Childhood Resilience and Vulnerability - Free Essay Example

Sample details Pages: 8 Words: 2447 Downloads: 7 Date added: 2019/03/13 Category Sociology Essay Level High school Tags: Childhood Essay Did you like this example? Abstract Resilience and vulnerability among children has been an ongoing topic in research of developmental psychology. These two definitions are closely tied together as they are considered both sides to the spectrum. Schaffer (2006) defines resilience and vulnerability as the susceptibility to develop malfunctioning following exposure to stressful life events, as opposed to the capacity to maintain competent functioning stress. Don’t waste time! Our writers will create an original "Childhood Resilience and Vulnerability" essay for you Create order If stressful life events are the trigger here, why is it that some children are far more vulnerable, yet others are more resilient? The three studies discussed in this paper will attempt to explain why these differences occur and what can we do to enhance protective factors. Introduction An easy way to conceptualize the term resilient is defined by Berger (2008). Berger (2008) refers to resilience as the capacity to adapt well to significant adversity and to overcome serious stress. According to Berger (2008) there are three parts to this definition: resilience is dynamic, it is a positive adaptation to stress, and adversity must be significant. In regards to Bergers first part, it is apparent that resilience is dynamic. In one article, a 14-year old girl was described as living absent from her institutionalized mother, and because of this she was responsible for taking care of her younger siblings and alcoholic father (Alvord Grados, 2005). Results of a longitudinal study concluded that although she should have formed an avoidant relationship with a future partner, she went on to form a secure and long-lasting marriage. The article questions if she was good at coping (resilient) or was she invulnerable? Second part to Bergers definition is the fact that resilience is a positive adaptation to stress. A more recent study has given us evidence that children can recover and develop normally (Alvord Grados, 2005). These findings were evident when deprived orphans from Romania were adopted to amorous families living in the United Kingdom. Following the adoption, cognitive and physical growth increased. These children had the ability to continue their growth through wise choices, enhanced education, and take advantages of new opportunities (Alvord Grados, 2005). Finally, Berger (2008) explains Adversity must be significant. Some adversities are comparatively minor (large class size, poor vision), and some are major (victimization, neglect). Looking at adversity from a humanistic perspective we need to recognize individual differences, such as culture, gender, and emotional experiences. Keep in mind, resilience is not a personality trait, it is a process. Contributing risks and factors Schaffer (2006) defines risk and protective factors as conditions that increase the probability of some undesirable outcome or, on contrary, conditions that buffer the individuals against undesirable outcomes. Risk and protective factors exist independently from one individual to another. Not only are an individuals characteristics important, but their physical, social, and family environments. According to the Centre for Addiction and Mental Health (2009), a protective factor would be considered a child living in a two-parent house. If one of the parents is in any form abusive to the other parent, or the child the living situation would be altered to a risk factor. However, not living with the abusive parent would result back into a protective factor. Therefore, factors rotate in a cycle. If protective factors are what we are aiming to improve, we must be aware of the individuals developmental stage, and also the cultural factors that come into play (Alvord Grados, 2005). Alvord and Grados (2005) have broken down protective factors into six categories. These six categories appear to be the buffers against risk factors (Alvord Grados, 2005). Many of these components are coexisting with each other. The first protective factor is proactive orientation. Proactive orientation is Taking initiatives in ones own life and believing in ones own effectiveness, this has been identified as a primary characteristic in defining resilience (Alvord Grados, 2005). Children who are high in proactive orientation develop hopefulness about the future, and view hardships as learning experiences. (Alvord Grados, 2005). Self- Regulation is another key protective factor. It is the ability to develop self-discipline or self-control (Alvord Grados, 2005). Connections and Attachment is the third protective factor. This consists of the desire to belong and to form attachments with family and friends (Alvord Grados, 2005). The need for connections and attachment is human instinct. Proactive parenting has a large impact in the production of protective factors. Children whom have at least one warm and caring parent or caregiver are more likely to be resilient (Alvord Grados, 2005). These caregivers should form limits and boundaries for the child to abide to; this improves compliance with caregiver-child relationships, along with better peer relationships (Alvord Grados, 2005). School achievements and involvement, IQ, and special talents are also an important protective factor (Alvord Grados, 2005). This gives the child a chance to excel, academically or socially. Building up a sense of self-pride and self-efficacy is good for any individual. Cognitive ability has been found to be associated with resilience in children (Alvord Grados, 2005). The last protective factor that Alvord and Grados (2005) talk about is community factors. The main question is, are there supportive relationships available outside the family? Children with positive role models and elders in their lives are often more resilient (Alvord Grados, 2005). Also, having mentors such as coaches and teachers are important, this is why after school activities are suggested (Alvord Grados, 2005). Theories derived from clinical designs There have been many research designs to make these theories empirical. Three studies will be discussed; they all examine the levels of resilience among individuals and how many unconscious surroundings have an effect on a childs vulnerability. Keep in mind that many stresses that might be daily hassles can accumulate to become major if they are ongoing (Berger, 2008, p 353). A wonderful study by Matheson et al (2005) made the quote by Berger evident. This study assessed the effects of road traffic and aircraft noise on the childrens cognitive development and health (Matheson et al, 2005). Over 2800 children were a part of the research method; ages 9-10, from eighty-nine primary schools situated close to three of the major airports in Europe. The three airports participating in the study were: Schiphol (Netherlands), Barajas (Spain), and Heathrow (United Kingdom). The question that Matheson et al (2005) were aiming to answer was, at which point are noise levels optimal for learning? The noise exposure was based on a sixteen-hour outdoor contour provided by the Civil Aviation Authority. Matheson et al (2005) measured the road noise based on the proximity from the school to the main roads, and traffic flow was based on the UK Calculation of Road Traffic Noise method. These were standardized tests. They compared the external noise to the levels of cognitive tests and health questionnaires administered in the classroom. Information about their socioeconomic status, education, and ethnic group was gathered from the childrens parents. The childrens outcome measures focused on two parts: recall and recognition. Matheson et al (2005) assessed episodic memory in terms of, delayed recognition, prospective memory, and delayed cued recall. Delayed recall and recognition were tested by the Childrens Memory Scale. The Childrens Memory Scale is an episodic memory task used in the USA and UK. The test assesses the ability to process, encode, and recall meaningful verbal material that is presented in narrative format (Matheson et al, 2005). The three countries were exposed to two stories, in audio form, taken from the Childrens Memory Scale. Matheson et al (2005) explains that the children were advised to listen carefully with understanding they would have to recall them later. There was a thirty-minute delay between the audio tape and the recalling of the story. In order for the child to receive a recall point, it had to be in the exact manner the information was presented in the tape. The other way the childrens answers were recorded was their conceptual recall of the themes, not just the details. The scoring of the conceptualized themes were much more lenient (Matheson et al, 2005). Following the recall test, a delayed recognition test was given. This test also consisted of two parts. Matheson et al (2005) explains the experimenter read out fifteen recall questions that consisted of facts. The children were instructed to check the yes or no box on a response sheet. The results of the study showed that, exposure to aircraft noise impaired reading comprehension and recognition. The average reading age in children exposed to aircraft noise in high levels was delayed by two months in the UK and one month in the Netherlands. The exposure to neither road nor air craft noise had no effect on the sustained attention, mental health, or self-reported health on the children. Long-term exposure to both the aircraft noise and road noise was associated with increased levels of annoyance. This shows that children are vulnerable to environmental factors that we impose on them every day. Some children are more resilient to these noises, whilst others are not. Thus, we need to be far more aware of the situations children are forced to learn in. If a child lives near an airport, tha t stress happens several times a day, but for just a minute at a time. (Berger, 2008, p 354). Cohen, Moffitt, Caspi, Taylor (2004) examined children that were exposed to socioeconomic deprivation. Cohen et al (2004) explains that children in low socioeconomic status families are at higher risk for both cognitive and behavioral problems. However, not all poor children develop problems, and some of these resilient children function better than expected (Cohen, Moffitt, Caspi, Taylor, 2004). The study tested for the factors that contributed to the resilience and vulnerability deprivation, such as genetic and environmental contributions. The findings that Cohen et al (2004) presented, explained that resilience is somewhat heritable. The childrens resilience had been assessed by the difference between their actual scores and the average scores predicted from the levels of their SES deprivation. Maternal warmth, stimulating activities, and childrens outgoing temperament appeared to promote positive adjustment in children exposed to SES deprivation (Cohen et al, 2004). With this knowledge, Cohen et al (2004) reveals that both genetic and environmental effects are a part of protective processes. However, Kitano and Lewis (2005) suggest that children who are more culturally diverse and come from low-income families have experience in overcoming adversity. It looks promising to say that higher intelligence or higher SES is not a requirement for resilient children. There are too many confounding variables to determine the cause of resiliency. Kitano and Lewis (2005) suggest that resilient individuals and gifted children share many of the same characteristics. This is why educating parents, counsellors, and teachers, on coping skills will benefit children both socially and academically. A study conducted by Daud, Klineberg and Rydelius (2008) was aimed towards studying the resilience among children whose parents suffer from post-traumatic stress disorder (PTSD). The test group consisted of 80 refugee children aged 9-17, 40 boys and 40 girls. The controlled group was made up of 40 children, whose parents were not diagnosed with PTSD. Intelligence tests and diagnostic interviews were set up to see if the test group children were mirroring their parents exhibited PTSD symptoms. Dauds et al (2008) questionnaires were able to assess self-esteem levels and the possibility of resilience and vulnerability characteristics. Daud et al (2008) conceptualized vulnerability as heightened susceptibility to develop PTSD or a clinical picture dominated by PTSD-related symptoms. Daud et al (2008) conceptualizes resiliency as a universal human capacity to cope with traumatic events, but that this capacity needs encouragement and support within a facilitative environment to enable resilience to win over vulnerability and risk. Parents and caregivers should be aware of Dauds et al (2008) findings. Family characteristics such as warmth, cohesions, structure, and secure attachments are all in relation to resilience among children. Promoting Resilience In order to promote resilience among children, counsellors, educators, and parents need to understand some of the protective factors. Resilience should be seen as a set of internalized attributes, Resilience involves action (Alvord Grados, 2005). Youth who are resilient are proactive when faced with challenges. They adapt to difficult circumstances by using internal and external resources. Resilient children come to understand that although they cannot control everything, they have some power to influence what happens next, explains Alvord Grados, 2005. Wouldnt it be nice if all children had the ability to make the best of everything? These studies indicate that risk and protective factors are usually cumulative: the more protective factors in young peoples lives, and the fewer risk factors, the greater the probability that these children or youth will be resilient (Center for Addictions and Mental Health, 2009). A metaphorical example to what resilience really is explained tremen dously by Centre for Addictions and Mental Health (2009): Conclusion Young people are like trees. They come in various shapes and sizes and grow up in most parts of the world. Families can be thought of as the soil and water at the base of the trees. Schools, neighborhoods, communities and society at large can be compared to the sun, rainfall, insects, birds and animals. The different characteristics of trees, qualities of soils and weather condition (such as the amount of sun and rainfall) can affect the health and growth of trees. Trees go through developmental stages as they mature from young saplings to full-grown specimens. Children also go through developmental stages on their way to adulthood, and what happens to them at various stages of development can affect their outcomes. Resilient children and youth grow, branch out and flower when systems supporting their healthy development (such as well-functioning families and environments) work together. Resilient children can be encouraged to become more resilient. And children who seem to have less resilience can be helped to develop it. In conclusion, every child has the potential to be resilient; it all depends on which factors attribute to each individuals situation. References Alvord, M., Grados, J. (2005). Enhancing Resilience in Children: A Proactive Approach. †¹Professional Psychology: Research and Practice, 36(3), 238-245. doi:10.1037/0735- †¹7028.36.3.238 Berger. S. K. (2008). The Developing Person Through The Lifespan (7th ed). New York, †¹NY: Worth. Centre for Addiction and Mental Health (2009). Retrieved March 20, 2011, †¹from https://www.camh.net/ Daud, A., Klineberg, B,. Rydelius, P. (2008). Resilience and Vulnerability among Refugee †¹Children of Traumatized and Non-traumatized parents. Child and Adolescent Psychiatry †¹and Mental Health, 13(3). doi:10.1186/1753-2000-2-7 Kim-Cohen, J., Moffitt, T. E., Caspi, A., Taylor, A. (2004). Genetic and Environmental †¹Processes in Young Childrens Resilience and Vulnerability to Socioeconomic Deprivation. †¹Child Development, 75(3), 651-668. doi:10.1111/j.1467-8624.2004.00699.x Kitano, M. K., Lewis, R. B. (2005). Resilience and Coping: Implications for Gifted †¹Children and Youth At Risk. Roeper Review, 27(4), 200-205. †¹doi:10.1080/02783190509554319 Matheson, M., Clark, C., Martin, R., Van Kempen, E., Haines, M., Barrio, I., Stansfeld, S. †¹(2010). The effects of road traffic and aircraft noise exposure on childrens episodic †¹memory: The RANCH Project. Noise Health, 12(49), 244-254. doi:10.4103/1463-†¹1741.70503 Schaffer, H.R. (2006). Key concepts in developmental psychology. Thousand Oaks, CA: Sage †¹Publications Ltd

Rhetorical Analysis Essay - 843 Words

Joyner Crane 9 /10/2014 EH 101-BD Many people in today’s society tend to believe that a good education is the fastest way to move up the ladder in their chosen. People believe that those who seek further education at a college or university are more intelligent. Indeed, a college education is a basic requirement for many white collar, and some blue collar, jobs. In an effort to persuade his audience that intelligence cannot be measured by the amount of education a person has Mike Rose wrote an article entitled â€Å"Blue Collar Brilliance†. The article that appeared in the American Scholar, a quarterly literary magazine of the Phi Beta Kappa Society, established in 1932. The American Scholar audience includes, Company’s , Employees,†¦show more content†¦The reader can also understand that the article was written to persuade the reader that intelligence cannot be defined by the amount of education a person has received. In the article, Rose use many emotional personal examples to help the reader understand the amount of hard work and intelligence a blue collar job requires. Rose creates a personal connection with the reader by describing his first-hand experience of growing up watching his mother put her heart and soul into being a waitress in a restaurant. Rose says, â€Å"She described the way she memorized who ordered what, how long each dish is supposed to take to prepare, and how she became a pro at meeting the emotional needs of her customers and colleagues alike.† From the quote in the article the reader understand that Roses mother was required to have a high level of intelligence in order to meet the needs of her customers and colleagues alike in order to do her job proficiently. Rose uses emotion in this quote to make the reader relate to his mother and understand that she was a hard worker and did everything in her power to do whatever it took in order to hopefully receive a tip t hat would be used to support her family. Rose also says, â€Å"I couldn’t have put it in words when I was growing up, but what I observed in my mother’s restaurant defined the world of adults, a place where competence was synonymous with physical work†. Rose uses in this quote to relate that his mother’s jobShow MoreRelatedThe Tipping Point: Rhetorical Analysis Essay813 Words   |  4 PagesThe Tipping Point: Rhetorical Analysis Throughout The Tipping Point, Malcolm Gladwell explains to his reader his ideas about drastic changes in society, and how they seem to occur so rapidly. In this particular selection, Gladwell emphasizes the purpose of â€Å"connectors†, saying that they have a â€Å"special gift for bringing the world together (page 38)†. 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Chronic and Complex Nursing Care Samples †MyAssignmenthelp.com

Question: Discuss about the Chronic and Complex Nursing Care. Answer: Introduction Nursing practice in regard to care for patients with chronic and/or complex conditions requires different guiding principles. The principles are particularly put in place to guide different aspects to be addressed in the design of anursing plan for the patients. These principles are not only paramount in ensuring proper patient care but also inform decision making for criticize care multi-disciplinary team members, the patient and their family members. In this regard, it is apparent that nursing plans be in line with set guiding principles. The principles include the need for: healthcare and support; teaching and coaching; advocacy and co-ordination and; education, research and evaluation. The guiding principles above are thus the main framework upon which patient care is centered while within the critical care unit until the patient returns to a stable condition within the hospital and at home after discharge. In this discussion, there is a deeper explanation of these guidelines in terms of their importance in the development ofnursing care plans within chronic and/or complex care units, including an examination of the approaches to be used in the improvement of a patients health outcomes. This presentation will also highlight the specific nursing plan necessary for the patient in the case study, who reportedly diagnosed of COPD exacerbations. Even further, the discussion will focus on establishing possible situations where a nurse can obtain opportunities for collaborating with members of a given interdisciplinary team assigned to the patient within the critical care unit. The Guiding Principles in Planning Nursing Care for Patients with Chronic and Complex Conditions Health Care and Support Under this guideline, a registered nurse has the sole responsibility to engage the interdisciplinary team to facilitate the provision of required care and support to a patient with complex and chronic condition. In the hospital setting, the nurse should ensure that the patient is diagnosed for any given body conditions which require attention and also to inform decision making on additional treatment of the conditions (Straughair, 2011). Under healthcare and support, the interdisciplinary team under the nurse focuses on managing breathing inefficiency, imbalanced nutritional status, proper positioning, and on administration of required medications. In regard to support, thenursing plan must comprise of different approaches of enabling the patient to manage themselves and independently move, eat, or groom (Elder, 2017). The team thus avails the necessary support to ensure that in the short or long-run, the patient with a complex and/or chronic condition is comfortable in the hospital or home environment. There is also need for environmental modifications to ensure that the patient is position to cope with the condition, minimize pain and avoid factors that aggravate the condition and or trigger its acute situation (Straughair, 2011). Healthcare and support thus involves specific approaches depending on the condition and age of the patient, but is a core requirement evidence-based practice. Teaching and Coaching Considering the guideline for the need for teaching and coaching, Registered Nurses have the responsibility to educate the patient, care takers and family; to be able to independently control their own health (Straughair, 2011). The nurse identifies presents the required educational needs including responses to specific requested information by the patients and/or clients. For a case of COPD management as is the case for Angela, the nurse should provide teaching and coaching materials for self-management to prevent exacerbations (Sciarra, 2012). These educational and coaching sessions can be formal and informal depending on the convenience of the patients and/or clients. The nurse can focus on in teaching and coaching on hygiene, patient movement and/or exercise, meal-time management, required medication, sexuality, death, dying and chronic sorrow (Sonola et al, 2013). While the teaching and coaching sessions can be formally done in sessions, nurses can identify special teaching mome nts each day and pass this crucial information to the patients and family. Coaching and teaching of patients on the above areas help in promoting their own participation in their health well-being and reduce any risks associated with chronic and complex ailments. Advocacy and Co-ordination Nursing practice emphasizes the need for a nurse to advocate for the rights of their patients and to coordinate the necessary nursing interventions required. In regard to advocacy, nursing respects human rights which encompass cultural rights, a right to life, right to consent to treatment, individual dignity among others (Sonola et al, 2013). It calls for the need to; provide a safe and healthy environment; ensure equity and social justice while allocating resources and further; enhance accessibility of healthcare and socioeconomic services. For the benefit of the patients under care, the nurse should also identify and explain any policies and/or practices that infringe their rights. They should also explain the policies, necessary procedures and specific guidelines to be followed in case patients rights are compromised (Sciarra, 2012). Advocacy in nursing assures patients and families of quality, safe and ethical healthcare. On coordination, nurses should collaborate with patient, their family, caretakers, the multidisciplinary health team, and the hospital management to offer quality healthcare. It is however important to understand the necessary guidance that each player might require in order to offer a quality nursing health intervention. It is the nurse role to therefore ensure that there is a multidisciplinary continuity of care to ensure that the patient experiences care as both connected and coherent (Straughair, 2011). Experience of continuity for a patient and their family is the perception that healthcare providers understand what occurred before, the different healthcare providers agree on certain management plan, and further that any of the providers that now knows them will provide care to them in the future. Education, Research and Evaluation Evidence-based nursing practice requires that the knowledge underpinning different approaches in nursing intervention be questioned. On education, the nurse needs to take part in continuing professional development programs to be abreast with the latest information, research, guidelines on care for patients with chronic and complex health conditions (Straughair, 2011). The nurse requires to have actively participated in this evidence-based practice professional development by presenting their individual experiences. They can also take part in short refresher courses offered online by different medical institutions, to sharpen their skills in interventions on managing chronic and complex complications. On research, nurses should take part in research studies especially on the required nursing care plan for individuals with chronic and complex diseases. They can do so by reading and utilizing existing research in evidence-based clinical practice, participating in relevant research projects, and be leaders in research projects after identifying any gap in nursing practice (Sonola et al, 2013). The nurse can thus rely on already existing online research database in Australia to extract information on research in chronic and complex care. These include the Cochrane Library, Google Scholar among others. Information acquired from research is important as it helps in informing the nurses decision making on nursing care plan and coordination of the constituted inter-disciplinary team. Evaluation involves setting and monitoring an individuals health goals, clinical governance aspects and use of reflective practice. A nurse should identify patients measurable goals, including those of their caretaker and the multidisciplinary nursing team to determine whether they are achieved. Clinical governance as part of evaluation requires that clinicians and/or administrators participate in joint action to ensure that quality of care. Lastly, reflective practice requires the nurse to engage themselves in continuous critical evaluation when alone, through journals, research articles and even under a special clinical supervisor. This helps them to improve healthcare quality and to have a stimulated professional growth. The role of the registered nurse, Nursing Plan appropriate Nursing Interventions for a COPD Patient Solving Knowledge Deficiency This nursing plan focuses on increasing the patients and their familys cognitive information on COPD. It is thus in line with the guiding principle of the need for teaching and coaching (Cramm Nieboer, 2013). Knowledge deficiency can be evidenced through request forms, misconceptions, poor instruction follow-through and a development of complications that are easily preventable. In this regard, the nurse should explain to the patient the disease process and reinforce these explanations for the message to sink. They should be allowed to ask questions and this reduces anxiety while boosting their willingness to participate in the nursing plan. The patient should be instructed on the importance of breathing exercises, effective coughing among other conditioning exercises (Lau et al, 2017). This exercises increase respiration muscles strength, prevents collapsing of small airways while at the same time controlling dyspnea. The nurse should emphasize the need for dental and oral care to prevent any bacterial growth that could contribute to pulmonary infections. The triggering factors of COPD exacerbations and the need to avoid them should be explained (Elder, 2017). They include dry air, extreme temperatures, wind, tobacco, aerosol sprays, and pollen among others. The nurse should also instruct the patient on the dangers of smoking and advice the patient on cessation to slow and/or halt COPD progression. Teaching and coaching should also focus on the need for medical follow-up and encouraging regular sputum culture including necessity of chest x-rays. This is important in altering a patients therapeutic regimen. The patient should also be encouraged to take part in support groups to reduce anxiety and depression due to its therapeutic emotional support and/or respite care (Lau et al, 2017). There is need to discuss the side effects and/or adverse reactions related to each respiratory medication to inform change in regimen or continuity of a particular medication. F urther, the nurse should instruct and reinforce information on inhaler medication and use to enable them self-manage when away from the hospital to control exacerbations. Managing Patients Imbalanced Nutrition Imbalanced nutrition refers to a situation where the intake of food nutrients is insufficient in order to meet the patients metabolic requirements (Howard Ceci, 2012). This agrees with the guideline; to provide healthcare and support to patients. Imbalanced nutrition can result from dyspnea and sputum production. It can also be caused medical side effects, vomiting, anorexia, fatigue and nausea. It can be managed first by confirming the whether the patient and caretaker understand the nutritional requirements so as to ascertain client informational needs (Cramm Nieboer, 2013). Lack of information can then be addressed through the teaching and coaching guideline on nursing plans. The nurse can evaluate patient dietary habits and recent food intake and ascertain degree of their eating difficulty. Body weight and size evaluation can inform the dietician on how to stabilize the patients nutritional needs. Bowel auscultation should be done to understand whether there is decreased gastri c motility which is an indicator of possible limited intake of fluids, hypoxemia and poor choice of food. The nurse should provide oral care and promptly remove expectorated secretions to prevent noxious tastes and smells from deterring patient appetite, trigger nausea and an increase in respiratory difficulty. A rest period of minimum 1 hour to mealtime should be allowed to decrease fatigue at meal time so that more calories can be taken up (Kuharic et al, 2015). The time may vary and the nurse can conform from research tools and any necessary additional directions they can take. Further, there is need for supplemental oxygen at meal time to reduce dyspnea and boosts energy for eating and thus enabling food intake. Managing Ineffective Airway Clearance This involves enabling the COPD patient to clear any secretions and/or obstructions within the respiratory tract so that the airway remains clear (Ides et al, 2011). In this regard, the nurse should first auscultate the breath sounds to ascertain wheezing, rhonchi and crackles. Moist crackles will inform the need to treat patient for bronchitis while expiratory wheezes indicate that the patient has emphysema and should be treated accordingly (Chin, 2017). The patient should be assisted to assume a comfortable position with the head elevated to enable easy respiration. The arms or legs can be supported with pillows to minimize fatigue and enable expansion of the chest. Environmental pollution should be avoided to avoid triggering of acute COPD through exacerbations within the ward or at home (Cramm Nieboer, 2013). The Registered Nurse should encourage the patient to use pursed-lip and abdominal breath exercises. This will help the patient to have coping means to dyspnea and also mini mize air-trapping, a condition that is common in COPD. The characteristics of the patients coughshould be examined as to whether it is persistent, moist, or hacking so that they can be assisted to improve coughing effort effectiveness. This is necessary, understanding that cough could be persistent yet ineffective particularly among elderly patients as Angela. The patient should be assisted to take an upright and/or head-down posture after chest percussion has been done. Further, the patient should be provided with a minimum of 3000mL daily but within the patients cardiac tolerance (Cramm Nieboer, 2013). Patient hydration assists in reducing secretion viscosity to aid expectoration. Opportunities for Collaboration with the Inter-disciplinary Team and Coordination of Care Understanding that COPD exacerbation presents with shortness of breath among patients, this is an opportunity for the nurse to collaborate with a respiratory therapist to ensure the patient gets enough air circulation. A respiratory therapist will help in solving the patients dyspnea and other respiratory healthcare problems the patient often goes through (Chin, 2017). The therapist for instance will draw arterial blood gases, ensure the maintenance of patients with mechanical ventilation, and provide incentive spirometry, among other intermittent respiratory treatments. They can also give respiratory medications to patients, intubate them, and help in bronchoscopy (Jan, 2013). Further, the nurse will need a respiratory therapist to offer pulmonary hygiene services to COPD patients including chest physiotherapy. They also help in preventing and managing cardiac and/or respiratory arrests. The second opportunity that calls for collaboration in the nursing plan for a patient with COPD exacerbation patient is at the point of meal-time management (Chin, 2017). The nurse will need to collaborate with a dietician within the interdisciplinary team to assess then plan, implement and later evaluate nursing interventions related to patient therapeutic dietary needs. At this opportunity, the dietician can educate the patient and family/caretaker on appropriate diet both in hospital and at home. Understanding that it is imperative for COPD patients to maintain healthy weight, as excess weight leads to more episodes of shortness of breath. On the other hand malnutrition among COPD patients leads to weakness and weakening of rib muscles that require energy for breathing (Jan, 2013). The nurse can thus involve the dietician to provide advice on calories needed to maintain breathing and keep the body muscles strong. Further, the nurse can collaborate with an occupational therapist to manage the patient with COPD exacerbation at the point when the patient requires independent movement and functioning and thus picking on an occupational therapist (Cramm Nieboer, 2013). The occupational therapist will thus assess the patient, plan, execute and evaluate any intervention provided in regard to those which facilitate a patient's ability to attain best level of independence possible in carrying out routine activities. These include for instance bathing, eating, dressing and grooming. An occupational therapist will provide the patient with adaptive devices including for instance sock pulls for him/her to don socks independently (Howard Ceci, 2012). The occupational therapist can assess and then recommend necessary Angelas home and/or ward environmental modifications to have ramps, handrails among others to ensure the safety and the independence of the patient. Conclusion Conclusively, it is clear that nursing plans in the context of chronic and/or complex care must be informed by the main guiding principles. It is even more imperative for healthcare practitioners, patients and family members to understand and grasp these guiding principles. This is because they are the pillars in regard to ensuring patient safety and the quality of care within the hospital facility. In the above discussion there are specific highlights on the major guidelines that need to be used in the development of effective nursing plans within chronic and/or complex care setting. These include the need for: healthcare and support; teaching and coaching; advocacy and co-ordination and; education, research and evaluation. The presentation explains the different ways towards improving the health outcomes of a patient. Different nursing interventions for included in the nursing plan for a patient who presented with exacerbation of COPD. Even further, the discussion identifies and ex plains the opportunities which Registered Nurses can use to collaborate with members of the interdisciplinary team while providing care for the patient. References Chin, E. (2017). The COPD exacerbation experience: A qualitative descriptive study. Applied Nursing Research. 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