Dq-Sheila Essay Example | Topics and Well Written Essays - 1250 words

Dq-Sheila - Essay Example Case studies as well as phenomenological studies are both appropriate for qualitative research (Astalin, 2013). The two research designs start with research questions that direct the type of data to be collected. Interview and observations as well as review of documents are the main sources of information/data to both designs (Cheneli, 2011). Despite being similar in some aspects, case studies and phenomenological studies have differences that make them unique from each other. Phenomenological study gathers information on the life experience of research subjects (Kafle, 2011). This research design is used to illuminate the reaction of the subjects to a specific phenomenon. Case study on the other hand relates to an event or a program that have specific influence on the research subjects in a given environment (Cheneli, 2011). The data collected aim at investigating the exact benefits of a subject being in one environment compared to the other. Due to the nature of the research design, phenomenological study ask questions that aim at exposing inner perceptions of a subject on a particular issues (Kafle, 2011). The interpretation to such information paves way to attaching meaning to reaction. For example, a phenomenological researcher may ask a question like; what is the importance of going through formal education to an individual? This question gives room to the research subject to express their view based on experience. The person will respond to such questions using their live world. A case study on the other hand asks questions whose focus is evaluating the effect of the different surroundings to the research subjects (Hyett et al., 2014). A typical question in a case study could be; what is the best approach to addressing negative external influence in an organization? This question directs the subject to think in line with different

Impact of Beliefs on Learning | Essay

Impact of Beliefs on Learning | Essay CPPD Introduction Reflection has become a fundamental component of professional development of teachers and lecturers in the Further Education (FE) and Higher Education (HE) sector (Harkin, 2005). The lifelong learning sector can be seen to transcend both these paradigms and contexts of post-compulsory learning. This essay addresses some key elements of reflecting upon the experience of a teacher in Beauty Therapy within the lifelong learning sector, addressing the intersection between the personal and experiential and the theoretical/pedagogical aspects of the role and its function. Teaching roles and context within the lifelong learning sector Teaching roles within the lifelong learning sector seem to be related to the kind of teaching, the kind of subject, and the kind of learner (Zukas, 2006), a three-way relationship which I have observed to be perhaps more negotiated upon a day to day basis than founded in one single pedagogical theory or framework. It is notable that within the lifelong learning sector, there seems to be a crossover between the vocational type of education, and more traditional ‘teaching’, and in particular, these roles of ‘teachers’ are very much based on how best to meet student needs. Therefore, it seems that one element of the teaching role within this context is related to learning ‘on the job’ or learning through doing (Eraut, 2004), and the ‘becoming’ element of the process of ‘becoming’ a teacher in this context is a response to the demands of the job, rather than a formal process which prepares you to carry out the role. While t his might run against the theories of pedagogy, being a much more personal take on what the teaching role is, it is based on perceptions of professional identity as well as an understanding of dominant concepts of the role in a formal sense (Beckett and Gough, 2004). Austerlitz and James (2008) describe the emotional journeys that students go through in further education as a process of cognition through which emotions help students to appraise situations and develop knowledge and understanding. This may be an important perspective to consider within the lifelong learning sector, because of the range of types of students and types of subjects that are prevalent within this sector. There is no single student demographic, no single approach to pedagogy, no one-size-fits-all model of teaching and learning. Bathmaker and Avis (2005) carried out research into professional identity formation amongst trainee FE lecturers, and found that â€Å"rather than identifying effective processes of increasing participation in existing communities of practice, a strong sense of marginalisation and alienation amongst trainees was observed† (p 47). Bathmaker and Avis (2005) suggest that this lack of engagement in communities of practice is â€Å"detrimental both to trainees and experienced lecturers if they are to actively engage in building new forms of professionalism for the future† (p 47). I would draw from this the concept that formal training processes do not necessarily pos itively contribute to role formation, definition and professional identity, and that learning is much more experiential and interactive. Hagger et al (2008) support this view, and suggest that experiential learning dominates learning of this type. Own teaching role and context within the lifelong learning sector My own teaching role is to teach and support students to learn on two levels. The first is to learn the practical skills and abilities of the beauty therapy industry, so that they can become capable, effective practitioners. Beauty therapy is no ‘soft option’. In fact, there is a great deal of precision, dexterity and deeper learning involved in acquiring the skills to function as a therapist. The second element of the learning is for students to develop knowledge and understanding of the body, of health, of individuals and their holistic wellbeing, in order to contextualise the activities that they carry out within their roles, and to be able to provide suitable treatments, therapies and the like to appropriate clients. The third element of the role is to support students to develop the communication and interaction skills necessary to be able to bring together knowledge and practical skill into their own ‘professional role’ and identity, and work effective ly as a therapist within a team. My role within this setting is to ‘teach’, but also to facilitate learning, raise difficult issues, support students to resolve complex questions, and act as a role model. Part of my role is to assess practical activities, and then provide feedback so that students can learn from their experiences and learn to improve their own practice through reflection and evaluation (Edwards and Nicoll, 2006; Solomon et al, 2006). My role also involves becoming more aware of the impact of my role on the students, and attempt to be as good a ‘teacher’ as I can be. More and more, however, my role involves other activities, including administration, engaging in marketing and recruitment activities, and looking for new topics and curriculum developments (Chivers, 2006). Impact of own beliefs, assumptions and behaviours on learners and others My own beliefs about learning affect not only the learners who I interact with, but also their interactions with others, particularly clients. I believe that my own actions, reflections, and the way I respond to emergent situations within the teaching context are likely to affect the students and how they learn as much as the formal, planned learning activities I provide for them. It is through reflection on my actions as a teacher that I have realised that reflection itself becomes a reflexive process, which changes the way I behave and react to students, which then changes their responses to me. Austerlitz and James (2008) have developed a model which describes and captures PPD statements which are used in the further and higher education sectors (see Figure 1). Figure 1 PPD Model (after Austerlitz and James, 2008). This model encompasses many of my own beliefs about the ways in which students interact with their learning processes, and in particular, how they respond to my teaching and learning activities. Every aspect of learning must have an emotional element, and to exclude this from pedgagogical processes and theories is to overlook important aspects of how students learn and how they behave when applying that learning. Yet there is some evidence that current perceptions of teaching roles within the FE sector are also changing (Thompson and Robinson, 2008). I believe that the Austerlitz and James (2008) model could provide a means by which students could themselves identify the emotional elements of their learning and address this, through reflection, in proactive ways. Impact of own professional, personal and interpersonal skills, including literacy, numeracy and ICT skills on learners and others. I have used a range of teaching approaches, including some innovative use of ICTs, including using ICTs to make posters and mind maps, to encourage the application of new knowledge and exploration of complex situations. These have had a positive effect on some students who relate well to ICTs, particularly younger students, and have also helped students who are more visual learners. However, in relation to professionalism, I think it is my professional skills and experience which have positively impacted on students’ development of awareness and understanding of the complex interactions between beauty therapist and client. The current social construction of beauty, particularly in relation to ageing, raises issues about client experiences and emotional/psychological wellbeing (Paulson, 2008; Radley, 2000). Students need to understand the emotions and thoughts which underlie the desire that women have for the different kinds of beauty therapies, and be able to interact in a cre dible way with clients and meet their requests in appropriate ways. My own professionalism helps this because I set a good example, exemplify proper interactions, and support students to address often challenging issues such as intimacy, privacy, body-image and the like. Conclusion Overall, the most important aspect of my role as an educator is as a role model, and not simply as a role model of good communications behaviours or good practical skills, but as a questioning, reflective, responsibly practitioner, who sees clients as individuals, not just in relation to their treatments. It is important not to simply perpetuate traditional ways of working, but to question practice and the self in the professional context, and by acting as a reflective practitioner myself, I can encourage my students to develop similar skills and perhaps become better professionals because of it. References Austerlitz, N. and James, A. (2008) Reflections on emotional journeys: a new perspective for reading fashion students’ PPD statements. Art, Design and Communication in Higher Education 6 (3) 209 – 219. Chivers, G. (2006) The work roles and development needs of vocational lifelong learning professionals in British higher education. Journal of European Industrial Training 30 (3) 166-187. Zukas, M. (2006) Pedagogic learning in the pedagogic workplace: educators’ lifelong learning and learning futures. International Journal of Pedagogies and Learning 2 (3) 71-80.

Argentina Essay -- essays research papers

I. INTRODUCTION Argentina lives in a democracy since 1986. Before this year lived it under a military regime. In the nineties under the presidency of Menem the country experienced a great increase in the liberalization of trade. Argentina has a free market economic system. Due to the recent privatization program, the State now has a very limited role in the economy. According to the Competitiveness Report of the World Economic Forum Argentina is classified as one of the most open, least protectionist countries in the world. Its currency is convertible to the US dollars and there is total freedom for moving capital internationally. Argentina has conducted one of the most intensive privatization programs in the world. The telephone company, airlines, most railroads, electric power production companies (including hydroelectric power plants), the Argentine oil company YPF (bought by the Spanish company Repsol) steel mills, ports, TV stations and most public services were transferred recently to the private sector. Consistent with Fundacion Invertir the combined value of privatized firms amounts more to more than US$ 30 billions. Many foreign firms have participated in this large-scale privatization program. Foreign investors do not need to seek any kind of prior approval and are free to repatriate full amount of their capital and earnings any time. Foreign and domestic companies are treated equally. Under the law, they have access to all economic sectors and are eligible for incentive program and state procurement. II. TRADE PATTERN It is hard to state the type of trade that exists between Argentina and Brazil in the automobile industry because both countries import and export cars of the same brand and very similar models. Volkswagen produces some of its model of cars in Argentina and some others model in Brazil. The reason for this is to achieve economies of scale; each country specializes in a certain model of car, by doing so they reduce the cost of each additional unit. Another reason for specialization of production in each country is that it might be cheaper to produce a certain model in either Argentina or Brazil. Several companies as Volkswagen have invested in production facilities in Mercosur. Additionally, joint ventures between local and foreign parts manufacturers have improved quality. A report on Argentina auto parts/services announced that loca... ...stment payments, and transfers. Argentina has generally maintained a deficit position in trade in services, and has historically paid out more investment income than it has received, keeping its finances on edge. Countries whose foreign direct investments keeps up with its domestic growth can afford such disparities. Nevertheless Argentina's deficit current account shows that the economy might be hurt even more by capital flight. Thus the development of exports, especially nontraditional ones, is taking on greater urgency. In recent years exports of manufactured products increased at respectable rates. "In 1995 industrial products grew 40 percent while primary products and manufactured agricultural products each grew 29 percent. In 1996, exports of industrial products decreased 0.6 percent, primary products grew 21 percent, and manufactured agricultural products 13 percent. In 1997, exports of industrial products grew 27 percent, and manufactured agricultural products 7 percent, however the primary products decreased 2.4 percent. Imports of capital goods and parts are a major component of total imports, which are being used to increase productivity." (Fundacion Invertir)

Rhetorical Analysis of Obama Speech

Literatures and Foreign Languages Let Us Learn and Resource Together 23 November 2008 Rhetorical Analysis of â€Å"A More Perfect Union† Speech The speech titled â€Å"A More Perfect Union† was delivered by Senator Barack Obama on March 18, 2008 near the historical site of the signing of the U. S. Constitution in Philadelphia, Pennsylvania. The speech responds to the video clip of Barack Obama’s pastor, Reverend Jeremiah Wright, making racially charged comments against America and Israel. The pundits and various news media outlets played the clip repeatedly on the television, radio, YouTube, and podcasts.First, the Senator’s speech attempts to address the nation on their concerns of his affiliation with Reverend Wright. Second, the speech addresses the sustaining and prevailing issues of race within America and how it paralyzes our nation. The speech is compelling because it possesses the necessary elements of effective and persuasive rhetoric; in summatio n, Obama’s rhetoric works. Rhetoric is the study of opposing arguments, misunderstanding, and miscommunication. Also, relevant to this analysis, rhetoric will be defined as the ability to speak and write effectively and to use language and oratory strategically.Despite the common employment of speech writers by most politicians, Senator Obama wrote the speech himself. By addressing the misunderstanding and miscommunication connected to and perpetrated by racism in America, the audience sees precisely how effective Obama’s speech is when examined through such lenses as the classical and 20th century rhetorical theories and concepts from Aristotle, Richard Weaver, Stephen Toulmin, Chaim Perelman, and Michel Foucault. Barack Obama’s speech echoes the rhetorical concepts of ethos, pathos, and logos that are explicitly discussed within Aristotle’s The Rhetoric.Ethos is how the speaker’s character and credibility aids his or her influence of the audience ; whereas pathos is a rhetorical device that alters the audience’s perceptions through storytelling and emotional appeals (181). Logos uses reason to construct an argument and to covey an idea (182). Finally, kairos attempts to conceptualize the need for the correct timing (201). Therefore, ethos, pathos, logos, and kairos are all evident within the speech and expressed in various ways, striking language and repetition, and through different receptors, emotions and logic.Ethos is accomplished on intellectual, social, spiritual, and biological levels. Senator Obama does this by giving factual information. He interjects historical references; he explains the extent of his family tree. Thus, the Senator gives creditability to his speech and validity to his message. The implication is that everyone should listen; he is the authority. He acknowledges that the press routinely looks â€Å"for the latest evidence of racial polarization, not just in terms of white and black, but blac k and brown as well† (Obama, par. 7).From this quote, the audience is being persuaded by the classical theoretical concepts of opposing arguments. The audience is fully aware of the division between the races, and the speech is very effective due to the fact that Barack Obama is willing to speak of what is often unspoken. When addressing his intellectual ethos, Obama mentions that he has â€Å"gone to some of the best schools in America† (Obama, par. 6). Secondly, he recites, â€Å"We the people, in order to form a more perfect union,† which is easily recognized as the first line in the U. S. Constitution (Obama, par. 2).Even those who do not possess complete knowledge of the famous line immediately understand that something of importance is being conveyed to them. Thirdly, he demonstrates his awareness of past occurrences and present concerns on the global scale. Senator Obama recalls the â€Å"legacy of slavery and Jim Crow† within our nation (Obama, par . 24). He acknowledges the present dangers of â€Å"conflicts in the Middle East† and explains the cause of such conflict (Obama, par. 10). The audience is given evidence that he understands the role of history as well as the present-day global concerns affecting our nation.Furthermore, Senator Obama uses ethos to gain credibility with his knowledge of social issues that pervade our society today. He states, â€Å"The most segregated hour of American life occurs on Sunday morning† (Obama, par. 12). He acknowledges that the resentments of the black and white communities â€Å"aren’t always expressed in polite company,† but these resentments are manifested within our society in destructive ways, like racism (Obama, par. 31). The audience feels that he is knowledgeable and credible on the immediate topics affecting our future and our daily lives.Ethos is also applied on a spiritual level by mentioning his present faith and making Biblical references. He stat es that â€Å"more than twenty years ago [he was] introduce[d] †¦to Christian faith [with] obligations to love one another, to care for the sick and lift up the poor† (Obama, par. 13). He noted how â€Å"black people merg[ed] with the stories of David and Goliath, Moses and Pharaoh, the Christians in the lion’s den, [and] Ezekiel’s field of dry bones† (Obama, par. 16). Senator Obama is altering the language.Christians did not exist in the Old Testament story of Ezekiel, but Senator Obama is effectively connecting with every major religion. Simultaneously, he is reaching out to the secular world as well. Being cognizant that everyone does not actively practice a religious faith, Obama chooses stories that everyone, Christians and non-Christians, could identify and recognize. Thus, these religious references connect with masses as well as members of the three major religions. Finally, Senator Obama gains ethos by explaining his own genetic makeup.He st ates that he is â€Å"the son of a black man from Kenya and a white woman from Kansas†¦ [He continues that he] is married to a Black American who carries within her the blood of slaves and slave owners†¦ [Then, he acknowledges that he has] brothers, sisters, nieces, nephews, uncles and cousins of every race and every hue scattered across three continents† (Obama, par. 6). In essence, he reveals that he has the blood of Africa, the birthplace of humanity, and the blood of a woman of French descent within him. He has married a woman who has both slave and slave owner flowing within her.Moreover, he has fathered children who have the blood of humanity: African, European, slave, and the Caucasian slave owner within them. Thus, he is an authority on race. He states, â€Å"[his] story [is] seared into [his] genetic makeup the idea that this nation is more that the sum of its parts–that out of many, we are truly one† (Obama, par. 6). The audience revels at hi s remarkable story, and ethos is achieved through storytelling. In essence, Obama forges a biological connection with his audience. The connection is strengthened through Senator Obama’s use of pathos.It is achieved through the use of emotional appeals. He alters the thoughts and feelings of his audience through storytelling, imagery, and allusion. The topic of race, within itself, evokes strong emotions, even to this very moment, this very second. The senator begins by telling a story of his grandfather â€Å"who survived a Depression to serve in Patton’s army during World War II† (Obama, par. 6). The use of key terms such as Depression, Patton’s army, and World War II evoke the emotional responses of patriotism and self-sacrifice.Toward the end of his speech, Obama shares another story; he tells of a young, white, Southern campaigner–Ashley Baia–who inspires an old, black, Southern man to vote (Obama, par. 45-46). In essence, Baia encourag es pathos by telling her story. Barack Obama uses Baia’s story of inspiration to highlight the power in sharing his own story. The audience is able to connect through the emotional appeals that take place at the very core of humanity. It is easy to disrespect and dishonor something that is foreign and unknown, but it is hard to turn away from the essence of another man’s soul.As fellow humans, the audience recognizes the sheer humanity in the story. Pathos is also achieved through the use of allusion and imagery. The imagery that is provoked with terms such as slave or slavery is still poignant today. Most people are cognizant of the plight of slaves within this country. The audience would be aware of the racism that ensued and the devastation and isolation that slavery caused in American history. When Barack Obama describes the various ways that racism manifested within our society, pathos is achieved because of the powerful imagery of the allusions to race and racial conflicts within our community.The audience is trapped and becomes aware of the prejudices and experiences of race and racism within their own lives, thus causing emotions to surge and overflow. Pathos, being the weakest form of rhetoric, is utilized by Senator Obama sparingly. Instead, he overwhelmingly utilizes the most powerful form of rhetoric, logos. Logos is the ability to embody rational, logical, methodical thoughts and persuasions. As it relates to Obama’s speech, examples of logos are found throughout the text. For example, by displaying objectivity, the element of logos is achieved.Senator Barack Obama methodically explains the problems with race within America, and he gives logical, reasoned resolutions to the problems. He explains, â€Å"The anger [of Blacks and] the memories of humiliation and doubt and fear have not gone away, nor has the anger and bitterness of those years†¦ [Later he offers resolution and states that] the African-American community [mu st embrace] our past without becoming victims of our past† (Obama, par. 34). Many African-Americans will identify with Obama’s assessment of race within the African-American community, and they will be inspired to act in a positive manner.Simultaneously, he acknowledges â€Å"a similar anger within†¦the white community. They [feel] they’ve worked hard all their lives†¦They are anxious about their future, and they feel their dreams slipping away [and] resentment builds over time†¦ [Furthermore, he offers resolution and urges that] the white community [must acknowledge] that what ails the African-American community does not just exist in the minds of black people; that the legacy of discrimination [exists]† (Obama, par. 36).From these lines, the audience is persuaded to respond in a positive manner as well, and they are urged to approach the subject of racism both subjectively and objectively. Senator Obama recognizes the duality of both pligh ts and asks the American people not to blame each other but investigate and seek out the true reason of conflict within our nation. Thus, Obama is using inductive and deductive reasoning, which is indicative of logos. By utilizing Aristotle’s method and system, Obama’s appeals to logic are beyond reproach.Once his reasons are defined, he states that this is the time that we must take action and secure our future together, and Obama begins to preach on the importance of time. The issue of time and timing directly correlates with the classical rhetorical term kairos. Obama conveys time in a powerful fashion. In the beginning of his speech, he states, â€Å"Two hundred and twenty one years ago [our forefathers]†¦produced [a document that was] eventually signed, but ultimately unfinished.It was stained by the nation’s original sin of slavery [that] brought the convention to a stalemate until the founders chose to allow the slave trade to continue for at least 20 more years, and leave any final resolution to future generations† (Obama, par. 3). Later, he explains how people often manipulate race to win political elections and prevent unity. Barack Obama speaks of the continual war between segments of our community. Then he states, â€Å"But race is an issue that I believe this nation cannot afford to ignore right now† (Obama, par. 23).Furthermore, he acknowledges â€Å"the complexities of race† in America have never been resolved. He urges Americans â€Å"to come together and solve [the] challenges [in America]† (Obama, par. 33). He persuades the audience to racial relations within America a priority. In summary, kairos is aggressively addressed and highlighted. The audience realizes that the problem at hand may have been ignored by our forefathers, but these problems must be addressed now. Toward the end, kairos reaches its peak of effectiveness. Obama states that what has been effectively dividing the races in the past will not happen again:Not this time. This time we want to talk about crumbling schools†¦This time we want to reject the cynicism†¦This time we want to talk about [healthcare]†¦This time we want to talk about [jobs]†¦This time we want to talk about [race]†¦This time—This time we want to talk about the men and women of every color and creed who serve together, and fight together, and bleed together under the same proud flag (Obama, par. 40-41). From these lines, the audience feels the urgency of time; the listeners realize that â€Å"this time† America must act.Obama effectually uses the sophistic rhetorical theories and concepts to ignite and unite the audience; however, he also incorporates modern-day rhetorical theories and concepts as well. Specifically, Senator Obama utilizes the hierarchy of definition, analogy, cause and effect, and testimony of the 20th century rhetorician, Richard Weaver. In the introduction of Language Is Serm onic, the narrator summates Weaver as stating, â€Å"Rhetoric†¦is a positive act with consequences in the world†¦Every utterance is an attempt to make others see the world in a particular way and accept the values implicit in that point of view† (1348).Similarly, Obama desires to persuade the audience to see the world from a different perspective, a different lens. First, toward the beginning of the text, Obama defines the Black church. He states, â€Å"Black churches across the country embod[y] the community in its entirety—the doctor and the welfare mom, the model student and the former gang-banger†¦[S]ervices are full of raucous laughter and sometimes bawdy humor†¦ [Full] of kindness and cruelty, the fierce intelligence and the shocking ignorance, the struggles and successes, the love [as well as] the bitterness and biases† (Obama, par. 8). If one really looks closely at the definition, it is also a definition of America as well as the Bla ck church. By explaining the polarity within the Black church, he explains the polarity within America as a whole. In this way, Obama uses rhetoric in a positive way to impact his audience and highlights that â€Å"every utterance is an attempt to make others see the world in a particular way [through definition]. † Second, Weaver asserts, â€Å"Rhetoric [is] the most important of all ends, the persuading of human beings to adopt right attitudes and act in response to them† (1351).From these lines, one can examine Senator Obama’s use of twentieth century rhetorical theories and concepts. Obama uses â€Å"cause-and-effect† by illustrating the history of racism within the United States (1354). He states: We do not need to recite here the history of racial injustice in this country. But we do need to remind ourselves that so many of the disparities that existed between the African-American community and the larger American community today can be traced direc tly to inequalities passed from an earlier generation that suffered under the brutal legacy of slavery and Jim Crow (Obama, par. 4). In essence, Obama is stating that the racism today has a sordid past in our history; it can not be ignored, but it must be confronted, discussed, and acted upon. Obama is using this cause-and-effect to play on the emotions of his audience. Everyone is aware of the gruesome history, yet, as Weaver puts it, â€Å"Humanity includes emotionality or the capacity to feel and suffer, to know pleasure† (1352). From these lines, it is obvious that Senator Obama uses cause-and-effect to evoke an emotional response and sway the audience to his point of view.Furthermore, Barack Obama utilizes the elements outlined by Stephen Toulmin’s The Uses of Argument. He uses the schema of the six components in analyzing arguments: qualifier, claim, data, warrant, backing, and rebuttal. The qualifier is the â€Å"word or phrase [that] expresses the speaker†™s degree of force or certainty concerning the claim† (1418). Next, the claim is the â€Å"conclusion whose merit must be established† (1417). Then, the data is the â€Å"fact we appeal to as a foundation for the claim† (1417). The warrant is â€Å"the statement authorizing our movement from the data to the claim† (1419).

Post Partum Haemorrhage (PPH) Essay

Introduction: Post partum haemorrhage (PPH) is an obstetrical emergency that can follow vaginal or cesarean delivery. It is a major cause of maternal morbidity and one of the top three causes of maternal mortality in both high and low per capital income countries, although the absolute risk of death in much lower in high income countries (1 in 100,000 versus 1 in 1000 births in low income countries). Furthermore, hemorrhage is the leading cause of admission of the intensive care unit and the most preventable cause of maternal mortality. The average blood loss following vaginal delivery, caesarean delivery and caesarean hysterectomy is 500 ml, 1000ml and 1500 ml respectively. Depending upon the amount of blood loss, post partum hemorrhage (PPH) can be- âž ¢ Minor (1L) âž ¢ Severe (10g/dl) so that the patient can withstand some amount of the blood loss. †¢ High risk patients who are likely to develop post partum hemorrhage (such as twins, hydramnios, grand multipara, APH, history of previous PPH, severe anemia) are to be screened & delivered in a well equipped hospital. †¢ Blood groping should be one for all women so that no time is wasted during emergency. †¢ Placental localization must be done in all women with previous caesarean delivery by USG or MRI to detect placenta accreta or percreta. †¢ Women with morbid adherent placenta are at high risk of PPH. Such a case should be delivered by a senior obstetrician. A availability of blood & or blood products must be ensured before hand. Intranatal: †¢ Active management of the third stage, for all women in labour should be a routine as it reduces PPH by 60%. †¢ Women delivered by caesarean section, oxytocin 5 IU slow IV is to be given to reduce blood loss. †¢ Exploration of the utero-vaginal canal for evidence of trauma following difficult labour or instrumental delivery. †¢ Observation for about 2 hours often delivery to make sure that the uterus is hard and well contracted before sending her to ward. †¢ During caesarean section spontaneous separation & delivery of the placenta reduces blood loss (30%). Management of retained placenta: This diagnosis is reached when the placenta remains undelivered after a specified period of time (usually half to 1 hour following the baby’s birth). This is done to apply pressure to the placental site. The whole hand is introduced into the vagina in cone shaped fashion after separating the labia with the fingers of the other hand. the vaginal hand is clenched into a fist with the back of the hand directed posteriorly and the knuckles in the anterior fornix. The other hand is placed over the abdomen behind the uterus to make it anteverted. The uterus is firmly squeezed between the two hands. It may be necessary to continue the compression for a prolonged period until the (during the period, the resuscitative measures are to be continued). Manual removal of the placenta: The operation is done under general anaesthesia. The patient is placed in lithotomy position with all aseptic measures, the bladder is catheterized. One hand is introduced into the uterus after smearing with the antiseptic solution in cone shaped manner following the cord, which is made taut by the other hand. While introducing the hand, the labia are separated by the fingers of the other hand. The fingers of the uterine should locate the margin of the placenta. Counter pressure on the uterine fundus is applied by the other hand placed over the abdomen. The abdominal hand should steady the fundus & guide the movements of the fingers inside the uterine cavity till the placenta is completely separated. As soon as the placental margin is reached, the fingers are insinuated between the placenta & the uterine wall with the back of the hand in contact with the uterine wall. The placenta is gradually separated with a side ways slicing movement of the fingers, until whole of the placenta is separated. When the placenta is completely separated, it is extracted by traction of the cord by the other hand. The uterine hand is still inside the uterus for exploration of the cavity to be sure that nothing is left behind. i) Management of third stage bleeding: In this third stage of bleeding or hemorrhage, the bleeding occurs before expulsion of placenta. Principles âž ¢ To empty the uterus. âž ¢ To replace the blood. âž ¢ To ensure effective haemostasis. Steps of management: a) Placental site bleeding: âž ¢ To palpate the fundus and manage the uterus to make it hard. âž ¢ To start crystalloid with oxytocin at 60 drops /min and to arrange for blood transfusion if necessary. âž ¢ Oxytocin 10 units IM or methargin 0.2 mg. is given intravenously. âž ¢ To catheterize the bladder. âž ¢ To give antibiotics (ampicillin 2gm.and Metronidazole 500mg. IV). b) Traumatic bleeding: The utero vaginal canal is to be explored under general anaesthesia after the placenta is expelled. ii) Management of true post partum hemorrhage: In this true post partum hemorrhage the bleeding occurs subsequent to expulsion of placenta (majority). Management: âž ¢ Call for extra help involve the obstetric senior staff on call. âž ¢ Keep patient flat and warm. âž ¢ Send blood for diagnostic test. âž ¢ Infuse rapidly 2 litres of normal saline. âž ¢ Give oxygen by mask 10-15L/min. âž ¢ Monitor the pulse, blood pressure, urine output, drug type, dose and time. B. Secondary Post partum hemorrhage: Definition: Secondary post partum hemorrhage is bleeding from the genital tract more than 24 hours after delivery of the placenta and may occur upto 6 week later. The bleeding usually occurs between 8th to 14th day of delivery. Causes: The causes of late post partum hemorrhage are- 1. Retained bits of cotyledon or membranes (commonest) 2. Infection and separation of slough over a deep cervico-vaginal laceration. 3. Endometritis and sub involution of the placental site- due to delayed healing process. 4. Secondary hemorrhage from caesarean section wound usually occur between 10-14 days. 5. Withdrawal bleeding following oestrogen therapy for suppression of lactation. Clinical Manifestation: 1. The lochia are heavier than normal & recurrence of bright red flow. 2. Offensive lochia if infection is a contributory factor. 3. Sub involution of uterus. 4. Pyrexia & tachycardia. Diagnosis: The bleeding is bright red and varying amount. Rarely it may be brisk. Varying degree of anemia & evidences of sepsis are present. Internal examination reveals evidences of sepsis, sub involution of the uterus & often patulous cervical OS. Ultrasonography is usual in detecting the bits of placenta inside the uterine cavity. Management: Principle: âž ¢ To assess the amount of blood loss & to replace it (transfusion) âž ¢ To find out the cause & to take appropriate steps to rectify it. Management: i) Massage the uterus if it is still palpable to bring about a contraction. ii) Express any clots. iii) Encourage the mother to empty her bladder. iv) Give an oxytocic drug such as ergometrine by intravenous or intramuscular route. v) Save all pads & lines to assess the volume of blood loss. vi) If retained products of conception are not seen on an ultrasound scan, the mother may be treated conservatively with antibiotic therapy and oral ergometrine. vii) Anemia is treated with iron supplement & in severe cases, blood is transfused. Nursing management of PPH: Assessment: 1. Assess maternal history for risk factors, plan accordingly and communicate to the perinatal area. 2. Assess pulse pressure, recording consistently less than 30bpm are consistent with hypertensive crisis. 3. Assess intake & output chart. 4. Assess location & firmness of uterine fundus. 5. Palpate the bladder distension, which may interfere with contracting of the uterus. 6. Inspect for intactness of any parineal area. Diagnosis: i) Deficit fluid volume related to blood loss as manifested by looking pale, dehydrated & decrease pulse rate. ii) Acute pain related to perineal discomfort from birth trauma and physiologic changes from births as monitored by wrinkled in forehead, restlessness & irritability. iii) imbalance nutrition less than body requirement related to restriction in food intake as manifested by fatigue, weakness and lethargic. iv) Sleeping pattern disturbance related to pain & bleeding as manifested by drowsiness, lethargic, irritated, etc. v) Risk for infection related to birth process & maintaining poor hygiene as manifested by patient’s verbal complain, irritable & discomfort. Goal: i) Monitoring for hypotension & bleeding. ii) Minimize the pain. iii) Improve nutritional status. iv) Improve sleep pattern. v) Reduce the risk for infection. Intervention: âž ¢ For 1st diagnosis: i) Monitor vital signs every 4 hours during the first 24 hours. ii) Assess vaginal discharge for clots and amount. iii) Maintained IV line as ordered by the doctor. âž ¢ For 2nd diagnosis: i) Assess pain level, location, duration and type also. ii) Provide comfortable position (i.e. supine position) iii) Administered medicine as prescribed by the doctor. âž ¢ For 3rd diagnosis: i) Assess the nutritional status of the patient. ii) Patient is advised to take liquid diet from 3rd day & solid from 4th day. iii) Weight in monitored daily. âž ¢ For 4th diagnosis: i) Sleep pattern is assessed. ii) Provide a neat and tidy bed to the patient. iii) Unnecessary procedures avoided during sleeping period. iv) Patient is advised to discourage day time sleeping. âž ¢ For 5th diagnosis: i) Assessed the level of infection, burning sensation and frequency of urination. ii) Washing hands & wearing gloves can reduce the risk for infection before doing any procedure. iii) Advised the patient to maintain the personal hygiene and also should teach how to take care of perineal area. Evaluation: i) Bleeding is reduced than before. ii) Patients pain level might be minimized. iii) Nutritional status of the patient is improved. iv) Patients sleep pattern is improved. v) Infection is controlled. Conclusion: Post Partum hemorrhage continued to be a leading cause of maternal morbidity & mortality. In this patient despite identification and attempt at correction of an identified clotting disorder, major obstetric hemorrhage was not avoided. However, these factors may be unavoidable and early surgical intervention as per local protocol is recommended to minimize maternal morbidity. After studying & presenting the seminar on the topic of PPH, I got a thorough idea about this disease and I am thankful to ma’am for giving me opportunity of presenting this topic. I think I can be able to import some amount of knowledge to the group & I will be able to provide proper care to such patient if I got in future. Bibliography: 1. C.D. Dutta â€Å"text book of obstetrics† 7th edition, new central book agency, page no- 410-418 2. Annamma Jacob â€Å"A comprehensive textbook of midwifery & Gynecological Nursing†, 3rd edition, Joypee brothers medical publishers (p) Ltd. 3. â€Å"Myhes Tex book for midwives†, edited by V. Rith Bennett Linda K. Brown, 12th edition. Page No- 462-470 4. Dr. Parulekar Shashank V., â€Å"Text book for midwives†, 2nd edition, voramidical publication. Page No- 351-356. 5. B. Basavanthappa T. â€Å"Essentials of midwifery & obstetrical Nursing†, 1st edition, Jaypee Brothers medical publishers. Page No- 544-555. 6. w.w.w.urmc.rochester.edu>URMC>Health Encyclopedia âž ¢ w.w.w.birth.com.au>Labour & Birth. âž ¢ w.w.w.rcog.org.uk>Home>women’shealth> idelines>search for a guideline. âž ¢ Bmb.oxford journals.org/..205full. âž ¢ w.w.w.ncbi.nlm.nih.gov> journal list>cases J/V.J;2008