Sickle cell disease, an disease of red blood cells

Sickle cell disease, an disease of red blood cells Introduction This paper presents a detailed overview of sickle cell disease, an inherited disease of the red blood cells. The paper begins with a brief discussion of the aetiology, prevalence of sickle cell disease. Next the paper investigates the pathophysiological aspects of the disease and the physical manifestation of symptoms the patient presented with. The paper then discusses how sickle cell disease affects suffer. Finally the paper presents and evaluates treatment and management of care. The conclusion will provide a summary of the points discussed. Sickle cell disease (SCD) encompasses a group of haemo ­globinopathies. There is currently no cure for adults with this hereditary disease, which mainly affects people of Afro-Caribbean origin and, to a lesser extent, Mediterra ­nean, Middle Eastern and Asian groups. There are large numbers of people around the world who suffer from acute or chronic pain, or indeed both, as a result of sickle cell disease. Sickle Cell Society (2008) estimates that sickle cell disease affects approximately 10 000-12 500 people in the UK. Sickle cell disease comprises of a group of inherited blood disorders that alter a persons haemoglobin, causing chronic haemolytic anaemia and producing acute and chronic pain as a result of reoccurring episodes of vascular occlusion (Lal. and Vichinsky, 2005). Adult haemoglobin consists of two alpha globin and two beta globin chains wrapped around a haem (iron containing) molecule. Haemoglobin is the main substance of the red blood cell. It helps red blood cells carry oxygen from the air in the lungs to all parts of the body. Normal red blood cells contain haemoglobin A. Haemoglobin S and haemoglobin C are abnormal types of haemoglobin. Normal red blood cells are soft and round and can squeeze through tiny blood tubes (vessels). Normally, red blood cells live for about 120 days before new ones replace them. People with sickle cell conditions make a different form of haemoglobin A called haemoglobin S (S stands for sickle). This is caused by mutation in the beta chain which means the haemoglobin has a lower affinity for oxygen that causes sickle cell anaemia is the most common (Serjeant Serjeant, 2001). The mutation causing sickle cell anaemia is a single nucleotide substitution (A to T) in the codon for amino acid 6. The change converts a glutamic acid codon (GAG) to a valine codon (GTG). The form of haemoglobin in persons with sickle cell anaemia is referred to as HbS (Bain, 2002). The nomenclature for normal adult haemoglobin protein is Hb. Red blood cells containing mostly haemoglobin S do not live as long as normal red blood cells (normally about 16 days) (De, 2005). They also become stiff, distorted in shape and have difficulty passing through the bodys small blood vessels. De (2008) explains when sickle-shaped cells block small blood vessels, less blood can reach that part of the body. Tissue that does not receive a normal blood flow eventually becomes damaged (Serjeant Serjeant, 2001). This is what causes the complications of sickle cell disease. People who inherit the mutation from both parents or the mutation from one and thalassaemia (lack of a beta chain) from the other will suffer sickling. Those who inherit the mutation from only one parent will be sickle cell disease carriers and rarely display symptoms (Information Centre for Sickle Cell and Thalassaemic Disorders, 2008). Patient X presented in accident and emergency (AE) in sickle cell pain crisis. Vaso-occlusive pain is caused by the tendency of sickle haemoglobin molecules to crystallise, distorting the red cells into crescent shapes on deoxy ­genation, occluding small blood vessels. Disrup ­tion of normal circulation leads to acute tissue ischaemia and secondary inflammation and, when prolonged, infarction of bone, joints and vital organs (Elander et al, 2004). According to Information Centre for Sickle Cell and Thalassaemic Disorders (2008) vaso-occlusive pain episodes experienced by patients with sickle cell disease vary tremendously in frequency and severity. Some patients rarely have painful crises, while others spend the greater part of a given year in the hospital receiving analgesics (Anglin, 2007). The cooperative study of the natural history of sickle cell disease showed that about 5% of patients accounted for one-third of hospital days devoted to pain control (cited in Johnson, 2004) . To complicate matters further, the pattern of pain varies over time, so that a patient who has a particularly severe year may later have a prolonged period characterized by only minor pain. According to Sickle Cell Society (2008) the frequency and severity of vaso-occlusive pain episodes often change as a person moves from childhood to being an adult. The breakpoint often occurs during the late teens or early 20s. Changes in hormonal status that occur during these years could contribute to the changes in severity of sickle cell disease (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). However, no causal relationship has been established, so the association remains only temporal. The mode of onset of sickle cell pain crises likewise varies. Roberts de Montalembert (2007) states patients can develop agonisingly severe pain in as little as 15 minutes. In other instances, the pain gradually escalates over hours or even days. Acute tissue ischaemia is associated with extreme pain, which may last from hours to weeks. The average duration is 5-7 days (Johnson, 2004) and the episodes are usually self-limiting. Streetly (2005) stresses prolonged infarction can lead to a multitude of compli ­cations, such as organ damage, degeneration of the spine and joints, and ischaemic leg ulcers. These compli ­cations are associated with chronic pain and disability. The sites affected in acute painful crises vary for each patient. Pain occurs commonly in the extremities, thorax, abdomen, and back (Oni, 2009). Pain tends to recur at the same site for a particular person. For each person, the quality of the crisis pain is usually similar from one crisis to another. Patient X had been managing the pain at home with paracetamol, heat rubs and 50mg of diclofenac a non-steroidal anti-inflammatory drug (NSAID). Sickle Cell Society (2008) states most patients manage episodes of pain at home. Oral analgesics, combined with rest and fluids often allows a person to ride out the pain episode. Some patients report that warm baths or warm compresses applied to aching joints ameliorates the severity of the pain (Roberts de Montalembert, 2007). Patient Xs pain became progressive worse so presented in AE for stronger opioid medication. According to the Trust policy a comprehensive, multidisciplinary team strategy is essential, particularly for managing patients with fre ­quent acute or chronic pain. Therefore, on admission patient X was assessed by the doctor and a pain assessment was undertaken by the nurse. According to Wright Adeosun (2009) patients presenting in accident and emergency departments with a painful episode should be immediately triaged and administered analgesia within 15 minutes of arrival and a prompt, accurate pain assessment is the cornerstone of effective pain management. It should include pain site, duration, score, character, exacerbating and relieving factors, associated symptoms, previous analgesia and physical examination. Ideally, the assessment tool would be locally recognised and used and therefore be familiar to patients. Moreover assessment should be prompt to expedite pain relief and allow life-threatening syndromes, such as acute sickle chest syndrome, to be treated urgently (Johnson, 2004). During the assessment patients will benefit from reassurance that they are believed when they report pain and that med ­ication will be delivered swiftly. De (2005) however reports incidences where healthcare professionals have not believed the patient report of pain which resulted in the patient displaying pseudo-addictive behaviour in an attempt to manage their pain and receive appropriate analgesia. This behaviour is an iatrogenic syndrome resulting from poorly treated pain (Serjeant Serjeant, 2001). According to Stuart Nagel (2004) without adequate knowledge of prompt assessment and management and how this can manifest, pseudo-addictive behaviour, such as groaning or other physical behaviour where the patient is trying to demonstrate that they are in pain, can be misconstrued as behaviour associated with substance addiction. Such behaviour could be, for example, aggression, conflict and arguments about analgesia. Wright Adeosun (2009) contends it is important to remember tha t this behaviour, although similar to behaviour found in substance dependence, is actually a result of poor pain management and is an indicator that this person needs their pain management approach reviewed urgently. In line with the Trust policy patient X was triaged within 15 minutes and during the evaluation, the doctor asked patient X whether the pain feels like typical sickle cell pain. Most patients can distinguish back pain due to pyelonephritis or abdominal pain due to cholecystitis, for instance, from their typical sickle cell pain (Anglin, 2007). De (2005) contends if the quality of the pain is not typical of their sickle cell disease, other causes should be investigated before ascribing it to vaso-occlusion. As this was typical of patient Xs sickle cell disease the doctor prescribed morphine 10mg titrated against the level of pain. Opioid-agonist drugs like Morphine are the mainstay of treatment for acute sickle cell disease pain and can be given orally. The dose must be titrated appropriately to reflect the drugs thera ­peutic duration of action and the intensity of the pain. Johnson (2004) contends patients whose pain is severe enough to warrant hospitalisation usually require opio ids. Morphine an agonists, opioid and it works by attaching to opioid receptors. There are four types of receptor: mu (ÃŽÂ ¼); delta (ÃŽÂ ´); kappa (ÃŽÂ º); and opioidreceptor- like (ORL). The ÃŽÂ ¼ receptors are thought to be responsible for most of the analgesic effects of the opioids and for some of the main unwanted morphine derivatives which include respiratory depression, hypotension, sedation, nausea, pruritis, constipation and dependence (Hall, 2009). Drugs may then need to be given to relieve and prevent analgesic side-effects (Hall, 2009). The morphine was administered intramuscularly (IM) however Johnson (2004) argues that pain relief occurs more slowly with intramuscular injections, and the injections themselves can produce substantial discomfort. Consequently, intravenous administration of analgesics is usually preferable. Maxolon 10mg was prescribed intravenously (IV) because of the undesirable side effects commonly associated with opioids. Opioids may induce nausea and vomiting by stimulating the chemoreceptor trigger zone, reducing gastrointestinal motility or increasing vestibular sensitivity (Hall, 2009). Evidence shows that nausea and vomiting can negatively affect the quality of life of patients in term of functional outcomes, patient-perceived care by hospital staff and patient satisfaction with regard to overall hospital stay (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). Identifying the incidence of nausea and vomiting and characterizing the prescribing of antiemetics are necessary in an effort to improve tolerability of opioids. Maxolon injection contains the active ingredient metoclopramide hydrochloride, which is a type of medicine called a dopamine antagonist (British National Formulary, 2010). Metoclopramide works primarily by blocking dopamine receptors found in an area of the brain known as the chemoreceptor trigger zone (CTZ). The CTZ is activated by nerve messages from the stomach when an irritant is present (Hall, 2009). Once activated, it sends messages to the vomiting centre in the brain which in turn sends messages to the gut, causing the vomiting reflex. Blocking the dopamine receptors in the CTZ prevents nausea messages from being sent to the vomiting centre. This reduces the sensation of sickness and prevents vomiting (Finlay, 2004). Once both drugs had been administered the role of the nurse was to monitor effectiveness and to reassess the pain score. Patient X was encouraged to report any further pain accordingly. According to Johnson (2004) as pain control improves, the analgesia should be maintained to prevent the patient from slipping back into a painful cycle. Patient X was then nursed in the observation unit and after 2 hours reported increasing. After being reviewed by the pain team a patient controlled analgesia (PCA) was offered. The popularity of PCA has generally risen since a report published by the Royal College of Surgeons of England and the College of Anaesthetists (1990), and PCA is now regarded as a routine, safe modality associated with high levels of satisfaction among postoperative patients (Ballantyne et al, 1993). While much has been written about PCA in connection with postoperative pain, comparatively little has been reported in connection with sickle cell disease pain. Of the few studies focusing on PCA use by sickle cell disease patients, Gonzalez et al (1991) has attempted to measure patients acceptance of PCA, and then only as the secondary goal of a clinical trial. In a much early pilot study of three adolescents with sickle cell disease Schechter et al (19880 suggested that drug usage may dramatically reduce as pain subsides, but the intended trial was never conducted because doctors feared it might fuel patients propensity for addiction. The Society Cell Society (2008) however report that some sickle cell patients actually disliked receiving morphine because of its association with drug abuse and addiction and Johnson (2003) findings indicate that some sickle cell disease patients prefer to receive PCA to promote fast and predictable pain relief and give themselves a degree of control over their pain. Moreover, continuous subcutaneous infusions have been used to counteract any delays between intramuscular and intravascular injections (Hall, 2009). This also takes away the reliance on the next dose having to be delivered by health professionals and thus promotes patient autonomy. The role of the nurse was to teach patient X and his family about the medication: description, action, effects, and possible side effects. Johnson (2003) stresses the importance of reinforcing that analgesics make pain manageable and it may not take the pain away completely. The subcutaneous route was used for the PCA. Diamorphine was prescribed because it has the advantage of being more water and lipid-soluble, making it more rapid acting, easier to inject in smaller volumes such as 5-10mg per ml subcutaneously (Hall, 2009) and avoids absorption problems (Rees et al, 2002). Typically, bolus doses of diamorphine need to be higher than in postoperative PCA regimens, for example 5-30mg, and lockout times longer, which can be 20-60 minutes. To increase safe practice around the use of PCAs, a double check of pump settings and medication orders is required when a new syringe is loaded into the PCA system and with subsequent dosage changes. This double check was performed by the nurses and documented on the PCA chart on an hourly basis. Hall (2009) points out that patient can become drowsy as their pain is controlled. Often, this reflects the fatigue that comes with one or more sleepless nights with pain crisis at home. Johnson (2004) reinforced by Oni (2009) argue that the analgesics should not be discontinued automatically for somnolence as long as the patient is easily aroused. A common misconception is that if a patient with sickle cell disease is sleeping, the analgesics are controlling the pain. Rees (2003) contends sickle cell disease patients often sleep despite severe pain. Therefore, when a PCA has been commenced the nurse should evaluate the patient for respiratory status (rate and depth), sedation level, side effects, and pain severity 2 hours x 12 hours, then 4 hours thereafter (De, 2005). A pulse oximetry was used to monitor saturations levels and patient X was commenced on 2 litres of oxygen as it is in their deoxygenated state that red blood cells containing Hb S take on their abnormal, rigid half-moon-like state (Information Center for Sickle Cell and Thalassaemic Disorders (2008). Research suggests that sickled cells can actually regain their normal disc shape when exposed to a higher oxygen concentration (Zipursky et al, 1992 cited by Sickle Cell Society, 2008). When oxygen therapy is being administered De (2008) advocates an upright position as this position optimises and maintains ventilation and perfusion. Patient X needed assistance due to the pain to sit upright and a mouth care tray was provided due to the side effect of oxygen therapy causing dryness of the nasal and oral mucosa (Sheppard and Davis, 2000). A jug of water was also made available at the bedside and the call buzzer was left in easy reach. Effective management of an episode of painful sickle crisis according to Lal and Vichinsky (2005) requires intravenous fluids as this will help to decrease blood viscosity, improve blood flow and reduce risk of renal compromise. Providing adequate hydration is a component of almost every treatment protocol for vasoocclusive crises (De, 2005). Dehydration is one of the principal precipitating factors for pain crises. However, overcorrection of fluid balance can have a negative effect, including possibly increasing the risk of acute chest syndrome. This syndrome, characterized by cough, chest pain, dyspnoea, fever, and radiographic changes, is the most common cause of death for patients with sickle cell disease (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). Stuart and Nagel (2004) suggest hydration should be provided to correct deficits, replace any ongoing losses, and maintain normal body fluid volume (euvolemia). In addition, to this the patients pain may improve with oral hydration. Patient X was prescribed 1 litre of intravenous (IV) normal saline over 8 hours and oral hydration was encouraged by the nursing staff. This was monitored on the fluid balance chart. Patient Xs vital signs temperature, pulse, blood pressure were continuously monitored to detect any changes. Patients with sickle cell disease are susceptible to overwhelming infection (Wright Adeosun, 2009; Stuart Nagel, 2004). The most significant factor is splenic autoinfarction during childhood (Sickle Cell Society, 2008). Functional asplenia leaves patients vulnerable to infections with encapsulated organisms such as Streptococcus pneumoniae and Hemophilus influenzae. Further, some studies suggest that neutrophils do not function properly in patients with sickle cell disease (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). How the mutation in sickle cell disease might lead to a defect in neutrophil function is unclear. Patients with SCD and unexplained fever should be cultured thoroughly. If the clinical condition suggests septicaemia, the best action is to start broad spectrum antibiotics after complete culturing. Signs of systemic infection include fever, shaking chills, lethargy, malaise, and hypotension (Oni, 2009). Patient remained apyrexial and 2 days after admission the quantity of analgesia was slowly reduced as patient Xs symptoms improve. While the tapering of intravenous analgesics can require only two or three days, control of a full blown crisis often requires 10 to 14 days. Less commonly, bouts of sickle vaso-occlusive pain require several weeks to control. In conclusion this paper has presented a detailed overview of the management of pain in sickle cell disease, an inherited disease of the red blood cells. Sickle cell disorder can have a profound effect on a persons life. Acute painful episodes among patients with sickle cell disease may occur in any body part or several sites simultaneously. A thorough pain assessment will indicate the type of pain management approaches that are most likely to be effective. Patients should always be encouraged to engage in activities that will help them manage their own pain and boost their confidence rather than make them dependent on health care professionals. This case profile has highlighted the importance of optimal care for a patient with sickle cell disease which should be a comprehensive, multidisciplinary team approach with prompt, accurate pain assessment as this is the cornerstone of effective pain management.

The Use Of Setting In A & P Essay -- essays research papers

The setting of 'A & P'; is quite usual for a regular grocery store on a weekday. The town is north of Boston, five miles from the beach. Since the store is right in the middle of town, banks and churches and the newspaper store can been seen from the front doors. The day is Thursday, so there is not very much business. Outside, the sun can be seen on the pavement. The main character, Sammy, is almost nineteen years old and his coworker, Stokesie, is twenty-two and married. The manager, Lengel, is gray and teaches Sunday school. The setting in John Updike's story, 'A & P';, is used as a way to show humor and realism.   Ã‚  Ã‚  Ã‚  Ã‚  Updike uses the setting in a way to show humor. In the beginning, Sammy is ringing up an older woman's groceries when three bathing suit clad girls walk in. Sammy, of course, forgets what he is doing momentarily, and rings up a box of HiHo crackers twice and the old woman catches the mistake (Updike 316). 'She's one of these cash-register-watchers, a witch about fifty with rouge on her cheekbones and no eyebrows, and I know it made her day to trip me up,'; Sammy thinks about the old woman (Updike 316). Updike also makes humorous descriptions of all the other customers. They are referred to as sheep because of the way they move about the store without anything on their minds except what is on their lists (Updike 318).   Ã‚  Ã‚  Ã‚  Ã‚  The setting also gives a sense of realism in the story, making everything describ...

Free Essays - Criticism of My Antonia :: My Antonia Essays

Criticism of My Antonia       My Antonia by Willa Cather is a novel based on the memories of the protagonist, Jim Burden. Many critics have criticized this novel, and have focused on such literary elements as symbolism, motif, and characterization. The strongest argument however is the one that states that the foundation of every element in the book is based on the personal memories of Willa Cather.    Many critics have discussed the symbolism in this novel. One symbol that some critics have discussed is the plow. It was said that the plow suggests a way of life that not only helps the land to flourish but the individual as well (Brown). Another symbol that many critics discuss is Marek Shimerda. The fact that Marek has webbed hands and feet sets him apart from the other "normal" children who seem to represent creativity and innocence (Shaw). The road that Jim Burden travels on is another symbol that critics focus on quite a bit. It is said that the road symbolizes the "road to destiny" that America itself takes. (Brown). Critics have also pointed out that the red dust that covers everything, the intense heat, the burning wind, the wilting oak groves, and the stifling vegetation represent oppression, paralysis, submergence, and loss of vitality (as in the old ways of life) as opposed to the alternatives of the new world such as discovery and recovery (Holmes).    One thing that many critics have discussed is that the plot of My Antonia revolves around the ideas of childhood and the fact that the structure of the novel is centered around scenes that have to do with children. This shows up in the beginning of the book as ten year old Jim is riding the train from Virginia to Nebraska; and at the end of the book when all of Antonia's children are around (Shaw). A contrasting motif to that of childhood is adulthood. Throughout the book, Cather describes how adulthood has many hardships as compared to the carefreeness of childhood.    Another element of the novel that critics spent a lot of time discussing is characterization. One critic pointed out the fact that many of the characters in My Antonia have imperfections in their physical appearance that seem to bring out the imperfections of society that exist, and put the ideas of "social perfection" on the back-burner (Randall).

Potential Abuse of Human Cloning :: Argumentative Persuasive Topics

Potential Abuse of Cloning It is understood that using forms of genetic manipulations has great potential, if the usage is based on the idea that it will be used to improve agricultural production, medicine technology, and the like. To use cloning as a coping device for those who mourn loved ones, or simply cannot deal with nature's life and death process, however, is simply wrong. It is not only idealistically wrong, but ethically, morally, and even lawfully unjust. If cloning human beings becomes a reality, it will be the process that will slowly deteriorate the diversity of the world, and the ability for people to deal with negative occurrences in their life. Ethically and politically cloning seems to be breaking all the rules, already. Supporters of cloning are pushing for a reform of any law or constitutional right, banning cloning, to be changed. Cloning is currently backing an ethical uproar around religious communities, due to its new explosion of advancements. Contemplations of a new race, and its laws, are already in the making.Despite the hoards of people who are anxiously gathering to ban it, scientists are continuing to push forward with experimentations.Some of them believe that no matter if a person, or group, likes cloning or not, they better learn to deal with it because it will not be stopped.It is hard to say whether or not the growing populations who are against cloning will be able to do anything to prevent it as a whole, or even partially.Regardless of how the U.S. chooses to deal with this issue, each country has their own plans and opinions.There are many variations on the new cloning policies, and the outcome of th is new technology will be very interesting to see. There are three different types of cloning.The first two are somatic manipulation and germline genetic manipulation.Somatic manipulation only changes the somatic gene makeup of a single person (their physical appearance).Germline genetic manipulation, however, passes all manipulated genes throughout the future generations (so any odd physical appearance or disease that is eliminated in one child will be forever eliminated in it's heritage line) (Hayes pars. 10-11). Many doctors are now suggesting parents test their unborn children and cure them of any maladies they could possibly encounter during their entire life through somatic manipulation (mostly including major outwardly physical disabilities).This way they can do everything possible to "perfect" their child's outward appearance and mental abilities prior to birth.

Explain the role of effective communication Essay

A common form of communication is texting. This electronic form is used every day and can be used as a replacement for voice utilized conversation if the communicator is unable to speak. Another form of communication is drama. Drama is an expressive art and is often used as a way to allow people to express themselves emotionally in meaningful ways or to relay a message. Sign language is an important form of communication as it aids communication with individuals who are unable to hear or speak. It consists of the use of the hands forming different shapes, movements or symbols to represent a word or phrase and it becoming increasingly popular. In health and social care, effective communication is essential and significant as it ensures that workers are doing their jobs correctly and patients are in good care. This means that workers need to communicate with a wide range of people such as colleagues, professionals, workers from different agencies and patients. When communicating with colleagues, health and social worker need to make sure they are being polite and respectful as not only does this build a strong working relationship, but it is also a way of practicing how to speak to patients and others who use the services. Having a strong working relationship with colleagues ensures that health and social workers are able to listen effectively which is highly important as they will need to know and remember important information about their job and patients. It also helps to build trust as, like with patients, workers must try to keep and respect the confidentiality of others. People who work in professions often have ‘language communities’. A ‘language community’ is a professions individual form of communication that contains unique words and phrases that are particular to that profession. When health and social workers are communicating with people from different professions it is easy for them to misunderstand each other, there for it is important for the workers to listen carefully and check to ensure that they understood correctly to avoid and problems later on. Likewise, health and social workers also need to make sure that when they are communicating with patients and others who use the services that they are explaining themselves properly and not using their community language so the patients will understand. Also, when  communicating with professionals from different agencies, it is important for health and social workers to be aware that not everyone is from the same language community so it is necessary to take extra care and communicate in a way that everyone will understand. There are two types of interpersonal interaction; verbal and non-verbal. Verbal communication most often refers to speech. People from different areas, backgrounds and professions often have different variations of speech depending on the words and phrases that they use; this is known as a ‘language community’. Although this brings people together, it can also shut them out and make people feel excluded. An example of this would be that health and social workers are all part of a language community however this could be a barrier to those who are not such as patients for example. In speech many people use their mother tongue or first language which is the language that they grew up knowing and speaking. However, some people are open to a second language that they may have learnt later on. Although this has its advantages, it is said that people who use their second language as opposed to those who use their first, cannot communicate their thoughts as effectively. Non-verbal communication can take many forms such as a person’s posture and body language, the gestures they use, their facial expressions and their ability to listen. Through non-verbal communication, people can often tell how others are feeling, for example happy, sad or even tense. A person’s body language can include their posture, proximity and movement which all send out messages. Sitting up straight can often mean a person is listening and they are attentive where as if a person was to slouch it would send out the message that they are bored or not paying attention. This is similar to other movements such as nodding your head. The way a person moves also conveys messages such as walking quickly may be recognised as stress or a lack of posture may mean a person is tired. The proximity between two people when they communicate also reveals information. If two people who are socially distant or do not have a close relationship are talking, they may stand further apart as to be polite and not get into each other space however if two people are very close they may feel they can close the distance and be a little more intimate.

Critical Review of Cook,  V. (1999). Going Beyond the Native Speaker in Language Teaching

Critical Review #1 Review: Cook,  V. (1999). Going beyond the native speaker in language teaching. TESOL Quarterly, 33(2), 185. In his article, Cook argues that the emphasis or dependence of native speaker model(NSM) in language teaching is not necessary. It is time to adopt non-native models both for language learning and teaching, and he provides some possible teaching methods. Firstly, Cook defines the native speaker and L2 users.Then he discusses the slight but salient differences between monolingual native speakers and multilingual native speakers in terms of â€Å"multicompetence† so that there is no stable NSM. He also argues NSM is implicit and L2 users are actually using L2 differently instead of deficiently from monolingual bias perspective, which means native-speaker level is not a must, even impractical, to most of L2 users because they do not need to proclaim their identity through the L2 and only few L2 users have achieved native-speaker proficiency.After this series of arguments, Cook proposes some practical suggestions of successful L2 user as models and applying L1 for teaching methods. Cook concludes that more emphasis should be added on the skillful L2 users and on using L1, and teaching language is not to imitate native speakers but to help learners so that L2 learners are successful in terms of multicompetent. In general this article is refreshing, especially 14 years ago. I absolutely agree with Cook that successful L2 learners are â€Å"successful multicompetent speakers, not failed native speakers† (p. 04). In non-English-speaking countries like China where English is neither an official language nor a lingua franca, a simple English native speaker, without teaching experiences or educational professional background, can be admired as a language specialist or an English authority only because he speaks so-called â€Å"pure English†. It is the time, 14 years later after this article has been published, to establish a positive image of nonnative-speaker teachers for the sake of both themselves and their students and for the fanatics of NSM to wake up.While in other places where English is adopted as a lingua franca, the reduction of NSM is more meaningful in the way of being equal, due to the speakers’ various lingual preferences and cultural backgrounds. Actually, nine years before this article, Rampton (1990) had called on the professionals to label native speakers as language experts in order to shift â€Å"the emphasis from ‘who you are’ to ‘what you know’† (p. 99). So in this sense, Cook affords L2 users agency on learning to use L2 instead of to transform their identity into native speakers. However, uncertainties still remain.First, although the author offers the definition of L2 users and even distinguished it from L2 learners, he does not make it specific what kind of languages one uses can be considered L2s in his statement. For example, languag es learned at what age or for what reason can be one’s L2? Or can one who learns L2 as an adult in order to stay alive in English-speaking countries be the same as one who simply uses L2 to serve foreigners in his own country? Second, the author observes that â€Å"students may feel overwhelmed by native-speaker teachers who have achieved a perfection that is out of the students’ reach. † (p. 00) I think the author slightly overstates the students’ fear of native speakers. The author himself admits that some L2 users could pass for native speakers, so why should all L2 learners be taken as not extraordinary in the first place? Also, the NS teachers do not only symbolize fluent target-language speakers, but also a bridge that connects two different cultures, which is cherished by students as well. Furthermore, according to Derrida (1998), language itself is essentially â€Å"oppressive†, thus both native speaker and L2 users are oppressed by languag e and nonnative-speaker teachers could also be overwhelming to the students.Third, since research supports the idea that teachers tend to teach the way they learn (Stitt-Gohdes, 2001), the nonnative-speaker teachers can be a distinguished example of successful L2 user, because such teachers are not only â€Å"fallible† as Cook states or â€Å"presents a more achievable model† (p. 200) but also they can share or deliver their knowledge, experience and strategies of becoming a successful L2 user. Fourth, the author mentions â€Å"successful L2 users† several times but does not give a definition or standard of it.Thus it makes me confused because is a successful L2 user one who is infinitely close to the native speakers? 733 words Reference Derrida, J. (1998). Monolingualism of the other: or, the prosthesis of origins. Standford, CA: Stanford University Press. Rampton,  M. (1990). Displacing the â€Å"native speaker†: Expertise, affiliation, and inheritanc e. ELT Journal, 44(2), 97-101. Stitt-Gohdes,  W. (2001). Business education students' preferred learning styles and their teachers' preferred instructional styles: Do they match? Delta Pi Epsilon Journal, 43(3), 137-151.

Comparing Ireland and Denmark ECC Essay

Choose two countries and compare their approaches to early childhood care and education. This essay will introduce and compare approaches to early childhood care and education in Denmark and Ireland. It will specifically focus on comparing the pedagogical approach, curriculum content and the inclusion of ethnic minority children aged 0-6 years attending early childhood settings in both countries. Provision of Services As one of the oldest nations within Europe, Denmark has made the welfare of families with children top priority within government. Under their Social Services Act, matters’ relating to the care and education of children is broken down. The Ministry of Social Services is responsible for day care facilities – dagtilbud, while the Ministry of Education is responsible for pre-school services – bornehaveklasse, primary and lower secondary and afterschool services and forest kindergartens are also available. These services are based on the rights of children outlined in the UN Convention on the Rights of the Child (OECD, 2000). In Denmark children are not required to enter the primary school sector until they are seven years old. In Ireland, there has been very little funding and resources into the development of childcare provisions with many working families relying on family members or child-minders filling the gap. Full day care exists at a cost and sessional services either morning or afternoon are in operation. In 2010, the Office of the Minister for Children and Youth Affairs introduced a voluntary, universal free pre-school year for children aged three years and two months and less than four years and seven months. For the year 2010/11, over 94% of eligible children were participating in the scheme (Dept. f Education & Skills, 2011). While it is compulsory for children to enter the primary education system at six years old, it is relevant to note that many children enter the system in the September, following their fourth birthday due to the lack of childcare provisions available. The Irish welfare state seems reliant on offering cash benefits rather than services especially for the youngest group of children 0-2 years (OECD, 2010). Pedagogy French, 2007 defines pedagogy as the practice or craft of teaching in the interactive process between teachers and learners and the learning nvironment which includes family and the community. Under Siolta, the national quality framework it is defined as the range of interactions to support the holistic development of children by embracing both care and education within settings. Denmark has a strong historical background in relation to the training of early care and education practitioners. The first training programme was implemented in 1885 for those working from the frobelian approach in education; this formed a basis for the two year study programme implemented in 1904. In 1992, an integrated training system was established to combine theory with practice. Those training to be social pedagogues complete three and a half year degree programme learning theoretical, culture based subjects and activity based subjects with stints in placement (OECD,2000). Ireland in comparison has yet to regulate for proper qualifications within the sector with only those working with pre-primary classes having the appropriate qualification – bachelor of education. In order for the pre-school year to be implemented room leaders must have a minimum qualification of a Level 5 major award in ECCE (Dept. of Education &Skills, 2011). Curriculum French, 2007, states that a curriculum being implemented in settings for children’s learning should contain a ‘body of knowledge with a clear set of goals and objectives’. The National Council for Curriculum and Assessment (NCCA) in 2004 wrote that curriculum refers to â€Å"all learning experiences, whether formal or informal, planned or unplanned, which contribute to a child’s development†. Denmark’s curriculum for children aged 0-6 years is predominately play based and incorporates the holistic development of children. Children work in partnership with the pedagogues throughout daily life. The main aims of the curriculum are to ensure children learn and experience the natural environment while gaining a true understanding of the Danish and other cultures represented. In 2004, a new law of pedagogical curriculum to â€Å"support, lead and challenge the learning of children† was introduced (Starting Strong 2, 2006). This outlined that all centres had the responsibility to outline their own curriculums with the cooperation of staff and passed by the board of parents and local authorities, the aspect of learning was not to become too structured. Six dimensions of aims as themes are to be represented within the curriculum. These include personal competences, social competences, language, body and movement, nature and nature phenomena and cultural forms of expression and values (Brostrom, 2006).