Prevention of pressure ulcers: nurses’ sole responsibility

Prevention of pressure ulcers: nurses’ sole responsibility Pressure ulcer is a major health problem. According to previous 10 years nationwide studies, 10% to 15% of the general population suffers from chronic pressure ulcers. In addition, Reddy, Gill and Rochon (cited in Walton-Geer, 2009) approximated 60,000 patients every year will die from hospital acquired pressure ulcers and the treatment of these wounds costs approximately $11 billion per year. These findings are significant in some areas such as patients in intensive care units, critical care units and nursing home residents. These situations cost patient in terms of suffering, impaired quality of life, reduced independence and even increased morbidity and mortality. The patients delay in hospital discharge and decrease the efficiency and efficacy of health services. The health industry is also concerned about lack of sources, work force hours to manage the problem. Various industries and government agencies are disconcerted to either treat these ulcers in early intervention or encou rage prevention (Lippincott Williams Wilkins, 2007). However, a good quality care is important in preventing these sores and nurses come at front to provide this care. In identifying the nurses attitude towards care and perception of barriers in that case may solve this situation. Search strategy The literature search was conducted by using the databases- Cinahl, Pro Quest, Pub med and Waiariki library catalogues. These databases identified the published studies, nursing journals and conference proceedings. The search engine used the terms for search were pressure ulcers and nursing, nurse and bedsores, nurse and hospital, pressure ulcer and patient, and nursing management and decubitus ulcers to search out the articles. The articles only written in English were retrieved for review. This literature review is based on the prevention strategies. Prevention and management of pressure ulcer is of major concern in health care system. Most of the studies revealed the appropriate knowledge of nurses for prevention. The gaps could be in the lack of performance in their practice. The hospital routines for early assessment and culture may be responsible for nurses to practice efficiently. Despite of increasing expenditure neither incidence nor prevalence is reducing. The attitude and supervision towards care of patient are significant review in whole populations generally. The search was wide to find the reliable material and needed to exclude some for relevance. The search boundaries were elaborated for nursing practice and attitude. The access to literature was sometimes limited to abstract only. Eighteen published articles were reviewed for possible inclusions in the final review. Among those ten articles were taken from previous conducted researches, three were the literature reviews and two relevant articles were based on life story of patients. One textbook and two non-research articles were kept for background information. The first line of defense in preventing the pressure ulcer development is the nurse practitioners behavior towards patient, nursing care by using various devices, patients status for devolving risk factors and hospital polices for further improvements. All ages were viewed as inclusion criteria with high-risk abilities. Four articles were more than ten years old and excluded to gather current knowledge for practice. One study was excluded because of emphasize was put on various positions of the patient that are inefficient for critical care units to take efforts in rising out of bed and were not valid. Two researches based studies were included to asse ss nurses knowledge in prevention and treatment strategies that were mainly researched for assessing the nurses knowledge about pressure ulcers and impact on practical decision-making skills and utilizations of various devices. The research literatures on pressure ulcer development filled the education and reliability assessment of nurses. One group of researchers created the longitudinal examination of hospital registered staffing to improve the quality of care and revealed the limited support for quality with number of registered nurses. These variations in favor of care presents a cross comparison of results, at best. Another research study revealed the influence of handling technique, and patients weight and disability that causes serious back injuries to nurses. One research supported computers for prevention and treatment of pressure ulcers at LCD hospital was included because the system reminds documentation to nurses. One life story article included tells about the negligenc e in care that leads towards the death of a woman, because of bone deep bedsores that remained untreated in last six months of her life. The selection criteria in three researches have been taken for use of preventive devices that underline the risk of pressure ulcers early assessment at time of admission. The potential inclusion admits a risk assessment tool, Braden scale in predicting pressure sore risk in hospitalized patients. However, two included studies exposed issues regarding the lack of clinical trials for effectiveness and the quality improvement implementations in nursing homes that associated with organizational culture. As the review included all ages, hospitalized and outside patients, one study assures about the sitting behavior of people lead towards building the risk of pressure ulcers. Nurses knowledge and attitude In 2004, Moore agreed the development of pressure ulcer is linked to nurses attitude, education and competence. Education increases awareness of the problem and gives a pathway for developing and maintaining competency. Thus, the successful prevention is dependent on staff knowledge, skill and attitude. This argument was underlined the content and quality of education, a major concern in decision-making. Hulland (cited in Moore, 2004) was able to identify nurses action, beliefs and opinion on pressure ulcer prevention and treatment. Anthony (cited in Moore, 2004) also agreed, however, nurses have good knowledge for prevention, still usage is inappropriate in practice. Maylor and Torrance (cited in Moore, 2004) supported the value of the attitude of nurses for preventive practices of pressure ulcers in clinical practice. Ousey (2010) accented the need of evidence-based education for whole staff involved in care of pressure ulcers. Another study by Wiechula in 1997 described the focus of quality improvement ought to on the appropriate education program that contains the instructions and guidelines of current and evidence based practice. The education program should include the etiology and risk factors along with risk assessment tools and application in demonstrating the positioning for prevention of pressure ulcers. In this study, the stress was also put on the accurate documentation and monitoring. Another cross-sectional study by a group of researchers explored the comparison between the knowledge among past time and present time nurses. The sample was large (n=522 nurses in 2003 compared with n=351 nurses in 1991), with written questionnaire method. The authors identified the knowledge of nurses in 2003 is better and nurses know the usefulness of preventive measures. However, the raised issue was again the knowledge did not come in practice in the organizations that monitored pressure ulcers (Hulsenboom, Bours Halfens, 2007). Comparing the views of all autho rs, one group of researchers conducted a one-time survey. Fifteen nurses were subjected to check the use of system increase their knowledge and skills. The study resulted in no effective knowledge about pressure ulcers and decision-making skills in practice (Zielstorff et al, 1997). Among various researches, one study by Smith and Waugh in 2009 uncovered the nurses knowledge of pressure ulcer prevention and treatment along with the perception of barrier in providing effective care. After using the Pieper Pressure Ulcer Knowledge Test among 96 nurses, the study revealed the nurses knowledge was higher significantly but the barrier such as the weight of patient, patients refusal, unavailability of equipments, not having enough time and staff was significantly considerable. Nevertheless, Mark, Harless, McCue and Xu in 2004 found limited support for enduring the belief that improvement in registered nurse staffing improves the quality of care. In addition, Skotte and Fallentin in 2008 s upports the barrier by assessing the low back load on health care workers while using preventive techniques such as repositioning and use of friction reducing devices that is higher than patients weight and disability. Pulkkinen (2009) explores this argument in an article about a health care workers second-degree criminal mistreatment. The evidence shows that the treatment for bedsores was not provided to Harrison and ultimately because of gangrene infection of bone deep ulcers, he died. Use of appliances in practice In 1997, Wiechula described the assessment of risk is important to consider causative and contributing factors that can eliminate the negative effects. This skin care assessment of patient should be at the time of admission, after change in condition and for long-term patients at regular intervals. Specifically, to relieve pressure, attempt should be put on positioning and turning frequently. The major concern was preventing contact on between prone areas and support surface by using devices such as pillows and foams and use of alternating pressure mattress for high-risk patients. Ousey (2010) explored the early detection and effective documentation of pressure ulcers is a key component of quality care if the nurses can identify risk development behavior appropriately. The study assures manual repositioning and pressure relieving support surfaces are important in preventive measures. The early detection includes the assessment within six hours of admission in hospital and in communit y settings; it should be at first visit of practice nurse. However, Wiechula in 1997 outlined, turning of patient every 2 hours is a reliable and cheap method of prevention. Schoonhoven (cited in Ousey, 2010) disputed the effectiveness of preventive measures in some patients. Based on this notion, Ousey agreed the pressure ulcer tool will be helpful for high-risk individuals if practice with professional jugdement. Stotts and Gunningberg in 2007 supported one evidence-based article for use of Braden scale, a good assessment tool. Considering the reliability and validity, Braden scale is affective to practice with the difference in patients culture. In the matter of devices in care of pressure ulcers, the Australian Medical sheepskin is a new pressure-relieving device is effective in relieving pressure with moisture absorbing capacities (Mistiaen et al, 2008). Gardner, Frantz, Bergquist and Shin (2005) explored another perspective study for measuring the wound healing is pressure ulc er scale for healing. When the workers apply this evidence-based tool at weekly intervals, it provides accuracy in differentiating healing of pressure ulcer from non-healing in tracking changes in pressure ulcer status. This study outlined the use of PUSH score can achieve changes during extended follow-ups during the time when pressure ulcers take more than 3 months to heal. As explained by Wiechula in 1997, massage on bony prominences ought to avoid and the ring shaped devices are ineffectiveness in practice. Ousey (2010) agreed the view of not rubbing the skin vigorously to prevent the damage of superficial and deep tissues. Interestingly, one cross-sectional study unveiled the use of these preventive devices and documentation is suboptimal even for high-risk patients. In practice, the documentation and preventive devices are important for all patients who are at risk and having pressure ulcers to note the status of patients. A research nurse to ascertain the use of pressure ulce r devices examined the patients. After examination, 68% patients were documented for pressure ulcers. Among those 15% of patients had preventive devices and 51% receive those were at high-risk. In multiple analyses, the type and stage of pressure ulcer were not associated with high-risk patient but the use of preventive devices (Rich, Shardell, Margolis Baumgarten, 2010). Similarly, Moore (2004) identified the use of pressure relieving devices are not as much helpful in reducing the prevalence of pressure ulcers without nurses positive attitude. Hospital policy The cost of treatment of pressure ulcers can be enormous and significantly run out the health system resources. According to Posnett Franks (cited in Ousey, 2010) the estimated cost for the treatment of pressure ulcer is between 1.8 billion pounds to 2.6 billion pounds annually. In 2009, Walton-Geer gave views on for the improvement in patient care the interventions should be initiated on evidence-based practice. Patients status AHCPR (cited in Wiechula, 1997) recommended the important link of malnutrition with the development of pressure ulcers. Wiechula (1997) indicated, on admission nutritional assessment should also be monitored such as weight changes, loss of appetite and decreased dietary intake. Patients with poor hygiene and skin moisture degrade the integrity of skin that further helps in developing sores. One literature review supported the components of Braden scale such as nutrition, sensory perception, evidence of moisture, activity level and mobility status are the most important predictive of developing risk of pressure ulcers. It is apparent in the study that the risk increases with the susceptibility of tissue tolerance and poor peripheral circulation that relates with poor nutritional status (Schultz, 2005). Ousey in 2010 outlined some intrinsic and extrinsic factors responsible for pressure ulcer development. Intrinsic factors included patients age, mobility, incontinence, medication, anem ia, thin skin, nutritional status and disease condition. The considered extrinsic factors were friction, moisture, poor handling and changing position. The stress was also put on initial assessment of all patients to improve nutritional intakes. Williams et al (cited in Ousey, 2010) considered poor nutrition and decreased tissue perfusion, the main cause of pressure ulcer development. Bain and Ferguson-Pell in 2002 considered the knowledge of sitting behavior of patients outside the hospital especially for wheel chair users who sit continuously for long time. The study tested the use of remote monitoring pressure distributing logger that keeps the record of sitting behavior after testing its feasibility. Phytochemical Method Silver Nanoparticles: Synthesis Phytochemical Method Silver Nanoparticles: Synthesis Phytochemical Method Silver Nanoparticles: Synthesis and Characterization The study of green synthesis of nanomaterials offers a valuable contribution to biomedicine at nanobiotechnology. This study focuses on the green synthesis of nanosilver from O. sanctum leaf extract and loading the nanosilver onto cotton fabrics and assessing their physical and biological properties. In this study, O. sanctum leaf extract was used as reducing agent for the synthesis of silver nanoparticles. When the silver nitrate solution was mixed with leaf extract, the color changes occur immediately in silver nitrate solution. Initially, the leaf extract was green, which turned yellowish brown on adding the silver nitrate solution. The color changes indirectly indicate the formation of silver nanoparticles. The color change was noted by virtual observation of O. sanctum leaf extract incubated with an aqueous solution of AgNO3. It started to change color from watery to yellowish brown at 4 h and dark pink at 24 h after incubation (Figure 1). It is due to the reduction of silver ions; this exhibits the formation of silver nanoparticles (Table 1). The color of the extract changed to intense brown along with threads after 24 h of incubation, and there was no significant change afterward. S.No. Time interval Colour change 1 0 min Dark green 2 10 min Pale green 3 30 min Reddish green 4 1hr Red 5 2 hrs Red 6 4 hrs Reddish brown 7 8 hrs Reddish brown 8 16 hrs Brown Threads 9 24 hrs Brown Threads Table 5. 1. Effect of leaf extract of O.sanctum on colour changes in silver nitrate solution at different time interval Biosynthesis of nanoparticles by time-dependent absorption spectrum The continuous formation of silver nanoparticles was investigated using UV-Vis spectroscopy, which has proven to be a useful spectroscopic method. The presence of silver nanoparticles was confirmed at a range of 200–600 nm. In UV-Vis spectra, silver nanoparticles can be shown by a SPR peak at around 400 nm, but a small shift (blueshift or redshift) in the wavelength of the peak could be related to obtaining —silver nanoparticles in different shapes, sizes, or solvent dependences. After 24 h of incubation, a typical peak of ÃŽ »max at 421 nm was obtained due to the SPR of silver nanoparticles (Figure5. 2). After the reaction time on adding of leaf extract reached 4 h, obtained silver nanoparticles showed a UV-Vis absorption peak, a characteristic SPR band for silver nanoparticles, centered at 400 nm (Figure 5.2). Figure 2, the intensity of the SPR peak increased with the increase in the reaction time, which indicated the continued reduction of the silver nitrate ions, whereas the increase of the absorbance value with the reaction time indicated the increase in concentration of silver nanoparticles. When the reaction time reached 12 h, the absorbance was increased and ÃŽ »max value was slightly blueshifted to 435 nm. At reaction time of 24 h, the absorbance value was also increased and blueshifted to 435 and 421 nm, respectively. At the end of the reaction (24 h), the absorbance value was considerably increased and there was no significant change in ÃŽ »max value (421 nm), compared with that at 12-h reaction time. FTIR spectroscopy analysis of biosynthesized silver nanoparticles FTIR measurements of the biosynthesized silver nanoparticle samples were carried out to identify the possible interactions between silver and bioactive molecules, which may be responsible for synthesis and stabilization (capping material) of silver nanoparticles. These were also to identify the possible biomolecules responsible for capping and efficient stabilization of the metal nanoparticles synthesized by leaf extract. Figure 5.3 shows the FTIR spectra of aqueous silver nanoparticles prepared from O. sanctum leaf extract. The presence of the signature peaks of amino acids supports the presence of proteins in cell-free filtrate as observed in spectral analysis. The silver nanoparticle sample shows peaks at 3313.48, 3193, 2976.90, 2883, 1670, 1452, 1338, 1196.78, and 1112.75 cm−1 (Figure 5.3). The peaks corresponding to protein and silver nanoparticles were found commonly present in the nanoparticles synthesized by leaf extract. X-ray diffraction analysis The crystalline nature of silver nanoparticles was studied with the aid of XRD as shown in Figure 5.4. The dry powders of the biosynthesized silver nanoparticles were used for XRD analysis. The diffracted intensities were recorded from 20à ¯Ã¢â‚¬Å¡Ã‚ ° to 80à ¯Ã¢â‚¬Å¡Ã‚ ° at 2à ¯Ã‚ Ã‚ ± angles. Many strong Bragg diffracted peaks observed at 27.82, 32.25, 46.22, and 76.63 corresponding to 126, 199, 131, and 24 height of the face-centered cubic pattern of silver were obtained. The average grain size of the silver nanoparticles formed in the bio-reduction process was determined using Scherrer formula and it suggested that the synthesized silver nanoparticles were crystalline. The size of the silver nanoparticles was found to be 26 nm, and it was determined using the width of the (126) Bragg’s reflection. In addition, yet some unassigned peaks were also observed suggesting the crystallization of biophase occurs on the surface of silver nanoparticles. Fluorescence spectral analysis Fluorescence spectroscopy is a type of electromagnetic spectroscopy which analyzes fluorescence from a sample. Figure 5.5 shows fluorescence emission spectrum from silver nanoparticles, dispersed in double distilled water. Fluorescence spectral analysis of silver nanoparticles used in the experiment was carried out to confirm the fluorescence emitted from the nanoparticles. A strong maximum at 431 nm wavelength and a quantum yield was 666.450 mV appeared in the fluorescence emission spectrum of O. sanctum leaf extract mediated silver nanoparticles. Potentiometry analysis of biosynthesized silver nanoparticles The biosynthesized silver nanostructure was shown and confirmed by the characteristic peaks observed in zeta potential, which will help to measure the diameter of nanoparticles with corresponding average zeta potential values, and also used for suggesting higher stability of silver nanoparticles. The reduction of silver ions to form nanoparticles was also monitored using a potentiometer. The large negative potential value could be due to the capping of polyphenolic constituents present in the extract. Figure 5.6 shows the results of time-dependent zeta potential analysis from 0 to 24 h of incubation period. A pointed reduction in the potential could be observed on 4 h of interaction, further indicating the formation of nanoparticles at this stage. The potential decrease from an initial value of 0.436 V for silver ions to 0.153 V at the end of 11 h (Figure5.6) was observed, after which the decrease in potential was gradual, decreasing up to 0.048 V at the end of 24 h. Zeta potential analysis of synthesized silver nanoparticles The zeta potential analysis was used to measure the electrophoretic mobility of the silver nanoparticles. The complex zeta potential is a parameter that is used to learn the surface charges and stability of nanoparticles. The zeta potential charges significantly affect the particle distribution and agglomeration of nanoparticles. The high zeta potential value indicates a high electric charge on the surface of the nanoparticles. It describes strong repellent forces among the particles, which prevent aggregation and lead to stabilization of the nanoparticles in the medium. The zeta potential of the nanoparticles formulated was only measured in systems that did not sediment after overnight equilibration. The alteration in zeta potential with a moment in time is shown in Figure 5.7. It can be observed that there was charge stabilization from 11 to 16 h, with the charge stabilized at around −57 mV. The zeta potential was −62 mV for the 14 h interacted samples, which further decreased to −35 mV for the 24 h interacted samples. SEM analysis of silver nanoparticles The morphology of silver nanoparticle was observed using a SEM instrument. The shape and size of silver nanoparticles were analyzed after 24 h of incubation using SEM as shown in Figure 5.8. In general, the nanoparticles were spherical with varying size ranged from 7 to 28 nm. Most of the nanoparticles were combined, with only a few of them scattered, as observed under SEM. The biosynthesized silver nanoparticles were mostly spherical. These were used to characterize the morphology, size, and distribution in aqueous suspension and were prepared by dropping the suspension onto a clean glass plate and allowing water to completely evaporate. It was evident that the ends of silver nanoparticles are brighter than the middle, suggesting the particles are encapsulated by biomolecules such as proteins in the Basil leaf extract (Figure 5.8). EDS analysis of silver nanoparticles The EDS spectrum (Figure 5.9) clearly identified the elemental composition of the synthesized nanoparticles, which suggests the presence of silver as the ingredient element. The vertical axis shows the counts of the X-ray and the horizontal axis shows energy in keV. The strong signals of silver correspond to the peaks in the graph confirming presence of silver. Biosynthesized silver nanoparticles typically show an optical absorption peak at 3.2 keV due to SPR. However, other elemental signals along with silver nanoparticles were also recorded, which were not observed for the biosynthesis of many other nanoparticles. TEM was used to visualize the size and shape of silver nanoparticles. Figure 5.10 shows the typical TEM micrograph of the synthesized silver nanoparticles. It is observed that most of the silver nanoparticles were spherical. A few agglomerated silver nanoparticles were also observed in some places, thereby indicating possible sedimentation at a later time. It is evident that there is variation in particle sizes, and the average size was estimated to be 26 nm and the particle size ranged from 8 to 45 nm. The natural products, namely glycosides, flavanones, and reducing sugars, are the main constituents of the O. sanctum leaf extract

Effectiveness Of Sex Offender Treatment

Effectiveness Of Sex Offender Treatment In previous years, the fear of sex offenders has led the public to believe a fallacy regarding sex offender treatments. The public often start to view anyone who commits a sexual offence to be a high risk sex offender. Society need to understand that some sex offenders are low risk offenders who are very unlikely to re-offend again. The public believe sex offenders should be sent to prison indefinitely, however this is an inefficient way in helping offenders from re-offending. One of the most controversial debate and problem around the world is crime. Crime is a massive issue around the world and it brings up more questions than it answers. This essay will discuss the myth that sex offenders are untreatable by providing various successful programmes used for treatment and to reduce crime rates. Initially, this paper will briefly define what a sex offender is, what drives people to become one and how the government has tried to prevent sex delinquents from re-offending. A sex offender is a person who has committed a sexual crime, an act which is prohibited by the jurisdiction. What constitutes a sex offence or normal and abnormal sexual behaviour varies over time and place (Pakes Winestone, 2007). Every country has different laws and perspectives on sex offences where age of consent to sexual acts vary from 9-21. Sexual offending mainly relates to adult rape or child molestation (Pakes Winestone, 2007), but there are many other types of sex crimes such as internet grooming, sexual harassment and incest. It is very different to distinguish between sex offenders with non offenders. It is presumed that many sex offenders have various sexual abnormal fantasies or an unusual high sex drive (Elsevier, 2007). People tend to believe most sexual offences are committed by strangers but the truth is most victims know their attacker and also are not very different to normal people (CSOM). Many theories try to explain why people commit sexual offences. Since sexual deviance takes several forms, no single theory maybe adequate to account for all aspects (Blackburn, 1993). Ellis (1989) identifies two major theories which can explain as to why a person may want to become a sex offender. The first being the social learning theory that suggests people commit sexual deviant acts because they learn and get exposed to certain things, which the person starts to assume is the right way to live life. An example could be childhood experiences, getting victimised or being exposed to pornography at a young age. The second theory, Ellis supports is the Evolutionary theory which connects with genetics and male aggression. Getting victimised by a sex offender can be traumatising and psychologically damaging. Sex offenders have been increasingly a focus of attention by the criminal justice system over the past decade (Thomas, 2000). In recent years, many countries have started to change their laws regarding sex offenders. The Criminal Justice System is strengthening the legislation and revising punishments for the publics safety and to lower recidivism rates. Before the Criminal Justice Act 1991, the laws on sex offences were very old; coming back from the Sexual Offences Act 1956 (Pakes Winestone, 2007). The Sex Offenders Act 1997 was later introduced. This Act made it easier to manage and identify the offenders on community release. Sex offenders had to register their names and addresses with the police which helped manage and protect the public. In 1998 the Crime and Disorder Act (Section 58), paid attention to extending the post release supervision of sex offenders to a maximum of 10 years for a prison sentence of any length (REF) and Section 2 introduced the Sex offender Order. This order places a number of prohibitions against the offender by magistrates of the court. This can be used to prevent certain sex offenders from going to specific locations (Legislation.co.uk). Furthermore, the laws in 2003 changed which introduced longer sentences and also life sentences were put into effect (Pakes Winestone, 2007). In 2003, the Sexual C riminal Act redefined the meaning of rape and internet grooming was also added into this Act as illegal. What happens to those that are convicted? Nearly two-thirds of sex offenders immediately go to prison (Homeoffice, 2003c), the rest are taken care by probation or supervision orders, fines and some are totally discharged. Those who are convicted or charged are often required to record their names in the sex offender registry. These names databases are classified into levels and are open to the public. A serious high risk offender must register for the rest of their lives whereas a low risk sex offender has to for a certain period of time. There are many advantages and disadvantages of the Sex offender Registry. Some of the advantages are that the public can easily access information about sex offenders on the internet and citizens have the right to know if there is a sex offender in their area. The disadvantages include records being inaccurate or not updated; this practice makes it hard for the offender to readjust back into the community (accommodation and employment). This could a lso lead to networking within sexual offenders (FIND). According to the Review of Sex Offender Treatment Programmes (1998) the highest risk sex offenders appear to be characterised by the following factors: criminal history, antisocial lifestyle, emotional loneliness, denial, psychopathic personality, low victim empathy and problem solving abilities. To manage these sex offenders the aim of each programme is to challenge offenders distorted thoughts and reasoning in relation to their victims and to help manage their impulses by providing alternative courses of action which they view as being more rewarding (Worrall Hoy, 2005). Many of the treatment programmes are taken place within a group format unless it is a high risk sex offender where its on a one on one basis. Sex offender treatment programmes require at least 80 hours of treatment (Evenden, 2008). The British Prison Service introduced the Core Sex Offender Treatment Programme (SOTP) to reduce the crime rates, which is now the largest of its kind in the world (Thornton Hogue, 199 3). SOTP have made a criterion for all of the sex offenders in prison or attending programmes in the community. This criterion has ten characteristics which a SOTP should have to be successful and effective (Journal Site). 1) Explaining how the programme will bring a change 2) Including whom the programme is intended for and why 3) Underline the risk factors 4) Treatment methods 5) Teaching different types of skills to avoid re-offending 6) Inform them that there are links between the management and the programme 7) Enforce engagement of participants 8) Explaining the sequence and duration 9) Monitor if the programme is being delivered properly 10) Evaluate the efficiency of the programme The main goal of the sex offender treatment programmes are that the person avoids committing another offence in the future. The offender must admit they are guilty for them to take part in the programme, not agreeing may lead the criminal to go back into prison. The programme expects the perpetrator to talk about his unacceptable behaviour, express their feelings, remorse for them and agree to apologize to the victim. To reduce reconviction rates it is suggested to also decrease the sexual arousal. Sexual arousal is one of the key factors which can lead to sex offending. Psychiatrists also contribute to the treatment of offenders along with probation and prison officers. The medication prescribed by psychiatrists is shown to reduce crime (Grublin, 2007). Most sex offenders are let off and released within the community under supervision before their sentence is completed. Due to this, there is a great need of effective SOTPs which can help lower crime rates. One common therapeutic app roach most countries use to treat sex offenders is the cognitive behavioural (Perkins, 1998). These treatment programmes involve individual and group therapy; victim understanding, future planning, identify emotions, solving problems, anger management if needed, social and interpersonal skills development and changing sexual arousal patterns (Centre of Sex Offender Management, 2000). Recent studies have shown specific areas of SOTPs that need more attention such as attachment issues, low self esteem, confidence and loneliness. Other types of approaches many SOTPs provide are psychotherapy, skills therapy, the psycho-educational and the pharmacological approach (FIND). These approaches focus on increasing victim empathy, uses of medication, getting out secrets, and also learning about the law. Therapists and probation officers have daily routines to inspect offenders during treatment hours and visiting them at home, this also includes drug/alcohol use checkups. UK prisons, have group s sessions with about eight offenders and two tutors. Therapy in prison started in 1991 and these sessions also consist of cognitive behavioural approaches but there are many other people involved than just psychologists, such as police officers, teachers and also chaplains (Psychology Textbook pg.435). Some of the techniques the prison SOTP uses are brainstorming, role playing and thinking strategies (Textbook). Many other types of SOTPs have been designed within America, Canada and the UK such as Community Sex Offender Group work Programme (C-SOGP) which pays attention to male offenders who have victimised children and Internet Sex Offender Treatment Programme (I-SOTP) is for offenders who have been convicted with internet only sex offences such as viewing indecent images of children (I-SOTP Site). The most effective way to manage and supervise potentially dangerous offenders in the community is for the relevant agencies to work together (leicsprobation.co.uk). This work is managed and directed by the Multi Agency Public Protection Arrangements (MAPPA). MAPPA was developed nationally on 1st April 2001 and works with many different types of agencies like Youth Offending Teams, Children Services, Adult Social Services, Health Trusts, local housing authorities, Job Plus and electronic monitoring providers (MAPPA book). MAPPA uses these agencies to get police surveillance, specialised accommodation, drug/alcohol rehabilitation and ongoing management by other services. Who are the MAPPA offenders? There are three categories of MAPPA offenders. Category one consists of sexual offenders who are required to register their names and address to the police. Category two includes violent offenders who have been sentenced to imprisonment for 12months or more. The last category is for danger ous offenders who are a risk to society but do not fit under the categories above (MAPPA BOOK). In 2009, MAPPA collaborated with Circles of Support and Accountability (COSA) to encourage and develop this programme. COSA was first introduced in Canada about 15 years ago. The purpose of this programme is to support and reintegrate sex offenders who are about to be put back into the community. This idea was introduced to the UK by the Quakers. Sex offenders are lonely people who feel isolated once released into the community. These are the key reasons as to why an offender might want to re-offend. COSA take place weekly which pay attention to employment, financial difficulties, isolation and loneliness (Print out). There have been many debates about the rehabilitation process and success rates. SOTPs not only have a significant impact on medium risk offenders but also are very successful in reducing crime with low risk sex offenders (Homeoffice, 2003). Treating high risk offenders is much more difficult as they have the most dropout rates and have no intention of recovering but it has been proven that many highly deviant offenders had a effective and successful treatment by joining long term therapy (160 hours) compared to short term (80 hours) (Homeoffice, no79). Sex offenders who attend and complete SOTPs overall have lower reconviction rates than those who dont receive treatment at all. This advice and support can change and save a persons life. Cognitive behavioural treatment and pharmacological treatment together have meant to be the most effective approaches to reducing crime and psychotherapy has been the most inefficient amongst sex offenders. A study was conducted for 2 years to see th e reconviction rates, 133 offenders who had taken treatment had lower sexual crime rates compared to 191 offenders who had not received treatment at all (12). Also, a sample of 264 people who had been convicted of internet sexual offences were examined after treatment given by I-SOTP and the results proved that sex offenders were positively changing their attitudes (15). There have been many pros and cons regarding the use of Sex Offender Register. The main arguments for why the Registry is not effective is because the criminals who committed sexual offences before 1997 were not added into the registry, criminals who were an acute risk to the public were excluded from the registry and there is no national sex offender registry (Pakes Winestone, 2007). MAPPA and COSA on the other hand give positive responses of effectiveness. Both programmes have been researched regarding their impact on crime rates. Offenders successfully completing these programmes are 3 times less likely to be re -convicted than offenders who have not completed this programme (NOTA). COSA has reduced re-offending by 70% and out of 35 offenders researched upon, only 3 criminals have been found to re-offend (paper). Receiving effective treatment is a very important. However, two major downfalls with SOTPs is that research has shown that there is a high percentage of drop outs. Another problem which arises is that probation officers have admitted to not being able to communicate properly with sex offenders and have said they need more skills and training to be able to protect the public (FIND). As new information comes available, the programmes are constantly being developed. Most sex offenders do get released into the community without having received any treatment in prison and reducing the risk of it happening outside within the community is a vital process. In order to asses and treat a sexual offender effectively, therefore, one needs to obtain a realistic account of his psychosexuality, something that is notoriously difficult to do (Elsevier, 2007). Till today, we cannot predict as to why people commit these harsh crimes to innocent people. It has become a hot topic within the public and the government have changed and revised many laws to ensure they are doing the best they can for the publics safety. Everybody wants to see positive future outcomes of SOTPs. Society hope to see an increase in public safety, tracking and monitoring of offenders, awareness of sex offender laws, changing of the offenders view on SOTPs and lastly to decrease the sexual offence crime rate s. The Cognitive behavioural approach is being used worldwide and has been proved most effective. Overall, there is evidence for a positive effect of sexual offender treatment. Categorising sex offenders and identifying the essential skills they need can help to what works and for whom under which circumstances. Thus, what needs to be said about SOTPs, is that they must continue to have a strong presence in the criminal justice system, so that we reduce victimisation and make communities safer.

Training Environment :: essays research papers

Using your Training Environment Tips for survival Your training environment is the most essential and important element of your presentation. It is the difference between a good presentation and one that will keep the participants asking for more. The five most important features of your training environment will be: 1. White Board 2. Flipchart 3. Projector 4. Space 5. Body Language A good presenter uses his training environment in the most effective and coordinative way possible. Here are a few tips that will help you use your training environment in a more effective manner, while giving presentations. White Board The white board is your medium of writing and projecting the presentation. In the modern world, white boards have revolutionarized and have added features in built such as a play, pause and stop button for you presentations and images. They can be connected to your projector to run your presentation more effectively and easily. But as much as technology may change, the basics of the white board will stay the same, and they are: †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Leave margins on the corners of the board. Do not fill up the board too much especially around the corners. Keep a spacing of 5 inches from the left/right and top/bottom corners of the board. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Always use a non-permanent marker on the white board. This ensures easy reusability of the board at various levels. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The color of the markers should be bright and solid. Do not use faint markers as they are not clearly visible. The purpose is easy visibility, not the formality of writing. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The letters should be at least  ½ â€Å" high and should be in capital letters. Caps case is easier to read. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Use a variety of color markers for highlighting and adding variety to what is written on the board. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  When using the white board as the projection screen make sure is cleaned and has no patches of ink. If you have written over the projection on the board then ensure that you wipe it before proceeding to the next slide. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Do not stand in front of the board if there is something written on it. Flip Chart The flip chart is your medium of that extra unit of writing and displaying your points. It is often termed as the trainers â€Å"companion†. The flip chart is mostly used as a tool for writing or illustrating points that are a part of the presentation, but may or may not be a part of the power point slides. Some key tips for using the flip chart are:

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Has anyone ever told your child "This is what you need to be focusing on," or "This is more important than what is outside that window"? If yes is your answer to this question, your child might have with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). Children who have ADD or ADHD are often more imaginative and outgoing without their prescribed medication. However, the medication does allow them to focus and decreases their tendency to be troublesome. Naturally, a permanent cure without having to take medication is what most sufferers of ADD would prefer. These children are smart, but they can be a gigantic distraction to other children. This disease has effected over seven million Americans alone and while doctors find it in few girls because the diseases mainly affect boys. Some of the children think they are immune to ADHD, but truthfully we need to obtain a cure for them. There are multiple reasons that might be the reason that people get ADHD, such as, parents having ADHD, or the possibility of brain injuries when they were a young child. Three other likely causes are exposure to a toxic substance as a child, too much lead in their blood when they were born or pre-birth are. There will, more than likely, have to be multiple cures for ADHD because there are numerous ways to get the disease. However, I am sure that American doctors are fully capable of inventing a cure that will finally stop the disease in no time. But for right now, with the current medications and treatments, we can merely temporarily stop the symptoms. There are rumors of a neurological cure which could be an everlasting cure for most cases of ADD and ADHD. This means that children with ADHD are failing and being disrup... ...de-effects that come with the disease include difficulty focusing, especially an adult who has ADD to organize tasks, finish work within a time limit, and remember information and that makes it perplexing to find a job. Ultimately ADD and ADHD are both diseases that will make focusing harder for anybody who has either of them. ADHD could, although not likely, ruin the USA and possibly the world. People need to figure out a cure for ADD and ADHD, and soon, because it affects myriad people across America, and is causing a ton of problems. Children are having an exhausting time focusing in classrooms and adults who have ADD straining themselvs to driving. Who knows, maybe the future cure will help them pay attention and allow them to keep their creativity. So in conclusion we talked about how children get ADD or ADHD, how it affects children, and how it affects adults.

Violence In The Media :: essays research papers

The Effects of Violence on TV Did you hear about the recent Jonesboro shootings in America where an 11-year-old and a 13-year-old shot down and killed four school mates and a teacher? The outrage has been put down to many things including exposure to violence in the media and computer games. Television authorities will tell you that TV doesn't breed murderers, and to some extent it is true, but the fantasy violence on TV and computer games is enough to tip a blood-drenched fantasy or perhaps a gruesome dream of revenge into an irreversible act of reality. The debate over the effects of violence in the media and computer games has been going on for quite some time, but it was only in 1997 that it reached significant status just after the killing of an 11 year old boy by a 14-year-old in Japan. The 11-year-old was decapitated and his head placed on the school fence. The idea supposedly came from a form of media or computer game. This lead to the investigations of the so-called "Nintendo generation", a generation so focused around computer games and television that reality is no longer easy to distinguish from fantasy and abnormality. Professor Fukaya of the New York Times says "They haven't been growing up with real feelings, living with real friends, or with real nature." Figures show that one in four British children has their own VCR and uses it to record s-rated films late at night. X-rated films are not the problem. The problem is that the films are x-rated for a reason and this reason is that they are not designed for children's ever believing eyes. Figures also show that they are very damaging, not least because of the desensitising more sex and violence has on children's minds. The rampage in 1987 by a sacked mail man put the term 'going postal' into the American vocabulary, meaning: a murderous rage. Since then a computer game has been made, although it is banned in Australia demo's are available on the internet. The game POSTAL, involves a series of massacres, including a school ground shooting. The player has to try and stalk as many school kids as possible and then shoot them. Then they have the chance to either listen to their plees for mercy of ignore them and finish them off for extra points. So the object of the game is to kill as many people as possible.

History of Chocolate Essay

Chocolate comes from the cacao bean, which comes from a cocoa tree, which are found in Central America. Mayans The Mayans found the cocoa trees down in South America, and then migrated up to Central America, where their empire stretched from the Yucatan Peninsula to the Pacific Coast of Guatemala. The Mayans are known for being the first people to create plantations, where they had people working on a cacao bean plantation. They also referred to the cacao bean as the â€Å"food of the gods. † Aztecs The Aztecs then conquered the Mayans. The Aztecs would tax anyone who they conquered who grew the cacao beans to pay them as taxes. In fact, the Aztecs used cacao beans as currency, and it was always in demand. No one outside of the Americas would hear of this magnificent drink (as it was used for early on) until about the 15th century. European Influence Christopher Columbus was the first European in the Americas, who was also the first to find cacao beans. He brought these cacao beans back to the Spanish king, whose friars sent the word of it throughout Spain. When the Spanish conquered the Aztecs, cacao beans were imported and changed into a chocolate drink, and was widely popular along the people. They would remove the chili pepper and add milk, sugar, and vanilla to give chocolate a sweet taste. They used chocolate as a drink until the Industrial Revolution. Post-18th Century Chocolate The chocolate we know today is created by mills that could create cocoa butter. This cocoa butter made it to where chocolate could become hard. After the Industrial Revolution, people began to sell these mills and â€Å"cocoa butter† to other people. A man by the name of Daniel Peter bought one of these, and began work on a new type of chocolate, called â€Å"milk chocolate. † This milk chocolate was toyed with quite a bit until Rodolphe Lindt invented conching, and this allowed for Milton Hershey to make chocolate famous and mass produce a cheap candy bar. This leads us up to the chocolate we eat today!

Krokodil: Signing Your Own Death Essay

Krokodil is a drug that is mostly sold in Russia. According to unofficial estimates, Russia is the country with the highest amount of heroin addicts; approximately two million. However, not everyone can afford this drug. Krokodil is a drug more powerful and more destructive than heroin and it is also a lot cheaper. Whereas heroin may cost $150 US and up per use, Krokodil can be obtained for $6-$8 US per injection. So what is Krokodil? It is home made and pretty much anyone can cook it. This drug is pretty much codeine turned into desomorphine by a relatively easy process of cooking. Codeine is narcotic found at any pharmacy. The problem with the desomorphine is that it has to be made by professionals in a special facility or laboratory to be perfectly pure. So these random citizens trying to perform this at home are going to use home products to turn the codeine into desomorphine, which is the cause of why the results after consuming this drug is so destructive. People use gasoline as a solvent, red phosphorus; which we find on average matches, iodine and hydrochloric acid, which is a highly corrosive substance, found naturally in gastric acid, it also balances the pH level of acidity which is why it is used in swimming pool treatment solutions, making it easy to purchase at specialized supermarkets. What does this drug do to you? The corrosive acids will eventually turn the skin greenish with a rough texture, which is why this drug is called Krokodil. The skin around the injection site is the first to gain this appearance and becomes an easy target for gangrene. The skin literally becomes rotten and, in time, it ends up sloughing off, exposing the bone. Victor Ivanov, the head of Russia’s Drug Control Agency, estimates that five percent of drug users in Russia are consuming Krokodil and other equally dangerous home made drugs. Heroin alone kills around 300 thousand people in Russia every year, but Krokodil brings a much faster death. Some of its consumers only inject it when they have no money to buy heroin; however, as soon as they manage to get the money they will stop using the Krokodil. In poorer regions of Russia, though, people are becoming 24/7 Krokodil addicts, which gives them no longer than a year to live, from the moment they first inject this drug. What’s bad about this is that there are actually websites showing how to cook this drug and it’s a growing hidden epidemic. After seeing pictures of what people look like after some doses of Krokodil, I wonder how someone would ever do this to themselves. Having said this, why do people still get themselves into this? What could be so terrible about their lives that they pick the path to self destruction in such a sordid, painful way? krokodil is 3 times more powerful and 10 times cheaper than heroin, and has become an epidemic in Russia. Krokodil has almost the same effects as heroin except heroin does not eat up your skin like krokodil does heroin is not that harmful as krokodil. Kokodril is consumed mainly injecting yourself the substance in your blood stream that’s the cause why it reacts destructively with your body. Many people call kokodril the drug that eats junkies. Many scientists say that this drug is one of the most dangerous drugs in the world. One good thing is that this drug is mainly used only in Russia but not in the united states. Overall if you take krokodil you basically sign your own death.