Minority Group and Multiculturalism Essay Example for Free

Minority Group and Multiculturalism EssayIdeas much or less the legal and policy-making accommodation of cultural diversity commonly termed multiculturalism emerged in the West as a vehicle for replacing older grads of cultural and racial hierarchy with parvenu relations of antiauthoritarian citizenship. Despite substantial evidence that these policies be devising progress toward that goal, a chorus of political leaders has declared them a failure and heralded the death of multiculturalism.This popular control narrative is problematic because it mischaracterizes the spirit of the experiments in multiculturalism that turn out been undertaken, exaggerates the ex hug drugt to which they have been abandoned, and misidentifies non only the genuine difficulties and limitations they have encountered but the options for addressing these problems. Talk about the kip d receive from multiculturalism has obscured the fact that a melodic line of multicultural integration re mains a make it option for Western democracies. This report altercates four powerful myths about multiculturalism. First, it disputes the caricature of multiculturalism as the uncritical jubilance of diversity at the expense of addressing grave societal problems such(prenominal) as unemployment and social isolation. Instead it offers an storey of multiculturalism as the pursuit of new relations of antiauthoritarian citizenship, inspired and constrained by humans being-rights ideals. Second, it contests the idea that multiculturalism has been in wholesale retreat, and offers instead evidence that multiculturalism policies (MCPs) have persisted, and have flush grown stronger, everyplace the past ten years. Third, it challenges the idea that multiculturalism has failed, and offers instead evidence that MCPs have had positive effects. Fourth, it disputes the idea that the spread of civic integration policies has displaced multiculturalism or rendered it obsolete. The report in stead offers evidence that MCPs are to the full consistent with certain forms of civic integration policies, and that indeed the combination of multiculturalism with an enabling form of civic integration is some(prenominal) normatively desirable and empirically effective in at least approximately cases. To supporter address these issues, this melodic theme draws upon the Multiculturalism polity Index.This index 1) identifies eight concrete policy areas where liberal-democratic states faced with a choice unflinching to develop more multicultural forms of citizenship in relation to immigrant groups and 2) measures the extent to which countries have espoused some or all of these policies over time. While there have been some high-profile cases of retreat from MCPs, such as the Netherlands, the general pattern from 1980 to 2010 has been one of modest strengthening. Ironically, some countries that have been vociferous about multiculturalisms failure (e. g. , Germ any) have not actually practiced an active multicultural strategy.Talk about the retreat from multiculturalism has obscured the fact that a form of multicultural integration remains a live option for Western democracies. However, not all attempts to adopt new models of multicultural citizenship have taken root or succeeded in achieving their intended effects. There are several factors that fuck any facilitate or impede the successful implementation of multiculturalism Multiculturalism Success, Failure, and the Future 1 MIGRATION POLICY embed Desecuritization of ethnic relations.Multiculturalism works exceed if relations between the state and minorities are seen as an issue of social policy, not as an issue of state credentials. If the state perceives immigrants to be a security threat (such as Arabs and Muslims after 9/11), support for multiculturalism will drop and the space for minorities to even voice multicultural cites will diminish. Human rights. Support for multiculturalism rests o n the assumption that there is a shared commitment to human rights crosswise ethnic and religious lines. If states perceive certain groups as unable or indisposed to respect human-rights norms, they are unlikely to accord them multicultural rights or resources.Much of the backlash against multiculturalism is fundamentally driven by anxieties about Muslims, in particular, and their perceived involuntariness to embrace liberal-democratic norms. Border control. Multiculturalism is more controversial when citizens fear they lack control over their borders for instance when countries are faced with large numbers (or unexpected surges) of illegitimate immigrants or asylum seekers than when citizens feel the borders are secure. innovation of immigrant groups.Multiculturalism works best when it is genuinely multicultural that is, when immigrants come from many source countries rather than coming irresistibly from just one (which is more likely to lead to polarized relations with th e majority). Economic contributions. Support for multiculturalism depends on the perception that immigrants are holding up their end of the mass and making a good-faith effort to contribute to society particularly sparingally. When these facilitating conditions are present, multiculturalism can be seen as a low-risk option, and indeed seems to have worked well in such cases.Multiculturalism tends to lose support in high-risk situations where immigrants are seen as predominantly illegal, as potential carriers of illiberal practices or movements, or as network burdens on the welfare state. However, one could argue that rejecting immigrant multiculturalism under these circumstances is in fact the higher-risk move. It is on the nose when immigrants are perceived as illegitimate, illiberal, and burdensome that multiculturalism may be close wishinged. I. Introduction Ideas about the legal and political accommodation of ethnic diversity have been in a state of flux around the huma n beings for the past 40 years.One hears much about the rise and transcend of multiculturalism. Indeed, this has become a kind of master narrative, widely invoked by scholars, journalists, and policymakers alike to excuse the evolution of contemporary debates about diversity. Although mickle disagree about what comes after multiculturalism, there is a surprising consensus that we are in a post-multicultural era. This report contends that this master narrative obscures as much as it reveals, and that we need an alternative framework for thinking about the choices we face.Multiculturalisms successes and failures, as well as its level of open acceptance, have depended on the nature of the issues at stake and the countries involved, and we need to understand these variations if we are to identify a more sustainable model for accommodating diversity. This paper will argue that the master narrative 1) mischaracterizes the nature of the experiments in multiculturalism that have been un dertaken, 2) exaggerates the extent to which they have been abandoned, and 3) misidentifies the genuine difficulties and limitations they have encountered and the options for addressing these problems.2 Multiculturalism Success, Failure, and the Future MIGRATION POLICY instal Before we can decide whether to celebrate or lament the fall of multiculturalism, we need first to make sure we feel what multiculturalism has meant two in possibility and in practice, where it has succeeded or failed to meet its objectives, and under what conditions it is likely to thrive in the future. The Rise and Fall of Multiculturalism The master narrative of the rise and fall of multiculturalism helpfully captures eventful features of our current debates.Yet in some respects it is misleading, and may obscure the real challenges and opportunities we face. In its simplest form, the master narrative goes like this1 Since the mid-1990s we have seen a backlash and retreat from multiculturalism. From the 1970s to mid-1990s, there was a clear trend across Western democracies toward the increased recognition and accommodation of diversity through a range of multiculturalism policies (MCPs) and nonage rights.These policies were endorsed both at the domestic level in some states and by inter discipline organizations, and involved a rejection of earlier ideas of unitary and undiversified nationhood. Since the mid-1990s, however, we have seen a backlash and retreat from multiculturalism, and a reassertion of ideas of nation building, common values and identity, and unitary citizenship even a call for the return of assimilation. This retreat is partly driven by fears among the majority group that the accommodation of diversity has gone too far and is threatening their way of life.This fear often expresses itself in the rise of nativist and populist right-wing political movements, such as the Danish Peoples Party, defending old ideas of Denmark for the Danish. But the retreat withal re flects a belief among the center-left that multiculturalism has failed to help the intended beneficiaries namely, minorities themselves because it has failed to address the underlying sources of their social, economic, and political exclusion and may have unintentionally contributed to their social isolation.As a result, even the center-left political movements that initially championed multiculturalism, such as the social democratic parties in Europe, have backed 1 For influential academic statements of this rise and fall narrative, claiming that it applies across the Western democracies, see Rogers Brubaker, The Return of Assimilation? Ethnic and Racial Studies 24, no. 4 (2001) 53148 and Christian Joppke, The Retreat of Multiculturalism in the Liberal State possibility and Policy, British Journal of Sociology 55, no. 2 (2004) 23757.There are also many accounts of the decline, retreat, or crisis of multiculturalism in particular countries. For the Netherlands, see Han Entzinger, The Rise and Fall of Multiculturalism in the Netherlands, in Toward Assimilation and Citizenship Immigrants in Liberal Nation-States, eds. Christian Joppke and Ewa Morawska (London Palgrave, 2003) and Ruud Koopmans, Trade-Offs between Equality and Difference The Crisis of Dutch Multiculturalism in Cross-National Perspective (Brief, Danish Institute for International Studies, Copenhagen, declination 2006).For Britain, see Randall Hansen, Diversity, Integration and the Turn from Multiculturalism in the United Kingdom, in Belonging? Diversity, Recognition and Shared Citizenship in Canada, eds. Keith G. Banting, Thomas J. Courchene, and F. Leslie Seidle (Montreal Institute for Research on commonplace Policy, 2007) Les Back, Michael Keith, Azra Khan, Kalbir Shukra, and John Solomos, New Labours White Heart Politics, Multiculturalism and the Return of Assimilation, Political Quarterly 73, No. 4 (2002) 44554 Steven Vertovec, Towards post-multiculturalism?Changing communities, conditions and contexts of diversity, International kind Science Journal 61 (2010) 8395. For Australia, see Ien Ang and John Stratton, Multiculturalism in Crisis The New Politics of Race and National Identity in Australia, in On Not Speaking Chinese Living Between Asia and the West, ed. I. Ang (London Routledge, 2001). For Canada, see Lloyd Wong, Joseph Garcea, and Anna Kirova, An Analysis of the Anti- and Post-Multiculturalism Discourses The Fragmentation Position (Alberta Prairie Centre for Excellence in Research on immigration and Integration, 2005), http//pmc.metropolis.Net/Virtual%20Library/FinalReports/Post-multi%20FINAL%20REPORT%20for%20PCERII%20_2_. pdf. For a good overview of the backlash discourse in various countries, see Steven Vertovec and Susan Wessendorf, eds. , The Multiculturalism Backlash European Discourses, Policies and Practices (London Routledge, 2010). Multiculturalism Success, Failure, and the Future 3 MIGRATION POLICY work away from it and shifted to a discourse th at emphasizes civic integration, social cohesion, common values, and shared citizenship.2 The social-democratic discourse of civic integration differs from the radical-right discourse in emphasizing the need to develop a more inclusive national identity and to fight racism and discrimination, but it nonetheless distances itself from the rhetoric and policies of multiculturalism. The term postmulticulturalism has often been invoked to signal this new approach, which seeks to overcome the limits of a naive or misguided multiculturalism while avoiding the oppressive reassertion of homogenizing nationalist ideologies.3 II. What Is Multiculturalism? A. Misleading Model In much of the post-multiculturalist literature, multiculturalism is characterized as a feel-good celebration of ethnocultural diversity, encouraging citizens to acknowledge and embrace the panoply of customs, traditions, music, and cuisine that exist in a multiethnic society. Yasmin Alibhai-Brown calls this the 3S model o f multiculturalism in Britain saris, samosas, and steeldrums. 4.Multiculturalism takes these familiar cultural markers of ethnic groups clothing, cuisine, and music and treats them as authentic practices to be preserved by their members and safely consumed by others. Under the banner of multiculturalism they are taught in school, performed in festivals, displayed in media and museums, and so on. This celebratory model of multiculturalism has been the focus of many critiques, including the following It ignores issues of economic and political inequality.Even if all Britons come to enjoy Jamaican steeldrum music or Indian samosas, this would do zip fastener to address the real problems facing Caribbean and southerly Asian communities in Britain problems of unemployment, poor educational outcomes, residential segregation, poor English lyric poem skills, and political marginalization. These economic and political issues cannot be solved simply by celebrating cultural differences . Even with respect to the (legitimate) goal of promoting greater understanding of cultural differences, the focus on celebrating authentic cultural practices that are unique to each group is potentially dangerous. First, not all customs that may be tralatitiously practiced in spite of appearance a particular group are worthy of being celebrated, or even of being legally tolerated, such as forced marriage. To avoid stirring up controversy, theres a tendency to choose as the focus of multicultural celebrations safely inoffensive practices such as cuisine or music that can be enjoyably consumed by members of the larger society. But this runs the oppo set risk 2.For an overview of the attitudes of European social democratic parties to these issues, see Rene Cuperus, Karl Duffek, and Johannes Kandel, eds. , The Challenge of Diversity European Social Democracy Facing Migration, Integration and Multiculturalism (Innsbruck Studien Verlag, 2003). For references to post-multiculturalis m by progressive intellectuals, who distinguish it from the radical rights antimulticulturalism, see, regarding the United Kingdom, Yasmin Alibhai-Brown, After Multiculturalism (London Foreign Policy Centre, 2000), and Beyond Multiculturalism, Canadian Diversity/Diversite Canadienne 3, no.2 (2004) 514 regarding Australia, James Jupp, From White Australia to Woomera The Story of Australian Immigration, 2nd edition (Cambridge Cambridge University Press, 2007) and regarding the United States, Desmond King, The improperness of Strangers Making the American Nation (Oxford Oxford University Press, 2004), and David A. Hollinger, Post-ethnic America Beyond Multiculturalism, revised edition (New York Basic Books, 2006).Alibhai-Brown, After Multiculturalism. 3 4 4 Multiculturalism Success, Failure, and the Future MIGRATION POLICY INSTITUTE of the trivialization or Disneyfication of cultural differences,5 ignoring the real challenges that differences in cultural and religious values can raise . Third, the 3S model of multiculturalism can encourage a conception of groups as hermetically sealed and static, each reproducing its own distinct practices.Multiculturalism may be intended to encourage people to share their customs, but the assumption that each group has its own distinctive customs ignores processes of cultural adaptation, mixing, and melange, as well as emerging cultural commonalities, thereby potentially reinforcing perceptions of minorities as eternally other. This in turn can lead to the strengthening of prejudice and stereotyping, and more generally to the polarization of ethnic relations. Fourth, this model can end up reinforcing power inequalities and cultural restrictions in spite of appearance minority groups. In deciding which traditions are authentic, and how to interpret and display them, the state generally consults the traditional elites within the group typically older males while ignoring the way these traditional practices (and traditional el ites) are often challenged by internal reformers, who have different views about how, say, a good Muslim should act. It can therefore imprison people in cultural scripts that they are not allowed to question or dispute.According to post-multiculturalists, the growing recognition of these flaws underlies the retreat from multiculturalism and signals the search for new models of citizenship that emphasize 1) political elaborateness and economic opportunities over the symbolic politics of cultural recognition, 2) human rights and individual freedom over respect for cultural traditions, 3) the building of inclusive national identities over the recognition of ancestral cultural identities, and 4) cultural change and cultural mixing over the reification of static cultural differences.This narrative about the rise and fall of 3S multiculturalism will no doubt be familiar to many readers. In my view, however, it is inaccurate. Not only is it a caricature of the reality of multiculturalism as it has developed over the past 40 years in the Western democracies, but it is a distraction from the real issues that we need to face.The 3S model captures something important about natural human tendencies to simplify ethnic differences, and about the logic of global capitalism to sell cosmopolitan cultural products, but it does not capture the nature of post-1960s government MCPs, which have had more complex historical sources and political goals. B. Multiculturalism in Context It is important to put multiculturalism in its historical context. In one sense, it is as old as humanity different cultures have always found ways of coexisting, and respect for diversity was a familiar feature of many historic empires, such as the Ottoman Empire.But the sort of multiculturalism that is said to have had a rise and fall is a more specific historic phenomenon, emerging first in the Western democracies in the novel 1960s. This timing is important, for it helps us situate multiculturalism in relation to larger social trans set upions of the postwar era. More specifically, multiculturalism is part of a larger human-rights revolution involving ethnic and racial diversity.Prior to World War II, ethnocultural and religious diversity in the West was characterized by a range of illiberal and dictatorial relationships of hierarchy,6 justified by racialist ideologies that explicitly propounded the superiority of some peoples and cultures and their right to rule over others. These ideologies were widely accepted throughout the Western world and underpinned both domestic laws (e. g. , racially biased immigration and citizenship policies) and foreign policies (e. g. , in relation to overseas colonies). 5 6 Neil Bissoondath, Selling Illusions The Cult of Multiculturalism in Canada.(Toronto Penguin, 1994). Including relations of vanquisher and conquered, colonizer and colonized, master and slave, settler and indigenous, racialized and unmarked, normalized and deviant, orthodox and heretic, civilized and primitive, and ally and enemy. Multiculturalism Success, Failure, and the Future 5 MIGRATION POLICY INSTITUTE After World War II, however, the world recoiled against Hitlers fanatical and murderous use of such ideologies, and the United Nations decisively repudiated them in favor of a new ideology of the equality of races and peoples.And this new assumption of human equality generated a series of political movements designed to contest the lingering presence or enduring effects of older hierarchies. We can distinguish collar waves of such movements 1) the struggle for decolonization, concentrated in the period 194865 2) the struggle against racial segregation and discrimination, initiated and exemplified by the AfricanAmerican civil-rights movement from 1955 to 1965 and 3) the struggle for multiculturalism and minority rights, which emerged in the late 1960s.Multiculturalism is part of a larger human-rights revolution involving ethnic and racial diversit y. Each of these movements draws upon the human-rights revolution, and its foundational ideology of the equality of races and peoples, to challenge the legacies of earlier ethnic and racial hierarchies. Indeed, the human-rights revolution plays a double role here, not just as the inspiration for a struggle, but also as a constraint on the permissible goals and room of that struggle.Insofar as historically excluded or stigmatized groups struggle against earlier hierarchies in the name of equality, they too have to renounce their own traditions of exclusion or subjection in the treatment of, say, women, gays, people of mixed race, religious dissenters, and so on. Human rights, and liberal-democratic constitutionalism more generally, provide the overarching framework within which these struggles are debated and addressed.Each of these movements, therefore, can be seen as contributing to a process of democratic citizenization that is, turning the earlier catalog of hierarchical relat ions into relationships of liberaldemocratic citizenship. This entails transforming both the vertical relationships between minorities and the state and the even relationships among the members of different groups. In the past, it was often assumed that the only way to engage in this process of citizenization was to impose a single undifferentiated model of citizenship on all individuals.But the ideas and policies of multiculturalism that emerged from the 1960s start from the assumption that this complex register inevitably and appropriately generates group-differentiated ethnopolitical claims. The key to citizenization is not to suppress these differential claims but to filtrate them through and frame them within the language of human rights, civil liberties, and democratic accountability. And this is what multiculturalist movements have aimed to do.The precise character of the resulting multicultural reforms varies from group to group, as befits the distinctive history that eac h has faced. They all start from the antidiscrimination principle that underpinned the second wave but go beyond it to challenge other forms of exclusion or stigmatization. In most Western countries, explicit state-sponsored discrimination against ethnic, racial, or religious minorities had largely ceased by the 1960s and 1970s, under the influence of the second wave of humanrights struggles.Yet ethnic and racial hierarchies persist in many societies, whether measured in terms of economic inequalities, political underrepresentation, social stigmatization, or cultural invisibility. Various forms of multiculturalism have been developed to help overcome these lingering inequalities. The focus in this report is on multiculturalism as it pertains to (permanently settled) immigrant groups,7 7 There was briefly in some European countries a form of multiculturalism that was not aimed at the inclusion of permanent immigrants, but rather at ensuring that temporary migrants would return to the ir country of origin.For example, mothertongue education in Germany was not initially introduced as a minority right but in order to enable guest worker children to reintegrate in their countries of origin (Karen Schonwalder, Germany Integration Policy and Pluralism in a Self-Conscious Country of Immigration, in The Multiculturalism Backlash European Discourses, Policies and Practices, eds. Steven Vertovec and Susanne Wessendorf London Routledge, 2010, 160).Needless to say, this sort of returnist multiculturalism premised on the idea that migrants are foreigners who should return to their real home has nothing to do with multiculturalism policies (MCPs) premised on the idea that immigrants belong in their host countries, and which aim to make immigrants 6 Multiculturalism Success, Failure, and the Future MIGRATION POLICY INSTITUTE but it is worth noting that struggles for multicultural citizenship have also emerged in relation to historic minorities and indigenous peoples. 8 C. Th e Evolution of Multiculturalism Policies.The case of immigrant multiculturalism is just one aspect of a larger ethnic revival across the Western democracies,9 in which different founts of minorities have struggled for new forms of multicultural citizenship that combine both antidiscrimination measures and positive forms of recognition and accommodation. Multicultural citizenship for immigrant groups clearly does not involve the same types of claims as for indigenous peoples or national minorities immigrant groups do not typically seek land rights, territorial autonomy, or official language status.What then is the snapper of multicultural citizenship in relation to immigrant groups? The Multiculturalism Policy Index is one attempt to measure the evolution of MCPs in a standardized format that enables comparative research. 10 The index takes the following eight policies as the most common or emblematic forms of immigrant MCPs11 Constitutional, legislative, or parliamentary affirmat ion of multiculturalism, at the central and/ or regional and municipal levels The adoption of multiculturalism in school curricula The inclusion of ethnic representation/sensitivity in the mandate of public media or media licensing Exemptions from dress codes, either by statute or by court cases Allowing of dual citizenship The funding of ethnic group organizations to support cultural activities The funding of bilingual education or mother-tongue instruction Affirmative action for disadvantaged immigrant groups12 feel more at home where they are.The focus of this paper is on the latter type of multiculturalism, which is centrally concerned with constructing new relations of citizenship. 8 In relation to indigenous peoples, for example such as the Maori in New Zealand, Aboriginal peoples in Canada and Australia, American Indians, the Sami in Scandinavia, and the Inuit of Greenland new models of multicultural citizenship have emerged since the late 1960s that include policies such as land rights, self-government rights, recognition of customary laws, and guarantees of political consultation.And in relation to substate national groups such as the Basques and Catalans in Spain, Flemish and Walloons in Belgium, Scots and Welsh in Britain, Quebecois in Canada, Germans in South Tyrol, Swedish in Finland we see new models of multicultural citizenship that include policies such as federal or quasi-federal territorial autonomy official language status, either in the region or nationally and guarantees of representation in the central government or on constitutional courts. 9.Anthony Smith, The Ethnic Revival in the modern-day World (Cambridge Cambridge University Press, 1981). 10 Keith Banting and I developed this index, first published in Keith Banting and Will Kymlicka, eds. , Multiculturalism and the Welfare State Recognition and Redistribution in present-day(a) Democracies (Oxford Oxford University Press, 2006). Many of the ideas discussed in this paper are the result of our collaboration. 11 As with all cross-national indices, there is a trade-off between standardization and sensitivity to local nuances.There is no universally accepted definition of multiculturalism policies and no hard and fast line that would sharply distinguish MCPs from closely related policy fields, such as antidiscrimination policies, citizenship policies, and integration policies. Different countries (or indeed different actors within a single country) are likely to draw this line in different places, and any list is therefore likely to be controversial. 12 For a fuller description of these policies, and the justification for including them in the Multiculturalism Policy Index, see the index website, www.queensu. ca/mcp.The site also includes our separate index of MCPs for indigenous peoples and for national minorities. Multiculturalism Success, Failure, and the Future 7 MIGRATION POLICY INSTITUTE Other policies could be added (or subtracted) from the inde x, but there was a recognizable multiculturalist turn across Western democracies in the last few decades of the 20th century, and we can identify a range of public policies that are seen, by both critics and defenders, as emblematic of this turn.Each of the eight policy indicators listed above is intended to capture a policy dimension where liberaldemocratic states faced a choice about whether or not to take a multicultural turn and to develop more multicultural forms of citizenship in relation to immigrant groups. While multiculturalism for immigrant groups clearly differs in substance from that for indigenous peoples or national minorities, each policy has been defended as a means to overcome the legacies of earlier hierarchies and to help build fairer and more inclusive democratic societies.Therefore, multiculturalism is first and foremost about developing new models of democratic citizenship, grounded in human-rights ideals, to replace earlier uncivil and undemocratic relations of hierarchy and exclusion. Needless to say, this account of multiculturalism-as-citizenization differs dramatically from the 3S account of multiculturalism as the celebration of static cultural differences.Whereas the 3S account says that multiculturalism is about displaying and consuming differences in cuisine, clothing, and music, while neglecting issues of political and economic inequality, the citizenization account says that multiculturalism is precisely about constructing new civic and political relations to overcome the deeply entrenched inequalities that have persisted after the abolition of formal discrimination. It is important to determine which of these accounts more accurately describes the Western experience with multiculturalism.Before we can decide whether to celebrate or lament the fall of multiculturalism, we first need to make sure we know what multiculturalism has in fact been. The 3S account is misleading for three principal reasons. 13 Multiculturalism is fir st and foremost about developing new models of democratic citizenship, grounded in human-rights ideals. First, the claim that multiculturalism is solely or primarily about symbolic cultural politics depends on a misreading of the actual policies.Whether we look at indigenous peoples, national minorities, or immigrant groups, it is immediately apparent that MCPs combine economic, political, social, and cultural dimensions. While minorities are (rightly) concerned to contest the historic stigmatization of their cultures, immigrant multiculturalism also includes policies that are concerned with nark to political power and economic opportunities for example, policies of affirmative action, mechanisms of political consultation, funding for ethnic self-organization, and facilitated access to citizenship.In relation all three types of groups, MCPs combine cultural recognition, economic redistribution, and political participation. Second, the claim that multiculturalism ignores the import ance of universal human rights is equally misplaced. On the contrary, as weve seen, multiculturalism is itself a human-rights-based movement, inspired and constrained by principles of human rights and liberal-democratic constitutionalism.Its goal is to challenge the traditional ethnic and racial hierarchies that have been discredited by the postwar human-rights revolution. Understood in this way, multiculturalism-as-citizenization offers no support for accommodating the illiberal cultural practices within minority groups that have also The same human-righ.

Bridge to Terabithia by Katherine Paterson Essay Example for Free

Bridge to Terabithia by Katherine Paterson EssayBridge to Terabithia is an ambitious, thrilling, and at propagation heartbreaking story about childhood, friendship, and individuality. Paterson begins the story by introducing Jess Aarons, an elevenyearold boy living in a rural area of the in the south who loves to run. He dreams of being the fastest boy in the fifth grade when school starts up in the fall, feeling that this will for once give him a chance to stand in the spotlight among his five sisters, and win him the attention of his constantly preoccupied father. Jess is very insecure in his individuation. He loves to paint and draw, notwithstanding he knows that this labels him a sissy in most eyes, particularly his father. As Katherine Paterson said Jess drew the way some people drink whiskey.I enjoyed instruction about Jesss confliction between his masculinity and effeminacy. With his family stretched so tight by poverty he has little chance to really explore his own identity during this crucial period of adolescence. He is determined to win in doing something masculine that will rid the undesired label of sissy or Girl in the eyes of his father and schoolmates which will allow him to shine in his own right. He practices each morning, always dreaming of his upcoming victory. However, when the races come around at recess, a new girl, Leslie Burke, who just moved next door to Jess, boldly crosses to the boys side of the playground and beats everyone.

Urbanization in Pakistan

Urbanization in PakistanABSTRACTThe query reported in this thesis was on Urbanization and Determinants of Urbanization in Pakistan The main manipulation of the research was to study the doers and determinants of urbanisation cause the problem of urbanisation in Pakistan. The secondary selective information was collected by referring to the literature useable in the libraries and the internet. prime data was collected by floating a questionnaire among the general public asking questions regarding the problem of Urbanization in Pakistan. Moreover, interviews were taken to get a break down understanding of the research subject. SPSS softw are was applied to analyze the data collected from the questionnaire for frequencies and cross tabulations were run to interpret the data by using the principles of Statistics. The findings suggested that migration, net-reclassification and net native extend were the major elements causing urbanisation in Pakistan. Trend of Urbanization in P akistan carry been increasing over the past years due to an cast up in the migration rate, mergers of sm in all towns into gravid cities and an excess of blood line evaluate of end rates which scrams tribe increase and an increase in the alive cosmos of the jumbo cities. It was suggested that government should make proper plans and policies to avoid this problem of Urbanization as for a developing nation Urbanization can become a in force(p) problem.CHAPTER 1INTRODUCTION1.1 Overview of the TopicUrbanization is the expansion of cities by the rise in total number of population. Urbanization is ca utilize by the mixer, sparing demographic aspects, which involve internal migration, mergers of adjoining surface areas in the city and by the excess of have a bun in the oven rates over death rates. Internal migration is caused due to the attractive opportunities city intent has to offer to the arcadian good deal along with better living standards and better wages. Mi gration can non be controllight-emitting diode as by the law every citizen of the country is free to blend in and live where ever he wants. Second main(prenominal) broker causing urbanisation is net reclassification that is, mergers of adjoining towns and villages into double cities. Cities of Pakistan bewilder expanded in price of their size and population over the past 50 years. This merger allows small towns and villages to excel and enjoy the facilities of city demeanor but in hark back it brings a banish impact on the quality of inwrought public services such(prenominal) as law and order, health, education, water energy supplies etc. as they in the beginning had been designed according to the population living within the city boundaries. This factor leads to un-regulated expansion of urban areas which cause social, economic and administrative problems. Third major factor causing urbanisation is the net natural increase, increase in birth rates over death rates. Adva ncement in medicine and health engineering science leads to an increase in the demeanor span of an average person and reduces the infant mortality rate, which brings a rise in the population if the country. According to the 1998 census, in Pakistan take of urbanization has grown from 17.5% in 1951 to 32.5% in 1998. The trend of urbanization is increasing over the past years in Pakistan. Now in Pakistan sylvan population is moving towards queen-sized cities due to the decreasing dependency rate on the agricultural sector. Females from the bucolic areas in like manner are moving towards the great cities to get earn in the informal sector. Lack of canonic necessities such as, food, energy, education and health in the hobnailed areas of Pakistan force mountain to shift to long cities bringing an proceeds on the prudence in a nix way. Lack of improper city boundaries in addition allow adjoining slums and small towns to merge in with the galactic cities causing Urbanizat ion in Pakistan. Small and medium sized cities of Pakistan are growing at a laster rate and are serving as hubs of business and trade. Growth in commerce and industry and better cultivation methods also lead community to shift to urban centers. Urbanization is a stark problem which needs to be control lead specially in a developing country like Pakistan where inflation rates are high, people live to a lower place poverty line, wages are less and political instability exists. It can cause infrastructure deficit, increase urban poverty unemployment, lead to scarce resources and cause further political imbalance.1.2 Background of the TopicPakistan was formed as a result of religious and cultural differences present in the sub-continent. These differences led to the migration among the two nations causing an uneven dispersion of people as well as resources. In the initial years after independence government faced a heap of trouble in allocating resources among the cities and vil lages according to the total population living. A biggish number of refugees settled in the big cities because they had no shelter and food to transmigrate in the unsophisticated areas. From 1951-1962 urbanization in the East and West Pakistan experienced the same urban ripening rate. Later West Pakistan saw an increase in the urban egression rate as people migrated to the two big cities of the West Karachi and Lahore in search of better job opportunities and adjoining towns merged with the big cities in order to avail the facilities cities had to offer such as electricity, gas energy. These two were the biggest cities where all the political, economic and social activities used to take place. Industrialization in the latter years attracted people from the rural centers to obtain a better lifestyle. Only a small number of refugees made their way to the rural areas where no special development had taken place. In 1981-1998 urban growth declined due to the deteriorating law and o rder situation. Political instability, partition of East Pakistan was the main rationalnesss for this decline. Urbanization in Pakistan has been taking place since independence. Refugees caused urban growth in the early years, in later years search for better job opportunities and independence from landlords made people migrate to big cities. Lack of governments policies in developing the rural areas of Pakistan also lead to this shift and overleap of proper family planning lead to population increase and improper city boundaries extend the size of the big cities which cause urbanization. Decrease in the agricultural sector over the years have also led to an increase in the urban growth as now people seek jobs in the industrial sector rather than the agricultural side.1.3 Importance of the learning With Respect To the WorldUrbanization is an emerging economic problem as the increase in voluminous cities is not equate to the facilities available for the citizens. Overcrowding in large cities is causing different problems which are difficult to handle by the political parties. Especially for a developing nation expansion of big cities related to the facilities available is a serious problem which needs attention. Urbanization is increasing at an alarming rate in the developing nations these days. Urban population increase in developing countries is double that experienced in the West years ago. Developing nations are less industrialized as compared to the Developed countries therefore people from rural areas migrate to the urban cities in search for better wage rates. The extent of poverty in the rural areas of the developing nations is negative, which is another factor causing migration. organism of primate cities in developing nations brings an increase in the population of these cities. In developing and under developed nations urban growth rate is relatively high than developed nations as rural poverty and its causes such as no stable earning patterns, drought low human capital make people to migrate to big cities in search of better quality of life. Urbanization has been increasing in the world due to the large difference in income and lifestyle surrounded by rural and urban cities.. Greater emphasis laid down on the industrial sector by the government is also a big reason why inhabitants or rural areas leave their jobs in the agricultural sector and shift to the industrial sector. Some economists believe that city growth is a attribute of development of every nation as it leads to technological and industrial advancement. But most researchers believe that urbanization is a serious problem which needs to be taken into bet immediately. Urbanization needs to be controlled as it can become a serious threat to the economy of any nation especially the developing ones as, they are indulged in other problems at the same time. It can also cause a problem to the people already living in the urban areas along with the people migrating to these areas. The Government has to take steps and regulate urban-rural migration to control the problem of urbanization1.4 Importance of Study With Respect To PakistanUrbanization is a serious problem faced by Pakistan these days. Urbanization in the early years was caused due to the problem of refugees after independence. Industrialization later made people shift to cities in search for better jobs and wage rates. Due to the existence of new technology and better health facilities the rate of births over deaths is high in Pakistan. The poor standard of living in the rural areas make people migrate to big cities to get the basic necessities of life. Mergers of adjoining towns into big cities formally read the rural areas into urban centers. Over the years there has been an increase in the size of Pakistans top ten big cities, areas which were considered small now have been include in the premises of the big cities. Trend of urbanization in Pakistan is going up on an increasing r ate. The rural population is expected to be equal to the urban population by the year 2030. Now female labor force participation is also causing urbanization as women from the rural areas are stepping ahead to work in the cities in the informal sector. In Pakistan the main factors causing rural verboten migration are unequal distribution of resources, lack of basic necessities and poverty. Government over the years has not been successful in implementing positive policies to stop rural out migration by developing the rural areas. The wide hoo-ha between the income distribution patterns in the rural urban areas lead to class conflicts which results in migrations causing violent activities. Moreover the mergers of small towns and slum into big cities also give rise to such problems like income disparities and class conflicts. Rapid increase in the size of the city leads to a deterioration in the quality of essential public services, such as, law and order/police, health, education, road works, water supplies, energy supplies etc., this expansions leads to economic, social and administrative problems. The population growth is unevenly distributed in the four provinces and the population of the 10 big cities is increasing over the years which need to be controlled as it is the root cause for the process of urbanization. Pakistani government should take into account some policies to control the problem of urbanization which is a hurdle in the process of development. If this problem is now controlled immediately Pakistan can face numerous challenges in the near future which will be difficult to control then.1.5 Research QuestionUrbanization Determinants of Urbanization in PakistanThe scope of the study is why urbanization takes place, what are the various components which give rise to the problem of urbanization.CHAPTER 2LITERATURE REVIEWArif and Hamid (2009) probed the trends in urbanization, city growth and womens share in rural to urban migration. This study was a joint project of UNFPA and PIDE financed by UNFPA. Growth of cities is a common practice in the developing nations, including Pakistan. The basic objective of their research was to examine the level of urbanization and urban growth of Pakistan, to analyze the role of migration in the expansion of cities and to over view the quality of life of female immigrants who have locomote to big cities in search of better job opportunities for their families. This paper has used both qualitative and quantitative approaches to work on the said objectives. They have used data from previous censuses and information from existing literature. This study has further used both the 2001 Pakistan Socio-Economic Survey (PSES) and Pakistan Rural Household Survey (PRHS) do by the Pakistan instal of Development Economics to study the share of female in rural-urban migration. The quality of life is examined by talking a sample of 50 women and interviewing them about their decisions which led them t o the migration. According to the 1998 census, level of urbanization has grown from 17.5% in 1951 to 32.5% in 1998. The nature of urbanization is different in the four provinces. More than 60% of the population of Sindh lives in Karachi, 22% of the total population of Punjab lives in Lahore and other 5 big cities of Punjab, capital of NWFP, Peshawar constitutes of 33% of urban provincial population and the share of Quetta, the capital of Baluchistan is 37%. Arif and Hamid say that there are 3 major components of urban population growth, which include Net-natural increase (increase in the birth rates over death rates due to the growth and improvement in the medical sector). Second component is the rural-urban migration, which is caused due to the attraction and opportunities the big cities have to offer to the rural population, the migration in urban growth was 20.1% in 1972-81 and 1981-98. The migration across provinces is also found in Pakistan. Third component is the Net-Reclassif ication (the mergers of adjoin areas into big cities). Medium and small cities of Pakistan have outgrown in harm of development over the past 50 years which have led to the increase in size by area of the big cities. Women comprise of a authoritative figure in the rural urban migration. Permanent migrant women move to urban centers in search for a better quality life for themselves and their children. The second type of migrant women includes those who shift to the city for a temporary time, to obtain full high quality education. Research says that permanent women migrate due to the economic crisis, lack of job opportunities and due to the domestic violence by husband and his family. The main findings of the qualitative research done by interviews of women who have shifted to the big cities reveal that low quality of life, in security in terms of their childrens future, low mentality of their husbands and the feeling of being independent motivated them to migrate. Further the find ings of this boilersuit study reveal that due to a fall in the agricultural sector, the rural population is shifting to the big cities, leading to urban growth. Pakistans projected urban population is said to be equal to its rural population by 2030, when one out of every two person will be a resident of the big city.Farooq and Mateen (2005) get hold ofed a study whose main objective was to study and explore the correlation about the socio-economic status and the determinants of internal migration by probit estimation technique. Their research was conducted in Faisalabad city and four tehsils of Faisalabad. Probit model was used to test the hypothesis of their study, the first one being that the poorer economic conditions of the rural areas lead to more rural out migration. This test showed that 35-50% of the respondents migrated to big cities due to low levels of income, poor economic opportunities and poor quality of life. Land holding is considered as an important economic fort une in the rural sector of Pakistan. The aspect of the rural economic opportunity hypothesis states that land holdings is an important determinant in the rural urban migration. The negative land holdings show that migration is most possible when people have small land holdings as compared to people who own land more than 13 acres, who do not think of shifting to other big cities. Another hypothesis tested by Farooq and Mateen was that the higher the rate of poverty reduction among the migrants families in the rural sector the greater will be individual migration. The result shown against this hypothesis was that people from rural areas migrate mostly because they get attracted to the economic opportunities cities have to offer. one-on-one migrants who had left their rural areas leaving their families behind have improved their household income by sending remittances which in sacrifice reduces their poverty level. Probit model shows that rural out shift is directly linked with the objective of poverty reduction in the urban as well as rural communities. The findings say that unequal distribution of resources, usually land, and poverty leads to rural out migration.Dao (2002) conducted a study to explain the differences in the urbanization growth rates of the developing nations. He argues that the difference in the actual levels of income between rural urban areas is responsible for the process of migration. He chose to use the ratio of agricultural value added per worker to GDP per capita as a proxy variable for rural wages and assumed that urban wages do not vary due to the influence of politically motivated factors such as minimum wage legislation, labor unions etc. He also hypothesize that a countrys development factors, rate of population growth, poverty, agricultural stringency all such factors affect the urbanization growth. Empirical tests applied on 3 developing countries showed that agricultural value added per worker relative to per capita GDP is mo derately significant in explaining the changes in urbanization growth rates which means that higher agricultural values given per worker does keep rural workers away from the ruling of migrating. Development factors such as long constructed roads divided by land area have a positive impact on the urbanization growth rate increase in population also has a direct effect on the urban growth rate. Impact of population density in agricultural areas does not explain the urbanization growth rates and the effect of the extent of poverty in rural centers on urbanization growth is negative.Satterwaite (2010) studied the reasons behind the lack and incomplete data available on the urban populations for many under-developed and developing nations and how this incomplete data effects future policies and makes world(prenominal) comparisons difficult. The study says that every nation has its own definition of urbanization and its own ways of conducting a population census. Official definitions s ay that a city comprising of 20,000 or more inhabitants is an urban city. But if this definition is applied to the developing nations the worlds level of urbanization may change by several points. As a large dimension of such cities live in the rural, underdeveloped areas. Moreover the study tells us that city boundaries are not set according to the universally agree criteria but are set by the local and national bodies and change over time. Statistics used to judge the environmental performance of the large cities are greatly influenced by the adjoining areas which affects the city boundaries. In many nations census is done after ten years and in most nations census are not done in the past 15 years as, censuses are seen as expensive. Satterwaite says that difference in data regarding the urbanization rates of many countries makes the task of making urbanization control policies a difficult task.Kasarda and Crenshaw (1991) studied the third world urbanization and its determinants and dimensions. They say that third world countries are facing an urban salvo which is somewhat like that faced by the West a century ago, the urban growth faced by the third world nations is double the growth faced by the West. Urbanization problem acts as a barrier in the development phase of the third world countries. Developing nations face a problem of over urbanization which is the increase in the countrys population as compared to the economic activities. Developing nations also face the problem of Urban Primacy which is all political, social, economic activities take place in one big city of the nation which in return attracts people from the rural sector. The existence of improper city boundaries also makes third world countries more underdeveloped and acts as a constraint to future development. Migration in these countries takes place at an increasing rate due to the attractions the big cities have to offer. Moreover the increase in the birth rates over death rates due to the advancement in the medical sector has increase the population which affects the rate of Urbanization. The wage difference and job opportunities also affect the decision of rural urban migration, as the wage rates in the rural sector are much low as compared to the urban sector. The housing facilities provided in the big cities of the third world nations are much better than those in the rural areas. The housing facilities provided in the rural areas of the third world countries are far less below than the criteria stated by the UNO.Jan, Iqbal and Ifthikharuddin (2008) conducted a study in ten most populous cities of Pakistan to study the trend and growth of urbanization in these big cities and their provinces. They say that province wise distribution of the rural urban population and its projections are important to make forecasts about the future. They have used the weighted matrix approach to make population projections. Sindh province currently has the highest proportion of urban population which is expected to increase by 12% by 2030 Punjab whose current population urbanized is 31.267% is expected to be 50.07% by 2030. The projected urbanization rate of NWFP is 41.36% by 2030 with an increase of approx. 24%. The projected urban percentage of Baluchistan is 45.56% by 2030 showing a rise of 22%. The findings say that the urban population is unevenly distributed in the four provinces. The population growth of the ten big cities is increasing over the past decade which is the gem cause of the problem of urbanization and it should be quickly handled.CHAPTER 3METHODOLOGYResearch TypeMy research type is quantitative research as a questionnaire was used to collect the data and then it was coded and was formed into a more statistical versionselective information Type and Research PeriodResearch is based on primary data as a questionnaire was floated to collect data. This is because there is no prior data available on the subject matter hence the questionnaire provided with sufficient material to conduct the research.Sources of dataA questionnaire was floated asking general questions regarding the relationship of the dependent variable with the independent onesTheoretical FrameworkRelated Definitions VariablesUrbanizationA process in which an increasing proportion of an entire population lives in cities or suburbs of cities, areas of population dense enough that residents cannot grow their own food(www.pbs.org/wgbh/rxforsurvival/glossary.html)Over Urbanization exuberant growth of a countrys urban population relative to economic growthUrban GrowthRefers to the rise in the increasing population living in urban areas (Jones 1991)MigrationShifting of people from small villages to big cities in search of better life style and job opportunityUrbanBuilt-up and populated area that includes a municipality and, generally, has a population of 5000 or more (http//www.businessdictionary.com/definition/urban.html)RuralRural population includes person s living in the open country or in towns of less than 2,500 people. It is subdivided in the rural farm population which comprises all rural residents living on farms, and the rural non-farm population which includes the remaining rural population (www.mnforsustain.org/rockefeller_1972_glossary.htm) vim factorsFactors responsible for shifting people from rural to urban citiesPull factorsFactors responsible for attracting rural population to the urban centersNet-ReclassificationMerger of adjoining areas into big cities due to lack of proper city boundaries and the development of these adjoining areasNet-Natural IncreaseThe increase in birth rates over death rates due to better health facilities and rise in populationPopulation, Working Population and Planned SampleMy sample include the population of Lahore, with a sample size of 50 people. It included people from all spheres of life who had recently migrated to big cities and the people living in adjoining areas of Lahore. People abov e the age of 25 were capable of change out my questionnaireResearch HypothesisHo Migration is an important factor in the process of urbanization and it has an effect on the countrys economyH1 Migration is not an important factor in the process of urbanization and it does not affect the countrys economyHo Lack of city boundaries lead to the annexure of adjoining small towns into big cities which in return increase the living urban population giving rise to urbanizationH1 Lack of city boundaries do not lead to the annexure of adjoining small towns into big cities which in return increase the living urban population giving rise to urbanizationHo availability of better health facilities in urban cities brings excess of birth rates over death ratesH1 Availability of better health facilities in urban cities do not bring any change in the birth and death ratesHo High rates of poverty poor economic conditions in the rural areas lead to rural out migrationH1 High rates of poverty poor ec onomic conditions in the rural areas does not lead to rural out migrationHo Uncheck urbanization leads to economic, social and administrative problemsH1 Uncheck urbanization leads to economic, social and administrative problemsHo Lack of government policies and plans have led to an increase in urbanizationH1 Lack of government policies and plans have led to a decrease in urbanizationTechniquesAfter the questionnaire was filled and coding was done, cross tabulations were run to analyze the relationship of the independent variables with the dependent one.Data outlineThe statistical software which was used was SPSS. Cross tabulations to interpret the results gathered by the questionnaire. It provided me with frequency tables to get a better understanding of the collected data.Data interpretationBased on the current analysis the main aim was to understand which variable was the major factor causing urbanization.CHAPTER 4RESULTS AND ANALYSIS4.1 Results AnalysisMigrationDo you think mig ration is a serious factor in the process of urbanization? Do you think Migration has a serious effect on the economy of Pakistan in a negative way?Ho Migration is an important factor in the process of urbanization and it has an effect on the countrys economyH1 Migration is not an important factor in the process of urbanization and it does not affect the countrys economyThis cross tabulation talks about migration being an important factor in the process of urbanization and affecting a states economy in a negative way. 20 people agree to the fact that migration causes an urbanization which affects the economy of the country. 29 people agreed and said that migration is a major cause in the urbanization problem. 12 people disagree and believe that migration do not have an effect on the countrys economy in a negative way. Total 7 people stay neutral and are of the view that migration is not a key factor in the process of urbanization.Therefore, we accept our null hypothesis as a majorit y agrees to the fact that urbanization is caused by migration which has a negative impact on the economy.Net ReclassificationDo you think lack of city boundaries is a major cause for urbanization? Do you think that there should be a pay off on the size of a city?Ho Lack of city boundaries lead to the annexure of adjoining small towns into big cities which in return increase the living urban population giving rise to urbanizationH1 Lack of city boundaries do not lead to the annexure of adjoining small towns into big cities which in return increase the living urban population giving rise to urbanizationThis cross tabulation talks about lack of city boundaries, and their role in the process of urbanization. 16 people stayed neutral when asked if they considered mergers of small towns and villages a factor in the process of urbanization. 15 people believed that the problem of urbanization was caused due to the annexure of small villages and towns into big cites. However, 14 people disa greed and said that they did not consider this merger to be a factor in the problem of urbanization rather this merger gave the opportunity to the people living in such poor areas to excel, bringing a positive effect on the economy. 16 people agreed that a limit should be set by the government or local authorities to the city boundaries. Whereas, 11 people disagreed in mise en scene up a city boundary.Thus, we accept our hypotheses as more people agree to the fact that mergers of adjoining towns and slums do cause urbanization and a limit should be set in the city size.Net Natural IncreaseDo you consider the increase in birth rates over death rates a cause for the problem of urbanization? Do you believe that an increase in the population size of Pakistan is a source of the countrys problems?Ho Availability of better health facilities in urban cities brings excess of birth rates over death ratesH1 Availability of better health facilities in urban cities do not bring any change in th e birth and death ratesThis cross tabulation discusses whether increase in population is a source of countrys problems and this increase is due to the excess of birth rates over death rates. 22 people strongly agreed that the population increase in Pakistan is a big source of the countrys problems. 8 people disagreed on the fact that population increase had to do anything with the countrys problems. 20 people said that an excess of birth rates over death rates was a factor in the process of urbanization, as urbanization means expansion of cities, which in this situation is done by an increase in birth rates. 14 people stayed neutral and said they somehow agreed and disagreed to the fact that the excess of births over deaths is a factor of urbanization.So, we accept our null hypothesis as more people believe population to be a source of a countrys problems and think that the excess of birth rates over death rates allow the cities to expand causing the problem of urbanization.4.2 Freq uency TablesQ3) Does Poverty act as a major dick in the process of migration?30 respondents agreed to the fact that poverty is a major factor which causes rural out migration which leads to urbanization.Q4) Better Lifestyles, health and education facilities, life security, independence attract the rural population towards the urban centers, do you agree?20 respondents agreed and 19 strongly agreed that better standard of living in the urban centers attracts the rural population which makes them migrate.Q5) Do you think people in u

The implementation of electronic health record

The instruction execution of electronic health phonograph recordingOnly 4 portion of U.S. doctors are using an electronic medical record agreement (EHR) beca office of a divers(prenominal) range of barriers and perceptions have-to doe with with implementing an EHR system of rules. The health care portion of the American convalescence and Reinvestment Act (ARRA) called Health Information Technology for Economic and Clinical Health or HITECH promotes the Meaningful map of randomness technology in the form of EHR systems for both American by 2014 (Hoffman, 2009). retributive having an EHR system is not enough meaningful use means the system must improve the quality, efficiency, security, access, and communication in the obstetrical delivery of health care among other functions. The United States government has provided $17 billion in available incentives to assist mendeleviums and health care facilities implement certified EHR systems that correspond Federal qualifica tions by the year 2014 (Blumenthal, 2009). This important health care burn pretends everyone in this country because of the nature of mysterious health randomness. The U.S. government mandate for the implementation of electronic health records presents a wide variety of write outs for and responses by physicians who want to retain their diversity relating to the authority they practice care for, while meeting the Meaningful Use requirements that go away positively affect their investment and efficiency.Meaningful use depends on interoperability, which means that physicians systems testament be able to communicate with each other for information exchange. Currently some physicians may urinate systems that are interoperable, but some may have invested in software that does not provide that function. Numerous vendors much market much than one type of system. Currently, estimates of physicians using a complete, fully functional EHR system are only at four deal out (DesRoch es, et al., 2008). This leaves the mass in need of researching software systems, purchasing, and implementing an EHR system to meet the Meaningful Use requirements. The practice of medicine is a highly individualized field where every physician has their own ways to provide for their longanimouss. A general practitioner will have different software needs than a surgeon or obstetrician. An issue the physicians have to address is that they have to choose a certified EHR system that will provide the functions they need for their particular practice of medicine. Many physicians are head start with a basic system and customizing it to fit their practice needs (Baron, et al, 2005). HITECH will need to certify systems that provide functions that the physicians require with enough flexibility to meet the diverse needs of every type of practice. whatever EHR systems are designed for primary care practices or bragging(a) hospitals and may not meet the needs of a specialist. Physicians wi ll have to choose a certified system that will have the required functions as wellhead as those his practice will require.Whichever system a physician chooses will require training in order to benefit from the functions the software can provide. A basic knowledge of computer use is a skill many another(prenominal) physicians do not even have. In fact, some physicians have technophobia when it comes to computers in their practice (Hayes, 2009). Statistics have shown that younger physicians are more apt to have a positive outlook on the EHR systems. Younger physicians also appear to have earlier word sense of an EHR system because of their prior photograph to computers. In-depth training to learn the functions and processes of the system are necessary to prevent severe disruptions in the work flow of the office. Many offices will train a few employees to be Super Users to be a resource for others in the office who have had less training. Super Users will be able to adjust the wor k processes when needed. Some physicians offices close for a period of days to bring the system online and prepare the office for going live. The diversity in computer abilities and comfort levels will affect the complexity, price, and amount of training required for each physician and his office staff for the chosen system.Cost is the biggest issue in the adoption of EHR systems. Cost estimates are among $12,000 and $24,000 to implement a fully functional EHR system (Baron, 2005). The equipment, software, training and one year of frequent can cost $140,000 or more (Baron, 2005). The HITECH incentives will covert some, but not all the cost of the conversion from paper to electronic records. Incentive payments can total $18,000 in the first year, for physicians implementing in 2011 and 2012 and will pertain for 5 years at reducing amounts. The available incentive amounts will decline each year and end completely in 2016. In other words, physicians who adopt in 2011 could collect $44,000 over the five-year period while physicians who adopt in 2013 would feel $27,000 in incentive payments over 3 years (Blumenthal, 2009). The incentives will provide more funding for physicians that implement early. Surveys indicate that the incentives are a facilitator for approximately 55 percent of physicians who see the incentives as a reason to make headway the transition now, and consume maximum financial benefit (Blumenthal, 2009). The diversity in size of practices will affect how the physicians perceive capital costs.Due to the diversity in the types and ways physicians practice, issues that need to be considered and addressed, and the many solutions available, physicians attitudes and opinions on EHRs and Meaningful Use vary from very enthusiastic to resentful and wary. Studies have shown that physicians who have already take an EHR system are generally satisfied with their system and the benefits it provides. However, although the physicians will be the ones assu ming approximately 89 percent of the cost of the system, they will not receive much of a make on their investment (Hoffman, 2009). The insurance companies will save bills on reduced testing, streamlined billing, and overall efficiency. The government will save money on the same things as well as have a medium for monitoring fraud. Physicians will save some money on record stor climb on, employee salaries previously paid for filing and transcribing records, and paper office supplies, but in comparison to the cost of the system, savings are minimal. Physician bushel over return on investment is 50 percent for physicians who do not have an electronic system but only 33 percent for physicians who are already using an electronic system (DesRoches, 2008). The results may reflect Medicare and Medicaid patient numbers, size of the physician practice or perhaps the diverse perceptions physicians have over the dollar value versus the benefits to their actual income.Seemingly, the biggest n umbers of implementers are the stupendousr practices who are often wear able to absorb the large investment than a small practice or single physician office. Statistics show that large primary care practices are more apt to implement EHR systems than other types of practices. These large group practices of fifty or more physicians were four times more likely to have a fully functional system than with physicians in practices of 3 or less physicians (DesRoches, 2008). The increased cash flow from a large practice makes the large capital expense less detrimental to the practice. This diversity in the size of physician practices is a significant basis for EHR implementation.EHR implementation itself will not provide for full Medicare and Medicaid reimbursement. In order for a physician to receive full reimbursement from Medicare and Medicaid, an EHR system must meet the Meaningful Use requirements. Physicians who do not have an EHR system that meets the meaningful use requirements w ill see penalties in the form of reduced Medicare payments. The reducing of payments will start at one percent in 2015, increase to two percent in 2016, and increase over again to three percent in 2017 (Blumenthal, 2009). Physicians with large amounts of Medicare and Medicaid patients will have a significant reason to implement a system that meets the Meaningful Use guidelines. This issue will not affect all physician practices and some physicians do not feel it is a significant impediment to their practice income to warrant the large expense twisting with implementing an EHR system. The diversity in the types of patients a physician or practice routinely cares for will have an effect on their financial return and willingness to implement an EHR system.For those who may not see a financial return there are many other benefits to adopting an EHR system for patients, insurance companies, and the government, and to some pointedness physicians. One benefit for physicians is a more ef ficient and streamlined insurance claims process, which will aid in cash flow. Physicians will also be better able to provide for their patients because the patient record will be able to go where the patient goes, including to hospitals and specialists, resulting in better coordination of the patients care. The EHR will provide a reduction in clinical errors because of the ability of the EHR to provide clinical decision support and monitor medication dosing and contraindications, and allergies. However, a group of physicians feel that this is questioning their judgment and do not want the interference in the way they practice medicine. Of physicians who are using a fully functional EHR system 86 percent esteem the avoidance of medication error function that their system provides. The diversity in the physicians response to clinical decision support may be due to age of the physician, the number of years he or she has been in practice or any number of reasons including the personal ity of the physician.Along with those benefits, there is disruption of the office workflow. This is a significant cause for physician concern (DesRoches, 2009). The learning curve for an EHR system slows down all the processes in the office. Some physicians are better able to need with the chaos that ensues while converting to an electronic system. Everyone within the practice has to relearn his or her job processes. All the office procedures of the practice have to be redesigned to work with the EHR system and the practice requirements. There is a period even after implementation of changes and adjustments that must be made to customize the system to the practice. Physician practices have reduced their patient load as much as fifty percent during implementation to try to reduce the waiting time for patients (Braon, et al., 2005). This essentially means a reduction in revenues until everyone can perform their jobs smoothly and handle the standard patient load again. Estimates are anywhere from four to six months before normal patient load is fully resumed. Physicians have reported losing patients because the wait time to see the physician was too long during the early stages of implementation (Baron, 2005). This is a major(ip) barrier for 41 percent of physicians in making the switch to electronic records (DesRoches, 2008). Physicians are very busy by nature and a slowdown in the office creates a diverse level of frustration that has caused some physicians to put off implementation or even to reverse the work already do in adopting an EHR system and return to their paper system.Those who do make the switch from paper to electronic records will have to consider HIPAA requirements for security of an EHR system. EHR systems require the absolute storage of EHRs, which contain patients private health information and interoperability requires secure access to patient EHRs. Some physicians will choose to be on an encrypted network to share information with their local hospital, laboratories, and other health care providers. A verification process will be required to allow authorized physicians access to patients private health information and to deny access to unauthorized persons. Security of patient records is a concern for many physicians. Some physicians feel this is something that needs more standard before they will expose their patients to the risk of a breach. The diversity in the EHR systems in operation now creates issues for secured patient PHI with system interoperability.With all the diversity involved in implementing an EHR system, physicians perceive the challenges of the U.S. government mandate for the implementation of electronic health records in different ways. Some feel there are too many barriers to address before implementation of an EHR and others feel the benefits outweigh the barriers. There are as many opinions on the issues of switching to an EHR system as there are physicians themselves. Addressing issues such a s cost, security, training without a major loss in cash flow, which stems from disruption to the workflow of the office, will all stress the doctor patient relationship at least for a time. This is important because it will effect how and when the physicians adopt and use the nationwide system. The diversity in the way physicians practice medicine is individualized and the approved EHR systems will have to be flexible enough to allow for that individuality. The one thing all physicians want is to practice medicine they way they always have and meet the required mandate for Meaningful Use so they may recoup some of their investment.ReferencesBaron, R. J., Fabens, E. L., Schiffman, M., Wolf, E. (2005, August 2). Electronic health records Just around the corner? Or over the cliff? Annals of Internal Medicine, 143(3), 222-226. Retrieved from http//search.ebscohost.com/.aspx?direct=truedb=a9hAN=17875478site= ehost-liveThis obligate is written by physicians in a 4-internist practice des cribing the processes involved with converting from traditional paper medical records to electronic medical records. Baron and colleagues address the problems and issues involved, and how they worked through them. Some topics of interest include both planned and unexpected finances, training, workflow and accommodations and the overall office environment. The condition describes the realized benefits and lacking areas of standardization and interoperability. I chose this source for its overall description of actual process of implementing an electronic records system. This article also addresses computer skills and requirements.Blumenthal, D. (2009, April 9). Stimulating the adoption of health information technology. New England Journal of Medicine, 360(15), 1477-1479. doi10.1056/This article describes the portions of the American Recovery and Reinvestment Act of 2009 (ARRA) that pertains to health information technology. The article addresses barriers physicians have for implement ing the mandated electronic medical record. Financial issues including incentives, costs and financial penalties are of adopting the mandate are covered. Other areas to promote and ease the transition, such as support systems, state and regional medical information exchanges, education initiatives, and extended HIPAA guidelines with regard to electronic records and transmissions are included in this article. This article explains the incentives for implementing the electronic records system. I chose this article to explain the diversity involved in the governments promotion for adopting an electronic health record system.DesRoches, C. M., Campbell, E. G., Rao, S. R., Karen, D., Timothy, F. G., Jha, A., . . . Blumenthal, D. (2008, July 3). Electronic records in ambulatory care A national cartoon of physicians. New England Journal of Medicine, 359(1), 50-60. doi10.1056/This article is a summary of statistics and results compiled from a survey of physicians in the US regarding the ado ption of electronic health records. Documented in the survey are physician statistics and opinions in areas of usage, implementation, and satisfaction with the electronic health record systems. Issues addressed are quality of care, age groups of physicians who have adopted an electronic system and size of practices more apt to adopt electronic health records. The positive effects on practice processes, barriers that hinder adoption of electronic health records, incentives for and reservations with switching to electronic health records are included in the survey. I chose this source because it provides actual statistics of the usage of electronic health record systems as well as the diversity in physicians perceptions of the process, the systems, the benefits, and problems associated with compliance.Hayes, F. (2009, February 2). No Rx for ROI. Computer World, 43(5), 40. Retrieved from http//search.ebscohost.com/.aspx?direct=truedb=a9hAN=36487540site=ehost-liveIn this article, the se nior news columnist addresses the issue of return on investment (ROI) for the adoption of electronic health records. The definition of ROI is given and how it applies to aspects of electronic health record adoption for physicians and hospitals is examined. Risks to, benefits of, and improvements needed regarding electronic health records are noted. The author confirms that those assuming the expenses for electronic health records will not be the ones reaping the benefits. I chose this article because it covers reflects my opinion one of the most important reasons for physician resistance to implementing the government mandated electronic health record system.Hoffmann, L. (2009, November). Implementing electronic medical records. Communications of the ACM, 52(11), 18-20. Retrieved from http//search.ebscohost.com/.aspx?direct=truedb=a9hAN=45021143site=ehost-liveIn this article, a basic history of George W. Bushs goals for every American to have an electronic health record is presented along with the progress of the government in making those goals real. Usage of electronic records is briefly mentioned. The article focuses on some major barriers and concerns of physicians for implementation and usage. The article also addresses some of the positive aspects for electronic health records. I chose this article because it provides concise overall answers to who, what, when, where, and why answers to the implementation of the electronic health record and health information technology.

Caring for a Child or Young Person with Severe Illness

Caring for a tyke or Young Person with Severe IllnessIntroductionThis assignment will theorize on and critically study an incident from a clinical setting whilst using a model of reflection. This will allow me to analyse and confine smell of the incident and draw conclusions relating to personal learning outcomes. The incident will be described and analysed, followed by the process of reflection using Driscolls Reflective Model (2000) as it facilitates critical thinking and in-depth reflection which will help me to accumulate learning objectives for the future. To comply with the treat and Midwifery Council (NMC) (2015) Code of Conduct, confidentiality will be maintained thereof the individual will be known by dint ofout as Ben.Reflection is defined as a process of explaining and expressing from our own scrams and helps to develop and improve our skills and friendship towards becoming professional person practiti superstarrs (Jasper, 2003). I project chosen to use the Drisc olls Reflective Model (2000) as a guidance as it is straightforward and encourages a make water description of the situation which will allow me to look at the experience and identify how it made me feel, asking what was good and bad, and what I can learn (Sellman and Snelling 2010). Wolverson (2000) includes this as an important process for all nurses wishing to improve their practice.What? Ben was born prematurely following an emergency caesarean section, whereby he received prolonged resuscitation and dumbfounded severe hypoxic-ischaemic encephalopathy (HIE). According to Boxwell (2010), babys with severe encephalopathy have a 75% risk of dying with coma persisting, or progressing to brain death by 72 hours of action. there was a realisation that continuing treatment may be causing Ben harm in that it was unlikely to restore his wellness or relieve suffering. Boxwell (2010) provided states that survivors of HIE carry an almost certain risk of poor neurological outcome. It i s these times when setting must be given to withholding and/or withdrawing treatment, afterward re-orientating treatment to compassionate finagle. I was informed by my wise man that there would be a multi-disciplinary team (MDT) meeting to discuss and justify the decision to withdraw treatment.I was invited into the MDT meeting by my mentor to both witness and actively participate in the discussion if I felt confident enough. The MDT consisted of two paediatricians, a paediatric registrar, the neonatal sister, and myself, a paediatric student nurse. The Royal College of Paediatrics and Child wellness (RCPCH) (2004) suggest that all members of the health care team study to feel part of the decision-making process in that their views should be listened to. At the time, I was hesitant to contri scarcelye due to my familiarity, understanding and experience surrounding the clinical and honorable matter. However, I was reassured that greater openness between disciplines will facilit ate better understanding of individual roles and enhance the sense of responsibility (RCPCH, 2004).We considered what was jurally permitted and required, al angiotensin converting enzyme alike at what was honorablely appropriate. In considering quality of life (QOL) determinations, it was important to refer back to the ethical foundation involved with surrogate decision making, which is the exemplar of best interest. Some professionals argued that Ben had no prior QOL on which to base a judgment. The Children Act (1989) provides an overall statutory framework for the provision of childrens welfare and services but makes no specific provision concerning withholding or withdrawing treatment (RCPCH, 2004). It does however state that the welfare of the child is paramount which is further have goted by The get together Nations Convention on the Rights of the Child (1989). Article 3 under this legislation states that actions affecting children must have their best interests as a pri mary consideration (RCPCH, 2004).The NMC (2015) framework governs the maintenance of standards of practice and professional conduct in the interests of patients, acting as a guide to ethical practice within treat. The principle of non-maleficence is one of the hallmark principles of ethics in health care which prohibits healthcare professionals from doing any action that will result harm to the patient. Also paramount, is the goal to restore health and relieve suffering, promoting good or beneficence. In the principle of beneficence, nurses are obliged to protect, prevent harm and maintain the best interest for patients (Beauchamp Childress, 2001). Those involved needed to be condent in their ability to understand the ethical dilemmas they faced, and had to ensure they were aware of the underlying ethical principles to support their contribution to the discussion.The decision to withdraw life sustaining treatment should be made with the parents on the basis of knowledge and trust, but ultimately, the clinical team carries the responsibility for decision making, as an expression of their moral and legal duties as health care professionals. It is not uncommon for parents to feel indecisiveness, shame or guilt about the decision to palliate their neonate, particularly when the outcome of the neonates intend is uncertain (Reid et al, 2011). However, the final decision to withdraw intensive care was made with the consent from both parents, and this was clearly recorded in his clinical notes, together with a written account of the process and factors leading to the decision.So What? Parents impending the loss of their infant experience a complex emotional reaction to their situation, typically one of anticipatory grief, shock and confusion (Gardner and Dickey, 2011). They may also experience feelings of profound loss, related not still to the imminent loss of their child but also to a loss of their expectations, aspirations and role as parents (Gardner and Dicke y, 2011). Parents are fundamental in the decision-making processes around neonatal palliation and as it is they who will be the most importantly affected by these decisions (Branchett and Stretton, 2012), neonatal EOL care places a particular focus on caring for parents. Developing a flexible, transparent and family-centred care plan is essential, and so that their preferences are met, parents should take a key role in this process (Williamson et al, 2008). Spence (2011) recommends that a holistic approach is taken to clarify the familys wishes, desires and needs in aim to effectively advocate for infants.Whilst most parents wish to be involved in decisions and think around EOL care for their baby, some may find this responsibility provoke (Williams et al, 2008). Despite this, we exposed the parents to a range of options which they synthesised in order to make the best decisions for their family. However, it was important for the neonatal nurse and I to realise that highly emotiv e situations can often cause significant deficits in parents ability to comprehend and process such information (Williams et al, 2008). As competent nurses, it is our responsibility to provide nursing care that advocates for our patients rights in life and death, showing respect and dignity towards them and the family. We advocated for Ben by protecting his rights, being attentive to his needs, ensuring comfort and protection, and by participating in the ethical discussion to ensure a collaborative perspective of ethical negotiation (Spence, 2011).The National Association of neonatal Nurses (2015) suggests that alleviant care should include comfort measures, such as kangaroo care, an ongoing assessment of pain using an appropriate pain assessment tool and written care plans to manage discomfort, pain and other disconsolate symptoms such as seizures using the least invasive effective route of administration. As the parents wished to be present at time of death, the neonatal nurse vigilant the family for what they would observe as life-sustaining treatment was discontinued. This included informing them of gasping and other noises, colour changes, and stating that Ben may continue to breathe and have a heart treasure for minutes or hours. This is an fundamental aspect of palliative care, and provides the family with the opportunity to ask questions. However, a study conducted by Ahern (2013) stated that nurses often express anxieties surrounding how to support parental grief and how to prepare them for the imminent death of their infant. Parental preferences were also assessed, including whom they wish present, whether they want to hold the infant, and whether they wished to participate in any rituals or memory-making activities.Although my mentor took the lead role in planning the infants EOL care, my contribution focused on memory-making activities. Although this is often nurse initiated, making memories is increasingly cognized as an aid in parental copi ng and grieving (Schott, Henley and Kohner, 2007). However, McGuinness, Coughlan and Power (2014) reported that rather than physical keepsakes, parents and families instead appreciated other actions and gestures that demonstrated respect for their needs, including having time alone with the infant and being encouraged and supported to provide care to their baby. I asked the parents if they would like photos to be taken, and although parents declined photography, I offered to take some to keep in the medical records in case they decided they would like them at a later date which they appreciated (Mancini et al, 2014). Despite this, the parents were acceptant of the offer to keep items that were related to Bens care, including his wristband, blankets and hat.Throughout planning Bens EOL care, the effectiveness of the therapeutic relationship in meeting the familys needs was achieved by showing empathy, and by doing so I obtained the individuals trust, and respect. Carl Rogers (1961) h as influenced the shift from a task- to a person-centred and holistic view of nursing care, with the adoption of Rogers core conditions (Bach and Grant, 2005). Rogers identified unconditional positive regard, genuineness and empathy as necessary conditions for helping someone change effectively through and through a good therapeutic relationship. This was achieved through both proficient nursing knowledge and utilising interpersonal communication skills. According to Jones (2007), there is little research in nursing literature that discusses interpersonal skills, particularly in nursing education. There is also a critique that nursing education is often removed from the realities that students experience during their clinical practice (Bach and Grant, 2005). I felt confident and assured that my interpersonal skills would bring positivity throughout a very difficult time, helping them through the grieving process. I acknowledged that both parents appreciated my forward-thinking and e mpathy towards the current situation. Being empathetic during this situation required my ability to be understanding not only of the parents beliefs, values and ideas but also the significance that their situation had for them and their associated feelings (Greenberg, 2007).Egan (2010) identies certain non-verbal skills summarised in the acronym SOLER that can help the nurse to create the therapeutic space. I did this by sitting facing the family squarely, at a slight angle adopting an open posture leaning slightly forward maintaining good eye contact, without staring and presenting a relaxed open posture. To enhance the communication through these skills, I used active-listening skills to ensure a successful interaction through techniques that facilitated the discussion. I did this by using sounds of encouragement, demonstrating that I was listening and assimilating the information provided by the parents. This was also done by summarising, paraphrasing and reflecting on the feelin gs and statements. Effective use of reective skills can facilitate exploration, build trust, and slip by acceptance and understanding to the individual (Balzer-Riley, 2004). Geldard and Geldard (2005) state that it is often the paralinguistic elements of speech rather than what is actually said that betray true feelings and emotions.Now What?As EOL approached, Ben was extubated on the neonatal unit and transferred to the bereavement suite whereby my mentor continued to provide one-to-one care. I was not present throughout the final palliative care chassis as I wanted to respect the familys privacy. At this point, I held emotions of helplessness, sadness and anxiety, therefore I took some time to reflect on what had happened. It is important that nurses recognise and confront their own feelings toward death so that they can assist patients and families in EOL issues (Dickinson, 2007).Nurses often experience sadness and grief when dealing with the deaths of patients, and without any support, can suffer distress (Hanna and Romana, 2007). Debriefing is a beneficial intervention designed to help nurses to explore and process their experiences. Irving and Long (2001) suggest that debriefing demonstrates a significant simplification in stress and greater use of coping strategies through discussion in a reminiscent fashion to let their feelings out. Through reflection, I have come to the realisation and understanding that patient death is an integral part of nursing practice in palliative care settings. I have recognised that support from all members of the MDT have positive implications for nursing students coping with stressors associated with patient death.Furthermore, the experience helped me learn the importance of both verbal and non-verbal communication. As an aspiring nurse, I have to continuously improve my communication skills because I shall be interacting with more varied patients in the future. I have also been able to utilise my knowledge of ethical p rinciples in relation to withdrawing treatment, thereby integrating theory into practice.ConclusionTo conclude, the care that patients receive has the direct potential to improve through reflective practice. seemly a reflective practitioner will help me to focus upon knowledge, skill and behaviours that I will need to develop for effective clinical practice. Reflection helps to make sense of complicated and difficult situations, a medium to learn from experiences and therefore improve performance and patient care.Reference ListAhern, K. (2013) What neonatal intensive care nurses need to know about neonatal palliative care. Advanced Journal of Neonatal Care. 13(2), pp. 108-14Bach, S. and Grant, A. (2005) Communication and Interpersonal Skills for Nurses. Exeter Learning MattersBalzer-Riley, J. (2004) Communication in nurse. Mosby, MO Mosby/Elsevier.Boxwell, G. (2010) Neonatal Intensive Care Nursing. 2nd Edition. New York RoutledgeBranchett, K. and Stretton, J. (2012), Neonatal pall iative and end of life care What parents want from professionals, Journal of Neonatal Nursing. 18(2), pp. 40-44.Dickenson, G. E. (2007). End of life and palliative care issues in medical and nursing schools. Death Studies, 31, pp. 713-726.Driscoll, J. (2000) Practising Clinical Supervision. London Balliere TindallEgan, G. (2010) The Skilled Helper A problem management and opportunity development approah to helping.9th edition. peaceable Grove, CA Brooks/Cole.Geldard, D. and Geldard, K. (2005) Practical Counselling Skills An Integrative Approach. Basingstoke Palgrave MacmillanGreenberg, L.S. (2002) Emotion-focused therapy Coaching clients to work through feelings Washington, D.C American Psychological AssociationHanna, D.R. and Romana, M. (2007). Debriefing after a crisis. Nursing Management. 8, pp. 39-47.Irving, P. and Long, A. (2001). Critical incident stress debriefing following traumatic life experiences. Journal of Psychiatric and Mental Health Nursing. 8, pp. 307-314.Jasper M ( 2003). Beginning reflective practice. Cheltenham Nelson ThornesMancini, A., Uthaya, S., Beardsley, C., Wood, D. and Modi, N (2014) Practical guidance for the management of palliative care on neonatal unit. London Royal College of Paediatrics and Child HealthMcGuniess, D., Coughlan, B. and Power, S. (2014) Empty arms keep bereaved person mothers during the immediate postnatal period. British Journal of Midwifery. 22(4), pp. 146-52.National Association of Neonatal Nurses (2015) Palliative and End-of-life Care for Newborns and Infants. Chicago National Association of Neonatal NursesNursing and Midwifery Council (NMC) (2015). The Code professional standards of practice and behaviour for nurses and midwives. London NMCReid, S., Bredemeyer, S., van den Berg, C., Cresp, T., Martin, T., Miara, N., Coombs, S., Heaton, M., Pussell, K., and Wooderson, S. (2011) Palliative care in the neonatal nursery. Neonatal, Paediatric Child Health Nursing. 14(2), pp. 2-8Royal College of Paediatrics and Child Health (2004) Withholding or Withdrawing Life Sustaining Treatment in Children A Framework for Practice. London Royal College of Paediatrics and Child HealthSchott, J., Henley, A. and Kohner, N. (2007) Pregnancy loss and the death of a baby guidelines for professionals. 3rd Edition. London SANDSSellman, D. and Snelling, P.C. (2010) Becoming a nurse A textbook for professional practice. Harlow Pearson EducationSpence, K. (2011) Ethical advocacy based on caring A model for neonatal and paediatric nurses. Journal of Paediatrics and Child Health. 47, pp. 642-645Williams, C., Munson, D., Zupancic, J. and Kirpalani, H. (2008) Supporting bereaved parents Practical steps in providing compassionate perinatal and neonatal end-of-life care. Seminars in Fetal and Neonatal Medicine. 13(5), pp. 335-340.Wolverson, M. (2000). On reflection. Professional Practice. 3(2), pp. 31-34