Writing Feedback / Evaluating my program basing on its success and the improvements that can be made [NEW]

Hey, i was wondering if i could get some help, I feel confident in the rest of my essay, but THIS paragraph i just don't know if it makes sense to anyone other than me!!

A little background on my essay: i developed a behaviour modification program and discussed it in the essay, and this paragraph is evaluating the program

here's my paragraph (sorry it's kind of long):

Now that my program has been executed, I can start evaluating my program based on the success of my program and the improvements that can be made. Comparing my pre-program and my post-program data, my target behaviour has decreased quite dramatically. It went from several snapping's a day to almost none. Admitting that snapping at my children for no reason was a problem , helped me to realize the severity of the problem and to take extra measures to stop this behaviour; this awareness partly helped make my program a success. Also, distributing a reinforcement (yoga) that I was already getting and was important me, but then only allowing myself to get it only if I did not emit the behaviour gave me the extra push to elicit an appropriate response. Giving myself a reinforcement that I previously used to take for granted was a useful strategy in my behaviour modification program. I also observed that Thursdays (Nov 8 and Nov 15) are particularly rough days to handle because they are anxiety driven due to the fact I have an early class, I have to get everyone to school/daycare/work in a shorter amount of time, and my boyfriend has to wake-up earlier than usual, which all ignite arguments and cause my frustration. On the other hand, Wednesdays are easier to manage because it is just me and my children all day without my boyfriend. Knowing this information, I can understand my target behaviour better and prepare in advance by better controlling and avoiding my antecedents.

One way I can improve my program is limit the wording of my antecedent control by stating: if me and my boyfriend are arguing we must set up a time to resolve the argument while the children are at school or sleeping before interacting with the children. Stating that we must try to resolve the argument right away, just continued the argument in front of the children which caused my snapping at them on Nov 11 and 15 (post-program data results) which was highly ineffective. I also decided that I will not end my program yet, I will continue with the program until I can rely on my reinforcements less and then I can gradually start phasing out my program.

Thanks in Advance!

Essays / Health promotion regarding teen pregnancies - my introduction-Does it Flow? [7]

Hi was wondering if my introduction to my essay sounded ok; it sounds really choppy to me, so im just trying to get feedback. Any and all suggestions are welcome, Thanks.

What my essay is about: health promotion regarding teen pregnancies (i.e how to prevent it)

so i've started writing my essay, how does it sound so far. Im particulary concerned about the second to last paragraph (i dont like my wording) and im also concerned if my essay is flowing nicely from paragraph to paragraph.

In the United States, nearly 900 000 conceptions occur in adolescents per year. More than 4 in 10 adolescent girls have been pregnant at least once before twenty years of age. About 51% of adolescent pregnancies end in live birth, 35% end in induced abortion and the other 14% result in miscarriage. Once an adolescent has had an infant, she is at an increased risk of having another. 25% of adolescent births are not the first birth. Even more concerning is that 90% of fifteen to nineteen year olds describe their pregnancies as being unintended. Currently 45% of high school females and 48% of high school males have had sexual intercourse. Approximately, one fourth of all youth report having had intercourse by fifteen years of age. 11% of high school females and 17% of high school males report having had four or more sexual partners. Research also shows that contraceptive use plays a role in adolescent pregnancies. Despite increasing use of contraception by adolescents at the time of first intercourse, 50% of adolescent pregnancies occur within the first six months of initial sexual intercourse. 39% of females in grade nine and 54% in grade eleven report using oral contraceptive at last intercourse. 15% and 17% respectively report using no contraceptive or the with-drawl method. However, many of the adolescents who report using prescription contraceptives delayed seeing a clinician for a prescription until they had been sexually active for one year or more. Adolescent pregnancy is a key health concern not only because the numbers are so high but because there are many risks involved when adolescents become parents.

Adolescent pregnancy continues to be an area of concern because maternal and fetal risks are the highest. Incidences of having a low birth weight infant among adolescents is more than double the rate for adults. Neonatal death rate is almost three times higher for adolescents than for adults. Mortality rate for the mother, although low is twice that for adult pregnant women. Adolescent pregnancy has also been linked to poor maternal weight gain, premature birth, pregnancy induced hypertension, anemia and STD's. Higher incidences of medical complications are not the only risks associated with adolescent pregnancy, there are also many psychosocial problems for both mother and child.

The psychosocial problems of adolescent pregnancy include school interruption, persistent poverty, limited vocational opportunities, separation from child's father, and repeat pregnancy. These factors are not independent of each other; they are all interconnected and influence one another. Adolescent parents tend to miss out on education, therefore, have limited job opportunities which lead to substantially lower incomes. They are more likely to suffer from relationship breakdowns and persistent poverty. As a result, children of adolescent parents have an increased risk of developmental delay, academic difficulties, behavioral disorders, substance abuse, early sexual activity, depression and becoming adolescent parents themselves. Adolescent pregnancy has several risk behaviors and factors associated with it that can be predictors of increased risk. Many of the behaviors are preventable, therefore recognizing and understanding them is important.

There are several factors that have been identified as predictors of adolescent pregnancy. The risk of becoming an adolescent parent is almost ten times higher in poor income households. Children of adolescent parents are one third more likely to become parenting adolescents themselves. Low education achievements, not being in school, training or work all increase the chances of becoming pregnant during adolescence. In some studies there has been a link between mental health problems and increased likelihood of adolescent pregnancy, as well as, 50%-60% of those who became pregnant during adolescence has a history of sexual or physical abuse. Many adolescent although have the capability to think as well as an adult, they do not have the experiences on which to build. Adolescents are generally incapable of making decisions based on a reasoned understanding of the future consequences of their actions. Adolescents often do not connect the actual act of intercourse with the real possibility of having a baby nine months later. This inability to perceive future consequences of current behavior is called cognitive immaturity. Another part of growing up mentally, adolescents experience what is called the personal fable. This line of thinking makes the adolescent believe they are unique, giving rise to risky behaviors, thinking that bad consequences won't happen to them. These factors lead adolescents to be at a much higher risk for the onset of sexual activity with all of its consequences.

There are several factors that correlate with the decreased risk of becoming an adolescent parent. Children who are raised by both parents have a decreased risk of becoming sexually active. Adolescents who regularly attend their places of worship delay the onset of sexual activity. Adolescents whose parents discuss sex with them are likely to delay the onset of sexual activity, as are adolescents who expect to get a post secondary education. An additional factor that helps protect adolescents is closeness or connectedness to their parents. Adolescents who relate well to their parents tend to delay the onset of sexual activity, and when they do become sexually active, they make better choices about contraception.

Writing Feedback / Jean Piaget - how is my grammar-Psych paper? [7]

Hey I'm back LOL! I really appreciate the feedback I recieve on my essay's, although I am improving my grammar with each essay I write, I'm still nervous about it! how's my grammar on this paper so far? It's not completed but coming along nicely! Thanks!

Jean Piaget's cognitive development theory consists of three main components: schemes, assimilation, accommodation, and the stage model. Piaget stressed that children actively construct their own cognitive worlds by creating schemes (Santrock, 2007). Schemes are actions or mental representations that organize knowledge. In Piaget's theory, behavioural schemes characterize infancy, and mental schemes develop in childhood. Piaget believed children use and adapt their schemes through assimilation, which is incorporating new information into existing knowledge, and accommodation, which is adjustment of schemes to fit new information and experiences (Santrock, 2007). Piaget believed that equilibration of assimilation and accommodation is what advanced children through stages helping them to understand the world. Equilibration is the shift that occurs as children experience cognitive conflict, or disequilibrium, in trying to understand the world. Eventually, they resolve the conflict and reach a balance, or equilibrium, adopting a more sophisticated mode of thought (Santrock, 2007). Each of the stages is age related and consists of distinct ways of thinking. Piaget's cognitive theory of development encompasses four main stages: the sensorimotor stage from zero to two years of age, the preoperational stage from two to seven years of age, the concrete operational stage from seven to eleven years of age, and the formal operational stage from eleven to fifteen years. This paper will examine in detail the preoperational and concrete operational stages of development, including their characteristics, abilities, and limitations. Three experiments will be conducted on two children aged between three to five and eight to ten. The purpose of the experiment is to observe the difference between a preoperational and concrete operational child's thought process regarding egocentrism and conservation.

Pre Operational Stage

The preoperational stage occurs between two to seven years of age, and is the second Piagetian stage. In this stage, children begin to represent the world with words, images, and drawings (Santrock, 2007). Symbolic thought goes beyond simple connections of sensory information and physical action (Santrock, 2007). However, although preschool children can symbolically represent the world, according to Piaget, they still lack the ability to perform operations; the Piagetian term for internalized mental actions that allow children to do mentally what they previously did physically (Santrock, 2007). Operations are also reversible mental actions. The preoperational stage can be divided into two sub-stages: the symbolic function sub-stage and the intuitive thought sub-stage.

During the symbolic function stage, which occurs between two to four years of age, children gain the ability to mentally represent an object that is not present (Santrock, 2007). Use of language and pretend play are prime examples of this symbol use. However, Piaget also noted that children during this phase are unable to take the point of view of other people, which he termed egocentrism. Animism is the other limitation Piaget observed during preoperational thought. Animism is the belief that inanimate objects have life like qualities and are capable of action (Santrock, 2007).

Intuitive thought is the second sub-stage of preoperational thought, occurring between four to seven years of age. During this sub-stage children begin to use primitive reasoning and want to know the answers to all sorts of questions (Santrock, 2007). At this stage, children seem so sure about their knowledge and understanding, yet are unaware of how they know what they know (Santrock, 2007). Children during this sub-stage tend to center on one aspect of any problem or communication at a time. Piaget labelled this centration, a centering of attention on one characteristic to the exclusion of all others (Santrock, 2007). Perhaps the most famous example of the preoperational child's centrism is what Piaget refers to as their inability to understand conservation. Conservation is the awareness that altering an objects or substances appearance does not change its basic properties (Santrock, 2007). It is the development of the child's ability to de-center that marks him as having moved on to the next stage.

Concrete Operational Stage

The concrete operational stage begins around age seven and continues until approximately age eleven. During this time, children gain a better understanding of mental operations. Children begin thinking logically about concrete events, but have difficulty understanding abstract or hypothetical concepts (Santrock, 2007). In this stage, the child not only uses symbols to represent the world, but can manipulate those symbols logically (Santrock, 2007). But, at this point, they must still perform these operations within the context of concrete situations (Santrock, 2007). The stage begins with progressive de-centering. Early on in the stage most children develop the ability to conserve number, length, and liquid volume (Santrock, 2007). Conservation refers to the idea that a quantity remains the same despite changes in appearance. If you show a child four marbles in a row, then spread them out, the preoperational child will focus on the spread, and tend to believe that there are now more marbles than before. The concrete operations child, on the other hand, will know that there are still four marbles. By mid-stage children develop conservation of substance: If I take a ball of clay and roll it into a long thin rod, or even split it into ten little pieces, the child knows that there is still the same amount of clay. And he will know that, if you rolled it all back into a single ball, it would look quite the same as it did- a feature known as reversibility (Santrock, 2007). By the end of the stage, the last of the conservation tests is mastered: conservation of area (Santrock, 2007). If you take four one-inch square pieces of felt, and lay them on a six-by-six cloth together in the center, the child who conserves will know that they take up just as much room as the same squares spread out in the corners, or, for that matter, anywhere at all. In addition, a child learns classification and seriation during this stage. Now the child begins to get the idea that one set can include another. Seriation is putting things in order (Santrock, 2007). The younger child may start putting things in order by, size, but will quickly lose track. Now the child has no problem with such a task.

Methods

Three simple experiments will be conducted to evaluate Piagetian concepts, particularly conservation of volume, conservation of area, and egocentrism. Two children, one from the preoperational stage aged three years old, and the other from the concrete operational stage aged eight years old will be observed conducting all three experiments separately without the other child in the room. Children participating in the first experiment will be asked to respond to a conservation of volume task. Specifically, the child will be exposed to two identical, clear containers holding the same amount of liquid. The liquid from one container will be poured into a shorter, wider container and the child will be asked to assess if there is the same or different amounts of liquid in the two containers containing the liquid. While responding to the second experiment, a conservation of area task, the children consider two identical sheets of paper upon which six blocks have been placed in identical positions. The blocks on one sheet of paper will be redistributed and the child will be asked if the same or different amounts of space are left exposed on the two sheets of paper. Measuring egocentrism, the third experiment, the children will be exposed to a two-sided card with a different picture on each side. As one side of the card is pointed toward the child and the other side toward the researcher, the child will be asked to say what they see and what they believe the researcher sees. The task will be repeated two more times using different cards. After interacting and observing two children of different ages, a thorough evaluation of the differences between a preoperational and a concrete operational child's thought processes can be done.

Writing Feedback / Health promotion - Article Summary [4]

Hi,
Just wondering how my grammar was doing, any suggestions are welcome!

Health Promotion Article: Summary

Research shows that one in five elementary school and one in ten middle school students in the US is bullied. Bully victims experience consequences such as sleep difficulties, bed wetting, headaches, stomach-aches, fatigue and school related problems. They can also experience low self-esteem, anxiety, depression, suicidal thoughts, and may feel socially rejected or isolated. Children who bully are more likely to be involved in activities such as fighting, vandalism, carrying weapons, stealing, and getting in trouble with the law. Several factors play a key role in predicting bullying experiences (both bullying and victimization) these include low socioeconomic status, divorce/separation, harsh home environment, child abuse, or authoritarian parenting style. The purpose of this study is to try to get a clear understanding of children's perceptions of bullying. Data was obtained from 1229 children aged 9 to 13 years. Significant responses show

- 1/3 of 9-13 year olds report being bullied once in a while
- 15% say they were bullied at least weekly
- 1 in 7 children were afraid to go to school at least once in a while because of bullying
- When bullied, almost half of the children stated they fight back, ź tell an adult, 20% do nothing, 8% try to talk to the bully
- 2/3 claimed they try to tell or try to stop bullying when they see it, 16% do nothing, and 20% join in
- Boys report being victims of more daily bullying but they are more likely to say they are never afraid to go to school
- Boys are more likely to act aggressively (fight back or join in)
- Girls are more likely to tell an adult
- Younger children are more likely to say they have been bullied, they are more likely to try to talk to the bully or to an adult and less prone to fight back

- Younger children were more likely to try to stop bullying or to tell someone who could help and less likely to do nothing or join in

- Younger children were also more likely to say they do not bully
- Children who admitted to frequently bullying others were more likely to think bullying is cool, but they were also more likely to claim they were victims of daily bullying

- The two most common responses for why kids bully were perception of increased popularity (35%), and to get what they want or to push others around (32%)

The study concludes that the key to bullying prevention may be the bystanders. By sending a clear message that bullying is un-cool, and that they should never join in bullying, and together with other bystanders getting assistance for the victims we can reduce bullying behaviour. Lastly we must remember that bullies are often victims of their environments and we must work jointly with teachers, parents and communities to raise the issue of bullying and to prevent it.

Writing Feedback / Summary On Pain Meds - paper [2]

Hi,
I really need help on my paper, it is just supposed to be a 2 page summary on a discussion regarding pain meds, i'm only half way done and already at 1.5 pages. If there is any advice regarding my paper I would really appreciate it (as well as grammer help is always appreciated as well). Thanks!

Pain is a universal phenomenon. It is experienced across all age groups, across all socioeconomic levels, and in all settings. Post operative treatment of pain is a nurse's responsibility and the process can be complicated. Morphine is the prototype drug from the opioid drug group, and is the drug of choice for post surgery. Morphine in post operative is ordered on a fixed schedule rather than on an as needed basis. There are several reasons for this which include post-operative patients are not fully cognitive and unable to request pain when needed, post operative pain is usually a persistent pain, and morphine's duration of action is only three to four hours (Lehne, 2007). A fixed schedule takes into account these factors, and prevents the opioid medication from becoming non-beneficial; therefore, medication is given before pain returns, rather than waiting for the patient to experience pain and then request the medication. When a drug is ordered on an as needed basis, the nurse can provide the patient with the best level of pain control by providing patient controlled analgesia. Patient controlled Analgesia (PCA) involves the on-demand, intermittent, self administration of a pre-determined does of analgesic drug (usually an opioid) by a patient (Shorten, Carr, Harmon, Puig, Browne, 2006). Interventions to ensure maximum pain relief using this method include provide patient education regarding the PCA; nurse should observe patients using the pump for the first time; teach the patient pre-operatively (Lehne, 1998); Monitor vital signs every one hour-for respiratory depression (Lehne, 2007); keep narcotic reversing agent readily available; patient should be told not to fear overdose; to reduce discomfort associated with painful activities, patients should be taught to activate pump ten minutes prior to anticipated activity (Lehne, 2007).

Interventions regarding pain relief often change depending on client goals. Client education and an open mind to pharmacological as well as non-pharmacological approaches to pain relief provide many alternatives to use when designing a plan. Many non-pharmacological methods can be used with or without traditional pharmacological methods; these include biofeedback, TENS, themoterapy, and cryotherapy. Non-pharmacological pain management are gaining populariy because it resolves many concerens about the overdose of drug, fear of syringe, involvement of medication pumps, capsules and I.V. lines. Also, it benefits self management of health problems.

An adequate and useful assessment is the first step before any goals or interventions are implemented. The nurse must assess pain characteristics, vital signs, patient's response to pain, patient's culture, and patient's expectations of pain relief, age, cognitive ability /mental illness, race, weight, hypersensitivity, cardiovascular system, prior treatments, present medications, and level of consciousness. Pain scales are a useful tool for the nurse to assess the severity of pain a patient is experiencing. For an infant a behavioral pain scale works best; for a toddler the Wong-Baker FACES pain scale; for a nonverbal adult check list for nonverbal pain indicators (CNPI), numeric scales or color scales; for an elderly patient with dementia the observable pain behaviors scale, checklist for non-verbal pain indicators (CNPI), pain assessment in advanced dementia (PAINDAD), and pain assessment for the dementing elderly (PADE). An assessment finding that warrants withholding medications include head injury/brain tumor/ increased intracranial pressure; hepatic failure; renal insufficiency; liver dysfunction; convulsions; gall bladder disease; bowel obstruction; allergies to narcotic medication; asthma; alcohol use; epilepsy; urinary tract infection.

Writing Feedback / Essay on labor and Delivery Pain [2]

Hi, I just wanted to check my grammer and to see if my essay flows, thanks in advance. Also I don't have a conclusion yet. Thanks

Many women use some type of method to deal with pain during childbirth. The management of labour pain is a primary responsibility of the nurse. It is important for the nurse and the labouring mother to develop mutually acceptable goals for pain relief. The nurse can best facilitate this process by conducting a thorough assessment, implement timely interventions, provide non-pharmacological methods of pain relief alongside or separate from pharmacological methods, and provide comprehensive health teaching regarding post-partum pain.

Pain assessment during labour and delivery focuses on the physiological factors. The nurse must assess for maternal vital signs, degree of pain, fetal heart rate and pattern, and uterine activity before and after administration of medication (Wong, Perry, Hockenberry, Lowdermilk, & Wilson, 2006). It is important to assess which stage of labour the mother is in before administering medication particularly morphine, because if birth occurs within one to four hours of dose, newborn may experience respiratory depression; however, if dose is administered too early on, labour can be prolonged and delayed (Wong et al., 2006). These assessments are made to ensure the health risks to the fetus and the labouring woman are eliminated.

Another important aspect of assessment is cultural factors specific to each patient and the instruments used to analyze the pain intensity level. Labour and delivery is perceived differently by each culture. The cultural assessment should encompass unique care giving behaviours and practices, presence of birth companions and assessment of view of childbirth as a wellness or illness experience (Wong et al, 2006). The patient's culture will also dictate how to express pain and whether pharmacological pain methods will be utilized or if preferences of non-pharmacological methods are in order. Even though pain is a personal experience, it can be analyzed with quantitative pain measure instruments. The Numeric Pain Intensity Scale is ranged from 1(no pain at all) to 10(unbearable pain). The NPIS is used by asking the client to choose a number that best represents the intensity of pain experienced during labour. The McGill questionnaire is composed of descriptive questions asked to the client to evaluate their qualitative pain level. The Visual Analog Scale is composed of pictures with different of state of faces arranging from little pain to worst pain. The VAS is used by asking the client to select a face that also represents the quality of their pain level. (Abushaikha & oweis, 2004) Pain assessment during labour and delivery is important to generate interventions that may possibly decrease the intensity of pain.

Interventions to relieve pain are one of the essential aspects of nursing care that must be considered during a woman's labour. Because of its strong effect on pain management, opioids are one of the most selected drugs administered to patients who are in pain, and thus; it is commonly administered to women experiencing labour pain through IM or IV injections during the first stage of labour. Intravenous administration is preferred to intramuscular because the medications onset of action is faster and more predictable (Wong et al., 2006). IV patient controlled analgesia (PCA) is now available for use during labour. With this method, the women self administers small doses of opioid analgesic by using a pump programmed for dose and frequency (Shorten, Carr, Harmon, Puig, Browne, 2006). According to Wong & Perry (2006, p.448), pharmacological management for pain must be established before pain in a patient reaches its intense severity. Before morphine therapy is initiated to a woman in labour, Lippincott Williams & Wilkins (2008, p. 421) advised that a morphine antagonist be established to encounter any adverse reaction during treatment. Regular patient monitoring of vital signs is a mandatory nursing intervention and must not be neglected during labour and especially after opioid is administered; maternal respirations of fewer than 12 breaths per minute should be notified to the physician immediately. The nurse should encourage voiding every two hours and palpate for bladder distension; bladder distension can inhibit uterine contractions (Wong et al., 2006). All these measures set in place will enhance the effectiveness of opioid therapy during the period of labour and delivery.

Along with pharmacological pain management, Wong & Perry (2006, p. 447), suggested additional and or non-pharmacological pain relief; when done aggressively, it can minimize patient's pain and aid in a satisfactory experience for the patient in labour. For non-pharmacological management of pain, the nurse can assist the labouring mother during deep breathing techniques to reduce anxiety and exhaustion. She can also beckon for a support person to be present during labour; the nurse can also implement the use of proper positioning by using pillows to relieve discomfort and promote circulation for the patient in labour. Effleurage and counter-pressure have been shown relief pain in women during the first stage of labour (Lowdermilk, Perry, 2007). Effleurage is light stroking of the abdomen in rhythm with contraction pain; it is used to distract the women (Lowerdermilk, Perry, 2007). Counter-pressure is steady pressure applied by a support person to the lower back region with the fist of the hand. This technique is used to help women cope with the pain in the lower back (Lowerdermilk, Perry, 2007). Non-pharmacological measures are usually simple, safe and provide the woman with a sense of control over her childbirth.

Women in postpartum may often experience some sort of pain for which the importance of health teaching is significant. Back pain seems to be a common type of pain in postpartum as it is experienced by two thirds of women instantaneously after delivery. (Russell & Reynolds, 1997) Mothers should be taught how to take care of their backs and ways to nurse the baby so that the least amount of pain possible is felt. (Russell & Reynolds, 1997) The nurse should also teach the mother about oral analgesics she may need to take. It's important to inform the mother that if a chronic pain syndrome develops because of continuing symptoms she may require psychological support. (Russell & Reynolds, 1997) It's also vital that postpartum mothers be educated about any side effects they can expect from the pain medications. They should be told that some of the side effects for certain analgesics include constipation, drowsiness, nausea and vomiting, hypothermia, and hypotension. (Wong, Perry, Hockenberry, Lowdermilk, & Wilson, 2006) The teaching should also include the interventions that can be implemented to reduce pain as much as possible.

Some women may experience pain related to perineal lacerations or an episiotomy, hemorrhoids, and breast engorgement (Wong et al., 2006). The nurse can provide health teaching to them so that they understand why this is happening, how long the pain will last, and ways that they can possibly reduce the pain. If a woman has hemorrhoids the nurse should tell her that she probably will feel pain or discomfort especially when defecating, within 6 weeks of delivery. The hemorrhoids should get smaller in size, and a sitz bath can be taken to relieve the pain (Wong et al., 2006). If pain is felt because of breast engorgement the mother can be informed that this is caused by abrupt hormonal changes and an increase in the amount of milk (Wong et al., 2006). Usually this disappears after 24 hours, and the pain can be relieved by placing raw, cold cabbage leaves or ice packs over the breasts or a tight support bra that is well-fitted can be worn (Wong et al., 2006). If the mother has pain related to an episiotomy or perineal lacerations she should be taught that either one of them occurs when the vaginal outlet needs to be enlarged (Wong et al., 2006). The pain can be relieved by using a pillow during sitting, using a side lying position, using ice packs, using a squeeze bottle to cleanse, or having a sitz bath (Wong et al., 2006). Teaching the mother about all the aspects related to the pain she is experiencing will empower her to make the right decisions and therefore possibly reduce her pain.

Writing Feedback / Twin Pregnancies-Impact on the family [2]

Hi,
I am having really hard time liking this essay, I'm just not sure how it is sounding so far, I am all essayed out :(

Any feedback would be appreciated. Thanks (oops forgot to add it is not completed yet, only half way through!)

The birth of twins can be a challenging experience for the family. Raising twins poses a unique set of challenges the family must overcome, including fatigue caused by multiple demands placed on the parents; managing the physical care of infants while meeting their individual needs; and experiencing a strain in the marital relationship due to the time consuming task of parenting twins. Nurses can play an integral role in assisting these families by conducting thorough assessments and implementing relevant interventions.

Caring for twins is a more difficult and physically demanding task than caring for one child; this often leads to parental fatigue. Forty four percent of parents of twins report fatigue or high levels of fatigue throughout the first two months after delivery (Williams, Medalie, 1994). Fatigue is often caused by the difficulties in coping with unsynchronized sleeping, feeding, and crying patterns of two infants (Taubman-Ben-Ari,Findler, Bendet, Stanger, Ben-Shlomo, Kuint, 2008). This fatigue is heightened when one parent must return to work, leaving the other parent to take on all the care-giving and household responsibilities. Often when the working parent returns from work, care-giving responsibilities are taken up again, leaving little or no time for rest for either parent. When raising singletons with two parents, parents receive half the time off, raising twins with two parents, parents receive little to no time off usually each parent being assigned to an infant. Studies show that by the time infant twins are six months old, seventy percent of parents complain of inadequate sleep (Williams, Medalie, 1994). Fatigue has negative effects on physical and mental status with regard to energy, motivation, and cognitive state (McQueen, Mander, 2003). Fatigue combined with the multiplicity of demands on parents with twins adds to stress, precipitating physical and mental exhaustion.

Parents of multiples found that managing the daily needs of infant twins was an all consuming task, taking twice sometimes three times as long as care-giving singletons (Holditch-Davis, Roberts, Sandelowski, 1999). Consequently parents of multiples had less time to spend in non-care-giving interactions with their infants. The logistics of caring for more than one infant dictated that the multiple birth infants were left alone more, received less care by both parents simultaneously, and received more care by someone other than the parents when compared to singletons (Holditch-Davis et al, 1999). Multiple birth infants were also looked at, talked to, and held less often (Holditch-Davis et al, 1999). Parents felt torn between the physical care of their infants and meeting each infant's individual needs. This can lead to parent detachment from their infants, or alternatively developing a bond with only one infant (Holditch-Davis et al, 1999).

The postpartum period following the birth of twins, poses time constraints on the parents leading to an increase in marital problems. Most parents of twins report diminished time for and quality of their relationship with their spouse during the first year of caring for infant twins (Williams, Medalie, 1994). Attempting to respond to overwhelming and competing demands placed by twin infants, parents felt a loss of control over personal time (Williams, Medalie, 1994). Couples considered it mentally healthy to have down time and or alone time but caring for multiples eliminated this extra time (Holditch-Davis et al, 1999). Since multiples filled these parents time, they reported feeling tied down and confined (Holditch-Davis et al, 1999). Degree of social support was found to be an important predictor of spousal conflict (Taubman-Ben-Ari, 2008). Decreased marital satisfaction can have significant impacts on the family, the most detrimental being divorce.

Grammar, Usage / Do these sentences make sense? Can I change the wording? [2]

Fatigue affects a person's ability to perform self-care and limits his or her capacity to fulfill role responsibilities in the family.

Nurse should begin by assessing parent's perceptions of their family unit and marital problems; if each person's perceptions are understood, resolution is more likely.

By evaluating strengths, coping skills, and current support systems a family has, the nurse can identify techniques that have been previously successful.

The nurse should provide an atmosphere where the couple can express concerns, fears, and expectations, this promotes communication and support.

The nurse should phrase problems as "family" problems, this way they are dealt with by the family and reduces blaming. Assist family in setting realistic goals; this helps family's gain control over the situation (is there any way the wording can be changed of these sentences?)

Research Papers / Research based article - annotated bibliography, how to organize it [4]

Hi,
I really could use some help organizing the bib and as per usual with the grammer please. I reaaly don't like this writing I've done I just need to know it flows!

thanks

Moore, K., & Haralambous, B. (2007). Barriers to reducing the use of restraints in residential elder care facilities. Journal of Advanced Nursing, 58(6), 532-540.

This research based article is a study to compare perspectives about barriers to reducing restraints. The study looks at barriers reported by staff, residents and family members of three different residential elder care facilities. One on One interviews were conducted with twelve residents, seventeen family members, and eighteen staff members including eight nurses, six personal care assistants, an activities co-coordinator, two general practitioners and a pharmacist. The intended audience of the study is anyone working or planning on working in the geriatric community. The study indicated that although participating facilities wanted to reduce the use of restraints, they were still being in all three facilities. Barriers included fear of resident injury, staff and resource limitations, lack of education and information about alternatives to restraints, environmental constraints, policy and management issues, beliefs and expectations, inadequate review practices and communication barriers. Staff reported more barriers that residents or family members. Family members put a lot of trust in staff to use restraints appropriately not realizing that staff was also lacking information. The study concludes that education and support for staff and family members was needed in order to provide minimal restraint use.

This article outlined researched based evidence justifying the need to reduce restraints, then providing barriers to reducing restraints this helped me understand why nurses are using restraints although the evidence proves contrary. It let me analyze if nursing is an evidence based practice then why nurses practice conflicting care, it gave me a different perspective on why nurses not so much ignore the evidence but rather have limitations that further prevent them from putting this evidence into practice. It influenced my practice as a nurse that now I know what barriers exist that refrain facilities from using minimal restraint use, therefore, now I know what to look for and can advocate for clients and can use least restraints in my own practice and can help other staff become drivers of change that move the facility towards least restraint use. What I learned about nursing in this article is that this profession is education focused. Continual education is the key to best practice care. Lack of education and resources can be the biggest barriers to providing efficient, autonomous, client centered care. Although the article clearly illustrates the studies point about barriers to reducing restraints, it does not explore many ways to reduce the barriers leaving the audience with many questions.

This article meets the criteria for a peer reviewed journal hence is a credible source. Compared to other articles cited in the study this article provides a new perspective and is relevant to the topic because although extensive research shows that restraint use should be minimized there is very little research showing why nurses have difficulty adopting the least restraint use policy. I would draw the same conclusions as the authors that restraints should be used minimally as possible and that barriers do exist that prevent this from happening. Limitations of this article are that they used a small sample size, no residents that had been in restraints were represented and respondents could have provided false information fearing about their jobs.

Writing Feedback / Chronic Illness and Family-Analysis paper [2]

Hi, Could you all please help me edit my paper, I am not sure if it is well written. I am stressed out because i am over the page limit and I know I can't shorten it any more thatn I already have. Anyways Thanks in Advance.

Although it is the individual who experiences a disability or illness, it is the family who must usually bear the primary caregiving responsibilities (Levine, 2004). A complex situation is created for all family members who can be affected negatively or positively by the chronic illness. The movie, Marvin's Room, exemplifies in many ways how chronic illness can affect the family. Marvin's Room is about two sisters who have very different attitudes toward familial responsibilities and duties regarding their dying father. The movie shows how the two estranged sisters are forcefully reunited through a cancer diagnosis which makes them deal with a number of issues with each other that they've never resolved, many concerning their responses to Marvin's illness. This paper will analyze how chronic illness affects the family caregiver as portrayed in the movie, Marvin's Room.

Family caregivers often suffer adverse health, financial, and psychosocial effects because of their role. Caregivers have vulnerable health with nearly 32.3 percent reporting serious health problems (Levine, 2004). Caregiving is a time consuming job which can translate into stress for people. Stress has been shown to either cause or exacerbate 70 to 90 percent of all medical conditions (Levine, 2004). Stress also increases a person's vulnerability to far more serious conditions, such as, increased heart disease, stroke and cancer (Paul & Del Orto, 2004). Caregiving is associated with psychological problems such as anxiety, depression, drug and alcohol abuse, and insomnia (Schultz, & Sherwood, 2008). Research shows that caregivers who provide assistance 20 hours or more per week resulted in increased depression and psychological distress, impaired self care and poorer self reported health (Lee & Gramotnev, 2007). Caregiving has the potential to cause financial strain on families. Approximately 20 percent of caregivers have to quit their jobs and 40 percent have to reduce their work hours in order to provide care (Hebert & Schultz, 2006). Caregivers often have other family responsibilities that conflict with full assumption of the caregiving role; these demands make it challenging to address the needs of other family members which often lead to family conflict (Hebert & Schultz). Caregivers may have loss or change of roles which can lead to intangible losses such as loss of hope, plans or dreams (Lee & Gramotnev, 2007). Many consequences of family care are apparent and well documented in the literature.

Caregiving can have positive outcomes or beneficial effects for caregivers. Caregivers reported that caregiving makes them feel good about themselves leading to personal growth and self acceptance, gives meaning to their lives, enables them to learn new skills, strengthens their relationship with others, and encourages autonomy (Hogstel, Curry, & Walker, 2001). Individuals who provided support to friends, families or neighbors and people who provided emotional support to their spouses had lower five year mortality rates than individuals who did not help others (Schultz & Sherwood, 2008). Caregiving can also provide the sense of feeling connected to others, which can decrease isolation (Larsen & Lubken, 2009). Although benefits of caregiving have been a neglected area, it is possible for caregiving to be a satisfying and rewarding experience.

In Marvin's Room, Bessie is dying of cancer, struggling to offer personal home health care to her dying father, with a limited income, and only another aging, half-crazed aunt to help her. Although Bessie's life has not been easy, caregiving has affected her in a positive way. Bessie feels that caregiving is rewarding, and she's come to love her father very much, it is evident that she has satisfaction with her role as a caregiver. She has strengthened her relationship with her father and her Aunt and we can see this when she says "I've been so lucky to have been able to love someone so much.'' in reference to her father. Although she has not developed other roles such as wife or mother, her life has meaning to it, the self sacrifice of caregiving has given her a deep sense of personal fulfillment which reaffirms and supports her sense of self and increases her self esteem (Hogstel, Curry, & Walker, 2006). This is evidenced throughout the movie when Bessie is the only one emitting hope and triumph in the face of death. Although we do not know if Bessie's cancer is a direct result of caregiving, we can see her strong coping skills emerge, and see her endure in stressful times; efficient coping techniques can be gained from caregiving situations (Levine, 2004). Bessie being the primary family caregiver had benefited positively from her caregiving role.

Lee, Bessie's estranged sister, has two kids, and long ago made the decision to concentrate on her own life rather than give needed aid to her sister. Levine (2004) states that caregiving can provoke a wide range of reactions to a complicated life choice involving personal sacrifice, Lee is clear that she is not willing to make that sacrifice to care for her dying father, this is illustrated in many ways in the movie starting with her being estranged from her family for 20 years. She demonstrates this further on her return by stating to Bessie "How could I help you, I had a husband and small children" and "In a few months, I'll have my cosmetology degree, my life is just coming together; I'm not going to give it all up, now!" In Lee's eyes, the sacrifice Bessie has made is too great and realizing that Marvin's welfare will fall to her if Bessie dies, Lee's first instinct is to look for a nursing home. It is obvious Lee is grieving her previous roles and is conflicted about the possibility of altered or relinquished roles as her former self. It is evident that Lee is disturbed to see her father physically and cognitively deteriorated, which provokes overwhelming feelings in her. She is also very angry and harbors feelings of being unjustly trapped, hence looking for nursing homes so that burden of care can be lifted off her shoulders. Lee, who has averted her caregiving responsibilities, has been more negatively impacted by family caregiving despite being minimally involved in it.

Caregiving can also have a profound effect on adolescents who have been exposed to a family caregiving environment. Evidence shows that adolescents residing in caregiving families have greater empathy for older adults, and show significant bonding with their mothers (Larsen & Lubken, 2009). In Marvin's Room, Lee's oldest son, Hank, who resides in an institution due to his mental illness, is a troubled teen who is quite disengaged from his family; however, after coming to Bessie's house he ends up having a complete turnaround. He develops a significant bond with Bessie evidenced by their significant amount of time spent together, his consent to the bone marrow test, and when he lets his guard down and stops lying to Bessie.

Marvin's Room deals with care of our elderly relatives, and parents and how such situations can often tear surviving family members and families even extended ones, apart. It shows how family caregiving can have positive influences as well as negative influences on an entire family.

sorry i know its long, i just need help with grammar!