Category: Uncategorized

Introduction

Background of the Problem

Parenting adolescents is a challenging task in modern American society. The problem is compounded when one is forced to raise such teenagers as a single mother. According to Elliott, Powell, and Brenton (2015), recent statistics show that about half of the African American children are raised by single parents. The study also indicates that 70% of single parents are mothers. Johnsen and Friborg (2015) state that many single mothers are forced to raise their children without the emotional and financial support from male partners who fathered these children. Taking care of the familys financial needs is challenging, but Williams and Smalls (2015) explain that parenting goes beyond that. It also entails understanding ones childrens unique needs and addressing them in the best way possible.

Some children are open with their parents and can express themselves effectively when dealing with issues affecting them at school or home. Others prefer not to express their issues to the parents. It largely depends on the relationship that has been developed between a parent and a child (Cokley, Awosogba, & Taylor, 2014). A parent who spends most of the time working to provide for the family may not have time to monitor their childrens trends and behavioral patterns unless an issue is brought to their attention by a teacher or a neighbor. It means that a child can deviate away from the standard norms and behavior expected by society without the parents knowledge. Determining the experience of single mothers of their relationship with their adolescent sons is important in this study.

The relationship that single mothers have when parenting adolescent sons is different from that of adolescent daughters. According to Groh, Fearon, Jzendoorn, BakermansKranenburg, and Roisman (2017), parenting a boy child is different from parenting a girl child. Leech (2016) also notes that a female parents approach to parent an adolescent boy is different from that which is taken when parenting an adolescent girl. As a child develops into an adolescent stage, they experience physiological and emotional developments that may be challenging for them to understand (Benner, Boyle, & Sadler, 2016). They begin to understand their sexuality and struggle to deal with their emotions. At this stage, a teenage boy would need the support of a father who understands this developmental stage based on experience.

Maynard, Salas-Wright, and Vaughn (2015) explain that it is easier for a teenage boy to seek help from an adult male than a female. Unfortunately, the majority of these single parented young boys are cared for by their mothers. In such families, the only adult member of the family is the female parent. Cohns (2016) report shows that the majority of these adolescent boys raised by female parents rarely share their experiences with their mothers. They suffer in silence and are easily convinced to join groups that may lead them astray. Parents come to learn about these childrens problems when something serious has happened (Maudry-Beverley, 2014). Others are forced to deal with the financial loss caused by the actions of their children. In extreme cases, it is often too late for the parent to act when these children ultimately lose their lives while engaging in dangerous activities due to peer pressure. The ability of a parent to guide a child depends on the personal relationship between the two.

The experience that these single African American parents go through can only be expressed by the affected group. Barnett and Scaramella (2013) explain that it can be frustrating for a single parent to learn that providing food, shelter, education, healthcare, and other basic needs is not enough for parenting. Others are forced to take two or three jobs to make ends meet, but that is not everything that the family needs. Her attention is equally needed, especially when there is no other adult in the immediate family that can offer guidance to the children (Hirsch, Dierkhising, & Herz, 2018). They have to find ways of balancing their limited time between working several jobs a day and giving their adolescent sons the attention they need. In this paper, the focus was to investigate single African American females experience of being mothers to their adolescent sons.

Need for the Study

The chosen topic was relatively new in the field of parenting in American society. Scholars have conducted broad studies on single parenting, as Weinrath, Donatelli, and Murchison (2016) observe. Scholarly attention is yet to be given on the experience of single African American female being mothers to their adolescent sons. This literature gap was addressed in this study. According to Irvine, Drew, and Sainsbury (2013), studies indicate that over 25% of African American females aged 22-44 are single mothers. 9% of white females in the same age bracket are single mothers (Cooper & Norcross, 2016). It means that single parenting is more common among African American females than it is among white females. It is necessary to find ways to improve these parents experiences as the problem becomes more prevalent among the targeted group (Cohn, 2016). As evident from the discussion above, this study was not focused on fighting the increasing cases of single parenting, which is a different but important topic.

The investigation looks at the experience of that these female parents have intending to understand the challenges they have to deal with and ways of improving their experience. These parents should not give up despite the psychological trauma they have to endure (Pachankis, Hatzenbuehler, Rendina, Safren, & Parsons, 2015). However, they need some form of support to overcome some of the painful experiences. Through this study, it was possible to bring the attention of the American public to this issue through various forums to find ways of improving the experience. A study conducted by Johnsen and Friborg (2015) shows that most single mothers prefer having girls to boys. They believe that it is more challenging to parent adolescent boys because of their rebellious nature. The negative attitude that some of these parents have can worsen the experience and deny the affected children the affection they need from the parent. They can easily become resentful adults who cannot sustain meaningful relationships or avoid breaking the law (Cooper & Norcross, 2016). Solving such social problems needs the attention of the American community.

Purpose of the Study

The purpose of this research is to investigate how single African-American mothers experience their relationship with their adolescent sons. According to a study by Slonim (2014), single mothers find it difficult to parent their adolescent sons than to raise adolescent girls. They went through the same stages that their girls are going through to easily relate to the physiological and emotional changes they are going through. It is also easy for female parents to talk about the sexual health and sexuality of their adolescent daughters, a very important topic for adolescents (Williams, Ryan, Davis-Kean, McLoyd, & Schulenberg, 2017).

However, the same cannot be said for single mothers parenting adolescent sons. Snyder (2016) believes that although American society has made significant steps in fighting stereotypes and traditional concepts that made it a taboo for mothers to talk about sex with their sons, it is still not easy for mothers to address sex-related problems with their sons. Sometimes they know the topic is necessary, but they cannot talk about it. This study identified the challenges that single go through and how it affects their ability to care for these adolescents to become responsible and successful adults. Doody and Noonan (2013) explain that society knows the problem exists, but the issue has not been given proper attention, even among scholars. It is evident that promoting public discourse on this issue, especially among scholars, can create avenues through which some of these single mothers can be assisted in the upbringing of their adolescent sons.

Significance of the Study

This research is of significance to American society. According to Wu, Appleman, Salazar, and Ong (2015), when parenting fails, it affects the entire community. In American society today, juvenile delinquency may not be as bad as it was in the 1980s and part of the 1990s (Leech, 2016). However, cases are still reported of adolescents who engage in the smuggling of drugs, burglary, robbery, and other criminal offenses. In most of the cases, the victims of such criminal acts are members of the public. Slonim (2014) argues that some male adolescents engage in criminal acts because they sympathize with their single mothers who have to work several jobs to provide for the family.

In their mind, they believe that engaging in such acts can help reduce the burden on their parents, especially if they can get enough cash that makes it unnecessary to ask for the same (Leech, 2016). The psychological trauma that some of these adolescents go through because of a lack of support from parents can transform them into dangerous criminals in society. In a study by Slonim (2014), most of the serial killers had unstable parenting. They grow up harboring bitterness against a section of the society, believing it was responsible for the pain they went through in their youth. They then try to revenge against these individuals. These are common cases when adolescents go to school with guns and then kill their innocent colleagues. Some of these cases are reported by the American media, while many others are not (Johnsen & Friborg, 2015). Failing to nurture these adolescent boys into responsible and law-abiding men is a danger to American society.

Psychologists in institutions of healthcare and guidance and counseling teachers will find this information critical in their fields. Stress-related health complications, such as high blood pressure, stroke, and cardiovascular diseases, are becoming common in the United States (Peleg, Vilchinsky, Fisher, Khaskia, & Mosseri, 2017). The African American females are some of the worst affected group, as Ebert et al. (2015) admit. One of the primary causes of stress among single parents is how to provide for the family while taking care of their childrens social and emotional needs (Cooper & Norcross, 2016). This document will provide important information on how psychologists can handle parents who are faced with such challenges. It will provide ways in which these parents can be supported in their parenting duties. Snyder (2016) explains that families that embrace specific religion may get the support needed from their community members. Instead of bearing the psychological burden alone, a parent can get the support of a church member to help address some of the emotional needs of an adolescent son (Johnsen & Friborg, 2015). Guidance and counseling teachers will find the document important when trying to meet the social and emotional needs of the adolescent boys at school. They will understand the factors that influence the relationship between adolescents and adults in a social setting.

The findings of this paper will help conform or dispute the relevance of theories developed by scholars in this field. Theories relating to single parenting and the unique challenges that African Americans go through in this society have been developed by various scholars (Williams & Smalls, 2015). However, it is important to appreciate that as society continues to experience social, economic, political, and technological changes, some of these theories become irrelevant (Cooper & Norcross, 2016). Through this study, it was possible to determine the relevance of the grounded theory, black psychology theory, and family systems theory in explaining the experience that single African American female parents go through and decisions that they sometimes take when faced with different challenges. The outcome of the study will explain the unique experience of single African American mothers of their relationship with adolescent sons.

Research Questions

In this qualitative study, it was important to develop research questions that helped collect data from various sources. The research questions should facilitate investigating the experience of single African American females when parenting their adolescent sons. The following is the primary research question that was based on the aim of the study:

How do single African-American sMothers experience their relationship with their adolescent sons?

The question was supported by sub-questions that focused on different experiences of these parents when parenting their sons. The following are the supportive questions that were used in collecting data:

1. What is it like to be a single African American mother of an adolescent son?
2. Describe your relationship with your adolescent son.
3. What are the most important aspects of your relationship with your son?
4. How has your relationship with your son changed over time?
5. Has the relationship changed since your son became an adolescent, or has it remained the same?
6. How do you typically communicate with your son?
7. What other factors affect your relationship with your son?
8. If you could change any aspect of your relationships, what would it be?
9. Are there any other comments you wish to add or issues that you believe are important to discuss in relation to this topic?

Research Design

The most appropriate design for this study was the qualitative research method. When investigating the experience of single African American females of being mothers to their adolescent sons, statistical analysis may be irrelevant (Ehde, Dillworth, & Turner, 2014). The experience of some parents may be so unique that it may not be possible to generalize through inferential statistics. Allowing them to explain these experiences and how they try to cope enabled the researcher to understand the pattern of the problem and how different stakeholders try to address it. Qualitative research design facilitated a comprehensive investigation of why the problem exists in this society and what can be done to address it (Johnsen & Friborg, 2015). It proposed how single African American mothers can parent their adolescent sons, with the help of teachers, religious leaders, and members of their community, in a way that minimizes the negative experiences. Qualitative data collected and analyzed identified areas of improvement needed to protect by members of the society to ensure that parenting of the adolescents becomes a communal responsibility other than being viewed as the sole responsibility of the parent (Cooper & Norcross, 2016). The chosen design should enable the researcher to achieve the objectives of the study.

Assumptions and Limitations

According to Haefner (2014), it is necessary to define the assumptions and limitations encountered when conducting research. One can easily understand the relevance of the study in case it is necessary to apply it in a given context. The following were the assumptions, limitations, and delimitations in this study:

Assumptions

Leech (2016) explains that different people have different experiences in parenting because of socioeconomic factors. However, the study assumed that most single African American females share the same experience when parenting their sons. Some of these single mothers also get direct financial and emotional support from their partners, family members, and fathers of their children (Johnsen & Friborg, 2015). However, the study assumed that these parents are not getting any form of emotional or financial support from their partners. The paper also assumes that American society still embraces race, gender, academic qualifications, and social status as defining factors. The paper presupposes that all the subjects of the study (single African American mothers) face the same problem of upbringing as a teenager. As Brown (2016a) observes, some teenagers are rebellious and very hostile, making the process of parenting more difficult. On the other hand, some teenagers are disciplined, intelligent, and understanding, making the experience of single mothers less painful. However, the paper assumes that all the teenage sons have a standard behavior.

Limitations

The research had limitations that should be discussed in this stage of the report. One of the main limitations was the time available for the study. America is a diverse country, even for people of color (Williams & Smalls, 2015). The experiences that a single African American mother has when parenting an adolescent son cannot be similar to that of a neighbor in the same city who faces the same predicament. It would be appropriate to conduct separate studies, classifying these single parents into different social classes to understand how their experiences vary. However, the limited time made it impossible to narrow down the study further. Another major limitation was finding the right people to help in collecting primary data. Convincing some of the parents to take part in the study was a challenge. As Leech (2016) explains, sometimes the experience of single parenting can be so painful that one finds it difficult to discuss it. Others are not proud of such status and do not easily admit that they are single mothers.

Delimitations

It was necessary to find a way of dealing with these challenges. As explained in the assumption section above, although socioeconomic status may make the experience of some single parents different, there are shared factors that make these single mothers face similar challenges in the upbringing of their adolescent sons (Cooper & Norcross, 2016). As such, it was not necessary to classify them further based on social status. The researcher worked closely with different schools to identify single African American mothers. It was easy to replace those who felt uncomfortable taking part in the study.

Chapter Summary

Chapter 1 provides a detailed discussion of the research background and the problem that the study seeks to address. It has eight sections. The first section provides a background of the problem and the need for the study. The next section discusses the need and purpose of the study. The significance of the research is also discussed to justify the project. Research questions and design are outlined. Assumptions, limitations, and definitions of terms are also provided in this chapter. The dissertation has five chapters. Chapter 1 provides the background of the study and the goal that should be achieved. Chapter 2 is a detailed review of the literature. Chapter 3 discusses the method used to collect and analyze data, while chapter 4 analyzes data collected from the respondents. Chapter 5 concludes the paper and provides recommendations.

Literature Review

Introduction

In this chapter, the focus is to provide a detailed review of the existing literature. The chapter starts with an explanation of the methods of research used to obtained secondary data sources. The chapter then provides a detailed review of existing theories. Black Psychology Theory and Family Systems Theory were found to be relevant in this paper. Factors that influence parenting of adolescents such as culture, social status, gender, level of discipline and academic excellence of a child, religious support, government support, personal relationship between mother and child are also discussed. The chapter provides a synthesis of research findings and a critique of previous research methods. It ends with a summary.

Methods of Searching

The literature review formed a critical part of the study. According to Benner et al. (2016), it is important to review findings made by other scholars when conducting research. The process not only provides background information but also identifies gaps in the existing knowledge. Sources used in this chapter were obtained from different books are reliable articles. The school library helped in finding the needed books and some journal articles. An online search also made it possible to find current articles on the research topic. Key-words such as single parenting, African American mothers, and parenting adolescents, among others, made it possible for the researcher to find useful materials for the study. Some of the databases that proved useful include Google Scholar, Journal Store (Jstor), Academic Search, Pro-Quest, and EBSCO Information Services. They provided books and journals recently published about single parenting, especially among African American women. Information obtained from these sources and findings obtained through the analysis of primary data informed the conclusion and recommendations made in the study.

Theoretical Orientation for the Study

It is necessary to analyze specific theories relevant to this research. According to Brody et al. (2014), theoretical orientation for the study offers a researcher a basis upon which ideas should be developed. Single African American females experience of being mothers to their adolescent sons can effectively be captured by different theories and concepts (Dörnyei & Ushioda, 2013). Two theoretical concepts were found to be relevant to the research topic. They include Black Psychology Theory and Family Systems Theory. Each of them was analyzed and effectively applied to the context of the study.

Black Psychology Theory

One of the emerging theories that concepts have used to describe the American social setting is the Black Psychology Theory. According to Elliott et al. (2015), it explains the beliefs, behavior, attitude, interactions, and feelings of African Americans (Ford & Moore, 2013). It has developed over time, and as Barnett and Scaramella (2013) observe currently is based on the Black Americans social environment. It is the desire of every American of goodwill to champion a united society and committed to a common goal, as was defined by the founding fathers (Jarvis, George, & Holland, 2013). Every person always desires to act in a way that would bring the society together irrespective of the demographical differences that we have. However, it is unfortunate that having such a perfect society is impossible (Pierre & Jackson, 2014). People tend to identify with their gender, race, religion, and other demographical factors. Haefner (2014) believes that every time people narrow down on their principles to specific factors such as race, they cease to be patriotic Americans committed to promoting a unified society where everyone is treated with respect. As Cooper (2013) notes, the theory offers a perfect explanation, why African Americans are disadvantaged compared with other races in the country.

African Americans often find themselves on the defensive whenever the issue of racism emerges. According to Brannon, Markus, and Taylor (2015), American society is still divided along the racial line, with Blacks considered inferior to whites. It emerges from the history of Africans in America. Most of them came to the United States during the colonial era as slaves (Emmen et al., 2013). The society highly cherished the caste system by that time, and it meant that they could not climb the social ladder through any means basically because of their skin pigmentation. When the country gained independence, slavery was abolished, but the perception towards Black Americans never changed (Johnsen & Friborg, 2015). It took several decades for African American men to gain the right to vote in this country. However, that did not help counter the negative perception that whites had towards them (Duffy, Blustein, Diemer, & Autin, 2016). Blacks who emigrated from Africa to the United States since independence did little to change the perceptions that the society had towards them (Percy, Kostere, & Kostere, 2015). Most of them were job seekers willing to do anything at the least possible pay. It strengthened the narrative that these people can only be servants (Pauker, Apfelbaum, & Spitzer, 2015). Fast forward to the 20^th century, American society is still segregated along the racial lines.

Family Systems Theory

When investigating single African American females experience of being mothers to their adolescent sons, one of the important concepts that cannot be ignored is the Bowens Family System Theory. It holds that people cannot be understood in isolation, but rather as part of a family (Wang & Kenny, 2014). There is a close interdependent and interconnectedness of individuals. Events that affect one individual also affect other individuals during the interaction. When a mother had a bad experience at work, the emotional instability may affect how she interacts with family members at home. The theory also explains the role of family members and expectations (Zimmerman et al., 2013). Parents are expected to provide for the family and offer protection and guidance. In a family with a single mother, the role of providing, protecting, and guiding falls on her. Working different jobs to provide for the family is not enough. Such a parent must also provide the emotional support that children need.

The experience of single female parents depends on the relationships developed with the child. When there is a close relationship between a mother and an adolescent son, it is easy for the parent to explain the difficulties the family is going through and ways in which she is trying to deal with them (Johnsen & Friborg, 2015). The son will also explain the socioeconomic challenges he is facing at school and home. The Family System Theory holds that when a positive relationship is inculcated, there will be minimal disagreement. Each party will understand the challenges of the other, and there will be a genuine effort to make the experience less painful. On the other hand, when there is a poor relationship between a mother and an adolescent son, cases of rebellion and disagreements become common. The theory is appropriate for this study.

Review of the Literature

Parenting is a widely researched topic, and other scholars have addressed some of the concepts that were investigated in this project. Barnett and Scaramella (2013) explain that socioeconomic and political changes in society mean that some realities have changed. According to Varner and Mandara (2013), a century ago, women in the United States were not allowed to vote, and only a few of them were active in the corporate world. However, that has changed. It means that the experiences that a single African American woman had when raising a son in 1930 is different from that in 2018 (Williams & Smalls, 2015). Although the study has been explored, these changes mean that revisiting the topic is important to understand the positive steps that have been made and areas that still need societys attention (Pachankis et al., 2015). This section reviews findings made by other scholars who investigated related topics.

Single Parenting in the United States

According to recent statistics, single parenting is becoming a common phenomenon in the United States. Williams and Smalls (2015) argue that single parenting may be caused by divorce, separation, incarceration of one partner, or death of a partner. According to Irvine et al. (2013), the primary causes of single parenting in the country are divorce and separation of the partners. Barnett and Scaramella (2013) argue that now more than ever, many marriages end up in divorce before their fifth year. The phenomenon is not unique, but the rate at which American marriages are ending in divorce or separation is worrying, as Barnett and Scaramella (2013) observe. Figure 1 below shows the statistics of the changing American families and how different groups are affected. The statistics show that the number of children living with an unmarried mother is consistently rising since the 1960s. In 1960, less than 10% of children were raised with unmarried mothers. The number has significantly increased to 24% in 2010 (Blankstein, Noguera, Kelly, & Tutu, 2016). The whites are the least affected group, although the problem is also becoming prevalent amongst them. In 1960, about 9% of white children were raised by unmarried mothers, as shown in the statistics below. The number has more than doubled to 19% in 2010 (Johnsen & Friborg, 2015). Hispanics are also experiencing a similar problem. In 1978, about 18 Hispanic children were raised by single mothers. The number is expected to increase as cases of divorce are on the rise.

The social problem of single parenting affects African American mothers than any other population in the United States. Since the 1960s, the number of African American children raised by single mothers has been more than twice the countrys average (Cooper & Norcross, 2016). The statistics in figure 1 below shows that the trend is not changing. In 1960, less than 10% of all American children were raised by single mothers. At that time, 20% of African American children were under the care of single mothers (Atzaba-Poria, Deater-Deckard, & Bell, 2014). In 1990, 54% of African American minors were parented by single mothers. At that time, the countrys average was 22%. As Leech (2016) explains, the problem is not as prevalent today as in the 1990s, but the Blacks are still the worst affected group. In 2010, 50% of African American children were parented by single mothers, while the countrys average was 24% (Benner et al., 2016). The prevalence of this problem among African Americans made it necessary to narrow down the study to this group because it is the worst affected.

Studies show that one of the leading causes of divorce and separation in the country is infidelity. According to Stinson (2013), modern technologies, especially the growing popularity of smartphones and other communication gadgets and software, have made it easy for couples to trace activities and determine if one is unfaithful. The rate at which men are cheating on their wives has not changed much, according to a study conducted by Nobles (2013). However, it is easier than ever for wives to determine if they are cheating. On the other hand, the rate at which women are cheating on their spouses has increased significantly in the modern society compared with the case a century ago (Johnsen & Friborg, 2015). The trend is attributed to the empowerment of women, especially those in the corporate world. They spend a lot of time at work and mingle with so many people, making it easy for them to get into illicit affairs (Williams & Smalls, 2015). Still, it does not mean that women are more promiscuous than men. The statistics only show that women empowerment has created platforms where women can easily cheat on their partners.

The emergence of social media platforms is another factor that is straining relationships. According to a report by Brown (2016b), social media can be very addictive. Some people cannot spend more than 30 minutes of their free time without visiting Facebook, YouTube, Twitter, and WhatsApp. They are so addicted to social media that they no longer have time for their families (Jeynes, 2015). Traditionally, couples were expected to have family times together after work to di

Introduction

Since time immemorial, administration of medications and drugs through prescription has always represented a paramount aspect especially in healthcare management. While prescriptions has served to lower the levels of morbidities and mortalities due to common illnesses, it has occasioned a jump in the cost of managing illness that is reflected in the skyrocketing budgetary allocation to healthcare. In view of the UK scenario, doctors enjoyed the preserve of acting as the only authorities to prescribe medicine. However, legislative changes introduced by the department of health has seen the conferment of prescribing powered to the nurses and pharmacists in tandem with the increasing demand for healthcare across the UK (Emmerton et al, 2005, p. 76). In addition, the government was compelled to introduce the policy changes in order to maximize on the potential of the healthcare force while ensuring enhanced access to common prescriptions thereby leading to savings brought about by delayed diagnosis.

The paradigm shift to availing of prescriptions by other health related professionals necessitated the introduction of prescribing models in the healthcare system in National Health Service (NHS). Increased lobbying and consultations between the government on one hand and the various professional groups and concerned stakeholders on the other hand led to the inception of supplementary prescribing in 2003. Concerns about the tripartite model of prescribing offered by the supplementary prescribing led the stakeholders to devise another model to encompass all health allied professionals. The allied health professionals felt underutilized and under submission to implement orders given by doctors taking into account the model only allowed them to utilize a clinical management plan, which was patient specific, when prescribing. In line with the envisaged changes, the Department of Health introduced the pharmacist independent prescribing that enhanced the roles of pharmacists while improving the level of efficiency (Emmerton et al, 2005, p. 76; Department of Health, 2005).

Although different types of prescribing are in use in the UK and internationally, training programs have always remained mandatory for the various cadres of health professionals before they are allowed to practice. In line with the developments, accreditation after successful completion of the courses has become the preserve of the single institution in order to streamline the regulatory process subsequently leading to practice. In the case of pharmacists, undertaking the course is required in addition to successful completion of the undergraduate benchmark. The prescribing training has formed the unique feature of the UK healthcare industry with analysts referring it as the keystone. The UK models contrasts with other non medical prescribing alternatives utilized around the world. The UK model provides the best approach to accreditation since it entails following of nationally agreed criteria. In contrast, the United States of America utilizes a devolved system whereby the states have the powers to undertake local assessments and make final submission based on the competencies of each practitioner. Training modes are very diverse with part time and largely distance programs receiving embracement within the UK. Both modes are crucial since they offer the practitioners time to gain engage in clinical practice where there is wide application of the clinical knowledge (Callum et al, 2002, p. 45; Lloyd & Hughes, 2007).

Medical practice has experienced increasing trends of errors with prescribing errors forming a significant proportion buoyed by the high frequency the prescribing takes place. Prescription has become the single most utilized method of treatment in all levels of medical care in the United Kingdom. According to the National Health Service records, about 637 million prescriptions were effected in 2000 with the cost estimated to account for an eighth of the NHS costs (The Audit Commission, 2002, p. 23). Despite the glaring statistics, prescribing has been become a neglected skill with little effort towards improving the outcomes. While there is no single solution, a wide array of solutions is required in order to improve the outcomes in the patients while enhancing confidence levels. Several models have been put into practice in explaining the prescribing errors. Although medical errors have received little research, a model developed by Reason has gained prominence (Lloyd & Hughes, 2007, p. 1846).

The model relies mainly on studying the risk factors mainly from the individual, organizational and the external environment. In view of the above areas of interest, the various cadres in health have faced significant challenges during prescribing. Despite the fact that majority of the challenges are common, variations in the extent has been observed across the groups. Major deficiencies occur in the preparation and eventual practice in the nurses, doctors and pharmacists. The field of therapeutics has greatly suffered from the lack of committed professionals who in turn could help the students to gain invaluable skills in controlling the chances of errors. Doctors admission of failing to secure adequate knowledge on prescription has raised concern among several scholars. To further add weight on the level of failure in prescription, occurrence of mistakes is a common occurrence due to the overreliance eon advice from pharmacists and nurses. While the information provided is usually correct, the coding of the message has remained a major challenge in the field (Callum et al, 2002, p. 45).

In tandem with the changes in the medical fields, doctors are now required to undertake preregistration training before receiving accreditation. In addition, incorporation of advanced prescribing programs has received wide application in the training of doctors, in addition to mentorship from practicing doctors. In line with international trends, demonstrable competence is imperative before the doctors are given the green light to prescribe. More importantly, sensitization on the implications of wrong prescriptions on the body functioning is also important. According to Barber, Rawlins and Franklin (2003), demonstrable competence in the appropriate interpretation of the drug charts while connecting the diagnosis with the right dosages. The modular application is in line with the norms followed by pharmacist and nurses. While the doctors are lagging behind in terms of relating diagnosis with prescriptions, much improvements has been seen in the recent past. In a bid to instill confidence on the treatment, the doctors must overly prescribe for patients by relying on their medical records. Testing through this mode has gained utilization in the recent past with wide replication internationally.

On the nursing field, disparities and contrasting evidence exist on prescribing. While the inception of new guidelines in the 1980s scrapped much of the education regarding pharmacology, emphasis in the clinical practice has not lost momentum (Centre for the Advancement of Inter-professional Education, n.d, p. 4). Shifts in educational philosophy were overly blamed for the development in nursing. More importantly, it heralded the introduction of intense practical lessons whereby nurses were required to demonstrate competence just as in doctors. Incorporation of further training in pharmacology has placed the nurses at a better place to practice and administer drugs. In fact, community nurses have received the green light to prescribe a variety of drugs, albeit after passing accreditation tests. In comparison with the doctors, some clinical nurse practitioners have become accredited to offer prescription in hypertension and diabetes (Barber, Rawlins and Franklin, 2003).

To ensure competency is achieved and the pharmacists are effectively prepared to undertake prescription while offering leadership and mentorship to the other cadres, extension of the training has occurred. Previous studies assert high display of importance in the field of supplementary prescribing with regard to improvement in confidence levels and bolstering of reflective learning (Jones, John & Luscombe, 2007, p. 36; Lloyd & Hughes, 2007, p. 1846). However, the limitations in the course duration owing to work commitments generated wide criticisms. The integration of the training of the pharmacies with other cadres such as nurses in the training programs has elicited debate taking into account the variation in training needs among the various groups. In view of the training needs, the nurses require holistic training in pharmacology unlike the pharmacists who overly desire to involve themselves in patient care and relations (George et al, 2006, p. 1856).

Emphasis on pharmacists training is crucial in order to avert occurrence of major disasters caused by adoption of wrong guidelines in the prescription. Detection of errors has continually formed the major roles of the pharmacists. In view of the above, Dean et al (2002, p. 342) has estimated that 1.5 % of prescriptions in general and medical wards are detected by the pharmacists. Regression modeling has largely contributed largely on the understanding of the occurrence of prescription errors. In fact, regression modeling espouses that the overall experience gained by the pharmacist coupled with the amount of time spent on prescribing in the wards form important parameters and influencers vital in enhancing improved detection rate. The type and the nature of the ward also influence the level of prediction. Improving the resource capacity of the pharmacy department not only forms a core factor in detection of errors in prescribing but also aids greatly in correcting them (Barber, Batty & Ridout, 1997, p. 398). Legal barriers in prescribing have become insignificant with the introduction of training guidelines and policy changes. However, disagreements prevail on the training and responsibilities owing to the limited exposure and interaction with the patients and medical records (Richard et al, 2008). Inadequate involvement in the design of treatment procedures is major factor that creates practice barrier unlike the nurses and doctors. While concerted efforts to ensure their involvement in all aspects of the patient care are being formulated, pharmacists will continue facing barriers especially in offering adherence support (Barber et al, 2003, p. 32; Cooper et al, 2008, p. 37)

Inter-professional learning is a controversial subject that confers both benefits and problems to the care givers during training and subsequently in pharmacology practice (Cooper et al, 2008, p. 37). Calls for the review of the traditional approach where training was carried out based on distinct career lines are laudable since they have brought forward the need for cooperation and development of guidelines on the training for each cadre. More importantly, benefits accrued from enhanced relationships and understanding of values of different professions combined with improved communication confer long term impacts in training while ensuring cordial relations and cooperation in subsequent practice (Elston, 2004, p. 168). The socialization process engineered from the training helps in improving the efficiency in the delivery of healthcare services. Although streamlining of training has been challenged, provision of varying levels of skills in practice remains untenable in modern practice as illustrated in pharmacology training and largely in the numeracy exams (Cooper et al, 2008, p. 37; Richard et al, 2008). Propositions of possible integration of prescribing into the undergraduate training of the studies raises concerns due to lack of empirical evidence denoting how the inclusion such training in the curriculum will enhance the success of the nonmedical courses. In addition, difficulties in compensation of the learning period and the time required to gain enough experience curtails the incorporation into the undergraduate course (Warchal et al, 2006, p. 65).

Antagonism between the various professions

Antagonism persists between the medical practitioners and pharmacists persist despite major policy changes in the last few years that allowed the latter to prescribe albeit with limitations. Concerns regarded the declassification of certain drugs and manner of prescribing finds its genesis from the antagonism between both professions prior to the 90s. While the application of prescribing by nurses, doctors and pharmacists showed improvements in the overall health status of the people in countries such as Denmark, the NHS remained indecisive owing to differing interests from different professional groupings. The ranging conflict between the dispensing doctors on one hand and the nurses and pharmacists on the other hand is mainly fuelled by the business interests. In the run up to the liberalization of prescribing, the representatives remained vocal in curtailing the involvement of pharmacists thereby delaying the enactment of the legislative changes. Taking into consideration the benefits brought by supplementary prescribing, the doctors have embraced the roles of pharmacist while offering them the required support. However, measurable discontent on the extent of involvement of pharmacists in independent prescribing still persist with various quarters arguing that the pharmacists are prone to cause detection errors (Stewart et al, 2009, p. 94). Contrary to the popular perception, Cooper et al (2008) through a review of case studies and interviews with doctors assert that non medical prescribing require protocol type while ensuring the nurses and pharmacists take full responsibility for the whole process.

More importantly, recent studies down play the notion of increased cases of prescribing errors in supplementary prescribing. Whilst little research exists on this field, the findings offer reassurance to discordant voices on the safety and appropriateness of the non-medical prescribing (Avery & Pringe, 2005, p. 76; Latter et al, 2007). However, critical debate is required in the diagnostic field in non medical prescribing to ascertain the predisposition to errors with the aim of informing policy changes in the future. It is worthy noting, similarities on the quality of drugs and prescriptions between the doctor sand pharmacists have been denoted in health management organization in the United States. In view of the assertions made by McGhan et al (1983), pharmacists need more encouragement if they are to continually achieve positive effect on the overall health of the patients. Although differences on parameters regarding blood pressures have occurred, lack of significance on the differences of outcomes denote increasing competence on the part of nurses and pharmacists.

In view of the increasing burden of hypertension in the aging population has reinforced the roles of primary care physician around the world. Effectiveness in the overall management of hypertension has resulted in reduction of about 40 % over the years, which in essence brings much economic savings while bringing substantial impact in clinical practice. Concerted efforts towards the promotion of clinical practice guidelines in the area of hypertension brings into fore the importance of mitigation measures such as blood pressure control while enhancing the integration of clinical evidence into day to day practice. Although there is widespread availability of substantial evidence based guidelines especially on hypertension prescribing, the level and standards in prescriptions remains marginally below average.

In fact, surveys and case studies indicate that slightly above half of the physicians have complied with the guidelines (Psaty et al, 2002, p. 2323; Marques-vidal & Tuomilehto, 1997, p. 214 & Holmes et al, 2004). In contrast, pharmacists adherence on the guidelines remains poor buoyed by the lack of support from the physicians and implementation barriers brought about by the workplace setting. Taking an economic perspective of evidence based practice, it emerges that its application does not confer reduction in the healthcare costs; rather it helps the physicians and pharmacists to initiate and develop efficacious therapeutic options that enhances the improvement of the quality of life for the individual and community in general (Primatesta, Brookes & Poulter, 2001). To this end, Fischer and Avorn (2004, p. 1850) intimate substantial saving with regard to utilization of evidence based guidelines when undertaking hypertension prescription. In support of the Fischer and Avorn (2004) findings, a study conducted among hypertension patients in government hospital in Hong Kong reiterated statistical significance and lowered drug expenditure occasioned by adherence to clinical practice guidelines (Wae et al, 2006).

Models of prescribing

Prescribing has gained prominence especially with the inception of prescribing by nurses in the last few years. While the extent of prescribing varies across the globe, literature is increasing point towards more involvement of pharmacists and other health professional in the future. Considerable debate on the pharmacists prescribing has shown that pharmacists are exhibiting expertise with regard to the evidence based practice. in view of the developments, more pharmacists are involved in prescribing while monitoring the therapeutic process hence complementing the efforts of the medical practitioners. Embracement of prescribing for pharmacists occurred in differing times around the world with increasing more drugs becoming available to the pharmacists for prescribing. A review of international literature shows variations in the models under utilization. The efficacy of the different prescribing models proves difficult to ascertain due to the limitation and implementation barriers coupled with the short duration of application in current practice. The implementation of the different models of pharmacists prescribing is overly reliant on several factors. Emmerton et al (2005, p. 217) asserts that protocols and formularies combined with collaboration exhibited by physicians and pharmacists form the major factors that dictate the method to be embraced. The models illustrate the capacity and autonomy enjoyed by the pharmacists in the initiation, modification and largely in the monitoring of medicines available for prescription. Figure 1 presents a large map of the eight models under utilization across the world while taking into account the level of restriction with regard to aspects of formulary and protocol.

Models of decision making in prescribing

To effectively make an impact on the health of the patient, the medical practitioners and the pharmacists require making the right decisions on the appropriate drugs for certain medical conditions. In fact, the medical and the enormous nursing literature is divided into two dynamic models that have proved vital in understanding the decision making in the health professional with regard to prescribing. Utilization of the scientific model and analytic approach has helped in directing the diagnosis and subsequent offered valuable tips in prescribing. To start with, the scientific model encompasses the logical analysis through the use of decision trees where a numerical value is usually assigned to all possible and relevant outcomes in the diagnostic procedure. Various studies have asserted that the quantitative approach is more dependent on available knowledge to enhance and direct the prognosis hence allowing the correct decision to be arrived at (Miers, 1990; Harbison, 1991). However, limitations in accessing available knowledge and inadequacy in research shows that urgency of clinical cases require the practitioners to arrive at decisions based on available knowledge while applying some element of risk. It therefore becomes necessary for the medical practitioners and pharmacist to weigh the benefits against the negative consequences before prescribing. In view of the above, probability of occurrence of negative consequences is greatly diminished (Wooley, 1990).

The analytical approach espoused by Benner (1982) is overly reliant on the intuitive knowledge achieved through exposure to clinical practice rather than evidence presented in literature. Basing the tenets of the model on the levels passed by a nurse during training, Benner (1982) theory have received support from several researchers who denote that it becomes easier to make decision based on the experience gained over time. Interpretation of Benner model by Hamm (1988) in relation to medical practice revealed similarities with medical novices believed to think analytically based on clinical guidelines while the experts intuitively make decisions on diagnosis. In addition Hamm integrates the concepts of analytical approach with intuitive thinking, rather than viewing them as diverse strategies, hence creating a continuum. In view of the integration, Hamm suggested that increase in the availability of time and information resulted in the tilt of balance towards the analytical end and vice versa.

The ability to inherently alter the combination of prescriptions largely determines the strategies to be utilized in the control of the overall cost and quality (Schumock et al, 2004, 558). While past analyses tend to emphasize prescribing behaviors among the doctors, modern practices in healthcare depict increased roles of pharmacists in decision making. This scenario is evident fin the modern hospital setting where policies regarding medication utilization remain under the custodianship of the therapeutic committee (American College of Clinical Pharmacy, 1993). In addition, the clinical pharmacists largely influence the approval and change in drug therapy. Whilst theoretical models has continually enhanced the understanding of the prescribing behavior in nurses and physicians, variations of the specific factors that influence decision-making exists among the professions. Generalization of models is hence discouraged. Safety and effectiveness coupled with administrative factors influence largely the decision making process. Drug-related factors Understanding of the influencing factors and taking into account the differences on the importance of each factor to the different cadres is imperative in informing the alteration of prescribing behaviors by the policy makers (Schumock et al, 2004, 557).

Decision making in nurses is largely determined by influences from the internal and external environment. The experience garnered through active practice in prescribing (Benner, 1982; Wooley, 1990; Schumock et al, 2004), persuasion from company representatives and the general attitude of the nurses (Hamers et al, 1994) impact greatly on the choice of medication. Inter-professional relationships between the nurses and the other health professional particularly the doctors and pharmacists influenced greatly and affected the self actualization in prescribing. Impaired relationship depicted insecurity and uncertainty in coming up with the appropriate decisions. Radwin (1995) also asserted the extent the decision making was hampered by the client-nursing relationship. Radwin describes the four strategies involved in directing the overall decision making process; starting with empathizing particular in cases where the patient has less encounters with the patient. On the other hand, the nurse tries to balance the preferences in view of the difficulties especially when a great of the medical and personal history of the patient is known to the nurse.

The attitudes of the nurses depicted the time administration of the drug would take place especially in cases where the patient is a child (Hamers et al, 1994). Nurses delayed in administering the medications owing to the assumptions of side effects or worse outcomes. Medical literature depict the same picture with considerable similarities in the factors causing increased influence in the decision making process. While studies have delved on wide range of factors in the social environment, a conclusive study depicting a single-most major influencer has remained elusive. Studies on the role of demographic factors, inter-professional relationships and interaction with company representatives showed differing extent of influence on the overall nature of prescribing in medical fraternity. In fact, Clark et al (1991) asserted demographic factors in the patient contributed immensely in reaching a conclusive decision on the nature of prescription. Age and class explained why there is likelihood for elderly patients to receive prescriptions than younger patients. In comparison with nursing literature, attitude of the doctors and urge to satisfy the expectations of the patients put pressure on the doctor hence influencing the nature of prescription. Familiarity with patients lowers the rationality of reaching the nature of prescription (Clark et al, 1991).

Doctors have a major role of furthering the evidence based practice in prescribing thereby addressing the issue of uncertainty in nurses. While pharmacist roe in influencing the overall prescribing process remains inevitable, better interaction with the other professional is symbiotic since they benefit from the rich experiences in nurses and doctors. In order to effectively reinforce the confidence of pharmacists and nurses, doctors have to shed the notion that they are under threat from the former in terms of their prescribing roles. Similar instances of backlashes experienced in the United States over nursing diagnosis serve as an explicit example of the negatives impacts caused by resent against a certain unavoidable partners at the workplace (Herbert et al, 2004). More emphasis on the harmful effects rather than the benefits of prescribed medications is required to curtail the onset of adverse effects occasioned by rushed decisions. Although taking risk is key to nonmedical prescribing, reflective learning is paramount in enhancing the reaching of informed decisions. Cooperation between the various cadres of professional not only result in enhanced professional development but also instill skills in best practices particularly to the non medical prescribers. In view of the decision making process, the expertise of pharmacists on formularies is tapped into influencing the decision making in the nurses and doctors (Luker et al, 1998, p. 663).

Herbert et al (2004) also found that a combination of evidence based educational interventions with personalized prescribing is imperative in enhancing minimal but pertinent changes in the nature of prescribing undertaken by doctors. To improve the embracement of the interventions, it becomes imperative to design clear-cut messages coupled with proper trial design that allows the deciphering of positive outcomes (Herbert et al (2004). Individualized feedback coupled with specially integrated education model remains effective than utilization of single intervention particularly in cases of hypertension prescribing (Wensing & Weijden, 1998). Evaluation of educational interventions that suggest improvements in the manner of improving prescribing especially in primary care have to been stressed (Grimshaw et al, 2001, p, 997). Modest changes in the educational interventions produce significant impacts on the influence of prescribing behavior exhibited by physicians, which in essence brought about cost effectiveness and more benefits to both the patients and the entire healthcare system (Herbert et al 2004).

The influences exerted by the pharmacists on the prescribing practices can be observed in all clinical situations. Their influences seem inconsequential in the developed countries due to the advancements in the health systems. Similar efforts towards the interventions in the developing countries have significant impacts with major improvements on the patient outcomes. Calls for pharmacists to involve themselves on diseases where they experience the greatest impact have intensified. Expected improvements in areas of HIV and tuberculosis can benefit immensely from the pharmacists input. However the training of pharmacists in the developing countries is hampered by lack of adequate resources in terms of funding and personnel. Taking into account their potential, there is an urgent need for the pharmacists to dedicate and commit their time in the practice thus ensuring the realization of optimum outcomes. While variations in terms of training and resources exist in the health systems, there is agreement that some level of influence in prescribing is achievable at all points in the continuum (Herbert et al, 2004; Cooper et al, 2008).

Practices and implementation issues

Despite the introduction of supplementary prescribing earlier in the decade, Cooper et al (2008, p. 64) indicate modest levels with regard to prescribing by nurses and pharmacists. Triangulating data has indicated that low levels of supplementary prescribing occasioned by implementation difficulties have occurred in the UK NHS. Prescribing software that lacked the ability to generate printed prescriptions curtailed the efficacy in the functioning of the pharmacists. In light of the shortcoming, the pharmacists led to the overreliance on doctors in the prescribing. While the inter-professional socialization was improved, the autonomy of the pharmacist was overly challenged through crosschecking of the prescriptions. The lengthening of the duration of prescription occasioned by hard written copies compounded the barriers in implementation. In fact, recent studies have observed similar implementation barriers with difficulties in overcoming the information technology comes remaining the most prevalent in several settings (Courtenay et al, 2007; George et

Introduction

Technology has become one of the most important aspects of healthcare in the modern world bearing in mind that it has been embraced extensively. In this regard, it has been integrated into various operational functions in the Indian healthcare information system. New programs have been developed continuously to solve the upcoming challenges in the healthcare arena (Eswarappa 178). Having solved some of these challenges, the technological programs have simplified the processes of treating diseases as well as the interaction between doctors and patients (Eswarappa 347). Based on this understanding, this paper will thus focus on the various technological developments that have been incorporated into the healthcare system with the help of computers and other devices.

Besides technology, it is essentially crucial to focus on the healthcare setup and how it is aligned to the level of illness in India. This undertaking can be accomplished by determining whether the healthcare providers consider illness when they are setting the various aspects of the healthcare system. In an attempt to make this crucial determination, this paper will also discuss some critical illnesses, such as HIV/AIDS, environmental causes, and disability, and compare them with the healthcare provisions. As a result, there are two distinctive objectives of this paper according to the above elucidations.

1. To discuss the technological advancements in the Indian healthcare system.
2. To determine whether Indian healthcare considers illness during the process of planning.

Technological Advancement of Indian Healthcare

The technological aspects of Indian healthcare has undergone a profound transformation, especially when it comes to information systems. In the recent past, the Indian healthcare system relied on the manual execution of roles and the physical presence of the professional. However, technology has brought new experience and development to the Indian healthcare system whereby patients can be monitored without the bodily presence of the practitioners and clinicians. The subsequent paragraphs discuss some of the improved systems that are used to accomplish the manual roles in the quest to reach more people in society.

Telemedicine Technologies

One of the most crucial technological innovations that have been conceived in the healthcare information system of India is the telemedicine program. It is evident that most of the physicians in India reside in urban areas while the others live in rural areas. Particularly, it is established that 3 percent of the clinicians live in the villages while 25 percent reside in the semi-urban areas and the rest in the towns (Khoumbati 174). This implies that the number of physicians who are available for the people in rural areas is essentially negligible. Telemedicine is a program that uses mobile phones to track the progress of patients in different parts of India such that the doctors do not need to leave the hospital premises. In addition, it reduced the need for patients to leave their residences and visit the hospitals for diagnoses. Through this program, the doctors can give a drug prescription, advise the patient about some health issues, or diagnose while the patient is still at home.

Among the fundamentally vital developments that have taken place in the program is the introduction of the mobile monitoring system. This program has been conceived by a student in one of the Indian universities known as Loughborough and some professionals in the telemedicine arena (Khoumbati 129). The program is a very innovative system that enables health professionals to track the health of patients using mobile phones. The mobile phone is capable of taking and transmitting information concerning various health aspects, including blood pressure and blood sugar. Having collaborated with other universities, the phone has been developed to make the special mobile phone more portable and powerful in terms of transmitting the information.

Apollo Hospitals ICT Initiative

Apollo Hospitals are committed to transforming Indian healthcare in collaboration with Cisco. In their attempt to fulfill their objective, the first step involves leveraging the ICT system in order to integrate it with the operations of Apollo Hospitals. In addition, the first phase involved the development of the Cisco Health-Presence initiative. The second step in their program involves undertakings that seek to develop and improve the technological standards in that attempt to transform the entire healthcare. In their third step, the Apollo initiative seeks to leverage ICT in order to provide solutions to the problems facing health care not only in India but also in other parts of the world that include Asia-Pacific and developing countries (Khoumbati 176). The Extended Reach program will enable the health practitioners to provide services in the entire country with ease in contrary to the past years where the physicians have been forced to attend to the patients physically.

Center for Development and Advanced Computing Technologies

In the past, the rural areas had been abandoned as far as healthcare attention was concerned. Besides the aspect of few physicians in rural areas, it is evident that India has a huge population that makes it difficult for the physicians to attend to all the people satisfactorily. For this reason, CDAC has developed Infothela software to facilitate the exchange of patients information. The system comprises both the back-end and front-end sides that help in executing different roles. The latter depends on the non-medicine experts who collect information from the patients and then transfer it to the former. The back-end is monitored by medicinal specialists who interpret the sent information, make conclusions, and diagnose by prescribing the necessary treatment. Infothela program, which is powered by a computer system, involves the use of the Internet, emails, and mobile devices when collecting information as well as administering treatments.

In regard to the development of infothela, the center for Development and Advanced Computing began working on the project in Bangalore where they sought to use it for primary care (Khoumbati 156). While accomplishing the undertaking, the specialists incorporated the database system and the information about the interaction between patients and doctors. Further, the two components were combined with the web-designed system of management, text-messaging and other web programs among others. Having considered the extensive use of mobile phones in India, the developers have been working to make a wireless application that can enable the integration of this system with these devices.

Further, CDAC has developed a program known as ONCONET that is involved in capturing, storing, transmitting and processing images using web-based systems. This software comes as a development of the telemedicine arena since it can be used to capture and transmit pictorial information from the patients to the doctors without physical appointments. It has been implemented to enable the operation of the ACI telemedicine networking system. In essence, CDAC has developed a total of eight technological programs that are set to improve the field of telemedicine (Khoumbati 127). The eight programs are focused on specific fields of medicine and aim at solving the problems that are related to those areas.

Health Management Information System

This is a system that was developed by ICTPH and another technology company known as Swath India. This system incorporates all the aspects of managing the healthcare sectors by using features that are easily integrated with other technologies. The system obtains data from three different external sources that include diagnoses, mobile technology and survey studies. In regard to diagnoses, HMIS obtains data from the previous treatment that have been prescribed by the doctors. The diagnostic data includes aspects such as blood pressure, CBC, and body chemical analysis. When it comes to mobile technology, it has been integrated into the system to focus on young children within the range of 2 to 24 months of age. For example, information concerning nutritional cases is collected using portable devices and recorded in the HMIS.

Importantly, it seeks to eliminate the health menaces conjoined to anemia that is caused by a deficiency of iron in the body. When collecting this information, the caregivers use mobile phones to conduct surveys and get helpful data concerning health issues. In addition, HMIS depends on the surveys that are conducted with the help of well-designed questionnaires. These questionnaires are scanned using unique technological devices that are incorporated in the HMIS to collect information about the patients. Particularly, the questionnaires are scanned using the Optical Mark Recognition and fed into the back-end to gather statistics. However, the rising use of mobile devices has been replacing the use of scanned questionnaires gradually.

HMIS Features

The HMIS comprises a demographic section that captures data related to the various individual aspects, including age, gender and geographic location among others. Most of the information stored in this part of the system grows organically so that the patients data is captured accumulatively as they continue visiting the hospital. Once the information is obtained, the HMIS organizes it into groups according to geographical entities and households (Swaminathan 143). In addition to the demographic section, HMIS comprises the outpatient module that is the most-used part of the entire system. This part accomplishes various tasks, including the provision of interfaces for clinical practitioners, moderation of individual information, and assignment of the location to the mentioned healthcare providers.

Health Care Consideration of Illness

Status of HIV Illness and Its Consideration in Healthcare

Unfortunately, the projections that can be made in regard to the future status of Indian health are notoriously uncertain. Nonetheless, the future status of Indian health rests on the general transformation of its political prospects that have been implemented in the quest to reduce poverty and mitigate its effects. In essence, the ability of peoples capability to pay for healthcare services will affect their willingness to take responsibility for their own health. In addition, the governments commitment to the effective dissemination of public information will also determine the ability of the citizens to take preventive measures. Importantly, the future level of morbidity will also be determined by the consciousness of the government and the private sector on the vulnerable people in the society, nutritional awareness, and womens empowerment. It thus follows that if these are the pertinent aspects that will impact the level of morbidity, the question of whether the Indian healthcare system considers illness during planning must revolve around them. In particular, there are various forecasts that have been made in relation to the future status of the illness. One of these forecasts relates to the deadly HIV/AIDS that has posed a great challenge and menace to the entire world. In one of the research conducted by the World Health Organization, the results showed that there can be a critical decrement in the level of HIV/AIDS prevalence if the healthcare system will be diligent on vaccination.

In this projection, it is evident that the HIV/AIDS vaccine can avert about 5.2 and 10.7 million additional infections that can arise from 2020 to 2030. If there is no vaccine applied completely, the country can suffer 26.8 million new infections (Ambedkar 124). This implies that when the vaccine is not applied, the rate of infection is even much higher than the way it can prevail without vaccine intervention.

In addition, the minister convened a meeting with all the stakeholders to determine the positive and negative impacts of implementing the policy in the healthcare system. A legislator known as Shirish Shinde had presented a motion in the parliament arguing that the projection showed a high probability of increasing numbers of people living with HIV (Ambedkar 157). He argued that the probable increase of PLWHA required the state to act boldly and swiftly in order to control the menace. In this regard, it is evident that the legislator was considering the possible level of illness during his proposition. A similar sentiment was elucidated by the minister women and childrens development where she argued that the level of HIV/AIDS prevalence in India reached alarming rates. Furthermore, she stated that the future projections were not favorable since there was a possibility of increased rates of the disease prevalence. This implies that the ministers decision to propose the bill with the help of a legislator was based on the fact that the rate of illness was predicted to rise in the future. The minister thus believed that the state needed to curb the rising rates of the disease among the people. In addition, this was inspired by the fact that people had shown reluctance in regard to taking the tests voluntarily. This shows that the administrators and other pertinent stakeholders were concerned about the illness, in regard to HIV/AIDS, when making their policies. In essence, this can be considered as the culture of the mentioned stakeholders when it comes to matters of developing and planning the healthcare system in India.

Healthcare Consideration of HIV/AIDS

Further, in order to determine the extent to which the involved stakeholders consider illness when planning for their healthcare system, it is essentially important to focus on the awareness of HIV/AIDS in India and compare with the above statistics. The comparison will show whether the stakeholders are considering the level of illness when conducting their awareness campaigns. In essence, this is based on the premises that if they consider the high expected rates of HIV/AIDS infection, the campaigns should be intensified and satisfactory.

In the above results, it is evident that the largest part of India comprises of women whose awareness on HIV/AIDS is between 40-50 percents. This implies that the government has not attained satisfactory levels of awareness in regard to the prevalence of illness. Bearing in mind that the future projection that was presented in first diagram predicted a 5.2-10.7 million increase in the level of HIV/AIDS by 2030, the state should have considered this and intensify the level of awareness among women. In this regard, we consider women since they are most vulnerable to the level of HIV/AIDS. In respect to the campaign and awareness concerning the disease, the stakeholders have not considered the level of illness while implementing their awareness programs.

Personal Opinion about Women awareness on HIV/AIDS

The awareness of women about illness is an essential factor when it comes to improving the Indian healthcare. This importance is based on the premises that women are among the members of the population who are confronted by a higher risk of contracting diseases. In addition, women are considered as crucial people when it comes to taking care of the family and the children. This implies that women are not only critical to their health, but also crucial to the welfare of the family in respect to hygiene, eating habits and other aspects that concern health. When it comes to the above discussion concerning HIV/AIDS illness and mortality occasioned by this disease, women must be involved actively to ensure that the battle against the disease is won. This becomes critical when because the vaccination of young children against the epidemic relies on the diligence of their mothers. If the mothers are sensitive about the importance of vaccinating and protecting their children against the disease, it becomes easier to reach the children and to protect them. On the other hand, if they are not aware, it becomes difficult to reach the at-risk population that mainly includes young ones.

Status of Illness Regarding Disability and it consideration in Healthcare

Besides HIV epidemic, disability forms another critical aspect of the illness among the Indian people. Indeed, when discussing illness, it could be completely inappropriate to disregard disabilities (Eswarappa 118). In essence, disabilities affect a substantial part of the population. The disabilities take many forms, including the mental and physical disabilities. In order to maintain the objective of this discussion, it is important to recall that the main aim is to determine whether illness is considered when planning the healthcare. In an attempt to make this determination, this section will analyze the status of disabilities and then determine whether the healthcare has been positioned to address these disabilities in relation to their prevalence. As a result, the comparison can help to adjudge whether the healthcare is conscious of illness status or not.

These demographics present the status of disability in India according to various aspects such as age, sex, and the extent of severity among others. The purpose of presenting these demographics and analyzing them is to form the basis of comparing with the healthcare provider and determine whether the illnesses were considered when planning the healthcare system. According to the census and NSS, the population of people with disability comprised 2.1 and 1.8 percent respectively. Whereas this is a very small portion when it is viewed in terms of percentage, the real population accounts for about 18 to 21 million people (Sorajjakool, Carr & Nam 197). This implies that the healthcare system of India must venture to consider these people when planning their healthcare system. According to the male and female results, it was evident that the number of women affected by disabilities was less than men. It was estimated by NSS that, for every 1000 men, there are 698 disabled men. On the other hand, the census established that there are 738 women affected by disabilities for every 1000 men (Thapa, Aalsvoort & Pandey 373).

Healthcare Consideration of Disabilities

Having analyzed the prevalence of people with disabilities within the country, the analysis of healthcare facilities is crucial for making a comparison. In Taluk village, there is research that was conducted to determine the extent to which the people of that village accessed medical facilities. When identifying the problem that inspired the research, the author stated that most of the health facilities are located in urban areas while most patients who need the services reside in rural areas. After conducting the research, they established that most of the disabled people in the rural areas were capable of taking care of themselves without the use of supportive devices. Further, it was discovered that about 13 percent were severely disabled, and they could not use the appliances. They noted that about 50 percent of the disabled people who needed medical attention were able to reach the facilities. However, the research established that the rehabilitation services were not effective in the village. Another research that had been conducted in Bangladesh showed that 98 percent of the visually challenged people had not used spectacles. On the other hand, 96% of the people who had a hearing problem did not use the appliance to mitigate their physical challenge. These analyses show that there are insufficient disability-based health facilities in rural areas. Nonetheless, 75% of the people with disabilities live in rural areas such as Takul. This comparative analysis shows that the government has not aligned the healthcare facilities in accordance with the illnesses occasioned by disabilities.

However, there are health-related provisions that have been stipulated to coincide with the aspects of disabled people. In this case, the government has ensured that the children with mental and physical afflictions have access to special education institutions that have training facilities. The government has provided professional trainers who take the students through programs that help them to recover their mental capability.

Personal Opinion on the Status of People with Disabilities

The people with special needs have been regarded as a minor portion of the population. They are not considered to pose a major problem to the healthcare of India. However, this is a dangerous and insensitive approach towards managing healthcare. The healthcare act that was stipulated in 1995 gave disabled people the right to live normally. It has provided children with the right to attend school and to have access to medical facilities. It has stipulated that children with special needs should be granted a certificate to access these facilities. This act recognized the importance of upholding the rights of disabled people. As a result, it is out of order for the government to marginalize these people and consider them as minors. Indeed, despite their small population, their interests are essentially pertinent to the welfare of the country (Singh 134).

Importantly, the government and other concerned authorities should be concerned about the medical facilities in the rural areas. In this case, it was discovered that most of these people are in rural areas. As a result, the medical facilities should not be concentrated in urban areas. Instead, they should be decentralized and brought to the rural areas so that a substantial number can access them easily. This will improve the healthcare system profoundly based on the premise that the medical facilities will be serving the people satisfactorily.

Status Illnesses Caused by Environmental Aspects

Diseases that are caused by environmental aspects are very crucial when it comes to matters of illnesses. In this case, this discussion will consider the various diseases occasioned by environmental hazards and compare them with Indian healthcare to determine whether the system has considered them. The comparison will bring out the risk factors and environmental diseases and show how they are curbed or ignored in the country. The table below shows some of the risk factors and the expected impacts on the populations health.

A research conducted by WHO in India revealed that the total burden of diseases caused by the environmental factors accounted for 24 percent of the illnesses. This was equivalent to a total of 2.6 million deaths per year. While considering the specific rates of morbidity in relation to India, the following statistics were released by the World Health Organization.

It is evident that India is confronted by critical illnesses, including neuropsychiatric disorders, cardiovascular disease, and musculoskeletal afflictions and asthma. Although there are other diseases affecting the country, these have a high rate as compared to the worlds highest and lowest recorded percentage of prevalence.

Healthcare Consideration of Environmental Illnesses

In essence, these are various illnesses that have been considered while setting up the healthcare of India whereas others have been ignored. India has produced highly qualified professionals to cope with the challenges posed by cardiovascular and musculoskeletal diseases. This is a step showing that the country has considered the level of illness when planning the healthcare facilities. However, they have disregarded asthmatic diseases because there are very few regulations that have been stipulated to control the causative agents of asthma, such as dust, the level of humidity and storms. For example, the country could have planted trees that break the strong storms in order to curb the level of dust in the air. In addition, the use of motor vehicles has contributed extensively to the prevalence of asthma due to the emission of Carbon IV Oxide (Sarkar & Panigrahi 129). The Carbon IV Oxide has a profound effect on asthmatic people who are vulnerable to the disease. In this regard, there should be policies that control the emissions of this gas and other particles that make cause asthma. In regard to diarrhea, there are pools of dirty water all over the country especially in places such as Tamil. The pools are occasioned by the high levels of convectional rainfall received in this region. The water pools cause the diarrheic condition to prevail in this region while the healthcare system does not consider this condition during the planning. In fact, the water does not only cause diarrhea, but also malaria prevalence within the region. This is because malaria is caused by mosquitoes that breed in dirty dirty water and infect people. Besides the water is dirty, there are landfills that accompany it making the situation worse.

Personal Opinion on the Environmental Diseases

In essence, the diseases caused by environmental conditions are very harmful to the welfare of Indian conditions. In this regard, there have been profound deaths that are caused by poor sanitation in households and public places. As a result, the people of India must take the initiative to curb this menace. First, the citizens should ensure that they maintain good hygiene in order to curb diarrhea and other related conditions. In addition, they should ensure that all the landfills are eliminated to remove the breeding areas for mosquitoes. Landfills do not only form the breeding places for the mosquitoes but also pose other dangers to the health of the people living around them. These dangers include aspects such as physical injuries bearing in mind that some of the landfills contain metallic objects. These objects are responsible for the injuries that can pave way for other diseases and illnesses caused by pathogens. In that regard, it becomes a chainlike process that leads to poor health conditions among the citizens. In general, the Indian healthcare stakeholders should pay attention to the vaccination against HIV/AIDS and the creation of awareness among the people. This will help to reduce the impact of the disease since it is projected that the vaccination can avert about 20 percent of the possible additional victims. In addition, people with disabilities should not be considered as minors since considering their afflictions is pertinent to the attainment of a proficient healthcare system. The environmental conditions should be considered in equal measures when designing the healthcare arena. This is based on the fact that there are considerable cases of mortality caused by the environment-based diseases.

Conclusion

India has been capable of integrating technology in their healthcare system profoundly and effectively. CDAC has been at the forefront of developing software and programs that enable the doctors to reach many people in the country. In this regard, special mobile phones that have the software can transfer information to the healthcare practitioners in order to get advice or treatment. As a result, doctors do not necessarily attend to the patients physically since they can accomplish the task through technology.

It is evident that the healthcare system of India is substantially consistent to the level and type of illnesses prevailing in the country. This consistency is caused by the commitment of all stakeholders towards eliminating various illnesses around the country. For example, they have shown a willingness to create awareness among women concerning the HIV/AIDS. This is an important step because women comprise of an important part of the population that does not only determine its own welfare, but also the health of the family members.

On the other hand, they have neglected various areas such as the construction of healthcare facilities in rural areas for people with disabilities. In addition, the government has not paid much attention to the elimination of landfills that pose a major threat to the health of the citizens. In this regard, landfills create breeding grounds for the mosq

Introduction

Our world is living differently than about a decade ago. Some say we are living in a global village. We mean proximity when we talk of village. So, it is just so near, or a short distance. This is the twenty-first century where everything and everyone are interconnected. Communications and transportation have never been so effective and fast phased.

What do we want to bring out before we expound further on the main topic of this Report, which is Outsourcing for the Pharmaceutical Industry? Some of the points we want to bring are:

1. Distance is no longer a problem of businesses and organizations.
2. Business organisations are free to locate many screen-based activities wherever they can find the best bargain of skills and productivity.
3. The world is having access to networks that are all interactive.
4. There is increased mobility.
5. Large networks enable us consumers to order and receive what we want to buy  where and when do we want these things to go.

There are countless other opportunities and benefits the world has offered to us, all because of the internet or Information Technology that is at everyones disposal. Transportation has also revolutionized that allowing peoples and organisations to travel faster than the speed of sound.

Technology is the powerful force that now drives the world toward a single converging commonality. No place and nobody is insulated from the alluring attractions of modernity. Almost everybody everywhere wants all the things they have heard about, seen, or experienced via the new technological facilitators that drive their wants and wishes. And it drives these increasingly into global commonality, thus homogenizing markets everywhere.

Levitt (1986) states this is the globalization of markets. The result is a new commercial reality  the explosive emergence of global markets for globally standardized products, gigantic world-scale markets of previously unimagined magnitudes (p. 20).

One of the phenomena that resulted out of globalization is outsourcing. There is insourcing and there is outsourcing. The root word itself is self-explanatory: source in and source out. Businesses can now get supplies or parts of their products from outside source. Although this is not something new, it has been refined, reformatted and reinforced by the internet and the power of computers. Multinational corporations have been outsourcing products and services, but now it is entirely different with the internet.

Outsourcing is a phenomenon in business transformation that continues to dominate business functions all throughout the world. With globalization and the continuing changes in technological advances, tremendous development is going on in business and organizations. Each passing day these organizations have to catch up with technological advancement and adjust with countless changes all throughout their existence. If they dont do so, they will be lagged behind, and they have to give way to others who are as smart and competitive as they are.

Communications have tremendously improved; it has now become easier for companies to track spare capacity and low prices. A knowledge-based company can buy in more of what it needs  design or marketing or packaging  than can a traditional company. It can thus grow more integrated horizontally, rather than vertically. There will be new opportunities to bring together customers and suppliers, using the corporate communications network as the connective issue.

Cray and Mallory (1998, p. 1) add:

The world of organizations and managers has expanded dramatically in the last decade. Suppliers, customers, competitors and personnel now move easily across national borders. Developments such as the integration of the European Union (EU), the implementation of the North American Free Trade Agreement (NAFTA), the conclusion of the Uruguay round of the General Agrement on Tariffs and Trade (GATT) and the subsequent establishment of the Wrold Trade Organization (WTO), and the entry into the world economic provided emerging opportunities for the expansion of international operations.

In globalization, everything seems interconnected. Its not only the philosophies of life that are interconnected, business is too. You are wired; we are wired with no connecting cables! This means from the remotest areas of the globe, we still can connect. And business has to take hold of this opportunity  or mis-opportunity  otherwise it goes down the drain.

Sussland (2000, p. ix) says:

The world has never been so tightly interconnected as it is today. These connections have been realized at almost no cost to the customer and at a reasonable cost to the supplier. Even small artisanal companies have access to a vast global market where they can sell their products while also comparing the quality of services offered by their suppliers.

Such is the reality nowadays. And there is no miracle; there is no click-of-a finger or easy way to success. Businesses simply have to plan and be competitive; they have to realize that the world has gone to the basic ways of evolution  survival of the fittest. If you are not really that good at competing, you just have to give in to the fittest of the species.

Michael F. Corbitt & Associates (cited in Mariotti 2002, p. 105) conducted a research done for The Outsourcing Research Council which showed that 3000 US companies with more than a half-billion dollars each in revenue will spend 7% of that revenue  thats $875 billion in total, heading toward a trillion dollars  an outsourcing.

Outsourcing is really big business. The pharmaceutical industry may have a staggering detail and statistics which can surpass to billions more. The study above also showed the projected outsourcing to grow at a 15-25% rate per year for the foreseeable future.

Cobb and Stueck (2005) say that production costs force companies to go abroad. Because U.S. compensation costs are higher than in low-income countries, factor-price equalization theory suggests that many service jobs not tied to location may move overseas. (p. 58)

Outsourcing is not limited to one or a few countries. Many countries, especially the developing ones, are implementing proactive strategies to attract jobs and industries. U.S. companies are encouraged to move work offshore because of the direct incentives these governments offer as part of their national industry strategy. (Hira et al., 2008, p. 167)

Definitions

Bamfield (2006) says:

Outsourcing, now an essential component of business strategy, is defined as the provision of a service, resource or product from outside the organisation. At one time the use of outsourcing by R&D managers was tactical, used only when in house provision was stretched or not available, but is now an essential component of the business strategy in most companies. (p. 89)

A lot of organisations are now doing this, buying or sourcing products, components, or services from other companies or organizations. The internet makes it easier for companies to manage outsourcing, because almost everything that a company needs, from management skills to the human-resources department, can now be bought from outside sources.

Cairncross (2001) states: Thanks to the Internet, companies find it easier to outsource activities they would once have carried out in-house (p. 150).

Why should we outsource? Is it necessary? Is it not only for the big businesses with big capital? For pharmaceutical companies, this is necessary. We will enumerate these reasons and interrogate the questions.

Almost all businesses and organizations outsource for precisely the same functions and objectives. In the pharmaceutical industry functions outsourced include human resources (operations or payroll), financial transaction processing (for accounts payable), procurement, distribution and logistics, and clinical data management. (Halvey and Melby 2006, p. 37)

Outsourcing is not a threat to this nations economy  it is an opportunity to raise American paychecks, productivity, and prosperity. Its an opportunity we will squander if we let the alarmists stampede us into boneheaded solutions.  John Castellani, President of The Business Roundtable to the Detroit Press Club, February 24, 2004 (cited in Brown and Wilson, 2005, p. 19).

Many say the primary aim of outsourcing is to make an organization move fast, or to let it advance as possible as it can. But are there negative results? There are a number of these what we call negative results, but actually they are disadvantages to outsourcing.

Nevertheless, outsourcing has revolutionized processes in the workplace, provided tools and valuable data and information to managers and employees, shortened workloads, and has done many things of great importance to businesses and organizations. Springsteel et al. (2004, p. 58) define outsourcing as the transfer of a commercial function to an outside service provider, subject to the customers retained authority and responsibility to third parties and shareholders for continued success of the customer organization.

Moreover, outsourcing is not like the mercantilism practiced by European countries in the 18^th century. Mercantilism used large, government-supervised companies to gather resources from around the world, like cotton, sugar, and gold, and then return them to the home nation or a third country to manufacture finished products. (Eltschinger, p. 2)

Reasons for outsourcing

In strategic outsourcing, Mariotti (2002, p. 105) provides these reasons for outsourcing:

1. To beat the competition, make more money, do it faster, better, and always to serve the customer better.
2. Where (execution)  where you cant do it alone (which is almost always), so you can concentrate on what you are best at doing.
3. Who (selection)  choosing the partner to trust for the things youre not good at.
4. What (need)  you cannot afford to be good enough at everything, so choosing what to be good at is a critical decision.
5. When (timing)  as soon as you realize you should.

Mariotti (2002) further states that if you truly understand the reasons for using partnerships and outsourcing  how and when to use alliances, partnerships, different forms of working together  then you will be on the road to doing strategic outsourcing (p. 106).

Factors that motivate pharmaceutical companies to outsource:

• Overall cost savings
• Flexible/variable pricing (not fixed/dedicated resources)
• Access to a broad pool of competent, trained resources
• Continued and early access to state-of-the-art technologies and processes
• Rapid standardization or globalization (Halvey and Melby, p. 37)

The pharmaceutical industry Research and Development utilizes outsourcing. (Bamfield, 2006, p. 89)

Why outsource? Innovative companies need to support a vigorous new product pipeline but still want to maintain fixed cost, they cannot hire staff or expand facilities at will.

Why must a company outsource?

This question suggests that a company needs to outsource. Not all companies use this, but a pharmaceutical company needs to.

Bamfield (2006, p. 89) cites 3 reasons why companies outsource:

• Businesses are under constant pressure to control costs, especially fixed costs, to do more work with fewer people. One answer is to stop any irrelevant support and to consider the outsourcing of non-core, but essential services.
• Everybody wants to get products to market as quickly as possible  the old adage that time is money is as true as ever.
• R&D has become increasingly technologically complex and multi-disciplinary. In drug research the advent of technologies such as combinatorial chemistry and high-throughput screening has meant that smaller companies can often provide the expertise required in a more technically advanced and efficient way.

Outsourcing in R & D of Pharmaceutical Companies

More sophisticated than any of the activities, and one more prone to risk, is the outsourcing of key steps in the discovery phase of R&D. Many managers think that it is very unwise to outsource those technologies that are critical to achieving the business strategy.

Outsourcing of only selected research activities and technologies is still the preferred option. Companies prefer to form strategic alliances or collaborate with other companies when essential technological core competencies are missing. (Bamfield 2006, p. 90)

Pharmaceutical companies spend a lot of time and capital in R&D. With globalization, they must think there is no option but to outsource. Research and development (or R & D) is extremely complex, bringing a new drug from the idea/concept phase to the market introduction phase is a difficult endeavor.

Global Companies and their strategies

DSM (a pharmaceutical company), carries its research at Geleen in the Netherlands, and also in North America and Asia. In 1999 they reorganised this effort into 25-30 competence units. In the preceding decade innovations from outside the company had increased from 10% to 50%. At that time the company believed that in future 90% of innovations would start outside. They therefore intended to sustain the innovative process by translating concepts invented elsewhere into innovations at DSM.

The following quote comes from DSM:

DSMs Venturing & Business Development group continuously scans the horizon for innovative ideas outside the company in which we can invest, enabling us to access and make the best possible use of new technological developments and resources (2004). (Bamfield, 2006, p. 90)

Another example is Pfizer which has the largest global pharmaceutical R & D organisation. Pfizers largest pharmaceutical R & D organization, Pfizer Global Research and Development, boasts of $7.4 billion spent in research & development in 2005. (Bamfield, 2006, p. 88)

Heres what people from Pfizer says:

Pfizers search for new treatments spans hundreds of research projects across multiple therapeutic areas  more than any other company. Our scientists, clinicians, technicians, and other professionals employ state-of-the-art tools ranging from robotic high-throughput screening (a method pioneered by Pfizer) to sophisticated genomic studies, to deliver a steady stream of innovative new products that enhance human and animal health. (Bamfield 2006, p. 88)

It further said that it had links with 250 partners in academia and industry, to strengthen their position on the cutting edge of science and biotechnology by providing access to novel R&D tools and to key data on emerging trends (Bamfield 2006, p. 88).

Wyeth too, could not be lagged behind. This is another large company which has gone on strategic global research alliances with companies on the cutting edge of technology and innovation. Bamfield (2006) quoted Wyeth as saying, Through our relationships with these companies, we are able to participate in combinatorial chemistry, high throughput robotic screening of compounds, in-licensing of important new products, and genomics initiatives (p. 88).

Another example is the Virtual R & D Company

Tom Peters (cited in Bamfield 2006, p. 92), a management guru, has been considered the strongest proponent of the virtual company. He argues that imaginative use of modern information technology renders the corporation redundant.

These virtual companies do not really have technical resource under their direct control and supervision. Instead, they use consultants and other outside agencies to advise on the various stages of the product development.

The working of a virtual company is that it will license a potential new product from a non-commercial research organization and then manage the process through to successful launch onto the market using CROs under contract. Bamfield (2006) says: Virtual companies are based on the premise that core competencies within chemical and pharmaceutical companies lie in discovery research and not in development.

Out there are so many research and manufacturing companies who can do the necessary product development process. The job of the virtual company is to access these skills and then utilize them in an efficient way.

The Drug Development Pathway and Outsourcing Opportunities

SOURCE: Adapted from Bamfield, P. (2006) Research and development in the chemical and pharmaceutical industry. Weinheim: Wiley-VCH Verlag GmbH & Co.

From the figure, the subtitle suggests that this is a pathway for outsourcing opportunities. Bringing a new concept or idea for a drug is entirely a difficult job. A lot of research is needed in the initial stages of making a drug.

Companies can save costs and deliver projects faster by the intelligent use of outside agencies.

Guidelines to successful outsourcing, from Bamfield (2006, p. 91):

• Commodity services and non-core technologies  these kinds are suitable for outsourcing;
• Enabling technologies, longer term and or fundamental research  these can all be outsourced but the company needs to retain enough internal intellectual capacity to be intelligent purchasers of the research and technology.
• Critical, core technologies  which the company needs to take great caution, since without core skills a company has little to differentiate it from others in the field.
• Confidentiality and intellectual property ownership  which must addressed and formalised from the outset of any relationship.
• Management time  the amount of management time required to monitor outsourced activities should not be underestimated.
• Suppliers  should have the right skills, the necessary facilities and can control quality and costs to the desired standards.
• Planning and project management  which should cover all eventualities and have shared benefits, the supplier being treated as a partner.

R&D Laboratory of chemical and pharmaceutical industries needs the support of professional and experts in the field. When a service, which previously has been provided internally, is outsourced it is an obvious concern that the support provided may not be of the same quality. To this end it is important that laboratory managers are involved in the drawing up of the contracts and in the assessment of the capabilities of the providers of a service. (Bamfield 2006, p. 96)

Once an overall R& D strategy has been defined, the first step in pharmaceutical project management is to select and evaluate the right projects. Many companies rely on the net-present-value method in order to select projects. This method projects future cas in-flows and out-flows and discounts the balance of each years net cash-flow to the present date by the relative costs thereby incurred.

Analysis

With all the good things said about outsourcing, is it really good for the company? Is it really good for business? And is it really good for mankind in general?

For business yes. The answer will also depend on the kind of business and how large the business is. But as to the question if it is good for mankind, theres a big doubt on this. It is a hypothetical question, even if the reality is we have passed from the days when there were no telephone, no cell phone, and the fastest means of transportation was just the horse.

One disadvantage  that can be seen as an advantage by the company outsourcing some business functions through the internet  is manpower is reduced in the area where outsourcing is served. For example, in the United States a lot of companies have resorted to outsourcing. Outsourcing involves servicing clients or companies whose customers are asking information about products and product warranties. These companies use Call Centers stationed in Asia, and operators reply to clients call. Companies in the United States and other European countries also outsource supplies from China and other developing countries. Companies lower costs of manufacturing and production through outsourcing.

Since the 1960s, the United States has been using outsourcing. American car makers such as Ford and GM used this to be more competitive with Japanese car manufacturers. They would source non-vital parts, for example carburetors, from specialty sub-contractors. Japanese counterparts also used the same method. Toyota and other car manufacturers outsourced their car parts from outside sources as an operational strategy to lower the cost of manufacturing. These companies have been successful in outsourcing that their finished products are mostly composed of outsourced products or components from their own valued suppliers. (Lynch, 2008, p. 765-767)

With the present economic downturn in the United States and all throughout the world, unemployment is aggravated by this process of outsourcing, although this refers only to buyer countries. This is therefore no answer to mass layoff of employees of many businesses.

Organisational learning in a new context

Writers and researchers try to identify the important factors that organisations must confront in the global environment.

Cray and Mallory (1998, p. xi) state:

The tremendous growth in international business over the last two decades has seen a parallel explosion in the literature devoted to the problems and techniques of managing across cultural boundaries. As with many explosions, this one has generated a good deal of noise and confusion, along with some heat and light. This is hardly surprising given the complexity of the field and the diversity of contexts in which research takes place, but such considerations offer small consolation to managers and employees seeking guidance for interactions with colleagues from other cultural backgrounds.

Really because of the global phenomenon, the business environment has become complex and more difficult for the managers and employees of business and organisations.

Barlett and Ghoshal (1987, cited in Cray and Mallory, 1998, p. 5) cite organisational learning to the usual considerations of global efficiency and local responsiveness.

These researchers cite two implications:

1. Managers must acquire a new set of skills to process information from a global network on an ongoing basis. They should encourage subordinates to generate and pass on the information to the important departments of the organisation, and they have to be willing to act on the new information. Learning does not occur simply by accumulating information from numerous sources.
2. Then we have the results of organisational learning. One of the results of organisational learning is that the context of management is evolving over time. With this new way of acquiring organisational learning, things become a bit more complex.

Cray and Mallory (1998, p. 5) say that strategy must not only take into account current developments and anticipate new ones; it must do so from a continually changing base. They further state that the comparative organizational behaviour field has not changed or has remained while the international organization has become complex. With the complexity of different information because of the fast phased world of the internet, managers and employees have to be aware of the biases.

Cray and Mallory (1998, p. 5) cite certain cultures wherein higher-level managers have a tendency to restrict the flow of information because it would seem to enhance status or power. A manager will need guidance in encouraging organisational learning.

One example for this type of environmental context is the case of Canadian oil firm. This is a global firm which had standard procedures for evaluating the potential of a production site. It had a local partner which was at that time not so well organized and had some problems, so that its Russian data was not to be relied on. It had to do its own exploratory drilling which increased the Canadian companys costs and also a waste of time. A complication further arose from the competing jurisdictional claims of some branches of government. This was new to the companys history. Things became complicated in the decision-making process of the firms potential partners and its procedures. The response to the complexity could be seen in the internal legal, financial and operational arrangements the company made in order to their field exploitation; the company also had to deal with the local culture. (Cray and Mallory, 1998, p. 6)

Cultural integration theories

The problem of integrating employees from several cultures becomes a major concern of organisations. One is overcoming value and behavioural differences when employees of different cultures mix or work together. One example here is when an organisation with its headquarters in a country that gives considerable deference to leaders. The organization may have a problem in imposing its policies if the norm or the common practice is consultation among supervisors and subordinates.

Cray and Mallory (1998, p. 7) state:

The literature is replete with studies that detail these differences, but theoretical or applied treatments which would help a manager to deal with the consequences of these differences have been in very short supply. The international manager is admonished to be aware of these differences and to minimize them, but is given precious little advice on how to do so.

Integration is the problem in new international organizations. Different cultures have to be dealt with. Higher levels of integration is needed to respond to the rapid pace of economic change and the need to respond quickly to customers, suppliers and other segments of the organization.

Cray and Mallory (1998, p. 8) explained it that there are two considerable organisational that focused on the concept of culture. One method of integration that continues to be used in many organisations with diverse workforces is the promotion of a cohesive culture.

In the topic of the two cultures, we have the study conducted by Hofstede and his associates which stated that the two cultural systems are essentially separate (Hofstede et al. 1990). Their findings state that national culture is derived from early socialization, while the corporate or organizational culture springs from specific organizational practices& National culture may affect organizational culture mainly through the nationality of the founder (Hofstede 1985, cited in Cray and Mallory 1998, p. 9).

Cray and Mallory (1998, p. 12) cite these issues in comparative organizational behaviour:

Conclusion

The traditional way of management does not work well in the globalizing economy. It is difficult to depart however from the traditional way of engaging business, but companies manage, especially the pharmaceutical companies. They have to outsource. Outsourcing is global but still seen as new, despite the fact that it has been with businesses and organizations for decades now.

The world is constantly changing. Mans ways of business, personal relationships, social relationships, have to cope with the increasing changes in the environment.

Sussland (2000) argues:

Confronted with an environment that is global and chaotic and with new organizational structures, management has resorted to the research that has been done on the theory of chaos since the 1980s. Scientists have looked to Nature for answers. They have found that in the universe and on Earth, Nature provides simple principles, and allows structures to self-organize. (p. 5)

What might this structure be? Order emerges out of chaos, these scientists found out. With globalization, can it be outsourcing?

Information Technology and the internet have totally revolutionized the processes of businesses. There are many functions now that can be outsourced or serviced by employees not organic in the company or organization. For example, call centers. Businesses in the United States use call center agents manning the many call centers in the Philippines and other developing countries to answer to their clients queries about product warranties or anything about their products.

BPOs from these developing countries also service clients in the Unites States or other countries. Countless changes, development, innovations, and advances have been going on. It is therefore not logical with new and emerging companies not to cope with these changes.

However, an organization should not rush into outsourcing right away. The buyer should follow some steps before outsourcing, conduct a feasibility analysis, define the parameters of the contract, and build a strong relationship with the vendor or supplier. After doing this, the organization can rely on the success of outsourcing.

As an outcome of outsourcing, many organizations have improved much in their operations and have soared to new heights in their operations. But with the present recession as a result of the global economic crisis, the chaotic start initiated by Wall Street companies, and the collapse of big insurance and investment companies, outsourcing has been affected but not in the process of outsourcing per se. Some countries may have been affected because their respective businesses have done outsourcing even before the outbreak of the present recession. But it doesnt mean companies doing the outsourcing have been at fault.

We have researched theories from Hofstede on organization behaviour. Our theories deal with integration or the intermingling of cultures because this is what outsourcing is all about. We tend to interchange outsourcing with globalization, or that outsourcing is an offshoot of globalization.

Hofstede and his associates have dealt a lot on organizational culture and the cultures of peoples working in organization. As we can see an organization which has gone global is like going into a pit or a deep of water where its resources are hidden in the deep. We say this because there are a lot of complex problems and situations that have arisen in this multi-phenomenal globalization of organizations and businesses.

But why are organisations opting to still go on global? Why should they outsource? Well, we can see that for pharmaceutical firms, most of them are large corporations, large o

Abstract

The study represents the evaluation of communication between nurses in handover reports in ward setting. This present the guide and design to improve and develop of flow nursing communication. The information takes place between the nurses is to be said complex. Furthermore, it is not yet known how the barriers and so other problems can be removed as these are the elements of the total issue. We mainly focus on to acquire the understanding of the communication pattern that used to support information transfer during the shift change. The paper begins with the introductory concept of the topic. What is the role of it in medical health care as well as in our daily life. The importance of the issue has been discussed clearly. How it can cause problems in the safety of patient care is also in the discussion. The background of the handover report has been focused on the relevant issues. The role of nurses and their impact on the success of patient safety has been focused. In the function of shift change the communication between the nurses in handover report has got the attention. It is expect to develop a set of design implications to support the elements of the communication of handoffs.

Literature review

The main theme of the total paper is to find the details on the communication in handover reports in ward settings. The abstract of the paper has been discussed at the beginning of the paper. In the total paper some keywords have used such as communication, nurses handover reports, shift change, information flow, impact, patient safety. To complete this thesis paper articles from various sources have been used. At the beginning just after the abstract introductory concept present the clear picture about what we are going to do. After that the background of the topic has been specified to understand more clearly.

Then there is an attempt to give the concept of handover report. How and when these features are used, has got the attention. The communication in content of shift change has focused elaborately. As it is known in everywhere there is an impact of technology whether it is negative or positive. So, at next it has been tried to emphasize on the technology and how it affects & play a major role to run the communication. The role of leadership is also the issue that needs to discuss to improve the communication and many aspect of leadership has mentioned. The complication regarding the issue is very vital thing that has been showed up. Why the issue is perceived worthy to research and why the topic has been selected got the points here. In next there is a questionnaire section by which the real theme of the total paper has been given.

Introductory concept

Any patient in hospital may become acutely ill. However, the recognition of acute illness is often delayed and its subsequent management may be inappropriate (CG050. (2007). Clinical work has become more complex due to the increasing population, increased reliability on the technology and for so many other factors. So it becomes necessary to redesign the service delivery. The communication between nurses in handover reports in ward setting is the substantial part of the healthcare daily routine. It is very much essential to make efficient and effective flow of information between the nurses in consecutive shifts. If there occurs any gap between the senders and recipients, then the shift work become very much difficult.

It is because when there is separation then wrong and misunderstanding is must. The handover reports by the nurses is a primary practice It is the total program of several elements such as mental recollection, verbal reports, white board chart, both printed and digital records, printed and handwritten notes. It has to be said that the communication between the nurses in the time of shift change is most probably unreasonably complex. It is very crucial to study and understand the process in the hospital ward, how communication happens between the nurses in handover reports at the time of shift change. What methods they actually use, what type of barriers are involved, what are the other problems and what problems the nurses face with the existing system while they seeking the required information are the million dollar questions. Communication of information between healthcare providers is a fundamental component of patient care (Alvarado, et. al. Sep. 2007).

Background

It is quite likely that with increased acuity and shortened lengths of stay, the work undertaken by nurses has changed (Duffield, 2005). It is an important practice of report handover by the nurses in content of exchanging the medical information and is a fundamental issue of health care delivery. There is no doubt that the unacceptable and ineffective information transfer can hamper shift work as well as the total function of the medical. It has a massive impact on the entire shift and the overall process of healthcare extended to patients. The information shared during the shift change is of paramount importance.

Notably, the ineffective handover reports in ward setting may lead the wrong treatment, make delays diagnosis, increased the complaints and health care expenditure, and increased hospital length of stay and so many other problems which has direct effect on the health system. Sometimes a number of relevant information misses because of the misunderstanding and distractions. Furthermore, the privacy of the nurse or patients is also an important factor to consider.

What is handover communication?

Handover is seen as an important part of each nurses shift, not only for information sharing, but from the resource management aspect of both the time and the subsequent financial cost of nurses being involved (Singh, Thomas, Petersen, and Studdert. 2007). At first it is needed to understand the term handover communication and the other synonyms terms that are used in several contexts and clinical settings. There are many relevant terms such as handoff, sign over, cross-out, cross-coverage, and shift change report. The term handover can be defined as the transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify and confirm (Friesen, et. al. n.d.). The function of handover is complex and comprises the communication between the shift change, communication between care planners with care providers about the

The benefits from the good handover communication reports:

• Surety of the safety:  effective handover communication increases the reliability, morbidity and mortality.
• Less possibility of wrong care:  there is the less possibility of discontinuity of care
• Reducing the repetition:  the patient become bored, when they answer the same question over and over again.
• Improve the service satisfaction:  The good handoff reports improve the satisfaction of the patients.

Communication during shift change

To provide the best possible healthcare to patients, nurses working in different shifts must work collaboratively to ensure all the tasks pertinent to patient care are carried out properly (Tang and Carpendale, 2006). There are two types of information used to communicate in the time of shift change. One is incoming nurse assembles information and another is outgoing nurse assembles information. Most of the features are same in the function of both incoming and outgoing nurse assembles information. It is understandable that, when the shift ends then another shift starts and the whole process goes in the same manner. In the function of incoming assembles the nurse make complete of the patient care paper-based summary and then prepare the patient chart. All these information are received from the previous shift. This handover is the instruction that the charge nurse give to the incoming nurse staff. And the whole process runs in this systematic manner. In content of incoming assembles, the example note sheet is empty but at the end it become full.

Comparison of some of the studies reviewed suggests that there are between ward differences in behaviour and attitudes towards computerisation that deserve further consideration (Reviewing the evidence on nursing record systems by Christine Urquhart and Rosemary Currell)

Role of leadership

The key issues of leadership:

• To make dignity a high priority it is very much necessary of board level commitment.
• There is no doubt that a strong leadership has the ability to make a difference.
• It is needed to make a clear communication to the staffs about the commitment.
• Though every trust is not clear to dignity issues especially for the older people, but most of the trusts were embedded within other policies. In the case of medical, trusts must be express clearly about their commitment and so other issues.
• There must be some implementation of several relating policies that can be applied on individual wards, which caused differences.
• There is the possibility to not receiving the reports on dignity.
• It is strongly recommended that trusts should give a pattern for staff and patients to make them confrontation in dignity without fear.
• The trusts need to make the link with community organizations and make sure of responsive to the population needs.

The strong leadership consist of the essential characteristics, such as clear policies, ability to provide a lead to dignity issues, working ability in partnership issues, communication and promise to learn. The philosophy of dignity is to be applied in every aspect of the care organization. It is clear requirement to make sure of the commitment to the top level, strong leadership at all levels, reliable policies which make sure of two-way communication process between the care planners and care providers.

The experience is important to make the policies and other relevant issues active to the changing expectation of the organization. For this, it is vital to ensure the mechanisms which are communicated to all levels. Besides this, the feedback is also play a major role to make the policies effective. Only the reliable commitment can ensure the total function of dignity successful. The handover reports in ward setting is the mechanism for transferring information, initiative responsibility and so others from the off going staff to oncoming staff. Conceptually, the information about the patients situation, the communication patterns between the sender and the receiver, the care for transfer responsibility, internal cultures and systems which affect patient safety and so other relevant information are to be provided by the handover reports. There is the risk of patient safety, if the information, communication methods and various factors become complex and undependable. It has a larger negative impact on the efficiency and effectiveness of the handover communication report.

Role of Technology

Shift handover plays a pivotal role in the continuity of patient care in 24-hour nursing contexts (Kerr P. Micky. (n.d.).There are some sources by which the nurses maintain their daily shift working communication in handover report settings. These sources may be verbal or may be paper based. The sources are:-

1. The patient care summary on the basis of paper and so others written consults that includes laboratory and diagnostic results.
2. The instruction given from the charge nurse and also the verbal handover from the nurse of previous shift.
3. The patient information which displayed on large whiteboards and the information of the nurse staffs.
4. The digital records of patient

The methods used in handover communication

1. Paper
2. Taped
3. Whiteboard
4. Verbal

Hamilton Health Science (HHS) is a one thousand-bed regional tertiary care facility that has five different hospitals and also a cancer centre. HHS provides service to more than 2.2 million residents of Hamilton and Central South and Central West Ontario. The facility provides over 3400 registered nurses and registered practical nurses. These nurses are involved in communicating patient information.

The complication

Health care now-a-days has become more functional and more specialized. It is now a wide area that ensures simpler and flexible health care facilities, which was more complex just few years ago. Notably, there are some possibility that may occur, if improper health care system makes the gaps in patient care and breaches. Any errors or omissions made during the handover process may have dangerous consequences (Pothier David, et. al., n.d.). The risk may be of medication errors, wrong site surgery and may cause the patient deaths. The environment of the clinic is very dynamic and challenging for the health care provider, health care planner, patients and families. As for example, if the nursing units discharge 45 percent to 65 of their patients every day.

So there is the possibility to make the mistake that may lead to the breaches. Therefore, the dynamic and specialized technology has some risks that can provide serious risk to health care delivery as well as the function of handover reports. As the health care has become more complicated because of the advanced technology that have the motive to reduce the riskiness of lives and increase the quality of life. So to increase the patient safety and to deliver the better quality of life, the issue of handover report communication can not be ignored as ineffective handoffs can lead to a host of patient safety problems. So, therefore, the improvement of strategies in this area to ensure overcoming these problems is essentially required.

An examination of how communication breakdown occurs among other disciplines may have implications for nurses. A study of incidents reported by surgeons found communication breakdowns were a contributing factor in 43 percent of incidents, and two-thirds of these communication issues were related to handoff issues. The use of sign-out sheets for communication between physicians is a common practice, yet one study found errors in 67 percent of the sheets. The errors included missing allergy and weight, and incorrect medication information. In another study, focused on near misses and adverse events involving novice nurses, the nurses identified handoffs as a concern, particularly related to incomplete or missing information. (Friesen, et. al. n. d.)

Challenges to continuity of information

• The increased number of patients
• The flexibility that make the consultant changes
• Involvement of a number of specialist teams
• Lack in implementation of proper knowledge
• Insufficient efficient workforce
• Unnecessary movements of patients between wards and departments though there is no knowledge of doctor.

Maintaining continuity between shifts is important, not only in the offshore sector but in all continuous process operations (Duffield, Christine 2005). Both the nurses and intensive care unit (ICU) are surrounded on the basis of perception. The patients are discharged from the ICU to the ward-based care and at that time it needs to maintain the effective communication. In that cases the handover report in ward settings is important to maintain. The study is also to find out the managing change of nursing handover whether it is traditional or modern. There is the issue of verbal handover that has been derived from the written information. The shift handover forms an important part of the communication process that takes place twice within the nurses working day in the gynaecological ward (Kassean, and Jagoo. 2005).

Why the issue is perceived as being worthy of research

One of the most important tasks that a nurse faces in the emergency room, when receiving a patient, is handover and the triage function (Bruce, and Suserud, 2005). The research is to get the findings of fundamental and important information regarding the communication at the time of daily shift change. The selection to study on the nurses instead of other relevant clinical shift work is a considerable matter. It is known that, nurses are the closest of patient care, spending most of their working time on patients care. The quality of the patients care is largely influenced by the information the nurses get during the shift change. Handover is such a thing that gives the nurses a better opportunity to communicate important medical information. It is to be said that, Nursing handover or verbal report is different in every unit (Bruce, and Suserud, 2005).

An example of wrong maintenance

It is very much imperative to give the workers guidance to improve health and safety. How the misunderstanding in the communication of shift handover may create a serious problem. As for example, a man was seriously injured while he was getting the treatment in high pressure line to repair a valve. The accident occurred because of the fault by the workers while they isolated the valve. They knew the isolating valves were not operating, so they shut down the drain-line again. They left a message for the next shift to re-open first to blow line down. Somehow, during the shift handover, the message was not passed on. A fitter removed the clamp bolts and give pressure instead of loosening them. The pressure increased and blew apart. The fitter become very serious injured which will not be fully recovered.

Questionnaire section

The communication in the handover systems on two American very different pediatric wards were selected as case studies, in each ward, 35 handovers were observed and 25 individual and two-group interviews on the nursing staff were conducted. The research was approved by hospital authority. The participants were fully informed about the research.

Dear participant,

I am going to conduct a study on communication between nurses in handover reports in ward setting for the requirement of a research. The findings of the study will help me to understand the communication pattern between the nurses in handover reports. The answer will be used for academic purpose only. All information you provide will be strictly confidential.

It would be very much appreciated if you answer all the questions carefully. The following questions are fairly simple and easy. Your true and careful opinion is highly encouraged for conducting the study smoothly.

Important

1. Please read every question carefully and answer.
2. Please do not omit any question
3. Please tick ()or write where it is necessary

Question regarding personal matters

1. What is your age and rank?&&&&&&&&&&&&&&&&&&.
2. Since when you are working here?&&&&&&&&&&&&&&&&&&
3. What is your working time?&&&&&&&&&&&&&&&&&&&&&
4. What are the restrictions in the field of communication with others in handover reports?&&&&&&&&&&&&&&&&&&
5. What type of method is used in the shift change? Verbal written taped whiteboard
6. Do you feel that a good leadership can make the differences?

   1. Yes
   2. No
   3. Dont know
7. What makes you to work here?&&&&&&&&&&&&&&&&&&
8. Is there sufficient service provider?

   1. Yes
   2. No
   3. Dont know
9. Have you ever seen any complexity regarding shift change?

   1. Yes
   2. No
   3. Dont know
10. Has everyone the adequate knowledge of technology used to communicate.

    1. Yes
    2. No
    3. Dont know
11. As a patient care provider, are you satisfied with the facility?

    1. Yes
    2. No
    3. Dont know
12. Why you are satisfy/why you are not satisfy?&&&&&&&&&&&&&&&&&&
13. What should be the criteria the organization needs to implement?&&&&&&&&&&&&&&&&&&
14. Have you the good interrelation with the other colleagues?

    1. Yes
    2. No
    3. Dont know
15. What is your recommendation to improve the communication?&&&&&&&&&&&&&&&&&&

Thank you for your active cooperation.

Outcome: the outcome of the survey was very complex. The responses of two different wards were not same. One group was very cooperative that indicates their commitment to their work. On the other hand was responding rather differently.

Critique on some relevant articles

Reviewing the evidence on nursing record system by Christine Urquhart and Rosemary Currell

It should have mentioned how the continuity of information can be ensured to make safety of the patients. It is not easy to run the information handover in a general way. There is a compulsory need to increase the number of individuals caring for patients. Now clinical information is the most important issue in handover reporting. Good and effective handover is such thing, which can be happened by chance. To make it happened regularly, it is necessary to make sure of involvement of everyone. The issue that the author has not pointed out; such as:-

• The coordination of the shift change
• The allowance of the sufficient time
• There is no recommendation regarding the individual and organizational involvement. Besides this the coordination of shift, time schedule, leadership in handover function, technology information and so other issues has been avoided.

The strong and relevant discussion

• The study emphasize on the patient safety with the recommendation of sufficient and relevant information that should be exchanged.
• The handover report has been discussed strongly and strategies for further plan have been put into place.
• The guide contains the informative advice, best practical example and relevant issues.

There is a reliable discussion on the changing patterns of nursing activities in the clinical handover reports and responsibility of the relevant issues. The recognition of training is essential to maintain in the high standards of handover reports for the safety of the patient care. The implementation of the working time has been acted as the driver of the total success.

Effective shift handover- A literature review, 1996

The article has met the core concept of the relevant issues. It has mainly focused on the care for dignity and the relation between the care provider and the care planner. It reviews available function of handover reports or shift handover. It has mainly defined and examined the key issues of the relevant matters. Effective communication and the implication of effective communication have been focused clearly. The incidents for good communication in handover reports are also explored. A lot of data from the studies and articles have described. The existence information on the issues has been analyzed and also compared with the other knowledge. It makes the sense of best implication of practical knowledge and the opportunity to overcome the related problems and barriers.

Recommendations

There are some strategies that without any doubt help to make the accurate and effective communication in the field of handover reports. It is strongly recommended to follow and maintain these strategies to make sure of the patient safety as well as the clinical goodwill. These strategies are shown through the following table understand it more clearly (Friesen, et. al., n. d.)

Handover should be a critical communicative process that explores care, rather than a descriptive historical narrative of what has already happened (Davies, and Priestly, 2006).

Clear statements of research issue

So the statement of the research on the communication between nurses in handover reports is to be said as, Because of the complexity in the communication process in handover reports, it has a strong and sophisticated impact on the patient safety as well as on the clinical reputation (Olson, 2005).

Conclusion

Shift handover has a vital role in the continuity of 24-hours patient care in the nursing contexts. The communication occurs is recognized within the term of nursing profession. The clear thought of this study is to understand the better realizing of nursing handover report and the function of communication and its effectiveness. Transferring end of shift information between nurses via both verbal and written routes in an intensive therapy unit (ITU) setting is complex and multifaceted (Philpin, 2006). The meaning derived from the above discussion is that Handover is the controversial system to conduct in general way. The outcome of the study was the flexible in managing competing elements as for example when they were unaware about the study then the result is different than knowing about the study.

Bibliography

Alvarado, Kim. et. al. (2007). Transfer of Accountability: Transforming Shift Handover to Enhance Patient Safety.

Healthcare Quarterly, 9(Sp) 2006: 75-79.

Bruce, Karin; Suserud, Björn-Ove. (2005). The handover process and triage of ambulance-borne patients: the experiences of emergency nurses. Nursing in Critical Care, Volume 10, Number 4, pp. 201-209(9).

CG050. (2007). Acutely ill patients in hospital, Web.

Davies S, and Priestly MJ (2006). A reflective evaluation of patient handover practices. Nursing Standard. 20, 21, 49-52.

Duffield, Christine. (2005). Nursing skill mix and nursing time: the roles of registered nurses and clinical nurse specialists. Australian Journal of Advanced Nursing.

Friesen, A. Mary., et. al. (n. d.) Handoffs: Implications for nurses. Chapter 34.

Kassean, K. Hemant. and Jagoo B. Zaheda. (2005). Managing change in the nursing handover from traditional to bedside handover  a case study from Mauritius. BMC Nurs. 2005; 4: 1. Web.

Kerr P. Micky. (n.d.). A qualitative study of shift handover practice and function from a socio-technical perspective.

Olson E. Nina. (2005). Complexity, Compliance, and Communication: Why Should Taxpayers: Comply in a Complex and Changing Tax Environment?. Presentation to the Presidents Advisory Panel on Federal Tax Reform.

Philpin, Susan. (2006). Handing Over: transmission of information between nurses in an intensive therapy unit. Nursing in Critical Care, Vol. 11, No. 2, pp. 86-93(8).

Pothier David, et. al., (n.d.). Pilot study to show the loss of important data in nursing handover. Web.

Singh H, Thomas EJ, Petersen LA, Studdert DM. (2007). Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 167 (19):2030-6. Web.

Introduction

Quincy is the 8^th largest city in Massachusetts, USA, and is located in Norfolk County. As of 2009, Quincy town had a population of 91, 073 persons (U.S. Census Bureau, 2009). The city is located to the Northern side of Boston and the Western side of Milton with the Neponset River marking its borders with the two states. To the south, it is separated by the Fore River which marks the border with Weymouth. To the East, Quincy shares a border with Hull (Wead, 2005, p. 59).

Within Quincys borders, the Hangman, Moon, Nut and Racoon Islands are all found and according to the United States Government; the total area covered by the town, including the islands is 26.89 square miles (Forbes Hill, USGS, 2010). Of this total surface area, 16.8 square miles is dry land while 10.1 square miles is covered with water. Comprehensively, about 37% of Quincy is covered in water (MassGIS, 2008). Although a great part of the town is urban, a good portion of Quincy is under reserved land. This land is largely uninhabited and maintained by the state. A great portion of the Southwestern part of the city is also uninhabited.

Initially, Quincy was part of Doechester around 1630 but it was annexed by Boston four years later and then renamed, Braintree (Lodge, 1902, p. 7). The area was largely under English colonialists who settled there to practice farming because of the areas favorable agricultural climate. In 1972, during the time of the American Revolution, Quincy obtained its own identity by having its own name, John Quincy. By 1888, the town had fully grown and developed economically to attain a city status (Adams, 1891, p. 3). Initially, the city was known for its rich iron business, stone cutting, shipbuilding and aviation but today, its economy is much more diverse (Jabaily, 2007).

Quincy has a fair climate but it is prehistorically associated with tornados (Quincyma, 2010). The climate is generally conducive for farming, with moderate rains and potentially sunny seasons witnessed throughout summer. However, the place generally experiences cold weather for most of the year (Boston Harbor Association, 2010). Housing is adequate for most Quincy residents with proper sanitation services provided by the municipality.

The municipality is therefore the major stakeholder in the provision of basic social, amenities like water and sanitation services. The municipality also forms the government because Quincy is largely categorized as a municipality and headed by a mayor. The mayor is therefore the main appointing authority for all city departments including the health department and his role towards the proper functioning of the town cannot be underestimated (City of Quincy, 2009, p. 1).

This study will develop a community assessment program based on the city with the aim of creating a care plan for tackling the issue of child obesity in the town. The above statistics are important in assessing the geography and governance of the city to determine the feasibility of healthcare services in the region. With regards to the demographic characteristics of Quincy, the city currently has approximately more than 88,000 households with a population density of approximately 5 people per square kilometer (U.S. Census Bureau, 2009).

Current estimates project that there are approximately more than 40,000 housing units at an average density of 2,388.8 square miles. In terms of racial segregation, approximately 80% of the population is white, 2% African American, 0.2% Native American, 15% Asian, and 0.03% Pacific Islanders while the rest are from other races (U.S. Census Bureau, 2009). Of the total population, Hispanics and Latinos constitute approximately 2% but of this population group, about 34% are of Irish origin, 13% of Italian origin and about 6% of English origin. Of the entire population described above, about 80% of the people speak English, 10% speak Chinese dialects, 2% speak Cantonese, I.5% speak Vietnamese dialects and the rest speak Italian as their primary language (U.S. Census Bureau, 2009).

Of the total households in Quincy, statistics show that about 21% have children considered as minors (under the age of 18) in their custody; close to 40% of the households have competed families (with the father and mother cohabiting together); about 10% of households are characterized by a female living alone (without a male companion); about 47% of households are not family setups and 37% of them are made up of individuals living by themselves. Also, approximately 14% of the total households have an adult above the age of 65 living alone (United States Census Bureau, 2003, p. 26). The average size of a Quincy household is estimated at two people but the average family is estimated at 3 people (U.S. Census Bureau, 2009).

In urban centers, the number of teenagers (those below the age of 18) is estimated at slightly less than 20% while the rest of the population groups constituted 8% for people between the age of 18 and 24, 1% for people between the age of 25- 44 and 22% for people between the age of 45 and 64. Finally, about 135 of the population were aged above 65 years. The median age for city inhabitants is 38 while the ratio of men to women is: for every 100 women there are 92 males (for adults) while for those aged below 18; for every 100 females, there are 87 males (U.S. Census Bureau, 2009).

The average income for a typical Quincy household is approximately $48,000 but the median income is safely above $60,000 (U.S. Census Bureau, 2009). However, males earn higher than their female counterparts because their median income is projected at $41,000 while that of females is projected at $35,000. The income per capita for the entire city is projected at $28,000 but approximately 5% to 7% of the total population is feared to be living below the poverty line (U.S. Census Bureau, 2009). In terms of age group classification, about 10% of the population aged below 18 years is living below the poverty line while 7% of adults aged above 65 are living under the same circumstances (U.S. Census Bureau, 2009).

These statistics are important in determining the lifestyle patterns of the population because some of the most severe forms of obesity are determined by the lifestyle patterns of the population. Nonetheless, the income levels of the population are important in assessing the capability of the population to afford healthcare. The higher the income level the more capable the population is in affording healthcare.

Childhood Obesity

Quincy has had a relatively comparable child mortality rate with the entire country. However, the major causes of child mortality in the city are factors such as birth defects, cancer, heart complications, pneumonia, flu and injuries caused by accidents or carelessness of the parents. Other common factors contributing to child mortality include drowning, fires, falls and suffocation (Greve, 2007, p. 3).

Nonetheless, Quincy has reported increased cases of childhood obesity which is feared to worsen the communitys health in coming years. Quincy has therefore in the recent past been grappling with the problem of childhood obesity with most initiatives aimed at containing the health risk. The Harvard Pilgrim Health care foundation and other similar organizations have consequently launched health programs to keep young children healthy in light of changing lifestyle patterns in Massachusetts and indeed the entire country.

It is bad enough that obese children go through psychological trauma and rejection from their friends and society but they also serve the risk of increased health complications such as liver problems, sleep apnea, type-two diabetes, high blood pressure and cardiovascular complications. Obese children have also been identified to run high risks of hypertension, digestive disorders while in their advanced ages (as adults), they are likely to be less economically empowered and more likely to die earlier than their thinner counterparts (Greve, 2007, p. 4).

Incorporating the statistics Massachusetts health department provides; there seems to be a big childhood obesity issue not only in Massachusetts but indeed the entire state. For instance, in Quincy, low to middle-income households contribute up to a third of childhood obesity cases in the city. A youth health survey was undertaken in 2007 also points out that approximately 20% of children in Middle school run high risks of becoming overweight but at the same time, more than 10% of the total population in middle school are already overweight (Greve, 2007).

Obese high school students in Quincy are projected to be around 15% of the total high school-going population. These statistics have tremendously increased and in fact almost doubled because statistics projected that about 7% of the high school population in 1999 were obese while 11% of the same population group were also obese in 2007 (Greve, 2007). These statistics have been affirmed at the Quincy public school for children in the first, fourth, seventh and tenth grade between the period of the year 2005 and 2008 through BMI testing (Greve, 2007). More accurate data between the periods of 2007 and 2008 are provided below:

From the above comparison, it is evidently clear that Quincy records obese rates comparable to national statistics. Lambert (2010) also notes that one in every five children in the town is currently obese. This fact is derived from a study to gauge obesity prevalence in Quincy schools based on the body mass index and the weight of the children. It was later confirmed that Scituate schools had among the lowest rates of childhood obesity after Arlington and four other communities although obesity rates in the town were still at an all-time high with Marshfield having obese rates slightly above 23% and Weymouth also having obese rates slightly above 38%. Lambert (2010) still identifies that other schools in the South Shore district had obese rates in the following manner Stoughton, 38.7; Plymouth, 35.5; Quincy, 32.2; Braintree, 29.4; and Canton, 27.3 (p. 7). Overall, these statistics project that in every sample of 110,000 students, approximately 34% were obese. These statistics can be further broken down as follows:

These figures have prompted many initiatives within schools to minimize calorie intake among students. Vending machines for example have been painted with many health messages that discourage against unhealthy foods. However, obesity is not the only health concern for the youth in the city because there have been increased cases of drug abuse and diabetes which have also greatly impacted on the community.

These lifestyle diseases have been noted to be on the increase because there is a reduced level of activity among Quincy teenagers and most of them do not observe a good diet that is supposed to boost their health. In addition, many teenagers do not exercise at all. Comprehensively, Quincy seems to be suffering from an acute problem of lifestyle diseases that need to be curbed before it turns out into a future catastrophe.

Community Planning

Childhood obesity is considered a bad health risk and has stood out in the past few years not only in Quincy but in America in general. It now stands as one of the biggest forms of health risk in the present generation. Child obesity is not difficult to notice as a medical condition though its treatment and management is a hard task. Nationally, obese conditions brought about by a lack of proper dieting are estimated to cause approximately 300,000 deaths (Greve, 2007, p. 10).

The treatment and management of this condition are also very expensive, with statistics estimating that childhood obesity potentially costs society up to $100 billion (American Academy of Child Adolescent Psychiatry, 2009, p. 6). The situation is much worse for children because they are more likely to fall victim to obesity than adults. At the same time, they are likely to live longer with the condition, thereby complicating their lives even further.

Normally, childhood obesity is variable because not all weight gain is considered as obesity. However, when a childs weight is 10% more than the recommended weight for the childs body type and height, the said person is obese (American Academy of Child Adolescent Psychiatry, 2009, p. 6). Obesity is often noted to begin in the early years of childhood, between the ages of 5-6 and is known to progress to later stages of adolescence. Statistics projecting adult obesity as a result of childhood obesity are also not encouraging because current data suggest that obese children who are between the ages of 10-18 have an 80% likelihood of becoming obese adults (American Academy of Child Adolescent Psychiatry, 2009, p. 6).

Treatment and management of obese patients is a difficult task because it is not easy to determine the real cause of obesity. However, obesity is caused by a number of known factors such as genetics, biological trends, cultural habits and poor lifestyle patterns. However, in literal terms, obesity comes from a low burnout of calories than is presently consumed. Despite statistics pointing out that medical disorders can cause obesity, the likelihood of this happening is very rare because less than one percent of obese cases arising from medical disorders have been reported (American Academy of Child Adolescent Psychiatry, 2009, p. 7).

Nonetheless, when obesity occurs, patients need to seek proper checkup by a physician to asses the possibility of treatment or physical management. In most instances, the treatment and management of childhood obesity is not difficult because it may wholly or partially involve increasing physical activities to increase calorie burn out; unless the condition is physical. A permanent solution can only be realized when there is an absolute sense of commitment from the patient. The role of a nurse is therefore to enable patients achieve a high sense of motivation and also assist them get the best treatment incase the condition is physical and cannot be solved through regular exercising or be minimized through a lifestyle change.

The reason why many teens slide back into weight gain is because of the fact that obesity is a lifelong matter and when most patients lose weight, they often assume they have achieved their goal and go back into their old lifestyle habits. Obese children therefore need to enjoy their new lifestyle patterns that enabled them to lose weight in the first place and not perceive it as a short-term measure or as a type of punishment. In nursing and management of obese children, it is important that nurses focus on the strengths of the patients as opposed to the issue at hand (weight).

There is a huge emphasis on parents and other relevant authorities to reduce the availability of carbohydrates, carbonated drinks, sweets and other foods that have high calorie content away from children. In fact, parents should be encouraged to celebrate occasions like birthday parties by cooking healthy foods that will improve the health of their children as opposed to cooking food substances such as cakes (Lambert, 2010). Due to the complexities of instilling a healthy diet on children, it is important that this approach be implemented slowly and with the input of all stakeholders.

Due to the fact that children who experience an obesity problem already suffer emotional problems, it is important that a comprehensive plan be devised to contain he comprehensive effects of obesity. Such a plan will have to outline specific short-term goals, incorporate physical exercising, diet modification, behavior change and family participation. These are the grounds through which this study will develop a care plan for childhood obesity in Quincy. Formulating short-term goals will be a primary strategy, incorporating physical exercises and diet modification will be secondary strategies while advocating for a behavior change and seeking family participation will be tertiary strategies.

Community Health Care Plan

This community care plan will be multifaceted because it touches on all the critical factors that contribute to child obesity. More comprehensively, it acknowledges the input of all stakeholders in containing the issue. In a detailed manner, this community healthcare plan will identify seven sectors that impact on fundamental aspects of childhood obesity and will further go ahead to identify two areas of action that need prompt attention (in every sector). Childhood obesity being a complex issue, many programs can cover some milestone in eradicating the problem altogether. However, this community health care program will provide a framework through which many partners can work together and compare their progress with each other (NuPAC, 2009).

State and Local community level

First, with the collaboration of the Quincy mayor and other local authorities, Quincy should launch a workable community program whereby paths and walkways need to be built along major residential and town streets to promote physical exercising. This approach should however also be done in collaboration with school boards, such that important matters of concern such as security issues, biking, and policies regarding food in public places are streamlined such that there are no conflicts on policy matters. Sample policy statements should thereafter be provided before such a measure is implemented and later, member organizations will be identified to lead such initiatives.

Secondly, the local authorities should expand the access people have to public facilities. This will improve household health at a local level including nutrition and physical activities so that parents are sensitized on the healthiest ways to reduce childhood obesity. This initiative should also be led at the forefront by voluntary advocates and a sample language template should also be provided to outline how the initiative is expected to be handled.

Family Level

First, strategies to promote the consumption of healthy food among families should be encouraged through neighborhood workgroup programs for families during mealtimes. Families should therefore be sensitized to take on the most nutritional foods for children aged below five years and also on the need to eat meals in a family set up, whenever it may be workable for the children. The importance of fruits and vegetables in family meals should also be emphasized.

This should also be done through sharing cultural foods that are acceptable and nutritional for children. Also this program should be done in the context of making family meals fun for children to avoid instances where children feel enslaved to such programs. Efforts by responsible parents and community advocates should also be brought to fore because they will act as role models for the children in adopting appropriate nutritional lifestyles.

Secondly families should be sensitized on the importance of undertaking family activities to increase the playtime with their children, hence increasing the level of physical activity for the children. Brainstorming should therefore be done to give families new ideas on activities they could undertake with their children such as taking family walks (both in their residential areas and at school). The brainstorming should also be done in collaboration with school authorities and local authorities (for access to parks and recreational facilities because Quincy is well known for its breathtaking nature sites).

Neighborhoods where such activities can be supported should also be made known to the parents and school authorities so that such activities can be undertaken in such localities. Youth volunteers should also be consulted so that they can coordinate such efforts to increase physical activity among children. Also comprehensively, parent advocates need to be encouraged to take part in such activities because they will stress the importance of regular physical activities to children and indeed act as role models to other parents so that they uphold an active family life with their children. Another strategy on the same would be to create more opportunities where parents can increase their participation or lend their support towards programs that encourage physical activity for their children.

Heath care Service Providers and Insurance Companies

First, health care providers should launch preventive standards of care which foster physical activity among children in a way that is appropriate for their age groups and in a manner that conforms to the conventional culture of Quincy inhabitants. Health care providers should also promote various preventive measures established by concerned bodies at a local or national level, such as the American Medical Associations Expert Committee.

Health care providers should provide collaborative programs with other health care facilities on critical areas such as the training of nurses to promote and implement preventive care programs. This should be done in collaboration with child organizations operating in Quincy. Later on, a follow up should be undertaken to ensure high standards of care and ongoing preventive programs, are being properly undertaken.

Secondly, health care providers should refer patients and their families to appropriate resource programs available at Quincy which can compliment their preventive efforts. Again, a list of resources that can supplement their efforts to prevent childhood obesity and treat it should be compiled and availed to the parents. A list of resources should also be compiled by other children organizational groups even for ailments that arise out of obesity such as diabetes or high blood pressure and availed to parents. These lists should however be first deliberated with health care planners, professionals, parent advocates and other partners of the community to ensure parents and their children are referred to resource centers that are appropriate for their problems. Insurance should thereafter come in to improve payment methods where interested parties can conveniently pay for these services without much difficulty.

Schools

The strategy outlined below will majorly incorporate the input of the Quincy department of education and more so, the participation of the mayor in facilitating the departments efforts. The department of education should therefore launch a dietary program in the context of nutritional education to encourage parents and teachers alike to promote healthy food and beverage policies that reduce child obesity in the long run. The practice should be able to meet or at times exceed the mandate given to the school by state or federal agencies. More importantly, this practice will instill a healthy eating habit among schoolchildren to avoid their overall intake of unhealthy foods.

Unhealthy food and beverage advertising should therefore be limited in all schools within Quincy. The promotion and distribution of only healthy foods should therefore be encouraged at all costs so that children have limited access to foods that only promote their health. This practice should be implemented through the advancement of healthy foods as an alternative to unhealthy foods which children are already used to. Class celebrations and all other activities that go on within the school should also be graced by serving strictly healthy foods. This should be implemented as far as club events, classroom celebrations, and even in events such as fundraising where parents, teachers and children will be required to observe a healthy diet as well.

A school breakfast program should also be promoted and implemented in schools which will have a significant number of children willing to enroll in the program. Promotion of the importance of nutritional foods should also be undertaken together with the above initiatives by painting educational messages on school locker rooms, hallways and such public places. The importance of eating nutritional foods should also be promoted as part of the physical education program where students will be encouraged to eat healthy foods as part of the physical education after program. Also the input of parents and student leaders can never be ignored because they will help in the promotion of a good and healthy environment for the children.

Alternatively, through relevant authorities, extra physical educational policies that compliment state and federal policies or supersede them should be implemented to improve childrens physical health and fitness standards. Later, teachers should be oriented on the best method of implementing such a program. With regard to physical classes, these programs should be emphasized as much as academic content is.

A standard should thereafter be established regarding what is strenuous, impractical, vigorous or moderate so that children can take part in certain types of activities that correctly suit them. With an increase in physical activities and more emphasis on physical education achieved, more public-private partnership needs to be fostered so that children can use existing educational facilities more freely. This will increase the quality and quantity of childrens physical activity throughput their time in and out of school.

Employers and Work Sites

Employers in work sites should be sensitized on the importance of serving healthy foods during important events where children are allowed to attend. A guideline should therefore be provided to highlight the type of healthy foods that can be convenient for both adults and children to enjoy. In the same manner, a sample outline should be provided to interested parties so they have a rough idea of the best foods to serve in meetings and events. This initiative is aimed at setting the right precedent for children because they learn best from their parents and older folks.

Apart from diets and food measures, more physical activity should be encouraged at work sites. This can be done by encouraging people to use the staircase more often and using walk paths, pedometers, lockers, showers and such like facilities especially during important meetings and events (which will act as an example to young children coming up). This initiative should also be undertaken through the provision of guidelines that are aimed at improving physical activity in the long run. The most common methods of physical activity such as stairway use should be most encouraged because children easily pick up on such elements.

Materials that support such initiatives should be visible in most public places within the work place context because children are frequenters of such zones, especially when they visit their parents or in such like circumstances. Such measures should not be downplayed because research has shown that children best pick their poor lifestyle habits from older people. Moreover, such an initiative is majorly aimed at instilling a responsible culture not only to children but parents as well.

Food and Beverage Sectors

The suppliers of food and beverage in Quincy especially need to be brought on board in implementing overall childhood obesity reduction programs because there is a need to post calorie information when packaging different types of foods. However, this type of commitment requires effective legislation and so the local authority should also be on board. On another front, restaurants should be required to post nutritional information on their menu boards. At the same time, they should also be sensitized to develop healthy foods that are most appropriate for children.

In addition, the preparation of quality and healthy foods should be done in a variety of ways so that parents have a wide choice to choose the best food for their children. At the same time, the general community should be willing to assist in identifying sources for healthy foods within neighborhoods so that the expansion of consumption of healthy foods such as fruits and vegetables is encouraged.

Entertainment and Sporting Events

Children are common frequenters of sports events and children entertainment funfairs. With this fact in mind, it is important to promote the consumption of healthy foods during such events because children are easily inclined to consume junk foods in such kind of events. Policy guidelines should therefore be implemented in forcing event organizers to avail healthy foods in such events.

Partnership should also be fostered with agencies willing to supply healthy foods to funfairs and negotiations need to be done with event organizers and venue owners to ensure such an initiative is a success. Such negotiations should especially be fostered in movie theatres where children are common frequenters because healthy snacks need to be availed in such places. Lastly, the community should consider investing in public facilities to promote physical activities through the availability of funds to support public places which ensure healthy foods are availed (Scribd, 2010).

Conclusion

Quincy is strategically located to implement most of the strategies identified in this study. Its huge endowment of recreational facilities and strategic governance structure can effectively see through the recommendations in this study. Considering the city suffers some of the worst rates of child obesity in the entire state, it is important that Quincy take a proactive approach in reducing child obesity in the area.

This study acknowledges the importance of curbing child obesity through the input of many stakeholders. Obesity being a multifaceted problem, it is important that strategies are developed to encompass all the relevant areas that need to be explored. In this manner, this study specifically identifies the input of the state and local authorities, parents, school boards and the general community at large in dealing with child obesity at Quincy.

However, a bulk of the responsibility rests on the community and parents at large because it is the future of the community which is at stake. If childhood obesity is left unchecked, Quincy may have a disaster in future because childhood obesity is on an increasing scale and immediate measures need to be employed to curb the problem. If the above policies are effectively implemented, such a problem may be eradicated in the coming future but key in its success is the unrelenting commitment of all the stakeholders involved.

References

Adams, C. (1891). History of Braintree, Massachusetts (1639-1708): The North Precinct of Braintree (1708-1792) and the Town Of Quincy (1792-1889). Cambridge, MA: Riverside Press.

American Academy of Child Adolescent Psychiatry. (2009). Obesity in Children and Teens. Web.

Boston Harbor Association. (2010). Beaches. Web.

City of Quincy. (2009). City of Quincy Departments. Web.

Forbes Hill, USGS. (2010). Geographic Names Information Service: 612914. Web.

Greve, F. (2007). Death Rate for US Children Falls. Web.

Jabaily, R. (2007). Coping with Economic Change: Quincy, Massachusetts. Boston: Federal Reserve Bank of Boston.

Lambert, L. (2010). Scituate Schools Get High Health Marks In Obesity Study. Web.

Lodge, H. (1902). Boston. New York: Longmans, Green, and Co.

MassGIS. (2008). Protected and Recreational Open Space Data. Web.

NuPAC. (2009). Orange County Obesity Prevention Plan: A Plan of Action 2009. Web.

Quincyma. (2010). About Quincy Beaches. Web.

Scribd. (2010). Family Nursing Care Plan. Web.

United States Census Bureau. (2003).