Urban Studies and Planning Essay Example | Topics and Well Written Essays - 1000 words

Urban Studies and Planning - Essay Example All these careers are exciting and personally fulfilling in the sense that they are well paying, challenging, and they give one an opportunity to grow. The urge of using my skills to establish a community where people can live and start families makes a career as an urban planner to be my first priority. I understand that a college degree in addition to extensive training is a requirement for a successful entry into this field of work. To qualify as an urban planner, one needs to take classes on environmental studies so as to understand the interactions between people and the natural environment as well as the dynamics of the environment. Moreover, a person needs to take classes on economics so as to comprehend how the markets operate, particularly, what makes a successful regional economy and business. Additionally, one needs to take classes in art and design so as to prepare oneself to think creatively about visual appearances. The prospect of getting employed as an urban planner is also high. First, there are many institutions, both public and private that hire urban planners. With a degree in urban planning together with the required experience, I can be hired by local/regional governments, private planning firms, and private property owners to facilitate the planning of commercial and communal developments, as well as transportation systems and public facilities (Bayer, Frank, & Valerius, 2009). Secondly, urba n planning is a growing field of employment. As Bayer, Frank & Valerius (2009) put it, the roles of urban planners remain in high demand, and is expected to grow significantly by 2014. For example, the U.S News and Urban Report rated urban and regional planner among the best careers in 2009 (U.S News, 2009). Additionally, the Bureau of Labor Statistics projects a 15% growth in planning jobs between 2006 and 2016. The salary and benefits of regional and urban planners is very attractive. The Bureau of Labor Statistics indicates that the median yearly pay for urban and regional planners was $63,040 in May 2010 (Bureau of Labor Statistics, 2013). Based on the fact that the planning industry has experienced growth in the past years, the prospect of career development is also looking good. This growth is stimulated by environmental concerns and population growth being experienced. Other than becoming an urban planner, I would prefer to become an architect. Since my childhood, I have alwa ys been fascinated with the science and art of building and construction. The prospect of becoming a renowned architect is exciting and interesting because this career path will enable me to design an entire built environment- from how a building associates with its surrounding environment, to construction or architectural details that entails its interior and designing and making furniture to be used inside it. Looking at this career path from a different perspective, I established that architecture is poetic in the manner that it presents itself. It is complex in the questions and issues it gives rise to. Contrary to popular belief that architecture is static, I have established that architecture is detailed and analytical. These qualities make this career path not only attractive, but also fulfilling. A career in architecture is interesting and exciting due to its longevity nature. As compared to most professions, architects can practice their

Impact of Cultural Revolution on China

Impact of Cultural Revolution on China What effects did the Cultural Revolution have on life in rural China? Introduction In 1966, China’s Communist leader Mao Zedong launched a movement in which became to be known as the Cultural Revolution in order to reassert his authority over the Chinese government. Mao called on the nation’s youth which formed the Red Guard and was Mao’s personal army to purge the impure elements of Chinese society. The Cultural Revolution continued for a decade until Mao’s death in 1976. The Cultural Revolution had such a tormented and violent legacy that it still resided in Chinese politics during the post-revolution era. The Cultural Revolution was a great political movement that took place in the People’s Republic of China in 1966. Mao Zedong was the in charge of starting this movement as he wanted to enforce communism more on the country by trying to remove capitalist and certain elements from the current Chinese society that were affecting his party negatively. This revolution helped Mao Zedong back into power even after the failed five year plan of the ‘Great Leap Forward’. This movement significantly affected China economically and socially which in turn had heavy negative effects on China’s position politically. Many of the youths of China started to from the Red Guard groups as an appeal to Mao to help bring more control and spreading of his influence. These groups conducted a mass purge even on senior officers who were so called accused of being more in favour to the capitalist side rather than following the road of communism that Mao Zedong wants all of China to follow. This group grew significantly and rapidly as more youths were influenced to join the cause in helping Mao and his movement. â€Å"During this turbulent decade, many events happened in China with the most notably the Red Guard movement, nationwide revolutionary rebels and great chaos, the fall of Liu Shaoqi and Deng Xiaoping, the Lin Biao affair and the movement of millions of youths and intellectuals to the rural country sides. During the different events and stages of the Cultural Revolution, millions of people were killed or who have suffered unspeakable hardships both physically and psychologically.† (Chang, 1999) Context The Cultural Revolution affected the Chinese system as a whole which resulted in many consequences. In the short run, political instability and the economy produced a slower economic growth which resulted in a significant decline in government expenditure and services. Although there were many problems in the main city’s the rural and countryside areas life prospered during the Cultural Revolution as many educated youths who joined Mao’s movement and became a Red Guard moved to the rural areas. â€Å"This first generation of educated rural youth helped village production brigades begin to mechanize agriculture, develop irrigation on a large scale, introduce chemical fertilizer, and experiment with new seeds, crops, and methods, and they also staffed the more than 2,500 small factories and other enterprises set up by Jimo villages during the Cultural Revolution decade.† (Han, 2008) During the Cultural Revolution, Mao who is in charge of the Communist Party implemented a policy which was known as the Down to the Countryside Movement, which was to move the educated youths from the urban areas down to the rural and countryside areas to live and learn. These youths were educated by farmers in understanding a greater role in agrarian labor. These educated youths which were mostly the Red Guards were moved out of the urban areas so that there would be less social disruption than in the urban areas during this conflict. Each individual youth learned the many ways of agrarian labor and were inducted into this new society. As the Cultural Revolution continued on there were a large number of experienced health personnel that were deployed to the countryside. Farmers were given the opportunity of medical training and the building of health centers was established in the countryside to help further improvement of life in the rural areas. This process led to a high improvement in health and life expectancy of the general population in rural areas. â€Å"There were massive expansion of rural middle schools and the development of rural-oriented vocational education during the Cultural Revolution decade.† (Han, 2008) â€Å"Agricultural production began to substantially improve and rural industry took off in Jimo County. The expansion of rural schools and especially the new vocational education programs provided village youth with the training required to modernize agriculture and develop small factories.† (Han, 2008) By June of 1966 many schools and universities all over China had closed down due to the majority of students spending all their time joining the Cultural Revolution movement and becoming a Red Guard for Mao. Millions of these youths were ordered to take part in attacking other citizens and high elite personal that are not wanting or following the movement’s ideologies. Many of the rural villages start to rise up and challenged village officials face to face with public debates, posters and mass meetings. In the first time ever in China, farmers were able to stand up and fight against the government and criticize them for all their faults especially during the Great Leap Forward years. The government officials in charge of the villages were significantly outnumbered and succumbed to the new communes of farmers. Government officials and leaders had lost all of their power and influence during the Cultural Revolution. â€Å"Enthusiastic urban youths in middle schools and colleges formed Red Guard organizations and served as Mao’s crusading army against the traditional party and state establishment before all 17 million in total were sent to the countryside to receive reeducation from local peasants. Deprived of regular school education in their formative years, most members of this cultural revolution generation were at a loss in the competiti on for employment in the post-Revolution reform era.† (Guo, Song Zhou, 2006) Government officials had no choice but to either leave back to the city or reform to the movement’s ways and activities. Many of them did reform and started new life’s and worked as farmers. They had to follow the rules implemented by the farmer’s communes and their new democratic culture which was now being heavily implemented by all villages in the rural areas during the Cultural Revolution period. As time passed on during the Cultural Revolution period, ordinary farmers were empowered and were given more control in the management of the affairs of production teams and brigades. During the revolution years the farmers started many committees which were democratically election. This helped provide the farmers with fair and equal election. With the elected leaders of each committee, production plans and budgets were greatly improved thus improving economic activities and providing a higher growth rate. This improved life greatly in the rural areas during the Cultural Revolution. â€Å"Hence Mao’s idea of a spiral of growth in the villages beginning from simple, labor-intensive, nil-gestation investment and leading on to the modernization of rural China.† (Gray, 2006) Conclusion In conclusion life during the Cultural Revolution period in China for the rural areas was quite successful. With a high number of youths that moved to the rural areas during the down to the countryside movement, the rural areas had a significant increase in overall production and economic growth as new societies were created and increase in infrastructure and services most notably agricultural factories were built. Although this revolution had terrible consequences during the short term such as millions of people suffering or being killed the revolution proved beneficial in its long term as it impacted the entire country for decades to come. â€Å"The Cultural Revolution involved virtually all Chinese people and indirectly many other countries in the world. During the Cultural Revolution, revolutionary art, music and dramas were pursued and major reforms in education, factory management, economic planning, medical care and other areas of Chinese life were carried out. Many of these actually brought bitterness and injury to the Chinese people. During this turbulent decade, China also encountered difficulties, setbacks and isolation in the international relations area in the late 1960s and only made some efforts to try and improve its relations with other countries and expand its diplomatic base in the 1970s.† (Chang, 1999) â€Å"This 10 yearlong class struggle on a massive scale caused unprecedented damage to traditional culture and to the nation’s economy. To a great extent, it was the disaster of the Cultural Revolution that prompted post-Mao Chinese communist leaders ahead of their soviet counterparts to implement pragmatic economic reforms. Major policies that the post-Mao government has adopted, even today may still be best understood as a reaction to the racial politics of the Cultural Revolution. â€Å"(Guo, Song Zhou, 2006) Word Count: 1447 Bibliography Chang, T. (1999). China during the Cultural Revolution, 1966-1976 (1st Ed.). Westport, Conn.: Greenwood Press. Depts.washington.edu. (2014). Cultural Revolution. Retrieved 19 April 2014, from https://depts.washington.edu/chinaciv/graph/9wenge.htm Gray, J. (1990). Rebellions and revolutions (1st Ed.). New York: Oxford University Press. Gray, J. (2006). Remembering Jack Gray (1st Ed.). Guo, J., Song, Y., Zhou, Y. (2006). Historical dictionary of the Chinese Cultural Revolution (1st Ed.). Lanham, Md.: Scarecrow Press. Guo, J., Song, Y., Zhou, Y., Guo, J. (2009). The A to Z of the Chinese Cultural Revolution (1st Ed.). Lanham, Md.: Scarecrow Press. Han, D. (2001). Impact of the Cultural Revolution on Rural Education and Economic Development. Modern China, 27(1), 5990. Han, D. (2008). The unknown cultural revolution (1st Ed.). New York: Monthly Review Press. HISTORY.com. (2014). Cultural Revolution Facts Summary HISTORY.com. Retrieved 19 April 2014, from http://www.history.com/topics/cultural-revolution HsuÃÅ'ˆ, I. (1970). The rise of modern China (1st Ed.). New York: Oxford University Press. Kissinger, H. (2011). On China (1st Ed.). New York: Penguin Press. Potter, S. (1988). The cultural construction of emotion in rural Chinese social life. Ethos, 16(2), 181208. Singhal, D. (1972). A year in upper felicity: life in a Chinese village during the Cultural Revolution (1st Ed.). Englewood Cliffs, N. J.: Prentice-Hall. Zhou, X., Hou, L. (1999). Children of the Cultural Revolution: The state and the life course in the Peoples Republic of China. American Sociological Review, 1236

Henry Ford Essay -- History

Henry Ford Henry Ford was one of the most brilliant entrepreneurs in creating the automobile assembly line, it was his controversial characteristics and unorthodox approach towards administrating the Ford Motor Company which resulted in the conglomeration of one of the most successful corporations in the world. At the turn of the century everything was booming! The growth of the economy and stock market increased the job opportunities as well as morals. As a result of this industrial revolution, out of the woodwork came a humble yet driven man, Henry Ford. Between the five dollar/day plan, his policies on administrating the company, and his relations with his customers, Ford was often presented as a suspicious character. This controversial behavior epitomized the success of the company, it did not lead to his own downfall as many suspect. The Anti-Semitic accusations, and the belief that Ford was taking advantage of his customers, were by far overshadowed by his brillianc!e and strong hand in r unning his company. Of course, there were not always supporters of Henry Ford. If fact, there were many critics, critics who believed that Henry Ford was so controversial that it prevented the potential of Fords from becoming greater than it is today. By the mid twenties the Ford’s was already the worlds most successful automobile company, but their great reputation would soon decline. Fords $5/day plan for all employees signified the overwhelming success of the company. Many believed this success was short-lived with the new policies dealing with the workers which soon followed. With the need to increase production and lower costs, in the mid 30’s Ford cut all Ford worker’s wages in half. Workers were expected to work faster, and harder. Department heads were ordered to ban all talking and whistling while work was in progress. All of this was a ploy by Ford to make sure he knew every move of his workers, he was very possessive. Secondly, Ford began to fire older workers and hire younge!r workers. His ideology was that the younger workers could work more productively and more efficiently. Which in turn would send more money flowing into his pockets. What resulted was quite humorous in fact. Black hair dye became a hot seller in the Detroit area . Older workers tried to disguise their age by dying their hair black. Ford’s manipulation of his workers was immoral... ...! Bibliography American Decades 1910-1919 New York: Gale Research Co., 1996. A contemporary survey on the backround of Henry Ford, and the Ford Motor Company. Collier, Peter. An American Epic. New York: Summit Books Co.,1987. A chronological study of the political and financial success of the Ford family. Lacey, Robert. Ford, The Men And The Machine. New York: Ballantine Books Co., 1986. A more personal study of the Ford family and the contraversy surrounding the success of the Ford Motor Company. Marcus, Paul: Ford: We Never Called Him Henry. New York: Tom Doherty Associates Co., 1951, 1987. A primary piece of literature related by Harry Bennett offering personal insights in the life of Henry Ford, including conspiracy and controversy. Primary Source â€Å"The Annals of America.† New York: Encyclopedia Britannica. Co., 1976. A primary source referring to the financial success of the Ford Motor Company as well as the financial policies administered. Video â€Å"The Great Depression† (no other info available) An interesting presentation offered by past employees of the Ford Motor Company re-telling the triumphs and demise of the Ford Motor Company. Henry Ford Essay -- History Henry Ford Henry Ford was one of the most brilliant entrepreneurs in creating the automobile assembly line, it was his controversial characteristics and unorthodox approach towards administrating the Ford Motor Company which resulted in the conglomeration of one of the most successful corporations in the world. At the turn of the century everything was booming! The growth of the economy and stock market increased the job opportunities as well as morals. As a result of this industrial revolution, out of the woodwork came a humble yet driven man, Henry Ford. Between the five dollar/day plan, his policies on administrating the company, and his relations with his customers, Ford was often presented as a suspicious character. This controversial behavior epitomized the success of the company, it did not lead to his own downfall as many suspect. The Anti-Semitic accusations, and the belief that Ford was taking advantage of his customers, were by far overshadowed by his brillianc!e and strong hand in r unning his company. Of course, there were not always supporters of Henry Ford. If fact, there were many critics, critics who believed that Henry Ford was so controversial that it prevented the potential of Fords from becoming greater than it is today. By the mid twenties the Ford’s was already the worlds most successful automobile company, but their great reputation would soon decline. Fords $5/day plan for all employees signified the overwhelming success of the company. Many believed this success was short-lived with the new policies dealing with the workers which soon followed. With the need to increase production and lower costs, in the mid 30’s Ford cut all Ford worker’s wages in half. Workers were expected to work faster, and harder. Department heads were ordered to ban all talking and whistling while work was in progress. All of this was a ploy by Ford to make sure he knew every move of his workers, he was very possessive. Secondly, Ford began to fire older workers and hire younge!r workers. His ideology was that the younger workers could work more productively and more efficiently. Which in turn would send more money flowing into his pockets. What resulted was quite humorous in fact. Black hair dye became a hot seller in the Detroit area . Older workers tried to disguise their age by dying their hair black. Ford’s manipulation of his workers was immoral... ...! Bibliography American Decades 1910-1919 New York: Gale Research Co., 1996. A contemporary survey on the backround of Henry Ford, and the Ford Motor Company. Collier, Peter. An American Epic. New York: Summit Books Co.,1987. A chronological study of the political and financial success of the Ford family. Lacey, Robert. Ford, The Men And The Machine. New York: Ballantine Books Co., 1986. A more personal study of the Ford family and the contraversy surrounding the success of the Ford Motor Company. Marcus, Paul: Ford: We Never Called Him Henry. New York: Tom Doherty Associates Co., 1951, 1987. A primary piece of literature related by Harry Bennett offering personal insights in the life of Henry Ford, including conspiracy and controversy. Primary Source â€Å"The Annals of America.† New York: Encyclopedia Britannica. Co., 1976. A primary source referring to the financial success of the Ford Motor Company as well as the financial policies administered. Video â€Å"The Great Depression† (no other info available) An interesting presentation offered by past employees of the Ford Motor Company re-telling the triumphs and demise of the Ford Motor Company.

Marketing A New Baby Food In Sweden For Nestle

The company that is planning to introduce a new baby food product in Sweden already has a presence and it is among a group of companies that are under Nestle Nordic where other Nestle companies that are operating in Denmark, Finland, and Norway are under and these four companies work in concert and represent Nestle’s operations in Northern Europe.This means Nestle is not new for Sweden where it is selling a number of products among which there are a few baby food products such as Bona and Piltti that have a wide range of acceptance among those that are using breast milk substitutes. [1] The baby food business had been and still is lucrative even if it is a very sensitive area of business that has a lot of controversies around it simply because there are a big number of organizations that are against breast milk substitutes and had been highlighting the problems that are related to it.[2] Because of that the company had always been on the defensive in order to do business in th is particular sector and it had made a concession with consumers and the concerned members of society, by putting a statement out on the very outset declaring that there is nothing better for a child than the mother’s milk and every mother had been encouraged to use breast milk at least for the first four to six month, even more if possible.The only time the company recommends the use of its mother milk substitutes early on is whenever mothers are not in a position to provide breast milk for their children, which could be because of a premature birth of a child or when the mother is either sick or deceased. Since it is not always possible to find wet nurses the breast milk substitutes come close to what the breast milk will provide the newborn children. [3]There are a few problems surrounding breast feeding where if somehow mothers start using the breast milk substitute early in a child’s life the possibility that their own natural milk producing process could be disru pted and they will have no choice other than to depend on the breast milk substitutes that are scientifically proven to be as good as a breast milk, albeit some shortcomings where the breast milk is proven to have a natural immune building mechanism that will enable children to fight disease better.At the same time in the absence of the scientifically processed and manufactured baby foods such as what Nestle is selling in Sweden, it is difficult to come up with a baby food recipe that could be prepared at home that will have all the required nutrition, and the only substitute that could come close to the mother’s breast milk, which is cow milk is not digestible by a small child’s metabolism process creating problems such as anemia in addition to forcing the child’s system to absorb a large amount of calcium and fat that it is not ready to do so.[4] Because of all these controversies organizations such as the World Health Organization (WHO) had to intervene and c ome up with a code that every company that is manufacturing and selling baby food products will have to adhere to and it has the support of all government bodies. The particular code is not new to Nestle that had been applying it for all these years, but when it is time to come up with a new baby food product and marketing it effectively, there are difficult procedures to follow, one of them being the code has to be observed.The main focus of the WHO Code is in preventing such companies that are marketing baby food products to have a direct access to mothers and to regulate the interaction they could have with those who are providing them essential services such as physicians, nurses, and other health care staff, because those who are against companies that are coming up with breast milk substitute products believe that mothers will have to be protected from their marketing ploy as much as possible, at least for the first six months of a child’s life.[5] Such approach is diff icult since most mothers living in societies such as Sweden will be strapped for time because most of them could be working outside of the home and nature itself is such that if the breast is not used continuously after birth it will stop producing milk. And in between the mother milk advocates believe that if mothers are not approached with various marketing tactics this problem could be averted and mothers will start to feed breast milk right after birth up to six months and more if possible.Without disputing this assumption, it is not difficult to visualize the hurdle a marketing team that is trying to promote a new product that the company had gotten a permit to manufacture and put into the market has to overcome. Nestle had been focusing lately on what is called functional or nutraceuticals baby food that has a dual purpose of serving as a nutritional breast milk substitutes while at the same time it has medicinal advantage that the children using the product will be benefited from.[6] The company did not want to come up with a new name for a product and what it did was it took one of its popular products Piltti and created a different version that is converted into a functional baby food and simply named it Functional Piltti. In doing so it added three ingredients, â€Å"selenium† which is a substance that helps the body get rid of harmful oxidants since it is a proven antioxidant that has the capacity to turn harmful radicals that appear in the body into innocuous water and oxygen.The second ingredient it added was â€Å"nucleotides† whose main function is helping the growth of good bacteria in the gut so that the gut can fight bad bacteria and this ingredient is available in breast milk enabling children to build a natural immune system. And when children are using breast milk substitute formula, unless this substance is added they could be vulnerable to many kind of diseases, one of the reasons breast milk advocates had been highlighting , although it could be solved by simply introducing this substance into baby foods, which nestle did.The third ingredient was â€Å"beta-carotene† whose main function is to create a fortified immune system in the body since it is an antioxidant and it also helps in developing good vision early on, as well as it adds to the good development of the skin. [7] These are ingredients that are supposed to raise the eyebrows of mothers and their pediatricians who are mostly responsible for recommending what kind of baby food formula is good for the newborn children.From the outset the team knew that it has a winning product on its hand and this product is expected to cannibalize the regular Piltti in the long run, which is a little bit cheaper, but it is also presumed to beat many of the competing products that have not yet introduced functional baby food products in their baby food product line, even if their catching up quickly is imminent.However, until that happens the team was a ware that there would be a window of time the company could do a quick profitable business. They have everything at their disposal except that they were aware of the WHO Code, which stipulates rules that make all the areas where an effective promotion could have taken place off limit.They are not allowed to have a direct contact with pregnant women or mothers of small children, although in today’s marketing campaigns that might not be essential, yet sometimes it is possible to come up with events where a close interaction between the marketing team and those who would be firsthand users of their product would have been possible. Because not only they can educate the mothers about their products but also they can give out samples and gifts that will build good relationship, which the code prohibits nonetheless.[8] It is not only that they cannot advertise using the known methods where they can put their ads on billboards, distribute brochures, or give out samples. All that can be carried out is through approved institutions by the WHO Code and if any of the allowed institutions are engaged in giving out free samples that are allowed to receive free samples from the manufacturers they have to make sure that there will be enough supply for the involved mothers for as long as they need it.This is so because this tactic had been highlighted where marketers and distributors of baby food products would usually start giving out free samples and if the mothers become dependent on it at the earlier stage of their breast feeding days and avoid breast feeding it will affect their ability to produce milk leading to their forced dependency on the substitute, which would mean they will be forced to buy the breast milk substitute products. Those who might not afford it could harm the normal growth of a child, which is a justifiable cause to be concerned about.[9] Therefore, there are very limited channels the marketing team could be promoting through and spotting those channels is very important. In addition, it is important the marketing team as well as the company should know that their new product should aim at those that are four months old and higher in normal circumstances and the only exception is when the mothers are not in a position to do breast-feeding for various reasons, there are no wet nurses, and at times access to breast milk banks might not be available since there are some of them in some communities.This would mean their marketing interaction is severely limited to interacting with health care personnel only and it is through them their would be customers will be educated to use their product as advertising to the general public is not allowed. Marketers do not have permission to show their existence at the point of sale, put posters, or any other means of advertising to promote their products.They cannot solicit mothers directly or indirectly or cannot give them gift nor free samples. Even if the health care system has the di scretion of recommending the use of breast milk substitutes, they cannot allow their workplace for promoting any kind of such products. Nor any of the staff of such establishments have permission to accept any money from distributors and manufacturers of such products.But at least if the authorities see it beneficial they can make arrangement where pregnant women and mothers of young children to be educated or to be informed by a sales team, but the purpose of the meeting is far from pitching a product and it will be educational, where they will always be advised there is nothing better than breast-feeding for the newborn children. The labels on the products should not display a child’s picture and labels should clearly describe what the ingredients are, how to prepare it, and at what kind of temperature to store the product.In addition, they have to testify that the substitute does not come near to breast-feeding and the message will have to be to the point, without idealizi ng the breast milk substitute. The overall scenario when promoting baby food formula resembles medicine where there are go betweens who are the health officials and the authorities, and manufacturers of medicine target physicians when it comes to promoting their product since they are the ones who would subscribe it to their patients.Furthermore, almost no medicines are available without prescription, even if there are a few over-the-counter products. With the same token, even if the breast milk substitutes could find their way into grocery stores or even drug stores where anyone can pick them off the shelf without prescription, the consumers of such products could get their information from health workers only or from the labels that are required to follow some procedures, and marketers should not try to reach the direct consumers who are mothers of young born children or expectant mothers.Therefore, the team only had to approach a given number of institutions, mostly health establ ishments, where they are allowed to distribute their samples, gifts, and educational material so that the health officers will be informed about the benefit of their products and pass it on to the mothers of the young children.Due to this restriction the cost and the effort involved in marketing a baby food brand is not very high since they are not allowed to put billboards on the highways of several comminutes, or they do not have to advertise on TV, print, or are not allowed to print brochures and distribute them to the public, but they can pass such material to the health officials to help them with their educating the mothers. Hence, the undertaking would not be expensive since doing it in a continuous basis until the product becomes popular is not required as the case is when promoting other products.Instead, what is involved here is arranging an appointment with the involved officials or at times, all it might take is visiting these establishments in person that might number l ess than hundred. Since such officials are not allowed to ask any payment directly or indirectly that also saves the company a lot of money and it can focus only on samples and at times gifts, to be given to the mothers through the health officials in a form of utensils and the like. Nevertheless, giving physicians bonus is a common practice in the pharmaceutical industry since it is through them all the manufactures are selling their products.When it comes to baby food market it is not allowed, yet the sales team had started taking note to see if there will be some that will qualify in the long run for a preferential treatment and if there is a possibility of getting around the restriction to introduce a bonus even if the code prohibits it, but since it is a marketing scheme there has to be some way of compensating some of the health care workers who would choose to recommend the particular Nestle product for their clients when there are other competing products, because even if Fu nctional Piltti is new in the market, it might not take more than three months for the other manufactures to come up with similar products. Consequently, the job of the sales team is cut out for them where they have made a list of the establishments that are responsible for advising mothers and expectant women what kind of breast milk substitute to use. The job of the establishments that are medical and health care centers, hospitals and private pediatricians is to educate the mothers when to start mixing the breast milk substitute with their breast-feeding and what quantity and frequency to use, a knowledge they would acquire from the manufacturers and from their own experience as a health care officials.There is always a department at the bigger institution that will deal with the various marketers and when the need arises it is possible to arrange a one-on-one appointment and the promoting and the education process could take any form and any length of time. But the anticipated e nd result is in due time the company will start selling its products, either through the drug stores of big hospitals and health centers that can arrange to receive a shipment or the mothers will have to go and buy it from outside market once it is recommended to them by the health officers. And here the other job of the sales team will kick in because they have to go around to talk with the retail establishment, big and small, in the cities they are operating, which will require an extended travel as sometimes they have to cover the outskirts of the city as well as the outlying regions.There is a huge competition to get space in the crowded shelves of retailers that will have to be convinced that the product is worth their recommendation and meets all the legal requirements to be sold for the public, which is part of the job of the sales team to furnish proof and explanation. This is also a very crucial part of their job, although at times it could be done through the distributors. However, the smaller retailers that are not chain stores might have to be approached individually or it might be the job of the distributors to convince them to carry the new product that should attract many buyers because of what it is offering, which is not only unique but functional foods are new even for the general food market that is catering for the adult buyers.After doing that, the particular brand depending on its popularity might start to sell itself, where distributors and retailers would want to put it in their stock and on their shelves because it is selling well, and when that point is reached the sales team could say their job is partially done, but they can still search for new locations and retailers in the same regions or in other regions. The conclusion is the baby food market is a highly regulated market and it is similar to the pharmaceutical market where manufacturers do not have a direct access to the buyers and users of their products, because of the sensit ive nature of what is involved, which is the life of young children whose growth could be harmed irreversibly if they are not given what they exactly need for their normal growth from the beginning.Even if there is no outright opposition to the existence of the breast milk substitutes, the authorities and other concerned groups would have preferred if mothers start using it between four and five months, but since that might not be possible because of the nature of the life of the mothers themselves who could be working outside of the home, which will result in their being time strapped, and instead of preparing food for their children at home it will be easier for them to pick the substitutes form the various stores and mix the feeding process with their own breast-feeding since it is proven to be vital for the children. Similarly, the existence of the breast milk substitutes will become handy for children whose mothers cannot breast-feed them for various reasons that were mentioned earlier, and in their case the breast milk substitute will come close to breast milk and they will grow up healthy as there are sources that are saying even if people simply wanted to believe that breast milk is better for the child and it will create some kind of bondage between mother and child, in reality the substitutes are proven scientifically to be as good as the breast milk if not better.Therefore, any company that is selling baby food, which has a global market of close to $21 billion a year will have to go over many hurdles to put the substitute on the hands of the mothers that will use it to feed their baby properly and everyone will be benefited at the end of the day. [10] REFERENCE 1. Nestle in Northern Europe. Retrieved from the Web on April 5, 2007. www. nestle. se/neobuilder/200108091943_6622_3b72cbb9544e1. html 2. Baby Food Business Assessment. Retrieved from the Web on April 5, 2007. www. researchandmarkets. com/reports/3492 3. Baby Food Industry Lobbies WHO. Retr ieved from the Web on April 5, 2007. www. bmj. com/cji/content/full/321/7273/1411 4. The Ecologist. Retrieved from the Web on April 5, 2007. www. theecologist. org/archive_detail. asp? 5. International Code. Retrieved from the Web on April 5, 2007. www. ibfan. org/english/resource/who/fullcode. html 6. Nestles Market War.HighBeam Encyclopedia. Retrieved from the Web on April 5, 2007. www. encyclopedia. com/doc/1G1-131934511. html 7. Breast Feeding. Retrieved from the Web on April 5, 2007. www. geocities. com/HotSprings/spa/3156/code. htm 8. Health Workers and the Baby Food Industry. Retrieved from the Web on April 5, 2007. www. bmj. com/cji/content/full/312/7046/1556 9. Nestle Public Relation Machine Exposed. Retrieved from the Web on April 5, 2007. www. babymilkaction. org/boycott/prmachine. html 10. Health-Conscious-Drive-Baby-Food-Market-Growth. Retrieved from the Web on April 5, 2007. www. rncos. com/Press_Release/Health-Conscious-Drive-Baby-Food-Market-Growth-July. htm

Exploring the Relationship Between Mother and Baby Essay

Exploring the relationship between mother and baby in the NICU in relation to nursing support. Abstract Aim -To explore the effect of interaction related to care-giving and information exchange between nurses and mothers in relation to maternal stress and maternal-infant relationship in the newborn intensive care unit (NICU) throughout the hospital stay. Background – Mothers in the NICU experience depression, anxiety, stress, and loss of control, and they fluctuate between feelings of inclusion and exclusion related to the provision of health care to their neonate. This literature review helps to identify nursing interventions that promote positive outcomes between mother and baby by reducing maternal feelings of stress and anxiety. Search Method – A literature search covering the period 2008-2012 was conducted. Five articles reporting both quantitative and qualitative studies relative to the subject were retrieved. Findings – Findings reveal that positive and trustful relationships between nurses and mothers develop when nurses communicate and interact with mothers. This alleviated mother’s anxiety and enhanced their confidence when interacting with their baby. Discussion – Critical analysis as well as strengths and weaknesses of the relative journals reviewed is given together with useful recommendations that emerge from the evidence. Conclusion – The literature reviewed shows that nurse-mother interaction improves mother-infant relationship. In turn, this will eventually assist in decreasing maternal stress and improve the maternal well-being. INTRODUCTION Mothers develop attachment to their baby during pregnancy, which continues and develops more fully after the child is born (Cleveland 2009). However, the pathway to becoming a mother is threatened with the admission of the baby to the NICU. This occurs due to the unfamiliar and intimidating environment of the NICU (Obeidat et al 2009). During the initial admission parents can believe that the healthcare team is more able to care for their baby and this can instill feelings of inadequacy (Cockfort 2011). As a result, maternal attachment may be delayed by the lack of socialisation between mother and baby as most of the care is done by nurses (Cleveland 2009). DeRouck and Leys (2009), found that the parents of an infant admitted to the NICU face challenges including access to information, disclosure about the diagnosis, treatment and prognosis of their newborn, as well as a lack of control over the care of their newborn. Adding to this distress is the uncertainty of survival or the eventual impact of the infant’s condition on later health and well-being. In addition, feeling guilty to mother an unhealthy infant creates fear of social prejudice. Further, the structure of the NICU places significant barriers on mothers’ abilities to enact the parental role since decision-making and the daily care of the infant is taken over by medical and nursing staff restricting interactions with the babies stripping off their maternal authority (Cleveland 2009). In fact, when babies are in the NICU, traditional conceptualizations of the parental role are altered. The situation demands heightened parental participation while simultaneously placing severe restrictions on parental involvement. In response, parents need to negotiate this tension and traditional definitions of the parental role, which must be continually redefined throughout their experience What emerges is that the predominant source of distress is inability of the mother to protect the infant from pain and provide appropriate pain management. (Fenwick et al 2008). A lot of procedures cause pain in the neonate creating concerns for the mother, starting from peripheral cannulas, indwelling catheters and intubation to mention a few. In intubated babies, even though morphine infusions are administered, the baby still shows signs of distress during nursing times. In this case, we administer a small bolus of pain relief prior to nursing so that the baby would be more comfortable. Conversely, Fenwick et al (2008) describes factors that contribute to parents’ satisfaction in the NICU. These include; assurance and psychological support, the provision of consistent information, education, environmental follow-up care, appropriate pain management, and parental participation and proximity, as well as physical and spiritual support. Therefore, it is imperative that nurses should do their best to improve the mothers’ sense of confidence, competence and connection with her infant through guided participation (Domanico et al 2011). Johnson (2008) notes that skin-to-skin holding or kangaroo care promotes maternal-infant feelings of closeness, builds maternal confidence, and may be a stress-reducing experience for both the mother and infant. Hence the importance of providing the opportunity for kangaroo care to occur. Hunt (2008), notes that KMC is also crucial to stabilize parameters, such as cardio-respiratory parameters whilst being beneficial for maintaining body temperature. They add that even the incidence of nosocomial sepsis and the duration of hospital stay decreased with practicing KMC. In addition, Ali et al., (2009), found that Kangaroo mother care also showed positive outcomes towards practicing exclusive breastfeeding. Cockfort (2011) notes that, continuity of care needs to be ensured hence the importance of documentation. Therefore, it is suggested that handover should not be rushed, whilst a more comprehensive handover can ensure the smooth transition of care for staff and the family. When parents ask questions relating to their baby they feel assured in the competency of staff when information has been passed on correctly. When information is not shared effectively parents can lose trust and the partnership breaks down. In Malta, even though handover of 2 consecutive days is given, conflicting advice is still given at times due to the nurses’ different view-points. Consequently, this requires ward meetings in order to clarify important issues so that advice given and practice is consistent. In Malta, about 373 babies are admitted yearly (Grech et al 2012). In view of the benefits discussed, nurses should do their utmost to improve the overall experience of the mothers of such babies. Search Method A review of published research consisted of the following steps; broad reading to determine areas of focus, identification of inclusion and exclusion criteria, literature search (appendix 1) and retrieval, critical appraisal and analysis of the research evidence and synthesis of evidence. Evidence was reviewed with the aims of identifying barriers that affect the motherinfant interaction within the neonatal intensive care unit and how nurses can actively support attachment. Articles were included if the setting was primarily in a neonatal intensive care unit (neonatal unit or neonatal intensive care unit) and the participants were mothers of infants admitted to neonatal intensive care units or nurses working within that setting. In addition, All articles were critically analyzed with two primary questions in mind: (a) What are the needs of parents in the NICU? (b) What nursing behaviors support parents in meeting these needs? Articles were also included if they were primary research studies published between 2008 and 2012 and written in the English language. Primary and secondary literature searches were conducted through the EBSCO, ERIC, Sciencedirect and Medline databases. The primary search terms included â€Å"NICU,† â€Å"Neonatal Intensive Care Unit,† â€Å"family support,† â€Å"communication,† â€Å"nurse† and â€Å"early intervention.† The secondary literature search terms included â€Å"nursing support,† â€Å"efficacy,† â€Å"family,† â€Å"communication,† â€Å"support†, â€Å"neonatal† and â€Å"Kangaroo Mother Care†. These terms were used and utilised in all possible combinations to perform an extensive literature search of the above mentioned electronic databases. Thirdly, a review of references was conducted of the identified articles for any further studies. Eighteen articles were found through the search. Six studies met the inclusion criteria of which, 3 were qualitative and 3 quantitative (appendix 2). The subject was limited to the last 5 years. This time frame helps in the getting the most recent experiences since NICU is a changing environment especially as regards to technology which effects the mothers as well as the nurses. Both quantitative and qualitative studies were found. Both qualitative and quantitative research was conducted to identify what is known about the needs of NICU parents and what behaviours support these parents. Both methods of research were included because of the potential for each to contribute to a more complete understanding of this topic. In selecting a research design, researchers should be guided by one overarching consideration: whether the design does the best possible job of providing trustworthy answers to the research questions. One needs to note that both studies have limitations (Cottrell & McKenzie, 2011). In quantitative research, the researcher’s aim is to determine the relationship between one variable (an independent variable) and another (a dependent or outcome variable) in a population (Morrow 2009). In contrast to quantitative designs, qualitative designs do not result in numerical data for statistical analysis (Schira, 2009). In qualitative methods, researchers are interested in interpreting social phenomena and exploring the meanings that people attach to their experiences (Polit and Beck 2010). Moreover, views, attitudes and behaviours may be explored (Wood & Kerr, 2011), through grounded theory as it develops theories that are â€Å"grounded† in the group’s observable experiences, but researchers add their own insight into why those experiences exist. Findings Table 1 includes information about the 5 studies that met the inclusion criteria . Once an infant is admitted into an NICU, many factors account for parental stress. Admission of the infant to the NICU places mothers in a stressful situation where they must cope with the NICU environment and its associated demands. In the study conducted by Parker (2011), a grounded theory approach was used to understand feeling and stressors of 11 mothers whose new-borns were in the NICU. It was found that the early days shock and numbness accompanied feelings of none or little control over their lives. Moreover, all mothers described feeling unprepared for the premature delivery and the sight of their baby in the NICU. Comparative results were found by Lee et al (2009), with regards to the shock experienced with the initial sight of the baby. Everyday unpredictable changes occur leaving no time for adjustment or preparation. Constant fears about the life and death of the baby do not subside and several mothers spoke about their experience of always anticipating the death of the baby. These findings are also reflected in my clinical setting when mothers would be recounting their experience once the baby’s condition improves. This is in line with the findings of Fenwick et al (2009) and Lee et al (2009). In addition, the findings imply that the positive reassurance of the effects of a positive and caring environment and support network between parents and nurses in the NICU is not always evident among every unit. Nicholas-Sargent (2009) found that assurance is the most important aspect to be fulfilled. Her quantitative study of 46 mothers found that the length of stay in the NICU and mothers’ information needs were found to be significantly inversely correlated. Therefore, this suggests that the longer an infant remains hospitalized in the NICU, the less emphasis the mother places on receiving information about the infant’s condition. This shows that the needs of the mothers in the NICU can change over time. My observations match these findings since mothers familiarise themselves and adapt to the situation. Moreover, they would eventually want to be successful with the care of the baby. This is reflected in the grounded theory analysis conducted by Fenwick et al (2008), using semi-structured interviews. They found that the nurse-mother relationship had the potential to significantly affect how women perceived their connection to the infant and their confidence in caring for their infant which occurred through a three way interaction. Being successful in their desire to care for the baby, engendered feelings associated with being a ‘‘real’’ mother. However, not all women in this study were able to successfully employ these strategies. In the situation where the mother perceived herself as ‘‘quiet and unassertive’’, and in a position without any power, it was very difficult to gain the confidence needed in order to be able to openly question, negotiate and direct the care of her infant. Therefore, it is very important to identify these mothers in order to help them by giving them continuous reassurance. This would particularly be required when the situation changes from support needing to encouragement in participation. Lee et al (2009) found that mothers received support from the healthcare professionals and the social networks that mothers made. These helped to create the connections that developed between the mothers and infants making their journey towards parenthood possible. They discovered that challenges are further compounded in Taiwan, where women are traditionally required to practice the cultural ritual which includes confinement to the house with a special balanced diet for the first month postnatal. Lee et al (2009) used the grounded theory approach with in-depth interviews and constant comparison. All interviews were audio-taped and notes were made during and immediately after the interview concerning actions and body language of the mother during the interview. The finding of this study further indicated that the initial sight of the life-support equipment was shocking. The technological environment created a fearful atmosphere, and the medical equipment attached to their infants caused the mothers further physical separation. The mothers indicated that they were so afraid of the equipment that it took them a long time to be able to participate in their infants’ care. In turn, this hampered them from establishing positive mother–infant interactions. Chiu and Anderson (2008), found that preterm births often negatively influence mother–infant interaction due to lack of physical contact. In addition, they found that skin-to skin contact post-birth has positive effects on infant development. These researchers conducted a randomized controlled trial (RCT) using questionnaires for data collection. In addition, mothers were further video-taped during a feeding session. Ali et al., (2009),highlight the importance of kangaroo care in their RCT where the researchers conducted their study with one hundred and fourteen infants. This study showed that the infants exposed to kangaroo mother care had an increase in rectal temperature compared to conventional care, therefore having a decreased risk of hypothermia. The mean temperature during kangaroo mother care was of 37 degrees Celsius while the mean temperature during conventional care was of 36.7 degrees Celsius. The data collected was through posted questionnaires. Discussion In the 3 qualitative studies found, the data was collected through interviews of which 2 were semi-structured while 1 was unstructured. Parker (2011), Fenwick et al (2008) and Lee et al (2008), used the Grounded theory approach. However, while Parker and Fenwick use semi-structured interviews, Lee uses unstructured interviews. In semi-structured interviews there is a topic guide with list of areas or questions to be covered with each respondent. This technique ensures that researchers will obtain all the information required, and gives respondents the freedom to respond in their own words, provide as much detail as they wish, and offer illustrations and explanations. Lee et al (2009) uses ground theory approach but incorporated with unstructured interviews. Unstructured interviews also known as are flexible but are more time-consuming than semi-structured since the interviewer listens and does not take the lead. The interviewer listens to what the interviewee has to say. The interviewee leads the conversation (Wood & Ross-Kerr, 2011). However, anonymity for confidentiality which is of utmost importance is not possible. When using unstructured interviews, the researchers have to be able to establish rapport with the participant. The reason is that the interviewers have to be trusted if someone is to reveal intimate life information. This may lead to interviewee bias. Also, it is important to realise that unstructured interviewing can produce a great deal of data which can be difficult to analyse. Lee et al (2008) and Fenwick et al (2008) conducted the interviews themselves while Parker (2011) did not, thus reducing the bias. However, interviewer bias occurs even if someone else is conducting the interview. The number of mothers in the study of Lee et al (2008) was adequate since with in-depth interviews 20 participants are enough. However, to account for the small sample, more interviews and observations were done with the same participants in order to reach theoretical saturation. Usually informants are selected for in-depth interviews in a purposive manner questioning the generalizability of the results (Wood & Kerr, 2011). A major controversy among grounded theory researchers relates to whether to follow the original Glaser and Strauss procedures or to use the adapted procedures of Strauss and Corbin (Polit & Beck 2010). Grounded theory method according to Glaser emphasizes induction or emergence, and the individual researcher’s creativity within a clear frame of stages, while Strauss is more interested in validation criteria and a systematic approach. Parker (2011) uses the original Glaser and Strauss (1967) paradigm while Lee et al (2008) and Fenwick et al (2008) use Strauss and Corbin (1998) procedures. One of the fundamental features of the grounded theory approach is that data collection, data analysis, and sampling of study participants occur simultaneously. A procedure referred to as constant comparison is used to develop and refine theoretically relevant categories. Categories elicited from the data are constantly compared with data obtained earlier in the data collection process so that commonalities and variations can be determined. As data collection proceeds, the inquiry becomes increasingly focused on emerging theoretical concerns. All 3 studies use constant comparison. All the above 3 studies use audio-taping for data collection except for Fenwick et al (2008) who used field note documentation as well. Audio-taping enables eye contact to be maintained and to have a complete record for analyses, however, some interviewees may be nervous of tape-recorders. On the contrary, in note taking on the other hand, a lot of eye contact is lost unless a type of short-hand is learnt. However, the interviewer will have plenty of useful quotations for report when transcribing the interview. Randomized controlled trials consist of a complete experimental test of a new intervention, involving the random assignment of a large and varied sample to different groups (Polit & Beck, 2010). The intention of an RCT is to arrive to a judgment as to whether the novelty of an intervention is more effective than the traditional intervention (Polit & Beck, 2010). This intention was well noticed throughout the RCTs chosen by Ali etal., (2009). Wood & Kerr, (2011) sustain that RCTs are the most rigorous method to determine a cause-effect relationship between the treatment and the outcome. Furthermore, RCTs were also described as the gold standard trial for evaluating the effectiveness of a clinical intervention ((Muijs 2010). One of the primary aims of RCTs is to prevent selection bias by distributing the patient, randomly between the two groups, so that the difference in the outcome and results can be justified and attributed only to the intervention under study. Thus, through random selection there is a better balancing of any confounding factors, therefore creating similarity between the groups (Cottrell & McKenzie, 2010). In effect in this literature review, RCTs were found to be useful and beneficial to compare the effect of KMC and conventional care on the physiological aspects of the infant. Ali et al., (2009) chose to add blocking to randomisation so as to ensure a better balance in the number of infants allocated in the groups. These groups were randomized through simple randomization and the disruption of groups was achieved by delivering a concealed envelope technique. Through random sampling, Polit & Beck (2010) explain that each element in the population has an equivalent, autonomous chance of being chosen. However, this design is not used frequently as it is lengthy and may be expensive (Wood & Kerr, 2011). Chiu and Anderson (2008), use mixed methods of data collection by using both questionnaires and video-taped interviews. The use of multiple sources or referents to draw conclusions about what constitutes the truth is called triangulation. This is one approach in establishing credibility as it enables the researcher to counteract the weaknesses in both designs. The use of video-taping provides the most comprehensive recording of an interview since it captures body language, facial expressions and interaction (Gerrish and Lacey 2010). However the interviewee may become uncomfortable and act differently than in normal circumstances questioning the reliability of the data collected. In addition, questionnaires are the main research tools used in quantitative research. They are very advantageous as they can be constructed in such a way as to meet the objectives of almost any research project. In the Family Needs Inventory used by Nicholas-Sargent (2009), the ‘not applicable’ part was removed from the Likert scale in order to report definite opinions. Questionnaires can measure the participants’ factual knowledge about a certain subject or an idea or else they can be used to explore opinions, attitudes or behaviours (McNabb, 2008). Moreover, questionnaires are also less expensive than most other research instruments and are also less time-consuming . Self-administered questionnaires provide the participants with anonymity, and responses are not affected by the interviewer’s mood or presence (Wood & Ross-Kerr, 2011). On the other hand, the main disadvantage of questionnaires is that there is a high possibility of a poor response rate since some questions are ignored, misinterpreted, incorrectly completed or inadequately detailed (Polit and Beck 2010). The RCT of Chiu and Anderson (2009) and Ali etal. (2009),, is one of the most powerful tools of research where people are allocated at random to receive one of several clinical interventions. However RCT’s are vulnerable to multiple types of bias at all stages of their workspan (Geretsegger et al 2012). Hence the need to establish validity and reliability. In the study done by both Ali etal.,(2009) and Chiu and Anderson (2009),the researchers increase the rigor on the study by using a large number of participants. In addition, Chiu and Anderson (2009) use the Nursing Child Assessment Satellite Training Program (NCAST) Feeding and Teaching scales. Nicholas-Sargent (2009), improved the rigour by using the Critical Care Family Needs Inventory (CCFNI), as a framework for the FNI. CCFNI has been thoroughly reported with results indicating internal consistency and construct validity (Gerrish and Lacey 2010). Despite this, Nicholas-Sargent (2009), use a small scale study and therefor e the results cannot be generalized. Limitations In the study done by Lee et al (2008), the data were only collected from one hospital in this present study causing generalisability of the results to be low. Moreover, the sample was restricted to those who did not have additional social, cultural or medical circumstances to consider. Moreover, coding was done by researcher itself and this might have caused some bias. Both Nicholas-Sargent (2009) and Parker (2011) use small scale studies but these were qualitative studies. Therefore, to a certain extent the findings cannot be generalized across the population of families involved with the NICU. In addition, Parker (2011) uses a retrospective study, which might have been subject to bias in recalling information. There was absence of pilot study in both Nicholas-Sargent (2009) and Chiu and Anderson (2009). The use of pilot studies helps to assess the design, methodology and feasibility of the tool and typically includes participants who are similar to those who will be used in the larger research study ( Wood & Kerr 2011). Hence, their importance. Also, the instruments chosen by Chiu and Anderson (2009), being the (NCAST and the feeding and teaching scales) for this study might not be sensitive enough to capture any between-group difference in changes resulting from the intervention. Finally, Ali et al., (2009) fail to mention intention to treat analysis where researchers can introduce reality into research by outlining that not all randomised participants will continue throughout the study. Therefore, this might be a potential weakness in this study. It was also noted the there was no detailed report about the time intervals between the two different groups. Hence, this may also have introduced performance bias. In the grounded theory approach taken by Fenwich et al (2008), limitations lie in the method of data collection itself through semi-structured interviews that were tape-recorded and field note documentation done. The authors did not acknowledge limitations in the study. Recommendations Maternal contact Fenwich et al (2008) suggests prioritising maternal-infant closeness when underpinning policies and protocols and suggests the unrestricted access to their child. Lee et al (2008) found that in Taiwan mothers are allowed to visit for 30 minutes twice a day. In Malta, mothers are allowed to stay with the child 24 hours a day. In addition, skin-to-skin contact is recommended by both Lee et al (2008) and Chiu and Anderson (2009). The latter suggests that all mothers, if they are able and whether or not they ask for it, skin-to-skin contact should be encouraged. My suggestions on interventions for critically ill infants include encouraging the parents’ presence at the bedside, assisting the parents in personalizing the bedside, and teaching the parents to gently touch their infant. Another approach is to hang a simple picture board with the first names of nurses and practitioners near the entrance to the unit. This picture board helps anxious families feel welcomed in this healing environment. In our unit, those babies who have central lines such as umbilical arterial catheters (UAC), the mothers are not allowed to hold the baby for fear of bleeding if the UAC gets dislodged. However, if the mother shows signs of needing contact with the baby, we allow her to hold the baby with constant supervision. In the case of babies that are ventilated mothers are only allowed to hold their baby if the prognosis is very poor. Therefore, this shows that, if the baby is on long term ventilation, skin-to-skin is hindered from being introduced. Fenwich et al (2008), recommend the development of tools that can better evaluate the satisfaction of the mother. Hence, the need for longitudinal qualitative research. In my opinion this would yield good results when past experiences would show which improvements were helpful and which were not. NICE standards (2010), specify the use of surveys. We can incorporate these surveys after consideration with the midwifery officer. Mother-nurse-infant interaction Because of the complexity of illness, parents of critically ill infants are anxious and fear the worst with every visit to the NICU. Strategies need to be adapted to decrease maternal anxiety while supporting the needs of these infants. (Nicholas-Sargent 2009). Nurses play a vital role in helping parents throughout the stressful and challenging experience of the NICU by developing therapeutic relationships and providing emotional support. These approaches enable parents to feel more supported, more involved, confident, and more effective as parents of their vulnerable newborn. The experience of parents in the NICU occurs during an emotionally intense period fraught with anxiety, stress, depression, and feelings of hopelessness. Therefore, Nicholas-Sargent (2009) suggests that, it would be vital to do an NICU orientation for expectant parents with a high risk of giving birth to a premature infant or a compromised newborn. Supporting and facilitating their parenting role will help decrease their stress, strain, anxiety, and depression. Lee et al (2008), nurses need to respect the cultural preferences of mothers as this would promote desired health outcomes. This would aid in meaningful, holistic and individualized care. According to Nicholas-Sargent (2009), personalized one-to-one as opposed as opposed to group support would be helpful. In addition Nicholas-Sargent (2009), suggests that nurse education is needed to improve the awareness of the impact of the counselling service. However, the service needs to be more flexible due to fluctuations in the health condition of the baby. In fact, what we notice is that mothers would require counselling at different stages of the hospitalization. Therefore, if the service was refused once, it may still mean that mothers would need it at some other point in time. Nicholas-Sargent (2009), further suggests that the counselling service would be extended to the whole family from the hospital as well as in the community., Both the DH (2009), and NICE (2010) highlight the importance of Family-Centered Care (FCC) views the family as the ‘child’s primary source of strength and support’ and allows for collaboration, respect, and support with the parents and family during all levels of the service delivery. To foster participation in care for the infant, unrestricted visiting hours should be encouraged for the nuclear family of the neonate. In Malta, visiting hours are restricted to parents only due to increase in cross infection when family members were allowed to visit for 1 hour everyday during the day. However, timing of care may still be arranged to facilitate parents’ participation. In addition, special moments such as baby’s first time off CPAP (continuous positive airway pressure) needs to take place during parents’ presence. Cockfort (2011), highlights that missed opportunities to involve parents in care, heighten anxiety and can create a sense of sadness and loneliness . Information for mothers Mothers vary in the amount of information they can assimilate under stress. Therefore identifying parents’ feelings through active listening and observing will help us to pick up on parents cues and respond appropriately in order to provide parents with accurate and clear information (Fenwick et al 2008). Nicholas-Sargent (2009), adds that, information regarding the health status of the baby needs to be give in a timely provision. Parker (2011), recommends the access to certified interpreters for non-English speaking parents to enable them to ask questions and get the information they need as well as information regarding the counselling services. Likewise, an updated information board at the infant’s bedside helps mothers retain information while feeling welcome at the bedside. In my opinion, these interventions create an environment that facilitates maternal- infant attachment by promoting maternal competence with meaningful positive parenting skills and fostering partnership in care.. Conclusion In summary, the findings showed that parents of infants admitted to the NICU experience stress, depression, anxiety, and feelings of powerlessness, hopelessness, and alienation within the environment of the NICU. These situations are often overwhelming and catastrophic for the mothers keeping in mind that the process of motherhood is a protecting and loving phenomenon. Therefore mothers should participate in the care of their sick, fragile infant in the NICU through mother-infant interaction. Nurses need to be supportive and informative in dealing with parents in the NICU. Therefore, the need for parents to be given the access of interpretation by certified interpreters in order to overcome language barriers has been identified. Further, information and emotional support is required throughout the stay in the NICU, However, it was further found that information in preparation for discharge planning is vital. This enhances parental knowledge and decreases stress, which promotes more effective parenting. Further, as understanding of the parents’ experience of having an infant admitted to the NICU increases, nurses will be better prepared to meet parental needs and alleviate parental suffering. Providing holistic, developmentally supportive care and open communication with parents in this stressful experience is essential. Moreover, the need for family-centered care has been identified. REFERENCE LIST Ali, M.S., Sharma. J., Sharma. R., & Alam. S. (2009). Kangaroo mother care as compare to conventional care for low birth weight babies. Dicle Tip Dergisi. 36(3), 155-160. Chiu S. & Anderson G.C., (2009). Effect of early skin-to-skin contact on mother–preterm infant interaction through 18 months: Randomized controlled trial. International Journal of Nursing Studies, Vol. 46, pp.1168–1180. Cleveland, L.M., 2008. Parenting in the neonatal intensive care unit. Journal of Obstetric, Gynecologic, and Neonatal Nursing, Vol. 37 (6), 666e691. Cockfort S., (2011). How can family centred care be improved to meet the needs of parents with a premature baby in neonatal intensive care? Journal of Neonatal Nursing, Vol.95(5), pp.365-368. Cottrell, R.R. & McKenzie, J. F. (2011). Health Promotion and Education Research Methods using the Five-Chapter Thesis/Dissertation Model (2nd ed.). Sudbury, Canada, United Kingdom: Jones and Bartlett Publishers. DeRouck, S. & Leys, M., (2009). Information needs of parents of children admitted to a neonatal intensive care unit. A review of the literature. Patient Education and Counselling, 76 (2), pp.159-173 DH: Department of Health, 2009. Toolkit for high-quality neonatal services. DH, London. Domanico R., Davis D.K., Coleman F. & Davis B.O. (2010). Documenting the NICU design dilemma: comparative patient progress in open-ward and single family room units. Journal of Perinatology, Vol.31, pp. 281–288 Fenwick J., Barclay L., & Schmied V.,(2008). Craving closeness: A grounded theory analysis of women’s experiences of mothering in the Special Care Nursery. Women and Birth, Vol. 21, pp.71—85. Geretsegger M., Holck U. and Gold C., (2012). Randomised controlled trial of improvisational music therapy’s effectiveness for children with autism spectrum disorders (TIME-A): study protocol. BMC Pediatrics Vol.12(2), pp.1471-2431. Gerrish K. & Lacey A. (2010). The Research Process in Nursing. Blackwell Publishing Ltd. UK. 6th ed. Glaser, B.G., & Strauss, A., 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine, NewYork. Gray, D. E. (2009). Doing Research in the Real World (2nd ed.). London, California, New Delhi, Singapore: Sage Publications. Grech V., Cassar M. & Distefano S., (2012). Nurse staffing levels on a regional neonatal paediatric intensive care unit. Journal of Paediatric Intensive Care, Vol. 1(1), pp.25-29. Johnson, A.N., 2008. Promoting maternal confidence in the NICU. Journal of Paediatric Health Care, Vol. 22 (4), 254e257. Lee S., Long A. & Jennifer B. (2009). Taiwanese women’s experiences of becoming a mother to a very-low-birth-weight preterm infant: A grounded theory study. International Journal of Nursing Studies, Vol.46, pp. 326–336 McNabb, D. E. (2008). Research Methods in Public Administration and Non-Profit Management: Quantitative and Qualitative Approaches (2nd ed.). New York: M. E. Sharpe Incorporation. Morrow V., (2009) ‘The Ethics of Social Research with Children and Families in Young Lives: Practical Experiences’. Young Lives. Oxford: Department of International Development. Muijs D., (2010). Doing Quantitative Research in Education with SPSS. London: Sage Publications NICE: National Institute for Health and Clinical Excellence, (2010). Quality Standard for Specialist Neonatal Care http://www.nice.org.uk/media/17A/A8/ Obeidat H.M, Bond E.A. & Callister L.C., (2009). The Parental Experience of Having an Infant in the Newborn Intensive Care Unit. The Journal of Perinatal Education | Summer, Vol. 18(3), pp.23-29. Parker L., (2011). Mothers’ experience of receiving counselling/ psychotherapy on a neonatal intensive care unit (NICU). Journal of Neonatal Nursing, Vol.17, pp.182-189. Polit D.F. & Beck C.T. (2010) Essentials of Nursing Research: Appraising Evidence for Nursing Practice, 7th ed. Wolters Kluwer Health | Lippincott Williams & Wilkins, Philadelphia. Nicholas-Sargent A., (2009). Predictors of needs in mothers with infants in the neonatal intensive care unit. Journal of Reproductive and Infant Psychology, Vol. 27(2), pp.195–205. Schira, M. (2009). Appraising a single Research Article. In Mateo, M. A. & Kirchhoff, K. T. (Eds.), Research for advanced practice nurses: from evidence to practice (pp. 73-85). New York: Springer Publishing Company. Strauss A. & Corbin J.( 1998). Basics of qualitative research. 2nd ed. Newbury Park, CA: Sage Publishers;. Watson, H., Booth, J. & Whyte, R. (2010). Observation. In Gerrish, K. & Lacey, A. (Eds.), The Research Process in Nursing (6th ed.) United Kingdom: Blackwell Publishing Limited. (pp. 382-394). Wood, M. J. & Ross Kerr, J. C. (2011). Basic Steps in Planning Nursing Research: From Question to Proposal (7th ed.). Sudbury, Canada, United Kingdom: Jones and Bartlett Publishers.