Terrorism And Its Impacts On Tourism Tourism Essay

Terrorism And Its Impacts On Tourism Tourism Essay This part of research project comprises of brief and deep look about the presence of terrorism and its impacts on tourism in management literature. At first the characteristics of terrorism risk and uncertainty discussed after defining terrorism and it history, and then discussion tries to narrate the some of the most important and basic concepts in strategic management relates with the terrorism research. We also need to critically analysing the different strategic concepts and about at which level of uncertainty, what kind of strategy may better for tourism industry. Terrorism is not new; it has long history as old as humans willingness to use violence or force against the civilian population to achieve political or social ends. It has been defined as a tactic and strategy, a holy duty or crime, a justified reaction to oppression and an inexcusable represented. It has been used since the beginning of the history. According to Richard A. Horsley (1979) the first terrorist group was Jewish group called Sicarii, who murdered Romans and their collaborators to oust their Roman rulers from Judea. The killing weapon of Sicarii was Sica (short dagger) which they used to murder their enemies (Romans and Greeks) and these killings normally took place in daylight and in front of people. The aim of such acts was to send a message to the Roman authorities and their collaborators that this tactics can be used against them as well. The Hashhashin was the 11th to 13th century Iranian terrorist group offshoot of by a person known as the Ismailis. Like Sicarii ter rorist they used the same method of stabbing their victims in daylight. There forces were too small to challenge the militarily, so thats why they killed city governors and military commanders in order to create uncertainty in militarily. They also carried out assassinations as retribution. Under modern definitions of terrorism some killings they carrier out do not qualify as terrorism (Mark Burgess 2003). According to Jeffrey Record (2003) the origin of modern terrorism and word terrorism was introduced in Europe in the French Revolution of 1789. In the early period of revolutionary years, it was mainly by violence that governments in France tried to impose their radical order on a reluctant citizenry. As a result during this revolution, the meaning of terrorism was recorded by Francaise Academie in 1798 as system or rule of terror. During these revolutionaries more than 40,000 people have been killed and 5 millions people being jailed as political suspects. This was one of the worst examples that show the terrorism and these cruel killings were justified as an attempt to reduce or eliminate the revolutionary government opponents and to create fear in others people trying to overthrow the existing government. According to Findley Carter Vaughn (1982) the French revolution created huge terror and become a prototype for the future terrorists. The terrorist groups formation happened in the late 19th century. Terrorist used to format small groups to attack nation states. According to Crenshaw M. (1981) one of the examples of theses groups was Russian Revolutionary Group (Narodnaya Volya). This terrorist group was trying to create uncertainty through quick attacks against current political regime. The ideas and tricks that these terrorist were used, later become the prime example of terrorism in around the world. They used modern weapons such as bombs, guns and suicide attacks. According to the Director of Central Intelligence (1981) report the Soviet Union was giving assistance to revolutionary movements throughout the cold war. They provide free training and supply of weapons to terrorist groups. The Soviet Union support revolutionary groups around the world in order to export revolution to non communist countries. This Soviet strategy resulted considerable terror and violence around the world. In early 20th century revolutionary terrorism continued to motivate political violence all over the world, much of this violence directed against the British government. The Irish Republican Army terrorist started violence against British Empire in 1910s and IRA carried out number of attacks from 1916 to 1923 against British power. During this period they attacked over 300 police stations, killed dozen police officers and burned down the Liverpool docks and warehouses. After years of violence finally British Empire agreed to create an independent Irish nation. Many terrorist groups inspired from IRA fighting tactics including Palestine Mandates, Zionist, Hagannah, Irgun, Lehi and even British army special operations unit used during World War II (Carr M. 2006). After the World War II terrorism was practiced by groups and individuals. According to Goren R. (1984), in late 20th century dramatic growth in terrorism began. Through this period many terrorist organizations were motivated by ideological considerations such as Palestinian Liberation Organization, Basque ETA and IRA appeared terrorists besides nationalists. These terrorist organizations introduced new and modern method of terrorism such as hijacking, attacks on public and private organizations. Many terrorist organizations consider terrorism as religious war and some use to achieve political goals. The recent and largest act of terrorism occurred on September 11 2001, when terrorist set of coordinated attacks on USA. The terrorist hijacked civilian airplanes and used these plans to attack the World Trade Towers and Pentagon. Other major terrorist attacks have occurred in London subway bombing, Madrid train bombing, Mumbai attacks and many more around the world in past decade. Defining terrorism: Terrorism in nature is very difficult to define but the acts of terrorism conjure emotional responses in the victims and the person who did it. No one is agreeing on one single definition of terrorism, because one mans terrorist is another mans freedom fighter. If we consider terrorism is an act of political violence, then the war on terrorism is another form of political violence to wipe out other (terrorists). The term terrorism is come from French word terrorisme based on Latin language words Terror means great fear related to the Latin verb terrere (to frighten). According to the Oxford dictionary, terrorism means act of terror. The word terrorism is emotionally and politically charged and it is also very difficult to provide a precise definition. The studies have found over hundreds definitions of terrorism. The concept of terrorism may itself be controversial because state authorities often use it to delegitimize political or other opponents by use armed force against them (Hof fman B. 1998). Defining terrorism is one of the most demanding tasks, because it has proven impossible to outline the scope of terrorist activities and find the meaningful delineation of actions that should be called terrorism in the context of philosophers and political scientists. The main reason is that (as said before) one mans terrorist is another mans hero. In the view of different authors and organizations terrorism has the different definitions. Hoffman B. (1998) describes as terrorism is violence or equally important, the threat of violence, used and directed in pursuit of or in service of political aim. According to United States department of Defence the calculated use of unlawful violence or threat of unlawful violence to inculcate fear; intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological. In the dictionary of United Nations An anxiety-inspiring method of repeated violent action, employed by (semi-) clandestine individual, group or state actors, for idiosyncratic, criminal or political reasons, whereby in contrast to assassination the direct targets of violence are not the main targets.. According to the FBI (2002), terrorism is unlawful use of force of violence against the person or property to intimidate government, civilian population or any segment therefore in furtherance of political or social objectives. A deep interpretation of terrorism in literature: Terrorism can take many shapes and forms and much literature has been produced about financial impact of terrorism on different economic sectors and industries. Now arguably it the biggest threat to the tourism and related industries around the world. In the past twenty years, we have seen a dramatic rise in terrorism in different parts of the world. Terrorism did not begin in 21st century after World Trade Centre terrorist attacks. Europe, United States and other continents have a very long and sad history of terrorist attacks. According to Harold Miller (2003), in 20th century IRA in UK, ETA in Spain, Brigate Rosse in Itely, Rote Armee Fraktion in Germany, 7 November in Greece are the few worse examples of terrorist groups in Europe. In United States we remember the bombing in Oklahoma City in 1994, World Trade Center bombing in 1993 and 11 September 2001 terrorist attacks. But September 11 2001 attacks have changed the world, as UN Secretary General Kofi Annan has said, none of th e issue that faced us on 10 September 2001 has become less urgent. Now the terrorism has grown to an unprecedented limit and in multiplicity. As we know that, even terrorist without the use of weapons of mass destruction can kill thousands of people and destroy the economic activities (Gabriele G.S. Suder 2004). According to Blomberg, Brock S. Gregory (2004), terrorism is associated with a diversion of spending from investment to governments expenditure. To fund these government expenditures, they borrow from foreign financial institutions and governments. The develop countries with less volatile currencies normally issue long term debts to cover the deficit and less developing countries confronting terrorism by government spending through sale of foreign reserves, printing more currency and increasing inflation. Gupta S. Clements B. (2004) reached the same conclusion, that the terrorist activities severe impacts on less develop countries than developed from monetary policy perspe ctive. Terrorism has its massive effects on tourism industry and related businesses. Darnell B. (2010) said, most businesses operating in the effected area gets impact from the thrust of government policies to quell terrorism, which is another kind of harm which tourism industry may gets, when the terrorist activities happens. This kind of wide-spread results predict an escalate unattractiveness of tourism in effected areas. It is conspicuous to secure all of the targets of terrorism at the same time. In the number of attacks done by small terrorist groups with least resources, the loss to tourism industry was massive. If costs of an attack be measured by the loss which tourism industry faced, the tourism industry always paid far great amount than the loss of terrorist group. Hoffman B. (1998) cited that the cost of the bomb was not more than $400, which was the reason of the loss of $550 million in the blast of World Trade Centre in 1993. The amount which is sending to protect the world fr om terrorism is many billion dollars, while the terrorist cost nothing in front of it. The word terrorism seized the worlds attention in September 11 2001 as a result of destructive and dramatic attack on core symbols (world trade centre and pentagon) of worlds most powerful country United State of America. The September 11, 2001 terrorist attacks on New York exposed the vulnerabilities of the tourism industry and it also change the perception of tourists as to travel safely and securely. According to Bruck T. and Wickstrom B. (2004), some economic sectors or industries are more vulnerable to terrorist attacks than other and consequently they suffer more losses. The vulnerability of sector or industry may be due to characteristics of its operation. Tourism industry is perishable and its services can not be sold at another time or stored, once the time passes. So tourism industry will experience the vulnerability in the times of terrorist attacks and it affect on patterns of demand. The main aim of terrorist groups is to communicate the massage of fear to the people as wide as possible. According to Lehrman S. R. (1986), tourists are the soft target for terrorists because politicians and embassies are less attractive as they have huge security measures. Connor, Stafford Gallagher (2009) said, targeting tourists has the potential to punish the ideologies of capitalism and damage the country economy. Richter and Waugh (1986) said that terrorist attacks on overseas tourists are less likely to alienate popular support than they attacks on local targets because in this way they threat to other tourists. Targeting the local tourists would likely to engage the public as a result to retribution of places the existence of the terrorist groups at risk. There are number of studies about tourists choice of destination based on the costs and risk of terrorism. Gray P. and Thapa B. (2003) examined the effect of terrorism risk on travel intentions after the September 11 2001 attacks. The results show that travellers were considering the safety concerns and risk of terrorist attacks during travel. McKercher B. and Hui E. 2003) said that, terrorist attacks have an immediate but short term impact on tourism and travel flows. They also suggest that after the initial attacks tourism industry has greater effect than the scale of initial attack. According to Connor, Stafford Gallagher (2009), terrorist will continue the biggest threat to the tourism industry and terrorist groups have to be active in order to maintain discipline, interest and morale. This statement is still valid after 19 years later, for this reason we can expect this to be continuing, because terrorist attacks can happen anywhere and no place is safe. Now the biggest challenge to tourism industry is to deal and manage the crisis in the event of terrorist attack. It is difficult to determine the impact of terrorism on tourism industry because structure of tourism and terrorism differ not across the countries but also over the time. Drakos K. and Kutan A. (2003) emphasizes the importance of differentiating between different types of attacks, the locations of terrorist attacks (e.g. urban or rural areas) and number of casualties. Aziz H. (1995) said terrorism could also be a reaction to irresponsible tourism development. The study of Enders W. and Sandler T. (1991) argue that it is found that the causality is unidirectional, that the terrorists affect the inflow of tourists but not reverse. The different studies, facts and figures show how tourism industry in particular country or region is affected by terrorist attacks. The deterrent impact of terrorism on tourism industry in particular country may benefit the tourism in alternative destinations. Financial impacts of terrorism on tourism industry: The literature on terrorism and tourism is scant. The two studies by Enders et al 1992 and Enders and Sandler 1991 provide empirical evidence on the link between tourism sector and terrorism. Enders W. and Sandler T. (1991) used monthly data from 1970 to 1988 and employed VAR (Vector Autoregressive Analysis) to find negative impact of terrorism on tourism in Spain. According to Drakos K. Kutan A. (2003), Enders et al studied a large sample of European countries, between the periods 1974 to 1988 to find the impacts of terrorist attacks on tourism. They employ time series analysis and ARIMA technique with transfer functions and construct a forecasting model to analyse the impact on tourism in these countries. In these models they used quarterly terrorism data to quantify the present value of loss in tourism revenue for selected sample of European countries. According to Enders calculation Italy, Greece and Austria lost $1.16 billion, $.77 and $4.5 billion respectively during 1974 to 19 88. During this period all Europeans countries lost in tourism $16.15 billion due to terrorism. They conclude that terrorism has significant impact on Europe tourism industry revenue and tourists find substitute destination in order to minimise the risk of experiencing terrorist attacks. The immediate effects of terrorist attacks are death and destruction but the subsequent effects are discourage investment, interrupt travel tourism patterns and destabilise economies. The economic effect of terrorism has been the main subject of number of studies. According to Enders W. Sandler T. (2002), the terrorist attacks have economically significant negative effect on the economic growth; these attacks have less persistent and considerably smaller than the impacts of internal conflict or external war. Frey B. and Luechinger S. (2004), said that terrorists change tricks and tactics in reaction to the government polices, and it has direct effect on investment and economic growth. They also said that the investor decision to invest in particular country is based on economic risk, monetary returns and political risk. The foreign direct investment is one of the economic benefits of tourism, anything that effect on tourism needs to be minimised. Coshall J. (2005) claimed that Pan Am flight bombing in Lockerbie Scotland had minimal impacts on UK tourism and receipts from international tourists, while September 11 2001 had severe impacts on UK tourism and rest of the world. Different strategic management approaches of the tourism industry may have the same analytical aspects to improve the performance of industry. According to context of world Tourism organization (2008) the international tourism is increasing day by day as in 2008, the trade happens of more than $944 billion and over 922 million international tourist arrivals at different destinations and 2009 number of tourist arrival to 880 million which is 4% decline compare to 2008. The most affected reign was Europe, especially UK with a 6% decline. Terrorism can also destroy tourism industry by reducing tourist arrivals in UK. After September 11 2001, terrorist attacks in UK and continued threat of terrorist attacks also reduce the foreign direct investment significantly. According to Ritcher and Waugh (1986), terrorism and political violence can destroy the tourism industry supply and demand because this industry is extremely sensitive to these extreme events. However, after September 11, 2001 the world has been threatened by terrorism, and acts of terrorism have increased in many countries including UK. The effects of terrorism on tourism decisions have been an area of research concern on demand. Drakos and Kutan (2003), Pizam A. (1999) and Krakover (2005) all agreed that the severity and frequency of terrorist attacks are negatively correlated with the tourism demand. The Pizam and Fleischer (2002) said that the frequency of terrorist attacks cause large decline in tourism industry demand. The intervention analysis by Coshal l J. (2005) employs explore that the dynamics of the effects of terrorism incidents on those travelling or visiting UK and UK people going abroad. Influence of Media Following a Terrorist Attack Modern terrorism is particularly onerous, because of characteristic of its time. The impact of terrorism on macroeconomic is crucial, customers feel themselves in stress and some kind of continuous fear which definitely effects the spending patterns. Media plays very important role with regards to terrorists activities around the world. Firstly, terrorist use media to send their massage to the audience, and general public relied on media for information in the times of crises. Now terrorist are using media to advance their causes of attacks. According to Sonmez and Graefe (1998), the escalation of terrorism after 70s has been linked to media, with instantaneous access to the global audience. Secondly, the media provide information to the public, what has happened, which normally influence the public decisions about travel. In the event of terrorist attacks, Fischer H. (2005) discusses the importance of information, he said it is very difficult for emergency personnel to receive and c ommunicate the accurate information at the time of terrorist attacks. According to Lynch Katju (2004), media only report during the time of crises, it provides coverage to particular incident as long as its news and then move toward new news story when it happens. She said tourism industry has a great influence of media reporting and constant coverage of terrorist related incidents discourages the restoration of consumer confidence. Beirman D. (2003) said that the globalisation of media enhanced the ability to report terrorist events as they occurred, it also gives rise some problems and benefits to tourist authorities. In the word of Mansfeld and Pizam (2006), the media coverage and reporting on terrorist attacks have great impact on tourism industry, which transform the terrorism from horrendous event into iconic event. Tourism industry needs to monitor media coverage of terrorist events, because this will help tourism industry to develop strategies, which will help it to restore the tourists and travellers confidence. Media have its ital role in endangering fear, among the society; the irresponsible reporting generates scenes of ever present possibility of terrorist act. According to Crenshaw M. (1990) the new and fastest ways of communication allow people to know about happens in the other part of the world within minutes about any terrorist attack. On the other hand terrorist groups are adopting the latest techniques to communicate with each other and even sometime just for spreading fear with in the specific community to achieve their targets. Czinkota et al (2004) cited that terrorist also using old traditional ways to communicate which are unable to penetrate. The latest ways of transportation system gives terrorist groups better way to move around. So we can say that media plays very important role for tourism industry in the time of terrorists incidents, as the media medium for terrorists to the public subsequently depend on the same media for more information on that incident. Conclusion: The discussion will cover some of the most basic concepts in the research of terrorism and its impacts on tourism. Tourism industry internationally and locally particularly affected by terrorism because when some things happen, it disrupts the activities of tourism and related industries. Every year more than trillion dollars are spent on combating terrorism. This along with billons dollars lost in property damage, loss of human resources and decrease in key industries potential profit like tourism, aviation, hotel and transportation industry. It is a plague on global economy and affects on everyone from entire countries to all the way down to individual. Terrorism in recent years has sparked, increase in fear and demand higher level of security. The cost of terrorism can be broken down into number of areas and come down to direct effects, response costs and negative effects on tourism industry. Terrorism effects tourism activates deeply. This threat compel almost every department of tourism industry, which cause decline in the profit of industry and on the other side the whole economy has to bear the cost of every single act of terrorism. According to LCCI (2005) report, after 9 11 terrorist attacks, majority of tourism related industries fear high risk of terrorist attacks and they have contingency plan in place to deal with uncertainty. As globalization integrates multinational organizations and financial markets, events like terrorism which spurn economic uncertainty have increasingly international consequences. Terrorism causes unpredictable political and economic consequences, infuses the public with fear and prevents the free flow of capital, labour, and free market principles. Because of their disastrous impacts, occurrences of terrorism have serious implications on the performance of tourism and related industries around the world. In past few years immediate respon ses and severe impacts are felt in tourism industry soon after terrorist attacks happened. These sustained reactions can be observed through macroeconomic impacts, government policy responses, tourists and investor confidence. As world move towards more liberal economies and democratic political structures, tourism industry must have the ability to adapt and respond to terrorist events. In order to do so, tourism industry and associated businesses, need a more complete picture and understanding of the deleterious effects of terrorism.

Organizational Values Essay

The decision individual makes reflect their personal beliefs about what is important for them and the decision organization make reflect their personal belief about what they think is important. The personal and organizational value develops based on the decisions we make. Value alignment comes into place when the values of an individual are same as the values of their organization. If there is no alignment between the organization and employees, then the organization becomes in a more stressful condition. Companies who create a value alignment have very few problems. They know what their employees want and they know how to provide it. The value of the employees is important for successful for an organization. The values of an organization and the values of the nurse impact nurse engagement and patient outcomes. If the nurses have a happy environment in the hospital, it becomes a happy environment for the customers too. When nursing staff members feel empowered in the decision making process, they are energized to share their best talent, and skill. Nurses are the nucleus of the health care organization (â€Å"Nurses as implementers,† 2003). An alignment between hospital and nurses will increase nurses’ satisfaction as well as patient satisfaction. The importance of effective communication in nursing is important when it comes to interacting with patients, medical team members and doctors. Miscommunication causes misunderstandings, low performance, misdiagnosis and patient suffering. Therefore, nurses acquire effective communication skills in order to competently supervise. Communication in nursing practice serves a vital function in the building of helpful relationship patients, and coworkers. Taking time to listen to and understand patients experiences convey a message that patients feeling cared for and respected. Through communication a patient can be reassured and understand their sickness fully. Once, when I worked as a charge nurse, a patient wanted to inform me about something. She told me that her assigned nurse was not giving pain medication on correct time, and demanded for a different nurse. When I talked to the assigned nurse she told me that she gave all pain medication on time and that patient was ready to be discharged but the problem as that the patient didn’t want to leave. I checked the medication administration record and it indicated that the nurse gave all the medication on time. I didn’t change the assigned nurse instead I decided to take care of the patient. I talked with the patient asked her why she doesn’t want to go home. She replied saying that the pharmacy she gets her medication from is closed on Saturday and Sunday and she cannot get her discharge medication until Monday. She also complained about not having any ride back home after being discharged. I called the social worker and she arranged to get her medication for the patient from hospital’s charity for few days and also provided the patient with a cab voucher. I called the cab and discharged the patient home without any problem. The way I handled this situation was by communicating to the patient, and knowing her needs, and acting accordingly. By effectively communicating, problems can be solved easier without any further dissatisfaction from the patient. Nurses are able to prevent or manage conflicts by improving their communication skills. It is important for the nurse to try to understand the other party’s situation. Then the nurses can become focused about being understood. Typically during a conversation, an individual is already tries to think of a response to give to a person instead of just listening to what is being said (Marshall, 2006). Most importantly the nurse must have the patience to listen, and not interrupt while the other person is talking. A good communication skill allows the nurse to resolve his or her own conflicts or take appropriate actions for conflict resolution between other individuals. Communication is the key factor in response to any problems. Effective communication helps maintaining credibility by solving the problems that arrive. Effective communication techniques influence the values of other nurses and are effective in problem-solving processes in the organization and the profession. People use organization values to lead themselves throughout their lives. Organizational values and each employee’s personal values need to blend in as well as impact people’s behaviors and attitudes in the workplace. When employees fails to connections between taking responsibility for living their own lives and the accomplishment of organizational objectives, those organizations run the risk of falling short on promises made to customers, or worse, failing to meet ethical or legal standards.

Health in Comminities Essay

The Internet has a wealth of information and you are advised to use the Internet as often as possible to broaden your knowledge on certain topics. Prescribed books You are expected to purchase the following prescribed books for this module: Clark, MJ. 2008. Community health nursing: advocacy for population health. 5th edition. Englewood Cliffs, NJ: Prentice-Hall. Edelman, CL & Mandle, CL. 2006. Health promotion through the lifespan. 5th edition. St Louis: Mosby. Edelman and Mandle (2006) has very valuable information on health promotion and covers the entire life span, from birth to death. In addition to your study guide, this book is very important: you will find a wealth of information. Clark (2008) is a book on community health nursing that emphasises the dimensions model of community health nursing right through. This is a very valuable model which will help you to gain a holistic and systematic approach towards the individual, family and community. (viii) The information in these two books is complementary. Together with the study guide it will help you to gain the knowledge and skills you will need to supply health care to individuals, families and communities. Activities The activities are planned to either reinforce content, to guide you to tackle upcoming content, or to motivate you to think about issues. You will note that in part 2 of the study guide there is only one activity at the end of each learning unit: here we want you to apply the dimensions model of community health to a member of the family. Feedback on all these activities will be given in annexure A. This CMH2602 module runs parallel with the practice module for Community Health, CMH2126. The theory cannot be separated from the practice. Icons You will find a series of icons in the text to guide you as you progress with your studies. Activity When you see this icon, you will know that you must complete an activity. We may ask you to read a specific section in the prescribed literature, apply given information, think about topics that have not been introduced, find your own information or ask other people for information. Please read the instructions carefully. Assessment criteria This icon indicates the questions that you can use to assess your own understanding of the work. These questions are adapted from the outcomes. You are told what you should do to prove that you have met the learning outcomes. Prescribed reading When you see this icon, study or read the prescribed book as indicated, before continuing with the next section. Learning outcome This icon tells you how you will benefit in the field of practice if you know the content of the specific learning unit. The outcomes tell you what you will be able to do after you have studied the work. h Feedback This icon tells you what was expected from you when you did the activity. It will not necessarily give you all the facts but will give you guidelines on how to answer the question. Not all of the activities will have feedback because many of the answers are given in your prescribed books. (ix) Conclusion This module is designed to enable you to work with families in the community. It is based on the needs and problems of the family. It covers individuals who are part of the family and the family as part of the community. After completion of this module, together with the practice module, you will be able to take responsibility for practising as an independent community nurse in any community setting. PART 1 THEORETICAL FOUNDATIONS IN COMMUNITY HEALTH 2 Learning unit 1 Concepts and theories/ models in community health Outcomes Since theories/models provide you with the knowledge you need to practise community health in a scientific way, it is essential for you to be familiar with the various theories/models in the field to be able to apply them to community health. When you have worked through this learning unit you will be able to: * * * * 1. 1 describe various concepts in theoretical thinking explain selected theories/models in detail describe the key concepts and themes of the selected theories/models apply the theories/models to community health Introduction While we will discuss theories/models in general in this learning unit, we will also deal with several selected theories in more depth in order to indicate how they can be applied to community health. It is currently accepted that theories form the basis of community health. Since theories provide us with the knowledge we need to practise community health in a scientific way, it is essential for the community nurse to be familiar with the various theories/models in the field and to be able to apply them to community health. 1. 2 Theoretical thinking as a language The terms theory, model, conceptual framework, conceptual model are often used synonymously in literature. The literature reflects various conflicting opinions about the terms, their usage and meaning. According to Polit and Beck (2008:141) a conceptual model or a conceptual framework represents a more informal mechanism for organising and discussing phenomena or concepts, while theories are more formal in nature. Conceptual theories, frameworks and models are composed of concepts or constructs. These concepts or constructs are interdependent because they systematically demonstrate the relationship between variables. A model is a symbolic representation of concepts or variables with an interrelationship. A phenomenon is the abstract concept under study, often 3 used by qualitative researchers, while a concept is a description of the objects or events that form the basis of a theory. Both models and theories can describe and predict the relationship between phenomena. Models and theories are terms that are often used interchangeably in literature. The term theory is often used to refer to the subject content that student nurses must be taught in the lecture room to acquire the information they need to perform the nursing tasks in practice. Researchers such as Polit and Beck (2008:768) define theory as â€Å"an abstract generalisation that presents a systematic explanation about the relationships among phenomena†. Theories include principles for explaining, predicting and controlling phenomena. In all disciplines theories serve the same purpose. This purpose is to make scientific findings meaningful, and to make it possible to generalise. A theory is composed of concepts and constructs that are systematically related and that are also goal-oriented (Stanhope & Lancaster 2006:196). Types of traditional theories include grand theories and middle-range theories. Grand theories describe and explain large segments of the human experience which are very broad. Middle-range theories explain more specific phenomena such as stress, self-care, health promotion and infant attachment. Metatheory is a term used to label theory about the theoretical process and theory development (Polit & Beck 2008:141). Metaparadigm refers to the main concepts that identify the phenomena or ideas of interest to a discipline, in this case the discipline of nursing. They provide the boundaries for the subject matter of the discipline. The metaparadigm concepts for nursing include person, environment, health and nursing (Clark 2008:67). However, current literature suggests that a four-concept metaparadigm for the discipline of nursing is too limited and suggests additional concepts such as transitions, interaction, nursing process, nursing therapeutics, self-care, adaptation, interpersonal relationships, goal attainment, caring, energy fields, human becoming and other concepts. The best-known and most used concepts are however the first four: person, environment, health and nursing. 1. 3 Choosing a theory/model to apply to community ealth Choosing a suitable theory or model is not always an easy task ? especially when most theories are geared towards the care of individuals and were never designed to apply to groups or communities. The theory or model that is chosen must be flexible enough to be adapted to the community health situation and its aim must be to provide guidance for those who practise community health . The importance of the family or community network and the social network must both be clearly reflected, and the theory or model must be realistic and simple enough to understand and apply. In addition, the theory/model should harmonise with the community nurse’s views about the individual, the environment, personal health and community health. You may find that the theory that is chosen may not always fulfil all your expectations and that it may also not be applicable to all circumstances. You may often be required to make adjustments or to develop your own personal model on the basis of existing theories. 4 Activity Explain why community health nursing should be based on a model or theory. h Feedback You should have considered the following points: * * * * * 1. 4 A systematic approach is needed. Theories/models assist community nurses to evaluate health status and to plan, implement and evaluate effective nursing care. The model/theory used directs attention to relevant aspects of the client situation and to appropriate interventions. Epidemiologic models help in examining factors that influence health and illness. Nursing models suggest interventions to protect, improve and restore health. The dimensions model of community health nursing Clark’s (2008:69) dimensions model of community health nursing is one of the few models designed for community health. This model is described in detail in your prescribed book (Clark 2008) and will therefore only be summarised here. This model is a revision of the previously titled Epidemiologic Prevention Process Model. The dimensions model incorporates the nursing process and the levels of prevention as well as an epidemiologic perspective on the factors influencing health and illness. The dimensions model consists of three elements: the dimensions of health, the dimensions of health care and the dimensions of nursing. The dimensions of health include: * * * * * * the the the the the he biophysical dimension psychological dimension physical environmental dimension socio-cultural dimension behavioural dimension health system dimension The dimensions of health care include: * * * primary prevention secondary prevention tertiary prevention The dimensions of nursing include: * * * * cognitive dimension interpersonal dimension ethical dimension skills dimension 5 * * process dimension reflective dimens ion You should study this model to enable you to assess the health status of individuals, families or communities and to guide your nursing interventions. Prescribed book Study chapter 4 in Clark (2008, or later editions), on the dimensions model of community health nursing. Activity (1) Name the three elements of the dimensions model of community health nursing. (2) List the dimensions included in each element. (3) Give an example related to the dimensions in each element that addresses the health of a population group. 1. 5 Orem’s self-care deficit theory of nursing Orem proposes a general theory of nursing which she calls the theory of self-care deficit. Orem’s theory focuses on people’s ability to practise self-care. The dominant theme of her philosophy of health is that people should be empowered and encouraged to practise their own self-care by means of their own efforts or with the help of significant others. Orem’s self-care deficit theory of nursing consists of three interrelated theories: the theory of selfcare, the theory of self-care deficit and the theory of nursing systems. This theory is consistent with community health, based on the following premises: * * * Individuals and groups must accept responsibility for their own health and consequently care for themselves. The community nurse should provide the necessary training and support that will enable individuals or communities to do this. The community nurse should intervene only when a deficit or need arises in the selfcare framework. The World Health Organization (WHO) also strongly emphasises that self-care and selfresponsibility play an important role in achieving the goal of optimal health. 1. 5. 1 Theory of self-care In order to understand the theory of self-care, one must first understand the concepts of self-care, self-care agency, basic conditioning factors and therapeutic self-care demand. Self-care include those activities and decisions which a person undertakes in order to maintain life, health and well-being. These activities are acquired by learning, and they contribute to the maintenance of human development and functioning. 6 Self-care agency refers to the ability of a person to exercise self-care in daily life. The ability to care for oneself is affected by basic conditioning factors: age, gender, developmental state, health state, socio-cultural factors, health care system factors, family system factors, patterns of living, environmental factors and resource adequacy and availability. Therapeutic self-care demand is the sum total of the measures which are called for at a particular time for the promotion and maintenance of health, development and general well-being. In the case of self-care, purposeful actions and steps are taken. Although selfcare should benefit an individual’s health, his or her perception of self-care may not always promote good health, as is the case with a person who smokes in the belief that it reduces his or her stress levels. Self-care requisites refer to the reasons for which self-care is undertaken. The three categories of self-care requisites include universal, developmental, and health deviation. Universal self-care requirements include those processes which are essential for the normal functioning and maintenance of health and life, such as the following processes: * * * * * * having and maintaining sufficient fresh air/oxygen, water and food intake finding the balance between exercise and rest, and having social interaction avoiding dangers and obstacles that can compromise human functioning and well-being promoting human functioning and development in a group roviding care associated with elimination processes and personal hygiene keeping a balance between being alone and social interaction Developmental self-care requisites are divided into two categories: * * The first concerns the maintenance of those conditions which are favourable to a person’s normal growth and development. The second is concerned with the prevention of those negative conditions, forces, influe nces and factors which can hinder and obstruct normal development. Awareness of such requirements reflects a person’s level of development and his or her general capacity for self-care. Health deviation self-care is necessary for preventing illness, injury and retardation. It involves taking whatever steps are necessary for preventing or treating illness or disability effectively. The requisites for health deviation self-care include: * * * * * * seeking and securing appropriate medical assistance being conscious of and attending to the effects and results of pathologic conditions conducting medically prescribed diagnostic, therapeutic and rehabilitative measures attending to or controlling the negative effects of prescribed medical treatment effectively ccepting oneself as being in a specific state of health and in need of particular forms of health care developing and sustaining health-optimising lifestyles 1. 5. 2 Theory of self-care deficit The theory of self-care deficit forms the core of Orem’s general theory of nursing. According to this theory, an adult who is unable to practise self-care requires dependent care; this refers to an adult who does not h ave the ability to meet his or her own needs or 7 only has partial ability to take care of himself or herself. This may happen or example when a person falls ill and this illness generates new demands, requiring the implementation of complex measures and specialised knowledge. Orem cites the following examples of support or help which can be offered in such circumstances: * * * * * acting on behalf of a person or undertaking certain activities for this person until he or she can once again care for himself or herself more independently providing guidance and direction in the new situation providing physical and psychological support creating and maintaining a new environment which supports personal development providing appropriate relevant instructions A self-care deficit occurs where there is a discrepancy between the need for self-care and the ability to manage this self-care. In such circumstances the individual needs to be assisted and educated to administer whatever self-care he or she may need. In short, a self-care deficit occurs when a person is unable to practise appropriate self-care on his or her own or without external assistance. 1. 5. 3 Theory of nursing systems The theory of nursing systems consists of two components: the nursing agency, and nursing systems. The nursing agency refers to the characteristics of people who are trained as nurses that enable them to act, to know and to help others meet their therapeutic self-care demands by developing their own self-care agency. Nursing systems are created when nurses use their knowledge and skills to plan and implement nursing care where there are deficiencies in self-care. The aim of intervention by the nurse is to compensate for the self-care activities which the individual, family or community cannot maintain at an optimal level. These compensatory activities are classified into: * * * The wholly compensatory system where the community nurse becomes the self-care agent to compensate for the client’s inability to maintain his or her own self-care. The community nurse cares for and supports the client wholly. For example, this would happen where a person is in a coma and cannot consciously look after himself or herself. The partly compensatory system where the client is capable of certain self-care measures but only to a limited degree. The aim of health care intervention is to lend support and carry out certain activities on behalf of the client until he or she is able to resume them again. The supportive/educational system where the client can manage self-care but needs the support and guidance of the community nurse. The community nurse regulates the selfcare agent’s performance and development so that he or she can function more independently (George 2002:126). Activity (1) Describe the different components of the self-care deficit theory of nursing. 8 (2) Explain what is meant by a self-care deficit. (3) A mother and her two-month-old baby visit your clinic. The baby is not gaining sufficient weight and the mother appears tired and stressed. Identify the self-care deficit in this particular case. h Feedback You should have covered the following points in your answer: (1) The mother is not able to care for herself with the demands of a new baby. (2) She therefore needs health education and advice on how to handle the situation. 1. 6 Neuman’s systems model/theory According to Neuman, her personal philosophy of helping each other live contributed to development of the holistic systems perspective of the her systems model. Neuman’s theory is based on: * * the two main components of stress and the individual or his or her body’s reaction to that stress the community’s reaction to certain stress factors (stressors) in the environment Neuman based her systems model on a general systems theory and regards the client as an open system which reacts to stressors in the environment. Stressors may be intra-personal, inter-personal or extra-personal. Intra-personal stressors occur within the client system boundary and correlate with the internal environment (eg feelings such as anxiety or anger within a person). Inter-personal stressors occur outside the client system boundary and have an impact on the system (eg stimuli between people such as role expectations). Extrapersonal stressors also occur outside the ystem boundaries, but are further away from the system than the inter-personal stressors (eg work or finances). Environment includes all the external and internal influences that surround the client system. The external environment exists outside the client system and the internal environment exists within the client system: * * * * The client system contains a basic structure or core construct (individual, family c ommunity) which is protected by lines of resistance. The basic structure includes system variables such as physiological, psychological, socio-cultural, developmental and spiritual variables. Penetration of the basic structure results in death. The normal level of health is identified as the normal line of defence which refers to the client’s usual state of wellness and represents stability over time. When the normal line of defence is invaded or penetrated, the client system reacts, for example with symptoms of illness. The flexible line of defence prevents stressors from invading the system and is a dynamic state of wellness that changes over time. It can for example be altered in a relatively short period of time by factors such as inadequate sleep or food. The lines of resistance protect the basic structure and become activated when the normal line of defence is penetrated by environmental stressors. If sufficient energy is 9 * available, the normal line of defence is restored; but if the lines of resistance are not effective, death may follow. Reconstitution involves stabilisation of the system and movement backwards to the normal line of defence. Health care intervention takes place in the prevention modalities, that is the primary, secondary and tertiary levels of prevention. (Clark (2008:67)) Prescribed reading Study Neuman’s model in Clark (2008, or later editions). Activity (1) (2) (3) (4) Explain what Neuman means by client variables. Describe the concepts of line of resistance and normal line of defence. Describe Neuman’s view on health. Define the term stressor. This theory/model can also be applied to community health because a preventive approach is followed and because of its flexibility. 1. 7 Pender’s health promotion model Pender described a model which is applicable to community health in particular. This model is based on principles of health promotion and, to a certain extent, corresponds with the Health Belief Model. Pender’s health promotion model comprises three basic concepts, namely individual perceptions, variables which can influence healthy behaviour and the probability that actions will be taken to promote health: * * * Individual perceptions include factors such as how important health is seen to be, perceptions on control and effectiveness, the definition of health, the state of health, the advantages inherent in preventive measures, and possible obstacles. Variables include factors such as demography, income, literacy, culture and family health patterns. The probability that action will take place includes matters such as ? ? ? ? how highly the person rates or values action any previous experience with health personnel the availability and affordability of preventive services the threat that the condition holds for the individual or family Prescribed reading Study Clark (2008, or later editions), the section on Pender’s health promotion model. 10 Activity (1) Name the variables which can affect the preventive actions that a family and a community may take. (2) Write short notes on individual perceptions and indicate how they can influence health-promoting actions. Pender’s model is applicable to community health because the promotion of health is taken as the starting point and factors which influence the measures for promoting health are defined and emphasised. The model can guide and lead the community health nurse in promoting health. On the grounds of the variables and perceptions that are identified, she/he can make decisions on the degree of intervention that is necessary. For example a degree of knowledge and motivation may seem necessary to allow the community to take certain promotive actions, or to decide whether or not the available options are acceptable. The community health nurse’s task could then be to give the community the necessary information or to influence them to modify perceptions that are detrimental to their health. Depending on the specific problems or behaviour that deviates from a healthy living pattern, the culture of the community, the level of literacy and so on, the community health nurse can plan a programme or develop his or her own model based on Pender’s promotive model. (Clark 2008:257) 1. 8 Gordon’s functional health pattern framework Historically, conceptual models in nursing have employed Gordon’s health-related behaviours and developed them into an assessment model with 11 functional health patterns. Your prescribed book (Edelman ; Mandle 2006) uses this framework throughout in the assessment of each developmental stage. The 11 functional health patterns include: * * * * * * * * * * * pattern of health perception-health management nutritional-metabolic pattern elimination pattern activity-exercise pattern sleep-rest pattern cognitive-perceptual pattern self-perception-self-concept pattern roles-relationships pattern sexuality-reproductive pattern oping-stress tolerance pattern values-beliefs pattern (Edelman ; Mandle 2006:131) Read Edelman and Mandle (2006 or later edition), the section on functional health patterns: assessment of the individual. 11 1. 9 Conclusion Various theories/models applicable to community health were discussed in this learning unit. It is very important that you as a community hea lth nurse have an understanding of these theories/models and how they could be applied to community health. Assessment criteria (1) Define the following terms: ? ? ? ? ? theory model conceptual framework phenomenon concept (2) (3) (4) (5) 6) Define the different constructs of Orem’s theory. Explain the defence mechanism in Neuman’s theory. Describe the principles on which Pender’s promotion of health model are based. Name the three elements of the dimensions model of community health nursing. Name the dimensions of the dimension of health in the dimensions model of community health nursing. (7) List the functional health patterns in Gordon’s functional health pattern framework. Note: Application of selected models/theories will be assessed in part 2 of the study guide. 12 PART 2 THE INDIVIDUAL AND FAMILY AS CLIENT 14 Learning unit 2 The family as client Outcomes When you have worked through this learning unit you will be able to: * * * * * * * 2. 1 describe the concept of family describe the structure of the family describe different family types and their characteristic features describe the stages of family development discuss family functions describe the family as a social system discuss cultural values in the family Introduction The family is the basic social unit in any community. Family members usually share living arrangements, responsibilities, goals, the continuity of generations, and a sense of belonging and affection. How well a family works together and meets any crisis depends on the composition of the family (the structure), the activities or roles performed by family members (the functioning) and how well the family is able to organise itself against potential threats. 2. 2 Describing the concept of family Clark (2008:318) states: â€Å"A family is a composed of two or more persons who are joined by bonds of sharing and emotional closeness and who identify themselves as being part of the family. Unlike those of other social systems, family relationships are characterized by intimacy, emotional intensity, and persistence over time. ‘ Santrock (2006:216) states: â€Å"[The family is] a social system, a constellation of subsystems defined in terms of generation, gender and role. Divisions of labour among family members define particular sub-units, and attachments define others. Each family member is a participant in several subsystems. Some are dyadic (involving two people) some polyadic (involving more than two people). † Stanhope and Lancaster (2006:322) refer to the following definition: â€Å"A family refers to two or more individuals who depend on one another for emotional, physical, and/or financial support. The members of the family are self-defined. † 15 Activity Ask different members of the multi-disciplinary health team to define family. Analyse the responses for similarities and differences. 2. 3 Structure of the family Family structure is the organised pattern or hierarchy of members that determines how they interact. Components of a family structure include the role of each family member and how they complement each other, the family’s value system, communication patterns and power hierarchy. The family structure influences the way that a family functions. Allender ; Spradley 2005:526) The genogram shows family information graphically in order to view complex family patterns over a period of time, usually three generations or more. d. 1956 Heart Peg 71 Housewife Al 72 Grocer Sue Housewife John Steelworker d. 1982 Cancer Mark 37 Engineer Jan 36 Housewife Jim 9 Jack 46 Mechanic Mary 16 Pat 41 Waitress Married 1979 Steve 18 Clerk Earl 17 Student Detroit Fig 2. 1 Genogram Source: Allender ; Spradley (2005:528) Nan 4 Married 1977 Divorced 1979 Joe 45 Teacher Sam 20 Student Lou 13 Los Angeles Married 1983 Ann 39 Nurse Pam 11 16 Activity Draw a genogram of your own family. 2. 4 Types of families There are many family types and a family type may change over time as it is affected by birth, work, death, divorce and the growth of family members. * * * * * * * The nuclear conjugal family. The traditional nuclear family structure consists of a husband, wife and children. Most young people move away from their parents when they marry and form nuclear families (no grandparents, aunts or uncles live in the home). The nuclear family is found in all ethnic and socio-economic groups, and is accepted by most religions. Today the number of nuclear families is declining as a result of the increase in divorce, single parenthood and remarriage, the acceptance of alternative lifestyles, and greater disparity. The extended (multi-generational) family. The extended family includes the nuclear family as well as other family members such as grandmothers, grandfathers, aunts, uncles, cousins and grandchildren. The advantage of such a family is that it means more people may serve as resources during crises and also provides more role models for behaviour and learning values. The single parent family. Single parent families consist of an adult woman or man and a child or children. Single parent families result from divorce, out-of-wedlock pregnancies, absence or death of a spouse, or adoption by a single person. A health problem in a single parent family is almost always a serious matter, because there is no backup person for childcare when the parent is ill. The blended family. The term blended family refers to a remarriage or a reconstituted family, where a divorced or widowed person with children marries someone who also has children of his or her own. Children of blended families are exposed to different ways of living and also have increased security and resources. They may become more adaptable to new situations. However, rivalry may arise among the children for the attention of a parent or there may be competition with the step-parent for the love of the biological parent. The communal family. The communal family is made up of groups of people who have chosen to live together as an extended family group. Their relationships with each other are motivated by social values or interests rather than by kinship. Because of the number of people present, members may have few set traditional family roles. The values of commune members are often religiously or spiritually based and may be more oriented to freedom and free choice than those of a traditional family structure. The cohabitation family. The cohabiting family consists of two persons who are living together, but remain unmarried. They may be heterosexual or homosexual. Some such relationships are temporary but others are long-lasting. Reasons for cohabitation include the desire for a trial marriage, the increased safety that results from living together and financial factors. The single alliance family. Many single young adults live together in shared apartments, dormitories or homes for companionship and financial security. Although these relationships are often temporary, they have the same characteristics as cohabitation families. 17 * * The homosexual family. The homosexual family is a form of cohabitation where a same sex couple live together and share a sexual relationship. Such a relationship offers support in times of crisis that is comparable with that offered by a traditional nuclear or cohabitation family. The foster family. Children whose parents are unable to care for them are laced in a foster home by a child protection agency. Foster parents usually receive remuneration for their care. Foster families may also include the parents’ own biological or adopted children. Foster care is theoretically temporary until children can be returned to their own parents (Clark 2008:318). Prescribed reading Read Clark (2008, or later edition), types of families. 2. 5 Stages of family development Stage 1: Beginning family During this first stage of family development, members work to accomplish three specific tasks: * * * to establish a mutually satisfying relationship to learn to relate well to their families of origin f applicable, to engage in reproductive life planning The first stage of family life is a tenuous one, as evidenced by the high rate of divorce or separation of partners at this stage. The time frame for this stage extends from marriage to the birth of the first child. Stage 2: The early child-bearing family The birth or adoption of a first child is usually an exciting yet stressful event in a family. It requires economic and social role changes. The duration of this stage is from the birth or adoption of the first child to 30 months after this date. The following developmental tasks are usually accomplished during this stage: * * * he establishment of a stable family unit the reconciliation of conflict regardin g developmental tasks facilitating developmental tasks of family members Stage 3: The family with pre-school children A family with pre-school children is a busy family as children at this age demand a great deal of time related to growth and developmental needs and safety: accidents are a major health concern at this stage. The time frame for this stage is when the oldest child is two to five years of age. Developmental tasks during this stage include: * * * integration of second or third child socialisation of children beginning of separation from children 18 Stage 4: The family with school-age children Parents of school-age children have the major responsibility of preparing their children to be able to function in a complex world. At the same time they have to maintain their own satisfying marriage relationship ? this can be a difficult time for a family. Many families need the support of tertiary services such as friends, church organisations or counselling. The time frame for the family with school-age children is when the oldest child is 6 to 13 years old. Developmental tasks during this stage include: * * * separation from children to a greater degree fostering education and socialisation aintenance of marriage Stage 5: The family with teenage/adolescent children The primary goal for parents with teenagers differs considerably from that of the previous developmental stages. Family ties must now be loosened to allow adolescents more freedom and prepare them for life on their own. Rapid technological advances have increased the gap be tween generations ? this can make stage 5 a trying time for both parents and children. Violence, accidents, homicide and suicide are the major causes of death in adolescents ? and death rates from HIV are growing. This places a still greater responsibility on the family. The time frame for this stage is when the eldest child is 13 to 20 years of age. Developmental tasks of this stage include the following: * * * maintenance of marriage development of new communication channels maintenance of standards Stage 6: The launching centre family For many parents this stage when children leave to establish their own households is the most difficult. It appears as though the family is breaking up and parental roles change from those of mother and father to guideposts. The parents may experience a loss of self-esteem as they feel themselves replaced by other people. For the first time they may start feeling old and less able to cope with responsibilities. The time frame for this stage is from the time the first child leaves home to the time the last child leaves home. The following developmental tasks should be accomplished during stage 6: * * * * * promotion of independence integration of in-law children restoring of marital relationship developing of outside interests assisting own aging parents Stage 7: The family of middle years At this stage a family returns to a two-partner nuclear family, as before childbearing. Some partners see this stage as the prime time of their lives with the opportunity to do things they never had time or finances for, such as travelling and hobbies. Others may experience this time as a period of gradual decline without the constant activity and stimulation of children in the home and may experience the â€Å"empty nest† syndrome. Support people may 19 also not be as plentiful as earlier in the parents’ lives. The time frame for this stage is from the time the last child leaves to retirement. Developmental tasks for this stage include: * * * developing leisure activities provision of a healthy environment ustaining a satisfying relationship with children and grandchildren Stage 8: The family in retirement or older age The number of families of retirement age is increasing rapidly, with people living longer as a result of advanced technology, medical research and increasing health consciousness. Family members of this group are, however, more apt to suffe r from chronic and disabling conditions than people in the younger age groups. The time frame for this stage lasts from retirement to death. Developmental tasks include the following (Clark 2008:323): * * * maintaining satisfying living arrangements adjusting to reduced income djusting to loss of spouse Prescribed reading Study Duvall’s and Carter and McGoldrick’s stages of family development in Clark (2008, or later editions). 2. 6 The family as social system All families share certain characteristics. Every family is a social system with its own cultural values, specific roles, functions and structure and each family moves through recognisable developmental stages. A social system consists of a group of people who share common characteristics and who are mutually dependent. What affects one member affects the whole family, and vice versa. Families have certain features that differ from other social systems: * * * Families last longer than many other social systems. F amilies are inter-generational social systems consisting of three or sometimes four generations. Family systems include both biological and affinal relationships (relationships created by law or interest). Biological aspects of family relationships create links to a larger kin group that are not found in other social systems. A social network support map gives a detailed display of the quality and quantity of social connections. The community nurse can use this to help the family understand its support systems and to form a basis for nursing interventions. 20 Fig 2. Social network support map Source: Allender ; Spradley (2005:528) 2. 7 Cultural values in the family The cultural values in a family can have a major influence on how a family views health and health care systems. Each new generation takes on the values of the previous generation, passing traditions and cultures from generation to generation. A family’s cultural values and behaviours can either facilitate or imped e the promotion of health and prevention of disease. Prescribed reading Read Clark (2008, or later editions), the chapter on the cultural context. Activity (1) Apply the four principles of cultural assessment to the family. 2) Discuss culturally competent care. h Feedback Note the following points: 21 (1) You needed to view the culture in the context in which it developed, examine the underlying premise of culturally determined behaviour and the meaning of behaviour in the cultural context. There is a need to recognise intercultural variation. (2) You needed to define cultural competence, consider the characteristics and challenges of cultural competence and the modes of culturally competent care. 2. 8 Family functions Family functions are the activities that a family performs to meet the needs of its members. These needs include basic needs such as food, clothes, housing, emotional support and guidance. All families ? regardless of the type of family ? have in common these basic needs that require a family to function in certain ways to ensure family survival. As the social system changes, the family system has to adapt if it is to meet individual needs and equip its members to participate in the social system. The family is a hierarchical system which is usually built on kinship, power, status and privileged relationships that may be related to age, gender, personality and health. All family functions can be reduced to two basic ones: * *

Displaying a PDF File in a VB.NET Form

PDF files have an internal document format that requires a software object that understands the format. Since many of you might have used the functions of Office in your VB code, lets look briefly at Microsoft Word as an example of processing a formatted document to make sure we understand the concept. If you want to work with a Word document, you have to add a Reference to the Microsoft Word 12.0 Object Library (for Word 2007) and then instantiate the Word Application object in your code. Dim myWord As Microsoft.Office.Interop.Word.ApplicationClass Start Word and open the document. myWord CreateObject(Word.Application) myWord.Visible True myWord.Documents.Open(C:\myWordDocument.docx) ( must be replaced with the actual path to the document to make this code work on your PC.) Microsoft uses the Word Object Library to provide other methods and properties for your use. Read the article COM -.NET Interoperability in Visual Basic to understand more about Office COM interop. But PDF files arent a Microsoft technology. PDF - Portable Document Format - is a file format created by Adobe Systems for document exchange. For years, it was totally proprietary and you had to get software that could process a PDF file from Adobe. On July 1, 2008, PDF was finalized as a published international standard. Now, anyone is permitted to create applications that can read and write PDF files without having to pay royalties to Adobe Systems. If you plan on selling your software, you still may be required to get a license, but Adobe provides them royalty-free. (Microsoft created a different format called XPS that is based on XML. Adobes PDF format is based on Postscript. XPS became a published international standard on June 16, 2009.) The Uses of PDF Since the PDF format is a competitor to Microsofts technology, they dont provide a lot of support and you have to get a software object that understands the PDF format from someone other than Microsoft right now. Adobe returns the favor. They dont support Microsoft technology all that well either. Quoting from the latest (October 2009) Adobe Acrobat 9.1 documentation, There is currently no support for the development of plug-ins using managed languages such as C# or VB.NET. (A plug-in is an on-demand software component. Adobes plug-in is used to display PDFs in a browser.) Since PDF is a standard, several companies have developed software for sale that you can add to your project that will do the job, including Adobe. There are also a number of open-source systems available. You could also use the Word (or Visio) object libraries to read and write PDF files but using these large systems for just this one thing will require extra programming, also has license issues, and will make your program bigger than it has to be. Just as you need to buy Office before you can take advantage of Word, you also have to buy the full version of Acrobat before you can take advantage of more than just the Reader. You would use the full Acrobat product in about the same way that other object libraries, like Word 2007 above, are used. I dont happen to have the full Acrobat product installed so I couldnt provide any tested examples here. How To But if you only need to display PDF files in your program, Adobe provides an ActiveX COM control that you can add to the VB.NET Toolbox. It will do the job for free. Its the same one you probably use to display PDF files anyway: the free Adobe Acrobat PDF Reader. To use the Reader control, first make sure that you have downloaded and installed the free Acrobat Reader from Adobe. Step 2 is to add the control to the VB.NET Toolbox. Open VB.NET and start a standard Windows application. (Microsofts next generation of presentation, WPF, doesnt work with this control yet. Sorry!) To do that, right-click on any tab (such as Common Controls) and select Choose Items ... from the context menu that pops up. Select the COM Components tab and click the checkbox beside Adobe PDF Reader and click OK. You should be able to scroll down to the Controls tab in the Toolbox and see the Adobe PDF Reader there. Now just drag the control to your Windows Form in the design window and size it appropriately. For this quick example, Im not going to add any other logic, but the control has lots of flexibility that Ill tell you how to find out about later. For this example, Im just going to load a simple PDF that I created in Word 2007. To do that, add this code to the form Load event procedure: Console.WriteLine(AxAcroPDF1.LoadFile( _   Ã‚  Ã‚  C:\Users\Temp\SamplePDF.pdf)) Substitute the path and file name of a PDF file on your own computer to run this code. I displayed the result of the call in the Output windows only to show how that works. Heres the result: --------Click Here to display the illustrationClick the Back button on your browser to return-------- If you want to control the Reader, there are methods and properties for that in the control too. But the good folks at Adobe have done a better job than I could. Download the Adobe Acrobat SDK from their developer center (http://www.adobe.com/devnet/acrobat/). The AcrobatActiveXVB program in the VBSamples directory of the SDK shows you how to navigate in a document, get the version numbers of the Adobe software you are using, and much more. If you dont have the full Acrobat system installed - which must be purchased from Adobe - you wont be able to run other examples.