Newborn Bloodspot Screening Test

Newborn Bloodspot Screening Test This reflection is on the use of the Newborn Bloodspot Screening Test (NBSST), which is undertaken when the newborn is between five and eight days old. I will discuss how the use of this screening test supports the assessment and well being of the newborn. The model of reflection implemented within my assignment will be the Gibbs reflective cycle (1988). I have selected this model due to the simplicity, as it guides you through the six stages of the reflective process by asking a series of questions, allowing the experience to be transformed into knowledge. Throughout this assignment I will be maintaining confidentiality in accordance with the Nursing and Midwifery Council (NMC) Standards (2004). I will therefore use pseudonyms to ensure the identity of my mentor and clients, remain anonymous. For the purpose of this assignment my mentor will be known as Michelle, the newborn will be known as Theo and his mother as Hannah. Using the Gibbs reflective cycle (1988), the first stage is to describe the event. The event upon which I am reflecting is the NBSST which I performed under the supervision of my mentor Michelle, when Theo was five days old at his home. This was undertaken with the consent of his mother Hannah who was present and observed the test being carried out. The second stage of the Gibbs cycle (1988), is to explore the feelings regarding the event. The view proposed by Bulman (2004, p.141) is that when we least expect it feelings can often affect our learning. Therefore to mention a range of feelings encountered, and the situation in which they occurred, can be useful to the learning experience. I felt in such a privileged position to be undertaking the screening test on Theo as a student midwife under the supervision of my mentor. The NMC Standards (2004), state that, every woman has the right to refuse a student to be involved in their care. Therefore Hannah had the right to refuse consent for me to perform the test, however as I had been involved in her antenatal care and built a rapport with her she was confident for me to proceed. I felt that I had gained both Hannah and Michelles trust this gave me increased confidence in my ability and practice. My mentor held Theo securely in an upright position while I warmed the heel by gently rubbing it, as recommended by Michelle. After washing my hands I cleaned the area on the heel I was going to use to perform the test. Then using the automated lancet I made a small incision in the skin, Theo let out a high pitched cry and Hannah became a little distressed. Following the instructions on the test strip I wiped away the first drop of blood to avoid contamination and subsequently dropped four good samples of blood onto the filter paper of the test strip. As soon as I had finished the test I placed a plaster on the heel and gave Theo immediately to Hannah for a comfort feed. I then filled out the information that was required on the test strip and documented the procedure in the maternity record and the Baby notes. I then notified Hannah she would receive the results in approximately six weeks time and this would be by her health visitor or general practitioner, if there was any cause fo r concern she would be notified sooner rather than later. The testing strip was then posted the same day as per the instructions. Although the procedure went well I did however feel slightly anxious when performing the test, as I was concerned about the number of times I would need to puncture the skin and how distressed Theo would become throughout the procedure. I felt comfortable after successfully obtaining enough blood samples for the test using the technique my mentor had provided me with and relieved that I had caused minimal distress to Theo and reassured as he was easily comforted following the distress of the test. Evaluation is the next stage in the Gibbs (1988), reflective cycle. As suggested by Taylor (2006) evaluation is the element of the process in which the situation is reviewed in light of all the feelings gained. Upon evaluating the experience I believe I had successfully performed the technique, and in doing so had enabled me to collect satisfactory samples for the test. I had excellent communication with Hannah and the continuity of care from the antenatal to postnatal period had enabled her to trust me and my confidence had grown immensely. I had been out on community placement, before so my knowledge base had increased so I was therefore able to use this and the skills I had learnt from my mentor to inform my practice. The negative aspect of the experience was the concern for Theo regarding the pain he would feel when attempting the test, and the high pitched cry that he released upon puncturing the skin was quite distressing for me and his mother Hannah. Following the evaluation of the experience, the Gibbss reflective cycle (1988), states that analysis of the situation is undertaken exploring the experience in greater detail. The NBSST is undertaken on a national scale, the UK Newborn Screening Committee (NSC) (2005), test the samples for metabolic disorders which can be treated, such as Phenylketonuria, Congenital Hypothyroidism, Sickle Cell Disorders, Cystic Fibrosis and Medium Chain Acyl-CoA Dehydrogenase Deficiency. The disorders screened for are subject to regional variations, however in my local placement area, all of these conditions are currently tested for as recommended by the NSC (2005). The purpose for conducting this screening test, is to detect the disorder at a stage early enough to introduce effective treatment to prevent the disease or condition from affecting the newborns development (Johnston, Flood Spinks 2003). The NBSST is not a compulsory test, the National Institute for Clinical Excellence (NICE) (2006), state that for the well being of the newborn, the test must be offered to all parents when their newborn is five to eight days old. They also suggest that the parents should be encouraged to be present when the test is undertaken. This was performed on Theo the fifth day after delivery and Hannah was present for the procedure. The UK Newborn Screening Programme Centre (UKNSPC) Guidelines for Newborn Blood Spot Sampling (2008) (Appendix 3), state that women should be provided with the relevant screening leaflet in the third trimester and no later than 24 hours prior to conducting the test. This has been developed to enable parents to make informed decisions about the screening and well being of their newborn. However a study undertaken by Cavanagh, Coppinger Franck (2005), found that all midwives involved in the study gave information to parents prior to the test, although there were large variations in the timing and frequency in both the antenatal and postnatal period. The UKNSPC (2008) also state that the test should ideally be performed on day five and verbal consent from the parents is required and must be documented in the maternity record and the baby notes. The NMC (2004) also states that midwives must provide the woman and her family with the information to allow them to make informed choices about the care of their newborn in a form that they can understand, and maintain accurate record keeping. McCullough Chervenak (2008), state that informed consent requires the physician to firstly disclose information to the client and must then obtain the clients acceptance or refusal. They must disclose material information, this being what the client needs to know regarding the procedure and what a person of average sophistication should not be expected to know (McCullough Chervenak 2008). This was carried out with Hannah on the visit prior to performing the test, I had asked Hannah to read the leaflet she had been given on discharge from the hospital prior to giving her permission for the test. On the day of the test before I proceeded on Theo I asked Hannah if she had read and understood the leaflet and if she had any questions, she confirmed this and had no questions, Hannah then gave verbal consent for me to continue. Upon completion of the procedure I fully documented the information in Hannahs maternity record and Theos baby notes. Cavanagh, Coppinger Franck (2005), stated in their study that prior to performing the test, the warming of the newborns foot was undertaken in most instances. However Janes et al. (2002), found in a controlled trial that there showed no differences in the time taken to collect blood, the number of repeat procedures required or the behavioural responses of the newborn, between warmed or un-warmed heels. The study performed by Cavanagh, Coppinger Franck (2005), showed that the positioning of the newborn for the test also varied, despite strong evidence to suggest that the newborn should be in a secure position and cuddled when undertaking the test. The UKNSPC (2008) state in their multi professional guideline an automated lancet should be used on the heel and that the heel should be warm and in most cases additional pre-warming should not be required. They also state that the newborn should be cuddled in a secure position for the taking of the sample. Upon performing the test on Theo I rubbed the heel to warm it as recommended by my mentor and Theo was held by my mentor whilst the test was carried out. The NMC (2004), state that other health professionals should be involved in the care of the woman or baby, when a situation deviates from the midwives normal responsibilities. I therefore advised Hannah that she would be notified of the results in approximately six weeks time by her health visitor, and if there were any concerns then both the health visitor and General Practitioner would be notified and she would be informed as soon as possible. Shepherd, Glenesk, Niven Mackenzie (2005) suggests that the procedure of the screening test is easy to complete however the pain experienced by the newborn and the anxiety of the parents is of concern. When performing the test on Theo I was successful in obtaining a satisfactory sample with only one incision however it was evident that this had caused pain due to the immediate cry upon commencement. In conclusion the neonatal screening test is an important element of the care and well being of the newborn, if these conditions are identified, early treatment can improve health and prevent severe disability or even death (NSC 2005). The new guidelines published by the UKNSPC (2008) reflect the findings from studies I have researched and are based on the recommendations concluding the studies. My action plan for the future is use to evidence based practice when performing the NBSST taking into account the factors highlighted in this assignment with regards to warming of the heel and positioning of the newborn. I am confident in my skills with regards to the incision using the lancet and my communication with the parents.

Informational Interview

Samuel Tiras is the Department Chairman in the E. J. Ourso College of Business Accounting Department at Louisiana State University. His job consists of full management of the accounting department, evaluation of performance, fundraising, handling student complaints, research, and evaluating tenure requests responsive to demands from the dean. Sam spends most of his time during the day in meetings, talking to people about various issues concerning the department, or its research. For a desk job, he does not stay in one place all the time, rather he is mostly up moving around from one place to another, working on whatever needs to be focused on at that time. Giving advice to students about their career decisions is one of Sam’s favorite things about his job, whereas his least favorite is handling the constraints of the budget and faculty evaluations. Before working here at LSU, Sam started off working as an international auditor at the age of 23, traveling to many different places, as well as living in the Northwest for some years. After that experience, he continued to find jobs within universities, until he came upon the opportunity at LSU, which he stated, â€Å"sort of just fell into my lap†. When the position was offered to him, his motive was because he wanted to see the accounting department to move in the direction he desired, in order for it to improve with its teaching research and service missions. He thinks his job is a fun one, sometimes a bit difficult, but much easier now working atmosphere, always learning something new and never has anything too repetitive to deal with. He enjoys his job very much, is comfortable where he is, and is not sure if he would take on any new options given to him right now. He advises anyone interested in this field to prepare to be flexible, and to find time to be able to concentrate on your own research. I personally am not sure if I would be interested in this sort of job; although it does seems fun, I would more likely be willing to consider this sort of job later in my life, when I have the experience and know what direction I would like to go with my career. He gets to work around his schedule well, being able to make it to his son’s baseball games while handling business over the phone. He did note that his phone is what helps make his life so much easier, being able to access his email and have anyone contact him wherever he may be so he is able to do his job well. I had a wonderful time talking to Mr. Tiras, for he is easy to talk to about anything you are interested in. He is a great listener, and helped me try to decide on what concentration in business that I would like to graduate with, which degrees would be best for what I want to do later in life, and where I should start looking for jobs that will help give me the experience needed to obtain my experience. I enjoyed having the interview with him and hope to see him again in the near future for further discussions.

Massacre of the Dreamers

Ana Castillo, the author of â€Å"Massacre of the Dreamers: Essays on Xicanisma† explores the 500-year old roots of Chicano feminism in America. Her collection of short essays dedicated to the issues of Xicanisma is aimed to denounce discrimination, the stereotypes and exploitation of Chicanos in the U.S. She begins her collection of essays by the phrase â€Å"I am a brown woman, from the Mexican side of town† and continues the confession with the astonishing confession, – â€Å"At an early age we learn that our race is undesirable† (Castillo, 1994). Chicanos â€Å"have been marginalized in every sense of the word by U.S. society† (Castillo, 1994). Probably, it seems too terrible to be true, but this what Ana Castillo asserts.The writer imitates no standard and generally accepted literary style of those times. The essays have no lack in tension, strength and dynamics. Ana Castillo doesn’t deviate from the theme, despite being limited by gende r bounds. This woman wrote the book in the course of important cultural and social changes; therefore Massacre of the Dreamers deserves detailed exploration. It is apparent, that Mexican-American literature cannot but place emphasis on social, feminist and racial issues. In this regard Castillo’s collection of essays can be called a perfect example of the literature of ‘resistance’. Ana Castillo tells not only about the loss of culture and land, but also the role offered to Mexicans. The ‘promised paradise’ turned into the land of changes and struggle for national identity.Ana Castillo evidently created her unique literary work at the intersection of numerous factors of social, political and cultural life at that time. The ‘historical chronicle’ brings the reader closer to the understanding of deep philosophical, social and political conflicts, patriarchal prejudices, gender stereotypes, nationalism, racism, the interests of influential academic structures of American society and mass media. Massacre of the Dreamers is notably complex, contradictory and ambiguous; it reflects the change in stereotypes, transformation of cultural and social space in U.S.The success of Castillo’s book can be explained not only by the ability of the author to tell the stories of Chicano movement, but, above all, by the ideological pathos of her essays. Ann Castillo tells the stories of discrimination and racism. She reminds that changes in social status and structure of people of Mexican origin created social and political prerequisites for mass movement of protest – Chicanos.The Chicanos movement was shaped in the image and likeness of any other movements; the ideology was based on the fact that Mexican Americans were people deprived of right for their territory. These people were treated like the objects of political and economic exploitation, and the second-rate nation. The writer dwells on inequality in economic, soc ial, political and cultural life of America, on long-standing discrimination in sphere of employment, focusing attention on high unemployment and crime rates, to mention a few.Ann Castillo dwells on the issues of language discrimination. Although Mexican Americans spoke Mexican language, in contrast to other ethnic groups, the system of education refused to take into account the peculiarities of â€Å"Spanglish† nation. The vast majority of Chicanos had to leave schools with no education necessary to get a qualified job. The language barrier was the main obstacle on their way.Ann Castillo brings the understanding that Chicanos accepted no ‘melting pot’ theory, according to which Mexican Americans had to refuse from their culture, language and traditions. The writer presents a proof of revolutionary consciousness and testimony, signaling real hope and inevitable changes. She even criticizes a ‘white feminism’, traces ancient Mediterranean roots for ma chismo, explores the moral dualism, repression of sexuality, and fear of death.Ann Castillo demands justice, writing that â€Å"When we profess a vision of a world where a woman is not raped somewhere in the United States every three minutes, where one of every three female children does not experience sexual molestation, where the Mexican female is not the lowest paid worker in the United States–we are not male-bashing or hating whites because overall they live a healthier life than we do, we are trying to change the facts of our condition† (Castillo, 1994).Massacre of the Dreamers can be compared with an ‘alternative’ letter, which is set off against patriarchal culture of that time. Ann Castillo’s literary style is a multilevel and dynamic system. The basis of her writing is feminist social and even literary movement, as well as radical changes in social conscience, attempt to overcome ‘masculine’ diktat, racism, the feeling of infer iority, gender stereotypes and clichà ©s. It seems that the writer’s main idea is to offer the alternative – not a mere equality, but creative cooperation and complementarity of cultures.Ann Castillo treads on forbidden ground. She dwells on problematic relationships between Chicanos and Americans, the issues of power and superiority of nations. She tells on correlation between racism both in literature and real life. The writer criticizes patriarchal culture with its racist’s values, and places emphasis on the necessity of self-realization through creative work. She strives for language expressiveness and makes an effort to create the independent Mexican American character.Massacre of the Dreamers sends a challenge to traditions, rules and stereotypes. Probably, she is not the first writer, who tries to express the history of Mexican Americans in U.S. but she is the first feminine writer, presenting a collection of the most acute and detailed literary confessi ons.Ann Castillo created the most brilliant and sometimes ironical essays. Although she writes from a palette consisting almost exclusively of grey and mud brown gloomy tones, she is extremely frank describing all nuances of Chicanos and their movement, their desires, fears, emotional experiences and doubts.ReferencesCastillo, A. (1994). Massacre of the Dreamers: Essays on Xicanisma. Albuquerque: University of New Mexico Press.

11 Funny Quotes About the Good Ol School Days

Whats the best part of school life? Some would vouch for the great education, the great learning experience, the knowledge sharing, and other such scholarly pursuits. But many would admit that the best part of school life is all the fun one has. These funny school quotes will take you on a trip down memory lane. Share them with your school buddies and renew old ties. Funny School Quotes Beatrix PotterThank goodness I was never sent to school; it would have rubbed off some of the originality.William GlasserThere are only two places in the world where time takes precedence over the job to be done: school and prison.Jeff FoxworthyI have never been jealous. Not even when my dad finished fifth grade a year before I did.Will RogersThere is nothing so stupid as the educated man if you get him off the thing he was educated in.Heinrich HeineIf the Romans had been obliged to learn Latin, they would never have found time to conquer the world.Mark TwainIn the first place, God made idiots; that was for practice; then he made school boards.Woody AllenI was thrown out of college for cheating on the metaphysics exam: I looked into the soul of another boy.Will DurantEducation is a progressive discovery of your own ignorance.Albert EinsteinIt is a miracle that curiosity survives formal education.Norm CrosbyMy school was so tough the school newspaper had an obituary section.B. F. Skin nerEducation is what survives when what has been learned has been forgotten.