guided by the norms of society, but their very personalities are organised by the very same norms and principles and morals, according to Parsons. Thus peoples actions are quantifiable, reducible to a law since they are mediated by common standards. As gravity is a constant, so are the norms of a society and therefore of personality. The positivist law here is that personality, every action of a human is controlled by the same standards of evaluation as society. The person’s personality is derived directly from society, it is society. Thus a scientific study of society is possible because there is cause and effect, there is a reaction to stimuli. Socialisation is the stimulation that people react to. For Parsons, laws can be discerned from humanity because people will react in predictable ways, mediated by norms, to the stimulation of events and socialisation. Thus sociology can be scientific, empirical and positivist. A major problem with Parson’s work is that it reduces human personality to being produced and organised solely by societal expectations and norms. This societal determinism fails to acknowledge or explain where certain feelings, motives and actions originate. Goffman argues that â€Å"it is . . . against something that the self can emerge. . . Without something to belong to, we have no stable self, and yet total commitment and attachment to any social unit implies a kind of selflessness. Our sense of being a person can come from being drawn into a wider social unit; our sense of selfhood can arise through the little ways in which we resist the pull.† (Goffman 196 p305) A favourite example of this for Goffman was that of mental patients in asylums. The total institution of an asylum probably forces more strict adherence to societal expectation than most other social situations by using methods such as drug induced control and disciplinary measures such as EST. Yet in the se institutions, despite being forced to play the role of the mental patient, to conform to societal expectation), patients still resisted those expectations. The hoarding of banned materials being an example of this. The motivation to do this does not come from internalisation of norms, as the correct way to behave is to not horde banned items. It comes from a need to keep ones own identity, to satisfy needs and drives and wants. These needs drives and wants are absent from the Parsonian model and a full understanding or explanation of society and social actions needs to take them into account. â€Å"The maintenance of this surface of agreement, this veneer of consensus, is facilitated by each participant concealing his own wants behind statements which assert values to which everyone present feels obliged to give lip service.† (Goffman 1990 p20-21) The norms and laws that Parsons believes to control personality and society, are revealed by Goffman as only being a veneer. Furthermore Goffman states that other feelings and motives in fact influence social action, not just norms. If, as Goffman claims, the so called common standards of evaluation that Parsons identifies are in fact a veneer that hides other motives and feelings, then the actions of humanity are not as easily quantifiable, reducible to a scientific, positivist law, as Parsons first shows. Freud’s metapsychology deals with the general structure of mental life. For Freud there were three psychic structures. The first, the id, contains, â€Å"those basic drives we have by virtue of being human, of which sexuality is the most important.† (Craib 1989 p3) The Id is often equated to by Freud as being like an infant, demanding immediate satisfaction irrespective of societal expectations. The Id makes up the greatest part of the unconscious and it is in this unconscious realm of basic biologically influenced drives that the motivational forces that Parson’s can not identity come from. The Id influences personality. It is important to remember that, as opposed to biological instincts driving us to act like a shark would, a mindless automaton, â€Å"the unconscious is composed not of biological instincts but of the mental representations we attach to these instincts.† (Craib 1989 p4) Thus each individual creates their own mental representation for the ir drives thus meaning that every persons internal world has a different geography. This clearly poses problems for the positivist approach to personality and society and social action, as represented by Parsons here, for if reaction to stimulation is not predictable because each person acts differently, then universal scientific laws can not be established. The second structure of personality according to Freud, the ego or the ‘I’ is the central organiser of mental life. The third, the superego is thought of as the conscience. â€Å"The superego is the internalisation of external control which demands the renuncification of instinctual satisfaction in order that society might be formed and maintained.† (Craib 1989 p21) The superego is the part of personality that Parson’s identifies the part that internalises norms. The basic drives of the id demand immediate satisfaction, immediate gratification of those drives, these demands are contrary to the superego norms and morality, and the conflict has to be resolved by the ego. Our consciousness, predominantly consisting of the ego and superego, protects us from our own id impulses that, if they were followed, would leave it impossible for us to exist within society. Freud stated that â€Å"Civilisation depends upon repression†¦If we tried to gratify all our d esires, sexual or otherwise, as and when they arose, society, civilisation and culture would vanish over night.† (Craib 1984 p195) For Freud the ‘I’, is the resolution of the conflict between the id biologically directed drives, and the superego’s societal restraints. Therefore personality is the site of the, hopefully, resolved conflict between the normative mind evaluated by common standards as Parsons identifies, and the basic id drives. These Id drives, as I shall show, influence personality thus influence social action and society. This being the case then Parsons’ explanation for personality is insufficient and so is the positivist claim for the scientific study of society. The positivist tenants of careful observation and measurement; quantification; formalisation of concepts precision in definition; operationalisation of theoretical questions; mathematisation; logic and systemisation of theory; symmetry of explanation prediction and objecti vity cannot be applied to individualistic Id drives and impulses. â€Å"The desire to kill anyone who frustrates us thus becomes unconscious, but none the less remains.† (Craib 1989 p24) Evidence for these desires for Freud appears in slips, where the unconscious desire can ‘slip’ into conscious conversation. â€Å"Freud quotes the husband who supposedly said, ‘If one of us two die, I shall move to Paris.† (Craib 1989 p24) One can not scientifically measure how these unconscious desires influence and effect social action, especially since it can be so hard to identify them as existing in the first place. â€Å"A feature of human life is that an instinct such as the sexual instinct is not directed at any one object, but has to be socially channelled, in our society usually towards members of the opposite sex.† (Craib 1989 p4) â€Å"Human beings are restrained by social organisation from a free and good expression of their drives. Through its oppression, society forces people into neuroses and psychoses.† (Craib 1989 p19) For Freud the very problems that he and other psychoanalysts dealt with were in fact often as the result of the repression of id drives by the superego and societal repression. As such the very existence of neuroses and psychoses can be seen as evidence to the fact that this conflict does indeed exist, that the resolution of this conflict does indeed produce the ‘I’ with all its faults and problems. To fully understand society, sociology needs to be aware of societal pressures, the Parson’s personality through positivism, but also nee ds to recognise the other meanings and emotions that cannot be quantified, cannot be analysed scientifically. Sociology needs to use interpretivism and positivism together. In terms of this example, Parsons positivist models needs to be considered at great length and detail as he does indeed identify a huge force in shaping society, that of norms and how they do penetrate into the psyche and personality. However, a study that only concentrates on the positivist methodology misses the crucial aspects of personality that Goffman and Freud identify, and that is not in the interest of any sociologist. â€Å"Positivism may be dead in that there is no longer an identifiable community of philosophers who give its simpler characteristics unqualified support, but it lives on philosophically, developed until it transmutes into conventionalism or realism. And even if in its simpler philosophical forms it is dead, the spirit of those earlier formulations continues to haunt sociology.† (Halfpenny p120) In conclusion positivism’s attempt at scientific sociological methodology, though fallacious is admirable and certainly many of the aspects of positivism should be considered desirable. As quoted elsewhere, â€Å"positivism is a way of thinking based on the assumption that it is possible to observe social life and establish reliable, valid knowledge about how it works.† (Johnson p231) The desire for reliable, valid knowledge is of course a relevant and important sociological aim and some of the tools that positivism uses to try to reach such knowledge are useful and wort hwhile. Careful observation, measurement; quantification; formalisation of concepts precision in definition; operationalisation of theoretical questions; logic and systemisation of theory; symmetry of explanation and prediction and objectivity, if all of these tenants of positivism can at least be attempted in a sociological study then that sociological study will indeed be the better for it. However, sociological study needs to recognise, as Comte himself did, that these aims, in their fullest, are unobtainable and that those aims are not ends in themselves, rather a very rough guide to sociological methodology. As I have hopefully shown above, sociological analysis needs positivism, needs scientific methodology, but a carefully tempered and monitored positivism. The aim of sociology is understanding and that understanding should not be limited by methodology, especially a methodology that is inherently flawed. Positivism shows us how to analyse data, data that is essential to soc iological understand, but that data must not be treated uncritically thus a synthesis of positivism and interpretivism is recommended. To study the social world using a strict scientific methodology is impossible, that does not, of course, mean that scientific methodology is not a useful and critical tool in sociological study. Bibliography Baert, P, 1998. Social theory in the twentieth century. Polity press Craib, I, 1984. Modern social theory. Wheatsheaf books Ltd Craib, I, 1989. Psychoanalysis and social theory the limits of sociology Wheatsheaf Craib, I, 1997. Classical social theory pub by Oxford university press Delanty, G, 2003. Philosophies of social science. Open university. Durkheim, E, 1963. Suicide, a study in sociology. Routledge Goffman, E, 1961 Asylums. Doubleday Anchor Goffman, E, 1990. The presentation of the self in everyday life. Penguin Halfpenny, P, 1986. Positivism and sociology. Routledge Johnson, G 2000 The dictionary of sociology Blackwell Hamilton, P, 1992. Talcott Parsons critical assessments. Routledge Marshall, G 1998. Oxford dictionary of sociology. Oxford university press Parsons, T, The structure of social action Free Press 1949 Poloma, M, 1979. Contemporary sociological theory. MacMillan Stones, R, 1998. Key sociological thinkers. Palgrave Winch, P, 1958. The Idea Of a Social Science. Routledge

Life in a High School

Cliques are small groups of between two and twelve individuals. Cliques are small enough that the members feel that they know each other better than do people outside the clique. Members of a clique share common activities and friendships. They are social settings in which adolescents hang out, talk to each other, and form closer friendships. Groups of friends, called cliques can be important for social upgrading, but in most cases the enormous power and effects of these cliques can create alienation, exclusion, and destructive results. In my high school, as well as every other high school in America there are social groups of individuals, called cliques, that effect every individual whether they are an insider or an outsider. Generally there are the cool cliques, the athletic cliques, the freak clique, the skater clique, the smart clique, and the average clique. Almost everyone finds their place in one of these cliques, but there are always a few outsiders who go through high school never knowing where they belong. these are the people who are constantly ridiculed, picked on, and talked about day in and day out. The effects can be devastating, even deadly. In Littleton, Coloraldo two outcast teenagers came into school one day and began shooting, targeting the athletes and other students who had made their lives awful by ridiculing them constantly. Seniors Eric Harris and Dylan Klebold stormed their suburban Denver school with guns and bombs last April 20, killing 12 students and a teacher before taking their own lives(Kenworthy 1). Augustana University education professor Larry Brendtro explained kids who feel powerless and rejected are capable of doing horrible things(Cohen 4). A high school student, Jason Sanchez understands why the two outsider snapped by saying If you go to school, and you dont have friends, it drives you to insanity(Cohen 4). So what do these lonely outcast kids do if they are rejected by everyone Roger Rosenblatt discusses in his article, Welcome to the Works of the Trench Coat, how kids will discover self-worth by hating an enemy(Rosenblatt 1). The kids of Columbine for example look alike; they conceal differences. People who are attracted to clans and cults seek to lose their individuality and discover power and pride in a group. As individuals, the killers Eric Harris and Dylan Klebold, were vulnerable, taunted by the other tribes in school– the cliques, the athletes– as geeks and nerds(Rosenblatt 1). The end result as a young girl involved in the murders reported was, He just put a gun to my head, and he started laughing and saying it was all because people were mean to him last year(Rosenblatt 1). The social warfare of cliques has no limits or boundaries; anything can and will happen. Columbine High School is only one example of how high school cliques can be damaging to teenagers. At Glen Ridge High School a group of jocks raped a retarded woman. In that attractive upper-middle-class New Jersey suburb, thirteen jocks were present in the basement where the young womans body was penetrated by a baseball bat and a broomstick. The country was sickened by the inhumanity of a bunch of guys who were among the most admired and envied young men in their community and high school (Lefkowitz 653). These star athletes were not even afraid of being punished. They told their friends and schoolmates of the incident not trying to hide it at all. Athletes are treated as kings of the school. This is not only true for the athletes, but for the cheerleaders too. In the article by Adam Cohen he says While others plod through high school, they glide: their exploits celebrated in the pep rallies and recorded in the school paper and trophy cases(Cohen 2). Another high school student Blake McConnell says that The jocks and the cheerleaders have the most clout, they get out of punishment — even with the police. Joe Blow has a wreck and has been drinking, and he gets the book thrown at him. The quarterback gets busted, and he gets a lighter sentence ( Cohen 2). How does this prepare the so called stars for the real world whenever they are just an average working man How does this make the normal and less special students feel What about the smart people, where is their recognition for all their hard work and success Cohen noted that assemblies to honor the best students rarely lasted twenty minutes. The school yearbook displayed ten photographs of the most mediocre football player. But the outstanding scholar was lucky to get one grainy photo ( Lefkowitz 654). This is leaving the impression on many teens that the jocks are superior while everyone else is below them. What kind of lasting impression will this leave on the kids Lefkowitz stated in her essay, I received hundreds of letters from people, some in their seventies and eighties, who recalled how excluded they felt when their schools anointed one group of guys as leaders(Lefkowitz 654). High school teaches us all many important lessons that stay with us all through our life, and sometimes the lessons inside the classroom are the least of it. High school is a chance for us all to invent ourselves. High school for me was the best of times, even though when I was still in school and someone told this to me I just thought they were crazy. My senior prom, the football games, the pep rallies, and even the trouble I got into are all memories that I will look back upon for the rest of my life and just think how great life was then. I guess though while I was caught up in all the fun and games of high school I never stopped and noticed all the people being left behind. The people who remember high school as pain and suffering. The outsiders that we all picked on not stopping to realize what we had cost them, the best years of their lives.

Nurse`s Work

I am a staff nurse work at government sector at hematology department. My service as a staff nurse almost 4 years. This is my semester 2 assignment which is to write a case study for my patient. I choose a patient with diagnosis of aplastic anemia as my case study for this semester. Aplastic anemia is a one type of blood disorder. The body's bone marrow in which the soft tissue in the center of bones doesn't make enough blood cells. (Bennington-Castro, 2015) . Our blood is composed of three types of blood cells in a liquid called blood plasma which is red blood cells, white blood cells and platelet. Red blood cells help to carry fresh oxygen to the body's cells and take carbon dioxide away from cells (and to the lungs to be exhaled).While the function of white blood cells is help to fight infections and foreign invaders. Platelets are disk-shaped cell fragments which help to form blood clots to stop bleeding. These blood cells have their own lifespan and die naturally, to be replaced by new blood cells formed in bone marrow. Without this replacement process, health issues involving the heart and lungs, bleeding, and infection can develop. As a nurse, we should be very careful when taking care of patient with aplastic anemia. The purpose of this paper is to examine an aplastic anemia patient with respect to review of subjective and objective data, determination of nursing diagnosis, formation of outcomes with interventions, evaluation of the outcomes that can be identified based on the patient's scenario. This paper will further discuss about the main risk problem that patient will be develop and the nursing intervention for the problem developed. (Knott, 2014) In his article:Epidemiology?The annual incidence of aplastic anemia is about two cases per million population.?Aplastic anemia is 2-3 times more common in Asia than in the West.?Acquired aplastic anemia most commonly presents between the ages of 15 years and 25 years but there is a second smaller peak in incidence after age 60 years.?Certain histocompatibility locus specificities, especially HLA DR2, are associated with an underlying predisposition to acquired aplastic anemia.Nursing assessmentSubjective dataMr. X is 57 years old gentleman, came from one of the island at Malaysia, was admitted from casualty into ward on 17/11/17 with complained of mild dizziness, gum bleeding the day before admitted but he stated that it resolve after brushing teeth. He denies any chest pain, palpitations, orthopnea, cough, fever, or chills. According to the Mr. X he has been diagnose as aplastic anemia since February 2016 from the BMAT result on Feb 2016. Patient also stated that he have known case of hypertension since 2012. According to the patient again he have previous admission on 17/5/17 till 10/6/17 for UGIB secondary to thrombocytopenia. On 20/7/17, he was admitted due to low platelet count and bleeding at gum. He was again hospitalized on 9/9/17 due to lot platelet count. Patient denies consume of alcohol and smoking. He claims that he has no family history of malignancy and bleeding disorder. According to the patient, he is allergy to the antibiotic penicillin which will make his body develop rashes and itchiness with mild short of breath but no known of food allergy. Currently patient claims that he staying with his wife and son.Objective dataPatient is alert, awake and oriented to self, place, and time. Full Glasgow coma scale noted (15/15). Upon physical examination, noticed scattered petechiae (pinpoint hemorrhages from arterioles or venules) at the buccal mucosa and over bilateral upper limb and lower limb. Vital sign taken during the admission (17/11/17) Blood pressure: 110/60mmHg Pulse rate: 100/min Respiratory rate: 20/min Underarm temperature: 37 degree Celsius Blood oxygen saturation (Spo2): 99% on room air Pain score: 1 Weight: 70kg Height: 162cm Body mass index (BMI): 26 Diagnostic lab taken during the admission (17/11/17). TEST RESULT Unit NORMAL RANGEHemoglobin (HGB) 7.8 g/dl 13.0-17.0Hematocrit (HCT) 22.4 % 40.0-50.0Platelet 4 10^3/uL 150-410White Cell Count (WCC) 1.3 10^3/uL 4.00-10.00Clinical progressReviewed by doctor in the ward, plan for 4 unit platelet transfusion and 1 pint packed cell transfusion, watch out for bleeding tendency and was started medication iv tranexamic acid 1g TDS and mouthwash tranexamic acid 10mls TDS. On the 19/11/17, 4 unit platelet transfusion done and no reaction noted during the transfusion. No sign and symptom of bleeding noted. Nursing Diagnosis The main nursing problem concern for this patient is risk of bleeding related to low platelet count follow by risk of fall related to dizziness. This paper will focus on risk of bleeding related to low platelet count based on the data collected. The nursing care plan will include intervention that is mostly to provide health education for the patient, bleeding precaution and bleeding reduction as well.Nursing Plan and InterventionFirstly, nurse should assess sign and symptom of bleeding. Assessment of skin and mucous membrane for sign and symptom of petechial, brushing, hematoma formation, oozing of blood is important because patient with low platelet count might experience bleeding into tissue. For my patient, I assess that he has scattered petechial (pinpoint hemorrhages from arterioles or venules) at the buccal mucosa and over bilateral upper limb and lower limb on the day of his admission. After been transfused 4 unit of platelet on 19/11/17 no more petechial noted at patient buccal mucosa while the petechial on the bilateral upper limb and lower limb is reducing. Beside this, monitor patient's vital sign is important especially blood pressure and heart rate to look for orthostatic hypotension. Tachycardia and hypotension are initial compensatory mechanisms always can noted with bleeding (Wayne, 2016). Marc Hemeryck, a Medical advisor General Practitioner ; Geriatrics also state that hemorrhaging from internal and external can cause low blood pressure, so the heart needs to boost its output by pumping faster, thus this form of tachycardia is a necessary means for the body to compensate for the lower blood flow. (â€Å"What are possible causes of tachycardia and hypotension?† n.d.) This is supported by  Ã¢â‚¬Å"a major injury or internal bleeding can quickly deplete an individual's body of blood and cause low blood pressure† (Saljoughian, 2014) which can s upport my statement. During the whole admission, 4 hourly vital sign was monitored and no abnormal reading noticed. Stool and urine should be inspect as well to look for any melena stool or hematuria. Melena stool may be a sign of bleeding from upper gastrointestinal (Ansari, 2016). Whereas hematuria may indicate bleeding somewhere along the urinary tract (Mandal, 2014). Mr. x have a normal bowel open, no melena stool noted and normal urine output with amber color urine noted. Lab result such as hematocrit and hemoglobin can be monitor because when bleeding is not visible, decrease of hematocrit and hemoglobin can be an early sign of bleeding (Gil Wayne, 2016). During admission, Mr. X hemoglobin level noted is 7.8, after being transfused of 1 pint packed cell hemoglobin increase to 9.0.Health care personnel should avoid intravenous or subcutaneous injection or rectal procedure such as enema and rectal temperature as possible as this can stimulate bleeding to patient and to reduce unnecessary bleeding (â€Å"Risk for Bleeding | Bleeding | Platelet†, 2012).   [Should have been cited as www.scribd.com/doc/97160447 (2012)] H If subcutaneous or intravenous procedure are needed for the patient, apply pressure to the puncture site. No subcutaneous procedure one to Mr. X but only intravenous procedure (set intravenous line) applied since medication IV Tranexamic acid was ordered by doctor. Whereas, body temperature was taken on underarm for Mr. X and no rectal temperature taken. Maintaining safe environment for patient such as raise side rail for confuse or restless patient, make sure floor is dry and have enough light can prevent patient from fall or injury. Mr. X is located at bed 12 which have adequate lighting and the floor at the ward always dry including the toilet. Medication adherence can help to reduce the risk of bleeding. Nurses should monitor patient to take his/her medication in the ward. I always make sure my patient to take his medication on time. Sometimes patient will request to take meal or to take bath before taking his medication and I will monitor again if the patient already take the prescribed medication. Heath education play an important role in our nursing. â€Å"It is a much better idea to avoid bleeding rather than having it and then trying to deal with it† (Naik, n.d.). For this case, nurses can educate patient about precautionary measures to prevent tissue trauma or disruption of the normal clotting mechanisms. In the Nurses lab risk for bleeding, by giving information to patient regarding precaution measures can decrease the risk for bleeding (Wayne, 2016). To maintain an oral hygiene, patient can use a soft-bristled toothbrush and nonabrasive toothpaste and avoid the use of toothpicks and dental floss. Mouthwash tranexamic acid are prescribed to Mr. X and he was advice to buy a soft-bristled toothbrush to use. Patient follow the advice given. Educate to the patient and family members about signs of bleeding such as petechial that need to be reported to a health care provider are vital as the health care provider can take early action and treatment for the patient which can reduce the complication from blood loss. Mr. X always been remind by staff nurses to inform if he notice any brushing in the body of gum bleeding while brush teeth. Educate to patient the important need to use water-soluble lubricants during sexual intercourse as lubricants are used to reduce friction and tissue trauma that increase the risk for bleeding. Mr. also being teach to use lubricants. Teach the patient about measures to reduce  constipation  such as increased fluid intake and dietary fiber. Hard and dry feces may cause trauma to the mucous membranes of the  colon  and rectum. Increasing fluid intake and dietary fiber soften the fecal mass for easier defecation. I advised my patient to take more vegetables and fluid intake to get easier defecation and Mr. x total fluid intake was around 1.5 litter per day. Educate patient not do heavy lifting, contact sports, or strenuous exercise as it may increase the bleeding tendency. Mr. X was always being advised not to do heavy lifting or strenuous exercise and he understand about that. Patient's daily activity at home include washing clothes and cooking. Patient should be informed to wear proper fitting shoes all the time both in and out doors to avoid cuts on their feet (â€Å"Learn about Managing Your Chemotherapy†, 2016). Mr. X are told to wear proper shoes and I noticed that patient always wear slippers i nstead of wearing shoes. Educate the patient and family members about limiting the use of herbal remedies that can increased risk for bleeding like dongquai, feverfew, ginger, ginkgo biloba, and chamomile). Most herbal preparations interfere with platelet aggregation through inhibition of serotonin release from the platelet. Other herbs increase the effect of antiplatelet and anticoagulant medications, thus increasing the risk for bleeding. The following herbs can increase the bleeding tendency to a low platelet patients (Peters, n.d.): GINGER- Ginger is for gastric, distress, migraines and headaches but it can interfere with platelet function.GINSENG- Use to treat colic, infections, aging, and stress. It can increase bleeding, and have side effects of nausea, headaches, and blood pressure changes.GINKO- Used to treat Alzheimer's and other memory disorders but it also been associated with excess perioperative bleeding.GARLIC- Garlic has been used as a medicine for centuries. It has been advocated for high blood pressure, fungal infections, heart attack and cancer. Consumption of garlic in high doses resulting in bleeding, nausea and vomiting as well as low blood sugar.Besides from herbal remedies, patient with high risk of bleeding should be very careful about their daily diet. Some food can lead to increase bleeding tendency.The Platelet Disorder Support Association (PDSA) states that the most common offenders for low platelet patients are foods that contain quinine (tonic water, bitter lemon, bitter melon), aspartame (diet soda, sugar-free and low-fat candy and cakes) or alcohol such as beer, wine, hard liquor (â€Å"Eating for Health†, n.d.). (Stein, 2017) Says â€Å"Leafy green vegetables and dairy product can help to reduce the risk of bleeding† in which this can support my statement. Leafy green vegetables are the best sources of vitamin K. The Platelet Disorder Support Association also recommends  foods like leafy green vegetables rich in vitamin K which is important for blood clotting and platelet creation. Chairman Tan, registered dietitian at Seventeen Nutrition Consultants advises: â€Å"Green leafy vegetables such as broccoli, spinach, kale, Chinese vegetables like choi sum and kai lan are rich with antioxidants and rich in vitamins and minerals which are believed to reduce inflammation and help increase platelet count. (South China Morning Post, 2018) Dairy products such as milk can help your blood clot because of their calcium. Calcium is an essential mineral at seven different points in the coagulation cascade that results in blood clotting when you've cut yourself, The Platelet Disorder Support Association recommends following an anti-inflammatory or macrobiotic diet to increase platelet counts. This diet focuses on whole grains, beans and vegetables and reduces animal foods. Sesame oil has properties that can increase the platelet levels. Two tablespoons of a natural sesame oil when taken orally twice a day, and even rubbing some externally on lymph node areas can help to increase platelet counts over a period of several weeks (SINGLETON, 2017).  I have told MR. X to consume more leafy green vegetables and drink more milk at home and I strongly remind him not to take herbs as it might increase the bleeding tendency and he claimed that he didn't take any herbs from others.EvaluationPatient being discharge on 20/11/17 with prescribed medication. Patient manage to get well and reduce bleeding tendency by adhere to the medication prescribed. Thus from here, nurses play an importance role in ensure patient is adherence to their medication to prevent bleeding for deteriorate. Beside for adherence to the medication, patient supposed to be advice to strictly follow the date given by doctor for their To Come Again (TCA) appointment to have regular blood checkup as this can detect early sign of bleeding. During the admission, patient not receive any injury like fall because the environment provided is safe for the patient. Patient aware that he cannot do any hard activities that might cause bleeding. This case study can managed to meet the desired goal.ConclusionAlthough aplastic anemia is consider incurable but the prevention of bleeding form aplastic anemia can reduce a lot of complication that can threat one's life. Hence patient must be instruct clearly about the adherence to the medication prescribed. Diet also play a vital role in reducing the bleeding tendency hence must be strictly implemented. Continuous of blood checkup must be strictly follow. Thus it is important to the nurses to provide a good heath education to the patient to increase patient awareness regarding the prevention of the bleeding that will take patient's life. Prevention is better can cure. We may never understand illnesses such as cancer. In fact, we may never cure it. But an ounce of prevention is worth more than a million pounds of cure. (Agus, n.d.). In writing of this case study, I feel happy that this writing meet the desired outcome. No further bleeding noted for my patient and no further deterioration condition developed. I have learnt many things after writing this case study and I hope that I can use it to others patient as well to increase their health and living. I have learn what intervention I should do while patient in the ward and what education I can give to patient when he discharge. I manage to know what diet are recommended to the patient and what diet are not recommended to the patient. I feel glad to write this case study because I able to use this knowledge from what I have learnt not only to teach my patient but also to share the knowledge among my colleagues to improve our nursing care. In future, to improve the nursing care and practice, nurses might can put a sign over the patient's bed as a reminder of bleeding precaution. This will make all the health care provider be more alert when handling to the patient. Besides that, those patient with high risk of bleeding can wear a bracelet as a sign of bleeding precaution to others as well. Environment also take a vital role in patient's safety. Nurses can advise patient and patient's family to create a safety environment such as put a holder in the bathroom as the floor wet and might easily fall down and not only focuses on the dry floor and adequate lighting. Creating a group of patient will high risk of bleeding can be consider as well. Nurses can gather them all and provide a health education to the patient. This can increase their awareness of the bleeding precaution. At the same time they can communicate and share their experience to reduce the risk of bleeding. I hope this will improve our nursing care and practice with a patient with high risk of bleeding tendency. Together we work to improve our patient's well-being and our nursing care practice as a professional nurse.

Comparing Cuban and Sierra Leone Youth - 2294 Words

In a world that is being assimilated by a digital revolution of mass media and better means of travel, most of the Earth’s population would like to have cultural traits that maintain their unique identity in a peaceful state of co-existence. Assimilation requires an understanding of cultural differences in order to bridge them. If assimilation begins with the newest generation, one must understand any difficulties that lie in differentiating the youth of that generation. In assessing the Cuban and Sierra Leone cultures, perhaps assimilation in some areas are needed. Although Cuban and Sierra Leone youth may seem similar, they certainly have numerous dissimilarities too. Specifically looking at boys from Cuba and Sierra Leone, we†¦show more content†¦The boys, thus, grew up in a patriotic, uniform society where defecting is traitorous. A critical aspect to unifying the nation was to educate everyone around a central curriculum based on every detail of the revolu tion that transformed the country and the governments version of events.(â€Å"Victory†). Billboard signs, erected all around Cuba, state, â€Å"In Cuba- Children in School 100%†; they proudly display that Castro has successfully catalyzed a 100% literacy rate (â€Å"Victory†). The manner in which Castro induced exemplary education was by providing it free to all children for six days every week and encouraging after school activities, such as boxing. Cuban boys have the freedom to chose if they wish to take government-provided boxing or other activities. The boxing boys learn to interchange their wits and patriotic lessons with discipline and passion; all of which will create a strong, intellectual man. With only one day to be spent with the family, the boys are provided, through government means, a new father figure, their coach. Their coach, a civil servant, molds them into young men through intense, omnipresent training and routine, thus focusing on their habitual self-discipline for the future of Cuba. Coach Yhosvani Bonachea tells the boys while tucking them in at night, â€Å"We’re going to put the book here (under the pillow), so you dream dreams of an Olympic champion. Sleep with the angels,Show MoreRelatedOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 Pagespiling job on job, here is a tall bold slugger set vivid against the little soft cities; Bragging and laughing that under his wrist is the pulse, and under his  ribs the heart of the people, Laughing! Laughing the stormy husky, brawling laughter of Youth, half-naked, sweating, proud to be Hog Butcher, Tool Maker, Stacker of Wheat, Player with Railroads and Freight Handler to the Nation. In more scholarly form, the â€Å"Chicago School,† a cluster of social scientists based at the University of Chicago