Category: Case study

Healing and Autonomy

There exists a contradiction between spiritual faith and medical intervention, globally. The Holy Books of Christianity, for instance, have not offered the right direction on the illness intervention. It remains a hot topic whether Christians should follow their faith or seek medical treatment in case of illnesses. Healing and Autonomy case study offers a similar scenario where we have a prayerful father (Mike), sick son (James) and the doctor. Since James is too young, the debate of the intervention is left between his father and the doctor. This paper, therefore, seeks to analyze what Mike and the physician doctor should do to save James’ life.

From the Case Study, Should the Doctor Allow Mike to Go On With a Decision that Appears to Be Harmful to James?

In the case study, Mike is guided by his faith and belief that God will heal James. On the hand, the doctor believes in the power of treatment and understands the dangers that may occur in James’ health if not treated. In this case, the physician should not alter the decision of James’ parents to take the faith route on intervention. Any attempt to do so will be a disrespect to the patient’s autonomy. According to the patient’s autonomy principle, patients have the right to make decisions concerning their health without the influence of physicians (Lindberg et al. 2014). At eight years, James cannot make a sound decision on his health. In this case, his choices are on the hands of his parents. If the parents opt for asking God to intervene with the health of their son, then the physician has to comply and offer the appropriate directives. Arguably, Mike is relating his decision with a past sermon and a real-life example of a person who was healed through faith. It is a decision that Mike believes will be the best for his son. Therefore, his decision has to be respected as he represents the autonomy of his young son, who cannot make a sound decision on himself.

How should Christians think about health and sickness?

Notably, God cares about both physical and spiritual life of His people. He created all human beings and is ever happy when we enjoy good health. However, sometimes people abuse their bodies, thus causing illnesses or some other times ailments are beyond human understanding. Christians should not attribute sickness to God under any circumstance. God wants all His people to have good health all the times so that they can serve Him better. Moreover, God does not promise to heal according to the Bible. However, he promises to save His people from all distress and pains of the world (Ferngren, 2014). In this context, sickness is one of the pains that human beings encounter, Christians should be assured of being delivered from it. Christians should always have their faith in God as the one who brings about good health to His people.

Christians’ Perception of Medical Intervention and What Mike Should Do

As mentioned earlier, the controversy surrounding Christianity and medical intervention have been widespread in the globe. Some opt to follow their faith to call for healing without consulting any medical expert. However, others mix the two and believe that each supplements the other (Carr, & Winslow, 2017). But how exactly should a Christian think about medical intervention? There are many instances in the Bible where medicine and physicians are mentioned. Revelation 22:2, for example, talks of the tree of healing in Jerusalem. This is a suggestion that medical treatment is included in God’s plan on His people. However, this is not a suggestion that cure should be sought from medical intervention alone. The fact is that God supports the life of His people through many physical services. These services include water, food, and sometimes medicine. Moreover, service to man is service to God. Therefore Christians should view medical intervention as one way that God uses to ensure good health to His people.

From the case study, Mike, as a Christian, should not entirely rule out the doctor’s advice. Instead, he should allow his son to be treated and use his faith to ask God to intervene with the health of his son through the medical process. This is the best decision that a prayerful father should make towards his ailing son.

How Should James Reason about Treating James and Honoring God

On the dilemma of whether to trust God or treat James, Mike should have a very sound reasoning based on the principle of beneficence and nonmaleficence. The principle of beneficence demands him to promote good through his decision on James’ health (Tagin, Zhu, & Gunn, 2015). On the other side, the principle of nonmaleficence obligates him not to do any harm to James. In this case, Mike should first think of the possible dangers if James is not treated as prescribed by the doctor. In this context, he should reason whether failing to take James to treatment will further deteriorate his health or even cause death. Heath deterioration or death will mean that Mike has gone contrary to these principles. Therefore, Mike should think of combining the two ways of restoring the good health of his son and have faith that all shall be well.

Would a Spiritual Needs Assessment Help in Intervening With James’ Health Condition?

In searching for the right treatment measure to be taken on James’ health condition, a spiritual needs assessment will significantly be of good help. It is through this assessment that both Mike and the doctor will understand the practices, religious beliefs, and the resources that may have a positive impact on James and the entire family. The assessment calls for physicians not to interfere with the faith and beliefs of their patients in the treatment process (Timmins & Caldeira, 2017). In our case, the spiritual needs assessment will make the physician understand that Mike is committed to God and wants to do everything to His will. With this knowledge, the doctor may advise Mike to direct his prayers on the treatment process. This would be the best solution rather than ruling out one intervention process since the two complements each other. The spiritual needs assessment also can save the kidney of James’ brother. Opting for treatment does not mean ruling out Mike’s faith in God. Therefore, after realizing that Mike was so prayerful through the assessment, the doctor may decide to give James time before the transplant. During this moment, Mike will be able to continue praying. If God’s healing happens in the process, then James’ brother will not have to donate his kidney. By so doing, everybody will have good health in the family.

In conclusion, all decisions concerning the health of a person should be aimed at promoting good. In this case, both spiritual and medical approach should not be ruled out in the treatment process. Doctors should understand the religious stand of a patient then strive to uphold that stand in the treatment process.

References

1. Carr, M. F., & Winslow, G. R. (2017). From conceptual to concrete. In World Religions for Healthcare Professionals (pp. 31-45). Routledge.
2. Ferngren, G. B. (2014). Medicine and religion: A historical introduction. JHU Press.
3. Lindberg, C., Fagerström, C., Sivberg, B., & Willman, A. (2014). Concept analysis: patient autonomy in a caring context. Journal of advanced nursing, 70(10), 2208-2221.
4. Tagin, M., Zhu, C., & Gunn, A. J. (2015). Beneficence and nonmaleficence in treating neonatal hypoxic-ischemic brain injury. Developmental neuroscience, 37(4-5), 305-310.
5. Timmins, F., & Caldeira, S. (2017). Assessing the spiritual needs of patients. Nursing Standard (2014+), 31(29), 47.

Part A:

Option 1: Contract law (SSO burgers)

Issue:

SOO burgers have been a famous chain of the hamburger restaurant that opened in Australia. With its immense competition worldwide, this restaurant started to organise a promotional deal called “the Fair Dinked deal”. Thus according to the rules, a token is provided to every ‘Double-decker Emu burger” and if 50 of these tokens are collected a golden card is given. When scratched if it showed a golden car then that person would be the lucky winner. This agreement SOO Burgers made with all its customers for brand and sale promotion. Now there were two customers – one was Michael Mickey and another was Brett. Both of them were very determined to win the golden ticket and also the car- “Mazda CX-9”.

Thus for Michael Mickey, he loves the Emu burger and ordered 50 of those and ate all of the burgers. Thus after eating he felt exhausted and rushed to hospital emergency to wash out his stomach. He was sure that he would get that golden ticket and also that golden car.

Next was Brett who was smart enough and collected all the tickets that people left ignoring the promotional fact. He collected 100 of them and then went to the restaurant to redeem all those. Luckily he got two golden scratch cards and both of them showed car prices. When Brett went to the headquarters to get his car prizes, he saw a hoarding mentioned that SOO burgers were sorry and apologetic for printing wrong and even the tickets were incorrect and will not be considered. Thus all the tickets were cancelled. Brett was dismayed and was frustrated with this. Even Soo burgers communicated this worldwide through radio and other media stuff. Thus Brett saw that one of the customers was provided with Car prize but Brett was not provided. So now Soo Burgers wanted legal advice regarding what should be provided to Brett and also to Michael Mickey.

Rules:

The rules that would be sued are Contract law which follows two-part one of agreement formation and second are the consideration of the agreement (Savelyev 2017). The “Australian contract law” is being used for enforcing the agreement and also governing the areas of the contract. Thus the scenario talks about the law implicated in agreement that Soo Burgers made with customers and then after considering, revocation and rejection of the agreement are done.

Assumptions:

Both Mickey and Brett have fallen prey to disagreed contract and agreement and how to want their prize from Soo burgers. Thus SOO burgers now are seeking legal advice as to who is prominent to get the car and who is not. According to the scenario, an agreement was made between Soo burgers and also the customers which said that 50 tokens will get one scratch card, and from there a car can we won. Thus according to “Australian Contract law”, it is prominent that agreement means a mutual understanding between the two parties or persons about their duties and rights regarding present or future consideration. Agreement always comes with consideration (Giancaspro 2017). Thus here the agreement was made between Soo burgers and customers where Soo burgers portrayed a promotional invitation and customers accepted that. Thus a legal relationship was created between them. Now both Brett and Mickey also considered that agreement and took a step to win that car. The assumption is now made on two half-

In the case of Brett, being a customer he agreed to the invitation for the promotional activity. Now Brett played a trick and collected all the Emu burger wrappers having tokens in it (Kerikmäe and Rull, 2016). Then he redeemed all those tokens and went to headquarters to receive his gift card. Thus after getting gift cards he scratched and got two golden car prizes. Now an invitation was given by Soo Burgers and Brett accepted the invitation without any further negotiation. Thus the invitation leads to a positive response which turned to an agreement of the deal. Now the case twisted when Soo Burgers revocated as well as rejected the offer that they made (Law.cornell.edu, 2019,)

Soo Burger’s revocated the deal as it is a general rule in “Australian Contract law” under the Agreement provision where any deal or agreement can be revoked before their acceptance. Thus the Revocation can occur at any time. The revocation can also occur if the person offering has promised to fulfil the deal but now is revocating before the deal is fulfilled. Thus the revocation to be successful, it needs to get communicated either indirect ways or in indirect ways. Soo Burgers, the dealer’s revocated when they promised their customers to fulfil the deal (Lacey et al. 2016). Thus Brett is one of the Customers who had fallen prey to the revocation of the deal. The Soo Burgers under the contract law, revocated before the deal was fulfilled and thus to make the revocation Successful they communicated through television, radio, and social media to make customers know that the deal was false.

Thus under this rule, Brett cannot be given the car. Now another rule is rejection. Thus under agreement contract, Rejection means to reject the offer by the offered so that no longer the agreement works. Now Brett was also prey to rejection because Soo burgers already rejected the offer. The refusal was made in front of Brett and now Brett cannot claim any of the prizes from Soo burgers Thus as the offer is rejected by Soo Burgers who are the Offered, then the agreement is valid no longer (Buchanan and Oliver, 2016). Thus under these two rules, Soo burger is not advised to support Brett and provide him with the car.

Now in the case of Michael Mickey, the Revocation under agreement contract is the perfect term to reject his proposal (Cooter and Ulen, 2016). The revocation of the offer was already communicated through online platforms, hoardings, radio, and television. Thus once the revocation of the invitation or agreement is given, further, no claims are supported. Mickey already admitted to the hospital had heard partially about the revocation and rejection of the offer. Thus even after knowing he decided to go to the headquarters and demand for the prize. Thus Soo Burgers is not advised on any ground to give Mickey the car because he already knew that Soo burgers have communicated about promotion to get cancelled. Thus once the offer is revoked before the time of acceptance, it cannot support any claim. Thus no claim was supported for Mickey (australiancontractlaw.com, 2019)

Therefore under Assumption 1 and 2, it was clear that Soo burgers are not legally advised to pay Brett or Mickey with the car. But if seen from another angle, Brett can put this point ahead that after his arrival for claiming the car he came to know about the breaking of the offer. So, in that case, Soo Burgers can breach the duty towards their customers (Cooter and Ulen, 2016). But since the revocation theory is communicated with hoarding and is much stronger, this deal and sue of Brett are almost neglected and Soo burgers win the positive case.

Conclusion:

Thus now the case is towards the side of SOO burgers and they take positive legal advice from the adviser. Thus according to Legal Advice from the court, the organisation is not liable to pay any of the demands and car claims to Brett or Mickey due to the Revocation and rejection theory under agreement. Thus the case side for Soo Burgers is much heavier and Brett and Mickey lose the case. Thus under “Australian Contract law” The case is won by Soo burgers and no Brett and neither Mickey is provided with the prize claims.

In the following section, discussion will be carried out with respect to the applicability of the Levitt-Jones’ Clinical Reasoning Cycle in identification of the two care priorities within the realm of the given clinical scenario. The nursing vocation makes use of the Clinical Reasoning Cycle for considering the situation of the patient, further collecting and processing information, followed by identification of the problems. Based on the identified issues, goals are established, and actions are taken accordingly. As part of the next step in this cycle, outcomes are evaluated followed by reflecting on the process that in turn leads to new learning (Hunter & Arthur, 2016). According to the narration in the given case study, George is a 51 years old Aboriginal and Torres Strait Islander man who has been diagnosed with several issues on arrival to the general practitioner for his annual health check-up. He suffers from stage 4 chronic kidney disease (CKD) alongside macro albuminuria secondary to diabetes nephropathy in addition to deteriorating kidney function, high blood pressure, excessive weight gain and raised level of cholesterol. He lives with his wife and three children in his own home and both husband-wife receives the Centrelink payments. He was ex-smoker and had history of stroke. Family history reveals that many of George’s extended family members undergo dialysis procedure. Moreover, he has been prescribed several medications, about which he is unsure as to whether he needs to continue taking the medications and is not aware about why they were given, even the names of the tablets. Deteriorating kidney function combined with elevated blood pressure and albuminuria prompted him to be referred to the nurse practitioner. Under such circumstances, it is imperative and most prudent on the part of the nursing professionals to streamline actions that in turn will aid in addressing the situation at hand in an effective manner.

The information presented in the case study shows that the individual is suffering from chronic kidney disease and likewise he has been subjected to various medications that are prescribed to be taken at appropriate doses and appropriate timings by the concerned physician. However, upon arrival for the annual health check-up, George has been referred to the nurse practitioner to deal with his deteriorating kidney function and elevated blood pressure. Therefore, as per the available data, George’s care regime should comprise of undertaking actions that will help in ameliorating his condition in an emergency basis and help to sustain long-term health thereby facilitating quick recovery. As per the given case scenario, effort is to be directed to tackle with the debilitating renal function condition together with elevated blood pressure conjointly first. Next, initiatives are to be taken so that the patient on recovery must adhere to the prescribed medications to avoid repercussions and bore the benefits for compliance to medications. Therefore, amidst all the care options those are practicable under such situation owing to excessive weight gain (10 kg in last two years), elevated blood pressure (153/93 mmHg) , macroalbuminuria (30 mg/mmol), faulty serum creatinine (237 micromol/L) , Glomerular filtration rate (GFR) and HbA1c (9.3%) function as evident from the assessment report of the patient, the issue pertaining to deteriorating kidney function coupled with elevated blood pressure need to be addressed on priority basis. Moreover, the issue of complying to the prescribed medications will also be addressed on a priority basis as the patient has been described of not having conform to his set of medicines and lack awareness regarding the utility of having them. As the practicing nurse, two of these care options are to be prioritized to ensure optimal recovery of the patient and long-term sustenance.

First, it has been suggested in the case study that George is facing a crisis due to his deteriorating kidney function in addition to the elevated blood pressure. Moreover, the names of the medications that has been prescribed to George has also been given. Amongst them, furosemide is one such drug that George is supposed to take. Furosemide has been identified as a medicine that find its use in treating fluid build-up under multiple conditions of liver scarring, heart failure or kidney disease. In fact, this particular medicine is also used in treating high blood pressure through administration of either intravenous injection or oral route. Research based evidence has already brought to the forefront the feasibility of using this medicine in case of renal condition where acute kidney injury has set in and furosemide stress test has been identified as a potential option to predict its progression (Rewa et al., 2019). Critically ill patients with acute kidney injury are also subjected to low dose furosemide medication to deal with their worsening situation (Bagshaw et al., 2017). Moreover, in order to treat specific subsets of this chronic kidney injury, furosemide medication has been relied upon as well due to its action as a diuretic. In such cases, furosemide attend onto sodium retention, volume expansion besides hypertension characteristic of the chronic kidney disease that has been vividly mentioned in prospective literatures (Greenberg, 2019). Apart from all these potential actions of furosemide, it has also been reported to be a safe drug in treating hypertension for the diabetic patients that do not cause increase in blood glucose level (Osmanovic et al., 2017). Thus, in keeping with the available evidence, it will be rational to administer the furosemide medication for dealing with the dual complications owing to deteriorating kidney function and elevated blood pressure. Post administration of the chosen medicine, the patient will be monitored adequately to see for the signs of improvement as might be expected through reduction in blood pressure and normalized Glomerular filtration rate (GFR), indicative of normalizing renal function. Finally, it may be said that charging the patient with furosemide medicine will harbor benefits that may be evaluated well through proper monitoring of various parameters.

According to the case study, George is prescribed medications like that of perindopril and lercanidipine, furosemide, atorvastatin, metformin, sodium bicarbonate and vitamin D. All these medications have been prescribed to him for dealing with the multitude of clinical problems he has been suffering from. However, George does not remember the name of the medications and is unaware of the fact why they have been prescribed to him. Moreover, he is also under delirium regarding the frequency of the medications and is doubtful about the efficacy of them. Considering, the present situation of the patient it is imperative on his part to regularly comply with the prescribed medications to tackle with his clinical condition and his present attitude and behaviour is quite antagonistic to that. It has been cited in appropriate literatures that the impact of compliance with acute kidney injury can lead to decrease in fatality in addition to reduction in progression of the condition (Kolhe et al., 2015). Moreover, other research has also highlighted the benefits of patient compliance and medication adherence thereby necessitating the urgency to monitor these two factors while evaluating patient outcomes (Loprinzi et al., 2018). Further, a study directed to identify the barriers to medication in case of patients with hypertension revealed certain pivotal themes. Themes comprised of environmental challenges of life, forgetfulness to take medicines, incompatibility of patients and inefficient recommendations of the family. Thus, these themes must be intervened properly to remove the barriers (Najimi et al., 2018). Moreover, it has been recommended in suitable study that it in order to prevent occurrence of further complications in case of hypertensive subjects, it is indispensable to tackle the problem of low drug compliance thereby lowering incidences of morbidity and mortality (Johnson et al., 2019). In the given case study, George will be given directions to adhere to his medication regime so that missing of doses would not endanger his health. He will be constantly encouraged to ensure compliance to medications on his return home. For further safety, his wife who also happens to be his caregiver at home will be taught about the importance of adhering to a medications chart to keep complications at bay. Every week, a follow up will be done to ensure that George is maintaining his medication regime properly.

The nursing profession, unlike other professions, requires rigorous training and sound judgment on the part of the attending nurses to provide cure to a particular problem. In order to attain optimal outcomes through nursing pursuit, it is desirable for the nursing professionals to take proper course of actions that will enable them to provide suitable remedy for tackling the patient’s issues. Prioritizing the care options is of utmost importance for the nurses to address the patient condition in a manner that will facilitate quick recovery. Further, for the sake of allowing the best possible remedy for the patient, the nurses must resort to the clinical reasoning cycle that in turn will help in making judgments about the patient care options and likewise pave the way for a definite treatment modality that will be beneficial for the patient. Critical analysis and reflection are two crucial virtues that nurses must possess in order to excel in their profession. In this connection, the clinical reasoning cycle appears as a vital tool to make judgments and prioritize nursing cares. For the given case study, administration of the medicine that is required immediately to start off the treatment regime and offer remedy in the imminent situation alongside ensuring compliance to medications on the part of the patient are two of the prominent nursing care needs that the nurse must promptly channelize in course of her duty.

Issue:

• Is there any legal relation between Soo Burgers and their customers (Michael and Brett)
• If yes than can Michael “mickey” “ask for his claim (grand price) from Soo burger?
• Can Brett vulture ask for his claim (grand price) from Soo burger?
• Whether Soo burger needs to provide both customers their claims?

Rules:

Under contract law, there are three element that define its existence as when one party makes a promise to other party, and both are abided by legal rights and obligation which are enforceable in a court of law.

Element 1) intention

The intention must be clear amongst the parties that contains the promises that is intended be enforceable in law.

Element 2) Agreement between the parties

The principle concept of agreement is that there must be offer by one party (the offeror) and acceptance (offeree) by another party. the facts that helps to continue the agreement are time, place and contents.

If it is clear in circumstances that one party wilful to create an offer, this fact stated in Carlil v Carbolic smoke ball Co [1893] 1 QB where court institute that the word uses by company relate to create an offer and any reasonable person who accepts it intended to be bound.

Element 3) Consideration

For every simple contract, the consideration must have its validity which involves the promisor giving something to promisee while carrying out the act.

Application:

According to the fact given in the case, it can be examined that Michael cannot ask for his claim and Brett can claim his grand prize as they both accepted the offer before cancellation of the offer by the SOO burger (offeror) is different in both scenarios. By application of the rule relating to contract law there is a clear intention by SOO burger to make an offer to public at large through social networks for promoting their sales. The offer known as the Fair Dinkum deal”. In this deal, a single token would be attached to every double decker burger and anyone who collects 50 tokens can redeem from the counter to get one golden ticket. Customer who gets the golden ticket can scratch it and if it discloses grand price (Mazda cx-9) they can claim for it from SOO burger’s head office. Michael and Brett collect their 50 tokens and 100 tokens respectively thereby indicating that they accepted the offer of SOO burger. This fact is similar to Carlil v carbolic smoke ball [1981]. In end it can be deduced that there is a clear scenario of offer and acceptance in the given case.

Furthermore, when SOO Burgers came to know about the printing error that instead of only one golden ticket in the promotion reveals Mazda CX-9 , every one in five tickets reveals the grand price, SOO burger immediately cancel the offer by declaring on every social network. By exploring the case , it can be said that prior to cancellation of offer , Brett went to claim his two golden grand price at SOO burger head office that means he already accepted the offer, but he told by reception to wait in waiting area and after that one of employee of SOO burger came outside and posted on the door that the offer is void. But Brett can claim his price because according to the contract rules he accepted before the cancellation of the offer. This fact is to similar to Brogden v Metropolitan Rly co, where the contract is accepted by the parties, in the given case its accepted by Michael and Brett by collecting the tokens.

Michael eagerly wanted to win the price and he ate all 50 burgers at a time and because of over consumption himself, he went with urgent haste to the hospital. When he woke up, he heard about the cancellation of offer from the people around him and nothing from official comptroller. When he went in rush to SOO burger head office to claim his grand price, he saw the official post on SOO burger head office door. According to rules relating to contract law it is clear cancellation of offer before acceptance means before claiming the golden price from the SOO burger head office. In addition, by applying the contract law there is an offer (by SOO burger) and acceptance of offer ( to claim the grand price by Brett) and cancellation of offer before accepting (Michael before claiming the grand price SOO burger cancel the offer) in the given both scenario (in case of Michael and Brett).

Conclusion:

By examining the contract law in all situation (offer, acceptance and cancellation of offer before accepting) and applying it in the given case, it can be concluded that

• A) In Michael’s case, SOO burger is not liable to provide any claim because there is a cancellation of offer before Michael claim his grand price from SOO burger head office.
• B) In Brett’s situation, SOO burger is liable to pay him grand price because he made the claim before SOO burger cancelled their offer.

Introduction-

Wellbeing is alluded to the condition of being healthy, though prosperity is considered as a comprehensive methodology that impacts individuals to have positive mental and physical experience both prosperity and wellbeing are significant for every person as it gives the chance of beating troubles by keeping up great wellbeing condition. These likewise impact individuals to accomplish their own and expert life objectives with proficiency.

The given case study is included with the discussion about a four years old boy named Atta, who has been suffering from obesity. Because of having this health issue, he experiences difficulties to stand up as well as face problems in the meantime of taking part in any physical activities and starts having breathing problems. To show concern towards the increasing weight of Atta, his father has figured out that unlike other children, Atta takes chocolate, sweet biscuits, crisps in his lunch along with taking foods like sugary cereals by discussing with the day center staff. By consulting with his mother, it is also found that their family is not at the state where they would be able to arrange healthy foods for Atta. So as his mother provides such food which Atta likes. Furthermore, because of having a fear of experiencing racist comments, she does not take him out to any playground. The purpose of this assessment is to explain the dimension of wellness and wellbeing in the early childhood context.

Socialization influences-

In the context of wellness and wellbeing, socialization prepares people to participate in a social group by teaching them its norms and expectation(Courses.lumenlearning.com, 2019). For both the mental and physical development of a child, the family plays a key role. From the given case study, it is found that for having a health issue of Atta, negligence of his family holds a huge contribution. Due to having financial problems, Atta’s father generally works for long hours for which he is not able to give proper time to Atta. Fathers are responsible for child development by shaping their child’s behaviour by involving them in healthy life practices (‘The Importance of a Father in a Child’s Life | Pediatric Associates of Franklin’, 2019). Fathers, like mothers, are pillars in the development of a child’s emotional well-being. They also look to their fathers to provide a feeling of security, both physical and emotional. So, because of having less time with his parents, Atta is not able to emotional support for having better health by reducing obesity. Besides that, Atta has no siblings so that he also does not get the chance of playing indoors. In terms of socialization, siblings are also essential for child development as, siblings positively impact by making children involved in physical activities for spending free time. Siblings are closer to the social environments that children find themselves in during the majority of their day, which is why it’s important not to overlook the contributions that they make on who we end up being (Science Daily, 2019).

Atta’s peers are also negative affect on Atta they always tease Atta because of Atta’s heavy weight.

The contextual analysis has uncovered that, on account of having heavyweight, Atta needs to confront negative remarks just as bizarre names which demotivate him to acknowledge foods grown from the ground offered by the childcare focus. Public health professionals wondered if the time spent watching television rather than participating in physical activity has contributed to the development (Liamputtong, Fanany & Verrinder, 2017). As far as media, it is discovered that TV promotion removes time from play and exercises. Youngsters who watch a great deal of TV are less physically fit and bound to eat high fat and high vitality nibble nourishments. TV seeing makes a considerable commitment to heftiness since prime time ads advance undesirable dietary practices. For making ad all the more drawing in, promoters utilize alluring music, vividly enhanced visualizations. That impact youngsters to allow unhealthier nourishments like fatty just as low supplement snacks (Anon, 2019). On the off chance that Atta, media has likewise contrarily influenced Atta by affecting him to embrace unhealthier nourishments. By watching the brilliantly hued boxes of sugary oats that he watches on TV, he feels more pulled in to that nourishment as opposed to the vegetables or natural products.

Environmental influences-

For leading children development, aspects of the physical environment such as families who are living in poor neighborhoods, with minimal access to resources, poor housing, low income, and poor health care, create a child-rearing environment that chronically stresses children’s developing HPA systems (Garvis and Pendergast, n.d.). From the case study, it is investigated that Atta and his family live in a two-bedroom apartment which is identified as a positive growing environment for Atta’s development. Proper indoor quality also influences the child to have good health because of having a higher capability of reducing disease emergence. But in the context of Atta, although having a good housing infrastructure, he is not able to involve in a healthy lifestyle for not getting proper time from his parents. Additionally, neighborhood quality also influences early child development by providing an impact on children’s long term behaviour (‘Neighbourhood influences on young children’s emotional and behavioral problems’, 2019). In the case of Atta, it is observed that because of being Muslim, in the region of Sydney his family has to face racist has put a negative impact on Atta because of it is his mother stopped him from taking into the playgrounds. From the case study, it is analyzed that Atta belongs to a poor neighborhood quality because of which he intended to be within the house rather than collaborating with others or making friends. As Atta is involved in the daycare center the number of people is huge; the environment impacts him negatively. Due to having heavyweight, Atta has to face bullying in his educational center. It does not provide any positive vibes to Atta feel free to being involved in a healthy lifestyle.

Equity Issues-

Health equity is the state in which everyone has the opportunity to attain full health potential, and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance (National Academies of Sciences et al., 2019). Maintenance of equity is responsible for leading children to experience social, emotional wellbeing by delivering the privilege of participating in inequitable practices. In the meantime, of participating activities, children also get the allowance of recognizing the cultural, personal, institutional and interpersonal levels. But, from the case study, it is observed that Atta and his family are living in Sydney, which is surrounded by white people mostly (‘Population – Australian Bureau of Statistics’, 2019). But, due to having a financial issue, Atta’s parents are not able to provide him a good as well as a healthy lifestyle. In terms of equity, children need to have similar resource access for having emotional and physical wellbeing. But unlike other parents, his parents are not able to arrange healthy food such as fruits and vegetables. It is obvious that generally, children do not like to intake green foods which influences children to waste most of the foods. For being poor, they are not able to afford such waste for which Atta’s parent avoid to serve healthy foods. Informs of equity, children are required to have a higher quality culturally responsive environment with racial equity as well as anti-racist activities. The home environment and the community are where young children spend the large, if not the largest, part of the early lives, interacting with parents, siblings, extended family members, and neighbours. These interactions and relationships have a significant influence on how children understand and experience the world around them (Unicef).

But, from the case study, it is observed that Atta belongs to such an environment where people are racist because of which they made racist comments upon Atta’s family. It influences Atta to become involved with obese by creating a pillar for him to visit playgrounds.

Strategies that early childhood staff and leadership could implement –

To increase awareness about Atta’s increasing health issue because of having obesity, the early childhood staff is firstly needed to consult with his parents and influence them to follow the core principles of the early years learning framework for motivating Atta to have a healthy lifestyle. Hence, the staff is required to take initiatives for supporting Atta as well as his family to involve in a healthy lifestyle by taking healthy foods and being involved in physical activities by collaborating with other people and visiting the playgrounds rather than spending time playing video games. The EYFL framework is also involved with the process of creating a vision that engages all the children in learning procedures to lead them towards having success in life (Australian Government, 2019). So, following this framework, the early childhood staff are required to take a leadership approach for communicating with the children of the daycare center to influence them to collaborate with Atta effectively. They should also talk to those children to stop bullying Atta along with letting them involved to motivate Atta to make healthy foods such as fruits and vegetables provided by the daycare center. On the other hand, they are also required to counsel Atta’s mother to remove her fear regarding the visitation of the playground. By enhancing the core principle of the National Quality Standard, the staff is needed to promote the distinguishing opportunity of having quality service among his patients. The main aim of the NQL framework is to ensure the health, safety, and wellbeing of children (Australian Children’s Education & Care Quality Authority, 2019). So they are required to collaborate media for increasing their awareness of the increasing obesity rate by reducing the advertisement of packaged unhealthy foods.

Identify strategies that early childhood staff and leadership could implement to address these environmental influences to promote children’s wellness and wellbeing-

As early childhood staff members are responsible for leading people towards the process of providing special care for child development, they are required to follow some strategies for influencing environmental aspects to promote wellbeing as well as wellness of children (Australian Children’s Education & Care Quality Authority, 2019). Firstly, in the context of increasing obesity of Atta, it is found that poor neighborhood quality is being the highest obstacle for leading him towards having a healthy lifestyle. Educators acquiring their concern about the increasing childhood health issues, they are required to take incentives for talking with the communities for influencing them to behave positively with Atta’s family by avoiding racist comments. On the other hand, the staff are also required to elaborate that in front of Atta’s family to take initiatives to take him to the playground and make them comfortable with white people also by being friendly and welcoming. From the case scenario of Atta, it is observed although having proper housing infrastructure, he is not influenced to have good health. In this context, early childhood staff is required to take a leadership approach for motivating his family to collaborate with Atta by being involved in indoor plays or indoor activities rather than watching TV or video games. Another environmental aspect which has been identified is Atta’s case study is that, because of being involved in an overcrowded care center, he has to face bullying where most of the children are different from him. In this context, early childhood staff members are required to make strategies for leading the care center towards becoming responsive for improving children learning procedure overplaying (Australian Government, 2019). The leadership approach is required to be undertaken for involving Atta with physical activities in his educational center.

Identify strategies that early childhood staff and leadership could implement to address these equity issues to promote children’s wellness and wellbeing-In the case scenario of Atta, he is leading towards the consumption of obesity because of having equity issues included racist neighborhoods, financial issue. For reducing the racist environment and enhance the equity level of their place, the early childhood staff is required to involve the community as well as Atta’s parents in the practices of the EYLF framework (Australian Government, 2019). In terms of leadership approach, they are required to enhance the practices for increasing cultural competence which would be beneficial for Atta’s condition. The settings within which children exist, such as families, schools and childcare environments, have been recognized as being effective vehicles through which to promote the health and development of children (Minniss et al., 2013). Respect for diversity and working for equity are critical aspects of the work educators do every day to create a more socially just community for all (Perez, Robbins, Harris & Montgomery, 2019).

By gaining the opportunity of facing racial equity, Atta will be influenced to make a friend in his neighborhoods also which would influence him to involve in playful exploration. Thus, Atta will get the allowance of having good wellbeing and reducing the obese rate. Additionally, from the case study, it is observed that poverty has impacted Atta’s wellbeing. So, in this context, early childhood staff are required to present a meeting with Atta’s family and the staff members of daycare center for enhancing Atta’s regular food consumption practice There are a range of protective factors that support family functioning, and early childhood educators can be involved in supporting, mentoring, coaching and engaging with families and communities to create better child-rearing environments through a focus on supporting parents to build effective friendships and social supports (Sims, M. 2017). The daycare center generally provides fruits and vegetables to the children on their premises. As Atta’s family is not able to arrange healthy foods, they should influence the daycare institution to serve them healthy food to Atta for improving his health condition, which, will put a positive impact on his obesity as well as breathing issues.

Conclusion-

From the above analysis, it is presumed that socialization, natural viewpoints, and value or equity assume a pivotal job in driving children to investigate health and prosperity. In this specific situation, regarding socialization, the contextual investigation examination has recognized that on account of having less time with relatives and demotivation from care home’s children Atta is being urged to have detached way of life which is expanding the event of stout. In this way, the above talk has recommended that early childhood staff are required to expand attention to his folks to time more go through with him for including him in healthy activities. Moreover, it is additionally investigated that poor neighborhood quality and stuffed consideration organization condition likewise sway on Atta adversely on account of which he cannot include in any physical exercises or make companion have a perky investigation.

For settling this issue, early childhood staff is required to take activities for working together with the networks to get steady of Atta’s family. Advises regarding the value, it is investigated that bigot condition and destitution has affected Atta by making boundary in the method for expending solid nourishments and sound way of life. For advancing health and prosperity in their area of Australia, it is prescribed to the early childhood staff to draw in Government just as populace’s understanding by exhibiting meeting about the addition of we

Observation is the essence of discovery. The Qur’an encourages observing the world and reflecting on signs. Research should enable one to gain wisdom which in turn is applied in order to benefit others. Since the manner is not specified, the Muslim researcher has the flexibility to design methods to describe social phenomena (Alias, 2005). Modern scientific research methods are not unfamiliar to Islam, having been used by Muslim thinkers of the past to study various religious or social phenomena (Alias, 2005). Therefore, there is flexibility in studying the eating habits of a sample of people. Habits are considered second nature; a concept that also applies to nutritional habits, which can be either harmless or harmful (Nimrouzi & Zare, 2014). Eating habits entail food preference and the frequency of intake, which has a direct association with overall health (Parekh, 2017). Lifestyle illnesses have grown in recent times due to the availability of fast food options. Cardiovascular illnesses, diabetes, obesity, and depression are linked to diet. As such, studying the eating patterns of people would provide insight into the scope of modern lifestyle problems, including the occurrence of eating disorders.

The sample in my research would be the local Muslim community in Cape Town. Naturalistic observation involves looking at behavior as it unfolds without intervening and adding extra variables, thus, it is ideal to observe the sample without participating and opening the doors for biases, as opposed to the questionnaire method. Before conducting the research, it would be wise to create a list of symptoms and common choices associated with eating disorders, for the purpose of looking out for these behaviors. Eating disorders are abnormal eating habits that negatively influence one’s self-image, mental state, emotions, and behavior. Anorexia and bulimia are examples of eating disorders that lead to unhealthy weight loss as well as a myriad of unhealthy symptoms. In turn, overeating due to emotional turmoil or habitual perceived hunger (Sibilia, 2010) leads to obesity and associated lifestyle illnesses (Parekh, 2017). The association between Body Mass Index and psychological distress adds to the frequency and quantity of eating, which contributes to obesity and other disorders, confirmed by a study done by Al-Thani & Khaled, (2018). Since judging stress levels and estimating BMI is impossible using the naturalistic method, I will look into other factors, such as the type of foods favored, the quantity consumed, and the overall time spent eating. My preferred means of recording would be field notes and a timer.

Via direct observation, recording can take the form of writing, audio, and videos which are interpreted later. A limitation is that, although uninfluenced during the occurrence of natural actions and attitudes, the bias of the researcher can influence later interpretations. This can be combated by recording videos instead of writing field notes at the moment. Field notes can also be written with language that states the obvious and is free from stereotypes of non-literal descriptions. The perk about this method in terms of gleaning eating habits is that it reduces self-report bias, and is independent of active involvement from the subjects. (Goodwin, 2010) I would aim to record the food choice options that attract Muslims in an open food court in a mall or at a halaal market, which is organized once a month to promote local vendors. A variety of products are available ranging from gluten-free and vegetarian options to fast food burgers, chips, and pizzas, as well as fruit-based and ice cream desserts. I would choose this setting as opposed to a mosque’s food fair due to the availability of healthier eating options. Furthermore, the mosque setting would be unsuitable due to the obligation to purchase food for the sake of fundraising. Due to the risk of under-reporting and self-bias that can occur in other methods, the naturalistic observation is ideal as it is a direct observation of eating behavior. Eating behavior is influenced by social factors (Meule & Vögele, 2013), and eating out is particularly popular among young adults (Al-Thani & Khaled, 2018). However, the attendees of food markets vary in age, therefore it would be easier to study a random sample as opposed to singling out particular age groups to observe.

The Islamic norm is to eat that which is confirmed to be permissible and avoid that which is impermissible (2:168, 2:172). A Muslim is advised to eat from what is good and not to transgress.

‘O children of Adam, take your adornment at every masjid, and eat and drink, but be not excessive. Indeed, He likes not those who commit excess. i.e. who waste by extravagance.’ (Qur’an 7:31)

According to various verses including the aforementioned, moderation is encouraged and overindulgence is discouraged in Islam (6:141); thus these values would form the basis of a conscious Muslim’s eating habits. One must avoid extremes and choose a moderate course, a notion that extends to eating habits (20:81). The Prophet (SAW) said: ‘No human ever filled a vessel worse than the stomach. Sufficient for any son of Adam are some morsels to keep his back straight. But if it must be, then one-third for his food, one-third for his drink, and one-third for his breath.’ [Ibn Majah, 3349]

Observing without the sample being aware brings about certain ethical implications, particularly on the part of the Islamic researcher in terms of whether covert observation would count as spying, and whether reporting would count as gossiping or backbiting.

‘O you who have believed, avoid much [negative] assumption. Indeed, some assumption is sinful. And do not spy or backbite each other.’ (49:12)

Thus, confidentiality must be respected. No names and stark identifying features should be noted in the field notes. Characteristics such as body type and build could be mentioned without going into detail. Video and audio should be kept private, especially if the sample is unaware. Afterward, one could approach the observed to obtain permission to use the observations in reports while respecting their respective wishes. This can be considered debriefing. It is important to make sure that the research is never to spy for the sake of exposing faults- but rather, an entryway into solutions and societal betterment. The research undertaken would have to abide by Islamic ethics and values, thus the rights of people should not be harmed.

The results of the naturalistic observation of the eating habits of Cape Town Muslim market-goers will be a good base to assess the popularity of fast food type stores versus wholesome health-conscious vendors. It may help to build a tentative image of the eating pattern and food preferences of Muslims in public. A limitation is being unable to make conclusive assumptions about whether eating disorders are observed without a follow-up with the individuals. As no consistent link can be identified between BMI, obesity, and food intake patterns, attempting a diagnosis of eating disorders based on food intake and preference alone would be inappropriate (Togo, Osler, Sørensen & Heitmann, 2001). The significance of this research would be that it marks an entry point for more in-depth inquiry that will in turn result in better marketing of healthy food alternatives, formulating a scope and providing solutions to eating disorders, and an overall improvement in the population’s eating habits.

Jane is a 14-year-old, obese diabetic teenager and this essay is going to address the reasons why her eating habits may have developed. There are many factors that determine children’s eating habits. Some models that explore this are developmental models, things that occur in the childhood of a child that will be a factor in their food choice and their eating habits. Exposure to food, social learning, and associative learning plays a part.

Jane’s eating habits of bingeing frequently may have developed as a result of emulating her mother’s behavior around food. Jane’s mom “eats for comfort”. This can be a result of social learning. A study showed that parents that emotionally eat are likely to influence their children and they will also repeat those patterns (Snoek et Al 2007) Therefore, Jane’s eating habits could be learned from her mother. Karen is obese just like her mother. Jane may see her mum’s eating as normal, therefore she is reluctant to change. Additionally, Jane’s mum is also obese and therefore might have tried to diet in the past and restrict what she can eat studies show that mothers who restrict their dietary intake may be allowing their children to indulge in unhealthy food items that they can’t have. (Birch and Fisher 2000). Another study showed that children were likely to eat breakfast if their parents did (Pearson et al 2009).

Additionally, Jane’s eating habits may have developed as a result of food offering from her mother.

Another reason why Jane’s eating habits may have developed maybe her lack of exposure to healthy food. A study showed that when a disliked vegetable was given to an exposure group, an information group, and a control group. After daily exposure to the exposure group for 14 days, the exposure group liked the taste of the vegetable more compared to the information or control group (Wardle et Al 2003). If Jane had not been exposed to healthier foods like vegetables then she would overtime have developed a likeness for vegetables, on the contrary, she has developed a love for junk food because that’s what she has been exposed to. Additionally, another form of exposure is the media, a study showed that television advertisements for young children had “unhealthy foods were given twice as much air time and was shown as valued significantly more than healthy food” ( Ogden, J., 2011, Radnitz et al 2009). This is so significant as food images can stimulate our brains and lead to neurophysiological changes in us (Spence et al 2016) continual consumption of such images and adverts could lead to children wanting more unhealthy foods. Additionally, another study showed that the more a child recognized food adverts, the more obese they were (Halford et all 2004).

Another possible reason that Jane’s eating habits may have developed may be due to the lack of family meals. In single-parent households, there are financial barriers to family meals due to cost and lack of time (Berge et al 2013). Jane’s mum works full-time and must take out a loan therefore family meals may be infrequent. Family meals are essential for weight management in children as healthier meals are normally eaten, for connection and communication, leading to the overall well-being of a child. (McCullough et al 2016). Therefore, bingeing could be a result of a lack of family meals and non-mindful eating as Jane eats while watching television, therefore it is easy to eat past satiety and binge. Her mom’s work schedule leaves Jane more freedom in choosing what and when to eat therefore she has more access to unhealthy food.

A psychophysiological reason for Jane’s eating habits could be due to stress eating. In teenagers, a lot of changes occur in the body that can lead to stress. Peer pressure, Low self-esteem, comparison to others, and being overweight can be stressors for Jane. In obese people, stress can lead to excess eating (Pine,1985) and can lead to weight gain in children (Bradley,1985). Psychophysiological model theories highlight food and the emotional link. Jane sees food as more than energy for her body and relies on it for more than she should. Her low self-esteem as she compares herself to her peers can trigger sad feelings which can then trigger a binge leading Jane to be in a vicious cycle of bingeing. Food can reduce depression and increase serotonin levels (Myrte Esther Hamburg 2014).

Another reason for Jane’s eating habits could be peer conformity. This is explored in the cognitive model of social norms. A peer study showed that overweight girls ate more when sat next to overweight girls than when sat next to girls of normal weight (Salvy et al 2007) Jane may eat the way she does to fit in with her peers as typical teenage diet patterns include eating fast food and snacking which are high in fat, sugar and salt and low in essential nutrients. (Gregory & Lowe, 2000, Livingstone, 1998). )

A complex reason why unhealthy eating habits may occur is that it plays a vital role in most aspects of our lives, we need them to survive, and they can be used to show love, during celebrations for example. Food offerings can make people closer as friendships or romantic relationships where food is shared are thought to have a closer connection. Food offerings can release positive feelings in both the giver and the receiver. If food offering starts to become the primary way to show love then it can lead to eating disorders in children as they start to see food as an object to cope with many situations. (Hamburg 2014)

Groupthink has become more dangerous today than ever before. With the emerging social media platforms, mob mentality has brought outrage daily. Groupthink and similarly mob mentality are not new concepts. The term groupthink was first used by William H. Whyte in an article in Fortune magazine in 1952 but it was Irving Janus in the 1970s who conducted the first research to aid in exposing groupthink.

What is groupthink? “Groupthink is a psychological phenomenon whereby pressure within a group to agreed results in failures to think critically about an issue, situation or decision” (Merriam-webster.com, 2019). Groupthink is not associated with just one group but can span across many different types of groups. A well-known example of groupthink and one that I had never read about before was one that comes from our history, the bombing of Pearl Harbor.

On December 7th, 1941 Pearl Harbor, a US naval base in Honolulu, Hawaii, was attacked by the Japanese Navy. Sources from the time period of the attack show:

Prior to the attack on Pearl Harbor, internal Japanese messages had been intercepted by US Intelligence and it was discovered that they were preparing for an attack in the Pacific. As a result of this, Washington sent a warning to the officers stationed at Pearl Harbor. (Hartmann, Smith, and Smith, 2019)

Circumstances of groupthink began with officers stationed in Pearl Harbor and their assumption that Japan was taking steps to prepare for unforeseen situations that would compromise its foreign stationed assets. Groupthink in parallel began to unfold with discussions commenced by the Army and Navy resulting in a unanimous opinion not to adhere to the warnings from Washington. An example of the rationale at this time; “Even if the Japanese were foolhardy to send their carriers to attack us [the United States], we could certainly detect and destroy them in plenty of time” (Janis, 1982).

With Janis’ eight symptoms of groupthink applied, two of the symptoms present themselves during the run-up to the attack on Pearl Harbor. The first that comes to mind is part of the type one overestimation of the group, the symptom, illusion of vulnerability. Janis explains groups may think they are invulnerable during their decision-making process and in this case, led to inaction to the warnings coming from Washington.

The second symptom of Janis’ that presented itself was part of type two closed-mindedness which is referred to as collective rationalizations. Collective rationalization shows a tendency of group members to rationalize their group decisions and stereotype those who are not part of the group (Hartmann, Smith and Smith, 2019). Referencing rationale at the time, officers and our military branches ignored the warnings from Washington, believing that Japan would not even think of attacking the US.

Unfortunately, the ramifications of the groupthink that took place during the lead up to the bombing of Pearl Harbor left the US vulnerable and unprepared for what was to come. The US’s failure to adhere to Washington’s warning of Japan’s attack brought death to many service members and civilians. Records from the bombing of Pearl Harbor show:

The total number of military personnel killed was 2,335, including 2,008 navy personnel, 109 marines, and 218 army. Added to this were 68 civilians, making the total 2403 people dead. 1,177 were from the USS Arizona. The number of wounded came to 1,143 with 710 navy, 69 marines, and 364 army, as well as 103 civilians. Total Japanese personnel losses were 55 men. (Visitpearlharbor.org, 2019)

Pearl Harbor is a prime example of how groupthink can become very dangerous. Although groupthink can produce acceptable outcomes, it is important and necessary, to understands the risks.

In hindsight, the Pearl Harbor attack might have been prevented if groupthink had been suppressed. Actions that may have helped prevent groupthink from occurring would have been to have qualified outside experts to challenge the military officers and government personal. This would give a different perspective rather than rely on the optimistic presumptions of a Japanese attack and falling into the illusion of invulnerability. Even if we were able to suppress groupthink during the Pearl Harbor runup there would be no guarantee that the attack would have had an alternate outcome but there is a definite possibility that lives could have been saved. Adhering to the Washington warnings and the officers taking it seriously may have given the US enough time to prepare.

As outlined the Pearl Harbor attack was a great example of groupthink in our history and the ramifications that it may bring. Janis’s breakdown of symptoms associated with groupthink is a good starting point on building a foundation of awareness in order to improve any decision-making process. With mob mentality and groupthink becoming more dangerous today modifying and improving your ability to think critically about a decision or situation will only help.

The NHS today struggles to maintain standards of care and deliver a comprehensive service to all [1]. For nearly a decade, the NHS has experienced a significant slowdown in funding growth while conversely, service demand (and cost of service provision) has snowballed [1].

Clinical radiology, predominately a service specialty, is an integral part of the majority of medical pathways with a vital role in the initial investigation and management of severely ill patients [2]. Patient-centered, high-quality care relies on rapid access and interpretation of imaging examinations [3]. “Prompt and appropriate imaging and intervention improves patient outcomes and avoids unnecessary procedures.” [3].

Royal College of Radiology [3] states ‘demand for imaging is unrelenting and set to increase’, with a year-on-year increase in sophisticated cross-sectional imaging; 54% increase in CT, and 48% increase in MRI within the past five years alone. Radiology departments are struggling to cope with workload; only 2% of UK trusts/health boards were able to meet reporting requirements within their contracted hours [3]. Departmental bosses anonymously commented that increased demand meant “working increasingly fast and becoming unsafe’ and “unable to provide a safe and reliable radiology service.” [3].

The workload increase is multi-factorial; increased patient expectations, and co-morbidities, and the GMC recognized 33% of doctors making unnecessary referrals to reduce their workloads [4].

Outside traditional working hours, radiology services rely on smaller teams to deal with urgent cases, and the full complement of general, specialist, and support staff is not available [2]. Consequently, weekend imaging is to be triaged by urgency based on the need for clinical decisions related to immediate care and clinical management ([2].

The current employer is a university teaching trust over three sites providing general and specialist acute hospital services including pediatrics and hyper-acute stroke unit as well as a designated major trauma center, for a catchment of 600,000 patients. Imaging service demand within this trust is increasing, 2017 – 2018 recorded a 10% rise, above the current UK trend, the recent Trust board report identified ‘imaging as a challenging area’ [5].

Weekend acute radiology demand has seen an exponential increase in both quantity and complexity, above the general service. Trauma scanning, a time-pressure investigation that generates 1000s of images and requires a dedicated hour of uninterrupted interpretation, rose from a weekend average of 5 trauma scans in 2015 to 18 scans in 2019 (Graph one).

The quantity and complexity of weekend imaging have increased, and the weekend workforce has remained static. The radiology workforce covering the weekend consists of 3 radiographers, one healthcare assistant, one consultant radiologist, and a single radiology registrar. The remit of the radiology registrar is multi-factorial;

• Provide an acute ultrasound service
• Clinical interface for referring clinicians
• Primary read for trauma scans
• Interpretation of the hyper-acute strokes

The radiology registrar (SpR) is supported by a consultant radiologist who undertakes most of the non-neurological interpretation.

Weekend working pressures as experienced by the radiology registrars had become unsafe. National training surveys are a core part of the work GMC conducts to monitor and report on the quality of education and training in the UK; these surveys are viewed as a robust quality assurance tool and trends to inform policy developments (GMC 2018). From 2015 – 2018 radiology trainees at this trust highlighted the weekend workload as unsustainable. GMC perceived this now as a recurrent training issue.

This paper explores the potential for improvement in patient safety in radiology weekend services within a regional trauma center through a grass-roots radiology registrar (SpR) solution.

Literature Review

The literature review was completed using the commenced with the MDM110 module reading list, Brighton University database, Scope, Athens, and Pubmed. Search terms, incorporating Boolean operators were identified in the research question ‘How to improve radiology weekend working conditions?’ to provide a PEO framework.

Hand-searched publications from NICE, BMA, BMJ, Department of Heath, The King’s Fund, The Nuffield Trust, and The Health Foundation dating back to January 2007 as well as the Royal College of Radiologists back to 2008. I accessed The NHS Leadership Academy for leadership models unique to the NHS.

Case Study

As alluded to in the introduction radiology workload has increased; however, there had been no concurrent staffing increase. Graph one provides insight into the weekend trauma scanning trend.

The proposed change was a rota modification to increase the radiology registrar weekend cover.

Sussex Radiology Registrar (SpR) training scheme is a relatively new UK scheme, and as such the program is growing in registrar numbers with increases in funding. August 2018 the number of available on-call radiology registrars would rise to 19 (previously 14). Figure one below is a simple diagram depicting the current service delivery and the proposed rota change to provide combined cover.

Change and Management

Change in healthcare is vital in a healthcare institution that seeks to deliver quality and patient-centered care to its clientele [6]. NHS appears to be in a constant state of change; although there is not always a clear definition of what these changes may be, it is accepted to be some form of movement along a continuum [7]

Change management meta-theories as described by Chin and Benne (1984) (Cited by Nickols 1996), [8] provide an overall framework to guide change. Many NHS changes, as epitomized by the unilateral variation of the 2016 Junior doctor contract, may be perceived as a ‘Power-coercive’ approach to change management where successful change is an exercise in authority and sanction imposition. This prescriptive top-down directive approach avoids duplication of efforts through central coordination with clear accountabilities, providing a standardized process within large organizations [9]. However, the top-heavy approach of the department of health assumed that people are compliant and will do as they are told to do, without an option of an opinion [8]. This leverage can come at the expense of trust and undermines commitment [9].

The Radiology registrar cohort is not an influential powerful cohort and consequently, change was induced through an alternative, bottom-up approach, an empirical-rational strategy. A bottom-up approach is less directive, where it encourages and empowers people to achieve change locally with locally-tailored solutions [10]. Importantly a bottom-up approach allows for local ownership of the change process, aiding to overcome barriers of inadequate engagement [10]. The empirical-rational strategy considers people to be rationally self-interested and therefore will adopt change when the proposal is logically justified and the change will bring the individual benefit [11]. The following assumption of that the SpR body and those involved in managing imaging services are rational beings once reasoned with, and the right information supplied, could be persuaded to engage [8]. Benefits of the proposed change particularly relevant to, and likely to stimulate engagement from, the registrar body included; the potential to improve patient safety, especially topical in light of the rising weekend workload, and the registrar’s own educational experience. The change proposed had very little in the way of a risk and was attractive enough to outweigh any downsides involved [8].

Change is not without resistance [12], and as alluded to previously, change may involve risk and potential disadvantages resulting in disengagement. Force field analysis, as described by Lewin in 1951, is the culmination of forces that either facilitate or resist change; where success results when the forces facilitating change exceed those resisting change [12]. Force field analysis was applied to the case study in figure 2, providing a visual summary of the various factors supporting and opposing the two registrars’ weekend on-call rota. The analysis delivered an insight into the group behaviors and barrier identification before initiating change and was used as an assistive planning tool.

Alternative Food and Feed Products

Globally, the demand for traditional protein sources (livestock and fish) is expected to grow by 76% from 2007 to 2050 (Alexandratos and Bruinsma, 2012). This increase is due to not only a growing population but also changing diets in developing countries compared to developed nations (Rosegrant et al., 2012). Land that is not suitable cultivation of crops can often efficiently be used to graze livestock. However, overgrazing and the creation of new pastures at the expense of natural ecosystems have detrimental environmental impacts. In addition, the projected increased meat production may also lead to a rise in greenhouse gas emissions, in addition to placing further pressure on natural resources (such as arable land and freshwater) and exacerbating the competition between humans and animals for grains and other high-quality plant food/feed (OECD/FAO 2017).

With the growing world population to be fed, there is a pressing critical need to provide additional food and animal feeds that are both safe and nutritious for sustainable products that can food safety while at the same time minimizing environmental footprints.

To fill this gap, alternative food, and feed products are receiving growing attention worldwide.

Within this challenging context, new and emerging solutions need to be considered in order to ensure a sustainable food supply: this brief will outline some considerations and perspectives on alternative food and feed products.

Key issues

Livestock Feed additives (needs further work from Daniela)

Livestock intensification requires producing more with fewer inputs. Advances in nutritional research and innovation are being leveraged to promote optimal animal health and production. Modern livestock production aims to understand the critical growth needs of the animals, and the varying ability to absorb and effectively utilize dietary nutrients which should result in increasingly allowing for the formulation of more balanced feed formulation in order rations to avoid that provide the necessary feed components without over-supplying valuable nutrients. “over-supply ”.

Feed additives, including probiotics, plant-derived extracts as well as enzymes can support the maintenance of the intestinal barrier, reduce the variability of nutrient utilization and improve the animal´s ability to cope with and recover from immunological challenges. Supplemental enzymes, like phytases, proteases, carbohydrases, and xylanases can improve nutrient release and digestibility, while specific hydrolases are used to counteract undesirable contaminants, like mycotoxins, transforming them into non-toxic metabolites, allowing for the use of feeds that would otherwise be wasted.

Well-nourished animals are also healthier. Recently, the feed additives sector has observed a loss of development and research mainly aimed to improve animal health, make more efficient use of available feedstock and reduce GHG emissions.

Healthier animals are less prone to disease, and need fewer inputs (such as antimicrobials) to grow; this in turn, will result in reduced food safety risks due to zoonoses and carriage of antimicrobial-resistant bacteria. In addition, Supplemental enzymes, like phytases, proteases, carbohydrases, and xylanases can improve nutrient release and digestibility, while specific hydrolases are used to counteract undesirable contaminants, like mycotoxins, transforming them into non-toxic metabolites.

Insect-based feed and food products

Insects have traditionally been consumed as a part of the normal diet in a number of regions of the world. However, with the expected global market value for insects as food and animal feed to cross $1 billion USD by 2020, intensified insect farming is gaining traction. Indeed, in recent years there has been a growing interest in the possibility of using insect farming to meet the growing demand for protein in animal feeds and in the human diet due to the efficiency with which they can convert their feed into protein. Among the most promising species for industrial feed production are black soldier flies, common housefly larvae, silkworms, and yellow mealworms.

While limited available data so far show a low risk for transmission of zoonotic infections from the consumption of wild-collected insects, a detailed investigation is still pending to determine microbial hazards of consumption of farmed insects. At the same time, attention should be given to the possible bioaccumulation of undesirable chemicals from the environment that has been identified in farmed insects intended for animal feed (including pesticides residues and heavy metals ) (Vijver et al., 2003; Charlton et al., 2015).

Despite their longstanding use as a food source, there are very few laws and limited harmonization across national borders that address insect farming as food or feed, considering: procurement of ‘seed’ insects to start colonies, required farm infrastructure, and standards for the trading of the final products (Lahteenmaki-Uutela A.et al., 2017). While regulations for insects exist in some regions (eg in Europe) the lack of defined regulations in other parts of the world has allowed for a multitude of substrates being used for insect farming ranging from chicken feed to various waste streams including from animal sources, such as offal from slaughterhouses, with various possible food safety implications.

Moving forward, it will be important that policy-makers are provided with science and evidence on which to develop guidelines and regulations covering all aspects of insect entomoculture and entomopathy from primary production through processing and distribution and labeling to establish standards for safety and trade.

Algae (needs further work from Roland)

Marine algae (e.g. seaweeds, spirulina)have been researched for many years as alternative sources for protein, carbohydrates, and unsaturated fatty acids, both in open as well as in closed cycle production systems – the latter allowing better process control but at higher investment costs. Due to their composition and certain properties, there is high potential in human food, particularly as dietary supplements. At the same time, the emerging trend related to the increase in plant based feed in a rapidly growing sector like aquaculture might also offer further opportunities for use of these products.

However, new uses and applications of algae might also lead to the presence of hazards that are not traditionally expected in the resulting final food products. Attention should be given to issues like possible diverse patterns of pesticides and heavy metals occurrences, marine bio-toxins, or risks associated with the opportunism of certain epiphytic microalgae.

Circular bio-economy: recycling of food waste for feed

As one of the consequences of the growing efforts to reduce food waste, livestock stakeholders and policymakers are increasingly considering the option of using food waste as feed. Feeding these products to animals can help improve sustainable food production by reducing waste streams, and greenhouse gas emissions and supporting the so-called “circular bio-economy”.

However, the promotion of such an approach requires adequate up-front food safety attention in order to ensure that it does not lead to contaminants and/or pathogens entering (or even re-entering), persisting, or amplifying in the food chain and further spreading. To ensure the safe use of food waste and loss, some of the key considerations relating to the need to develop innovative technology for treatment and usage, ensure that traceability systems are in place together with standards and policies that provide an adequate regulatory framework. Incentives and investments to develop infrastructure for food waste and loss treatment and for the education of consumers and retailers to make the best possible use of food waste will be needed to ensure a successful implementation of this approach. For instance, some national authorities (do you want to spell out Japan?) have put in place laws to regulate food waste and loss recycling and have developed incentives for farmers and retailers such as a premium market for “eco-feed” animal products produced using food wastes and loss.

Use of food wastes as feed.

While efforts to reduce food losses have focused on the increase of the “best before” data of the food products or raising awareness among consumers and retailers, livestock stakeholders and policymakers increasingly consider the option to use food losses as feed. Feeding food losses to animals is a sustainable solution and brings more co-benefits by reducing waste streams, and greenhouse gas emissions and supporting a circular bio-economy. It comes with some threats such as risks of spreading animal diseases and food safety due to their potential chemical or microbial contamination. To ensure the safe use of food waste and loss and traceability, it is essential to develop innovative technology, retailer standards, and policies to frame their collection, treatment, and usage. These innovations can be supported by incentives and investment to develop infrastructure for food waste and loss treatment and the education of consumers and retailers to separate food waste and loss from other wastes. For instance, the Japanese government has put in place laws to regulate food waste and loss recycling and has developed incentives for farmers and retailers such as a market premium of “eco-feed” for animal products produced using food waste and loss.

Conclusions

New food and feed technologies have to include approaches to improve utilization of by-products, increase nutritional values, and monitor and prevent hazards, while exploiting industry 4.0 solutions and covering the whole product life cycle process, including farm management, feed, and water-related activities, logistics, as well as full value chain traceability.

Some of the alternatives presented in this brief might be able to offer valuable solutions if accompanied by adequate oversight and control to ensure their safety and appropriate application.

References

1. Commission Regulation (EU) 2017/893 of 24. May 2017. Official Journal of the European Union. L 138/92 -116.
2. EFSA (2015) Scientific Opinion on a Risk profile related to production and consumption of insects as food and feed, The EFSA Journal (2015);13 (10):4257.
3. Krska, R., H. Sen Y Uva, J. Gilbert, H.J. Van Der Fels-Klerx, O. Mcnerney (2018) Smart Tools for Farmers to Provide Advice to Mitigate Fungal Infection and Mycotoxin Exposure. 299-204. In: S.C.O.P.E. Scientific Challenges and Opportunities in the Protein Economy. E.M. Binder (ed.) ISBN 978-3-200-05831-6.
4. Ghanbari, M. and A. Köstelbauer (2018) Resistome: A New View by Next Generation Sequencing (NGS). 63-66. In: S.C.O.P.E. Scientific Challenges and Opportunities in the Protein Economy. E.M. Binder (ed.) ISBN 978-3-200-05831-6.
5. OECD/FAO (2017), OECD-FAO Agricultural Outlook 2017-2026, OECD Publishing, Paris. http://dx.doi.org/10.1787/agr_outlook-2017-en. Accessed January 1, 2019.
6. WHO (2014) Antimicrobial Resistance: Global Report on Surveillance 2014. Geneva, Switzerland. World Health Organisation.