Reflection On Experience Working In Accident And Emergency

Reflection On Experience Working In Accident And Emergency This fieldwork exercise was a visit to the Minors Department within Accident and Emergency (AE) for a large London National Health Service (NHS) hospital, to observe and interview an Emergency Nurse Practitioner (ENP) within the Department, and link their role in relation to primary health care (PHC). I had expected to learn further about the main connection between PHC and an acute care setting such as AE, assuming that it would be due to poor PHC management and issues with accessibility. These assumptions were based on some experience in AE as an Agency Nurse, along with colleagues, patients and media reports. 2.0 VISIT TO MINORS IN ACCIDENT EMERGENCY My fieldwork exercise began with covert observation in the AE waiting room, waiting for my fellow Nurse Practitioner (NP) student to arrive for a Saturday night shift. There were around 15 people and one child within the waiting room; a relatively calm environment, albeit for quiet restlessness, sighing, guarding and rocking, questioning companions as to when they would be seen, alongside comparing with others who had got in. Reception was a glass-shielded counter staffed by two personnel, informing patients registering, that there was a three hour wait. An electronic sign above reception welcomed patients, friends and relatives to the hospital, also informing them that we endeavour to see you in 4 hours; a reference to the Department of Healths (DoH) target, for patients to be discharged, admitted or transferred within four hours of presenting, in 98% of cases. The sign also requested for those with a minor illness, to attend the adjacent walk-in centre (WIC). Of note, aside from a clear focus on hygiene, was a sign notifying patients that treatment may not be free if not a United Kingdom (UK)/European Union citizen or resident. Such signage brings a principle of the Alma Ata declaration into question. The Alma Ata declaration arose following a joint World Health Organisation-UNICEF international conference, with a vision for healthcare for all people worldwide, with PHC at the heart (World Health Organisation, 2010). Although it can be argued that international guests are not paying into the NHS, and healthcare in the UK is not essentially free, given the National Insurance levy, the declaration views healthcare as a right for all, and not just those who are in a position to pay. On arrival, my fellow NP student showed me around AE. Within the adults section, the Department can be broken down to: Table 1: AE layout Department/Room Cubicles/Rooms Additional/Other Information Resuscitation 5 +1 paediatric cubicle Majors 16 Including 1 psychiatric cubicle Minors 12 Assessment/Triage 3 Clinical Decisions 10 Investigations and short term treatment (not more than 24-36 hours) Eye 1 Ear, Nose Throat 1 Plaster 1 X-Ray 1 Adjacent CT room being built next to Resuscitation The hospital is one of Londons major hospitals, opening in the 1700s in central London and developing into a main teaching hospital. With the increase in healthcare demands, more space was needed, and the hospital relocated to its present day location in the 1950s. In the 1970s, construction on the present hospital building began, and by the early 2000s, building and the final relocation of one of its hospitals was complete (Hospital website, 2009a). The AE Department is a 24 hour service, seeing around 100 000 patients per year, and of those, around 21% are admitted to hospital. Twenty two percent are children, to which a separate paediatric AE between the hours of 9am and 2am is available (Hospital website, 2009b). From April this year, the AE Department will become one of Londons four major trauma centres (MTC), and one of eight acute stroke centres (Healthcare for London, 2010). Preparations for this new designation were evident by the building of a computerised tomography scanner next door to Resuscitation, enabling suspected stroke patients to be scanned within two minutes of arriving. I spent most of my visit in Minors, a Department with 12 cubicles, which is staffed by two to three ENPs, one Senior House Officer, Registrar support, and a General Practitioner (GP) on Saturday and Sunday evenings. Despite having an adjacent WIC, this section of AE is dedicated to patients with minor injuries and illnesses. The most common presentations are due to infections (mostly ears, nose and throat, and urology), foreign bodies, wounds, fractures and head injuries. Numbers seen can vary, and around 150 patients had already been seen that day. There is a difference between days and nights, with days mostly seeing occupational injuries and GP referrals, with alcohol, drugs, domestic violence, assaults and foreign bodies featuring in the nights. In addition, weekends and evenings can see Minors taking on the role of an extended hours GP practice; supporting my hypothesis of poor PHC management and accessibility, as being a key cause of PHC in AE. The Department closes at 3am to reduce costs, but is sometimes too busy to do so. From next year, Minors will be a 24 hour service, with the aim for a Nurse-led service with Registrar support. This is to release medical staff for the new MTC, and in response to recommendations in Lord Darzis review on healthcare for London, discussed further in this assignment. The most surprising element of my visit, was to find out that ENPs are viewed and treated as junior doctors. This was mirrored by the consultation: history taking, examination, assessment, plan of care and documentation was that of seeing a medical doctor. While I was aware of the advanced and autonomous role of a NP, enabling diagnosing, prescribing and referring, I was taken back that NPs, certainly in this Department, have shifted from the nursing side of healthcare, and are now affiliated with medicine. The ENPs line management is a Registrar, who also supervises and signs off competencies. Any problems or concerns which need to be escalated, are dealt with by the Consultant. The AE Matron, and ultimately, the Director of Nursing are nowhere in the ENPs reporting line. The role of NP, reviews of urgent care, and PHC management are the topics I have chosen to base my discussion on. 3.0 DISCUSSION 3.1 Urgent care reviews The key review of urgent care in London is Lord Darzis Healthcare for London: A Framework for Action report. It was commissioned by NHS London in December 2006, in order to fulfil Londons healthcare needs over the next 5 to 10 years. The report acknowledged that many patients presenting to AE for minor illnesses and injuries would be better looked after in polyclinics or urgent care centres (UCC) with longer opening hours. Patients presenting to AE is not optimal due to the waiting period and being seen by junior doctors rather than GPs, who more suited to these complaints along with managing long-term health conditions (Healthcare for London, 2007a). The report proposes UCC with diagnostic equipment, where patients will have access to a Nurse or GP, recommending 24 hour access if based in AE (ie. Minors), or to be open on weekends and afterhours for those not hospital based (Healthcare for London, 2007a). A co-located UCC within AE can be important, in diverting urgent care away from attending AE/MTCs (Healthcare for London, 2007b). However, the ENP reported problems recruiting fellow ENPs with appropriate qualifications and experience, and was unsure whether Minors would be a Nurse-led 24 hour UCC, to coincide with the transformation of the main part of AE into a MTC in April. The Darzi report received criticism, largely directed at cost cuttings, cashing in on privatisation, the demotion of acute hospital services, the question of elderly care, and that future predictions on PHC and AE usage was an understatement. There is also criticism that recommendations have been made without practicalities, including polyclinic staffing, failings and costs of minor injuries units, and the future of healthcare staff (London Health Emergency, 2007). The ENP reported a poor skills mix at the adjacent WIC, such as not being able to read x-rays or suture, with patients being referred on to Minors. Alongside the question of resources being doubled up, such referring on leads to disjointed care and greater waiting lengths to be treated. It could also be confusing for patients to know where the best place to attend is, especially having been diverted from AE to the WIC on the advice of the Reception sign, only to end back up in AE. Clarity and streamlining of services is needed to improve patient experience. The Royal College of Nursing (RCN) survey found that Emergency Nurses were under huge strain to meet the DoHs four hour target, termed as unrealistic (RCN, 2010: website). The survey also reported that the majority of respondents felt that patients with various and complicated needs, have had their care rushed to meet targets, and 59% of respondents feeling the responsibility lying solely within Nurses (RCN, 2010). Yet the ENP I spoke to was happy with the target, which gave momentum if a patient needed to be seen by a Registrar and had been waiting over an hour, this would then be escalated to a Consultant. On questioning, the ENP felt that the target was realistic, practical and they had the resources. 3.2 Primary health care management and accessibility London has the most AE attendances and admissions than anywhere else in England, and many of the 83% of patients not admitted could be treated elsewhere, with 40% of complaints able to be resolved through PHC. However, access to PHC services in London after hours is inadequate; a main thought behind AE attendance. AE patients are more likely to be fulltime workers and may take reassurance in knowing that they will be seen in four hours, rather than a wait of up to (or longer than) 48 hours to see their GP (Healthcare for London, 2007b). According to the ENP, patients report issues making GP appointments and that AE is quicker than seeing their GP, as the main reasons for presenting with PHC matters. The Healthcare Commissions (HCC, now the Care Quality Commission) review on urgent care in England, found that more than 50% of patients have problems calling their GP surgery, and a quarter of patients found GP hours were not convenient, and avoided going (HCC, 2008). Incentives for GP surgeries to provide afterhours care was a recommendation by The Royal College of General Practitioner (RCGP) in their review on urgent care (RCGP, 2007). Yet, the HCCs review found that where GP services provide afterhours care, less than half had organised a phone diversion with local GPs, to divert afterhours calls to their services. The majority of patients attending afterhours GP services are seen within two hours after an initial telephone assessment (HCC, 2008). This is not only faster than attending AE, but a more appropriate use of resources. The review found that many people are not aware of healthcare services other than their own GP and AE, or they might be unsure of using them. There were also examples of patients being referred to services that were not accessible. Work needs to be done to increase both patients and healthcare professionals understanding of alternative healthcare services, and when to use them (HCC, 2008). This is a view shared by the RCGP, along with GP practices implementing systems to deal with urgent care and GP training (RCGP, 2007). The ENP expressed frustrations with GPs making inappropriate referrals to AE, rather than to Specialists, generally noting the practice of defensive medicine. Despite referring back to the GP on discharge, patients were bouncing back for simple things, such as to have their dressings attended to. The ENP rarely had time to speak with GPs, but when they did, it was mostly to phone to question why they had referred. In respect to patients, the ENP felt that they were either not taking responsibility for their health or there was poor self management, possibly due to poor or no patient education, such as not taking analgesia and attending AE to request. The RCGP also note the need for improved patient education and self management promotion in their review (RCGP, 2007). The ENP was also very critical of NHS Direct, Englands telephone advice line for healthcare. They felt that the service was inadequate, as it was not possible to make an assessment over the phone, and defensively referring to AE. Yet half of callers to NHS Direct were given advice on self management at home (NHS Direct, 2010). 3.3 The role of the Nurse Practitioner 4.0 SUMMARY This fieldwork exercise has been a valuable experience. It has demonstrated the impact PHC has on AE, an already stretched resource, exacerbated by poor PHC management and accessibility. For these reasons, I will bear in mind my present practice and on qualification as a NP, to make seamless and appropriate referrals.

Consciousness As Determined Th Essay examples -- essays research paper

Consciousness is understood in a variety of ways. In one belief, a person is conscious when awake, but unconscious when sleeping or comatose. Yet people also do things requiring perception and thought unconsciously even when they are awake. A person can be conscious of their physical surroundings, pain and even a wish or fantasy. In short a creature is conscious if it is aware of itself and that it is a physical and emotional being. Consciousness is a psychological condition defined by the English philosopher John Locke as "the perception of what passes in a man’s own mind".1 Consciousness is defined and perceived differently in many psychological view points. For instance the earlier views around the 19th century was diversely considered. Most perceived consciousness as a substance or "mental stuff" unlike an object from the physical world. Others deferred that the conscious mind was what separated man from lower forms of life. It is an attribute characterized by sensation and voluntary movement which described the difference between normal waking state of animals and men and their condition when asleep.2 Other descriptions included an analysis of consciousness as a form of relationship or act of the mind toward objects in nature, and a view that consciousness was a continuous field or stream of essentially mental "sense data." The method believed by most early writers in determining consciousness was introspection—looking within one’s own mind to discover the laws of it’s operation. This belief was limited when it was apparent when observationalists could not agree on observations. Obviously due to the differences in one’s own idea of introspection and the underlying views they possessed. The failure of introspection to reveal consistent laws led to the refection of all mental states as subjects of scientific study and thus psychology attached consciousness to its diversity. The term consciousness is most often used by philosophers and psychologists as meaning "attention to the contents or workings of one’s own mind." This notion had little significance for the ancients, but it was emphasized in the 17th century by John Locke and Rene Descartes. Contemporaries of ... ... physical framework of reality.6 Smythies presents that everyone has a private space in addition to the shared, public version. Each individual’s personal framework intersects with the familiar dimensions while remaining distinct from them, and it provides an arena for all conscious sensations that have spatial extension or location–objects discernible by sight or touch.7 To understand Smythies’ theory see Appendix A. In conclusion one can determine a variety of theories in the evolution of consciousness. As cited earlier, consciousness is viewed as being physical or material in some cases and yet in others it is viewed as a function of the inner mind or the minds eye. These theories have even been as radical as Smythies’ philosophy that the state of consciousness is a sort of physical plane. If we were to collaborate these theories to form a conclusive view point, individuals would possibly be able to understand consciousness and the workings of consciousness. Perhaps the mystery of consciousness is to remain a mystery. Possibly this mystery is the key to cognitive thinking. And perhaps the key to our personal evolution.

Critical Thinking Question Essay

1. Explain the differences between bacterial meningitis, aseptic meningitis, fungal meningitis, and tubercular meningitis. Bacterial meningitis is a primary infection of the pia mater, arachnoid and subarachnoid space, ventricular system and the CSF of the brain. The subarachnoid space is accessed either by a systemic, bloodstream or direct extension infection. Common causes of bacterial meningitis after the neonatal period are Meningococcus (Neisseria meningitidis) and pneumococcus (Streptococcus pneumonia). For neonates, pneumococcus and gram-negative enteric bacilli are common agents. Aseptic meningitis (viral meningitis, nonpurulent meningitis, lymphocytic meningitis) is an inflammation which is thought to be localized to the meninges. The population at risk depends of the virus. A variety of symptoms are caused by a plethora of viruses such as enteroviral (most common), mumps, herpes simplex types 1 and 2,, St. Lus encephalitis virus, West Nile virus, California encephalitis virus, Venezuelan equine encephalitis, Colorado tick fever, lymphocytic choriomeningitis virus, Epstein-Barr virus, and influenza virus types A and B. Fungal meningitis is a chronic, much less common condition than bacterial or viral meningitis. It most frequently occurs in persons with impaired immune systems or those with altered normal flora. Development is insidious and usually occurs over days to weeks. Also associated with chronic meningitis are syphilis, tuberculosis and Lyme disease. Tubercular meningitis is the most common and most serious form of CNS tuberculosis, and is found mostly in those with acquired immunodeficiency syndrome (AIDS). Miliary tubercules form in the brain and meninges, later eroding in the pia mater with mycobacteria entering in the CSF producing a hypersensitivity reaction which causes purulent exudate to the basal meninges, cerebrum and spinal nerves. Vasculitis occurs causing cerebral ischemia and infarction. Symptoms include headache, low-grade fever, stiff neck, nausea and vomiting, irritability, difficulty sleeping and fatigue. These signs and symptoms lead to increase to confusion, stiff neck, significant behavioral changes, and seizures. Additionally, hydrocephalus and cranial nerve palsies or cerebral infarcts may occur. Early diagnosis and treatment with proper antituberculosis may cause a 90% recovery rate. 2. A neonate has a harsh, loud, systolic murmur shortly after birth. This is best heard at the left lower sternal border. The neonate is acyanotic and has no other symptoms. What type of congenital heart disorder does this infant have? Explain why the neonate is not cyanotic. When could the infant become cyanotic? These symptoms describe a ventricular septal defect (VSD). This type of defect is a left to right shunt of blood flow through the septum of the heart and symptoms depend on the size of the shunt. Because of the increase in blood from the right ventricle (RV) into the pulmonary artery (PA), the PA, left atrium (LA) and left ventricle (LV) become enlarged. A large VSD causes a large amount of pulmonary volume. Over time, the smooth muscle layer of the arteriolar wall thickens and a decrease in diameter of the pulmonary vessels occurs which causes resistance to the new blood flow. An increase in pulmonary vascular resistance causes a reverse shunting through the VSD causing cyanosis from deoxygenated blood flowing through systemic circulation. This phenomenon is termed Eisenmenger syndrome. 3. How does defective gastric secretion of intrinsic factor (IF) cause anemia? What is this type of anemia called, and how does a person get it? Intrinsic factor (IF) is a mucoprotein that is produced by the parietal cells. It is responsible for absorption of vitamin B12 in the ileum. Decreased amounts of IF causes a lack of absorption of B12 resulting in pernicious anemia. IF deficiency may be congenital or from adult onset gastric mucosal atrophy and parietal cell destruction. In older adults, failure to absorb IF is the cause of almost all vitamin B12 deficiencies. Congenital IF disorder is caused by an autosomal recessive inheritance pattern which is a genetic disorder. Gastric atrophy may be autoimmune and occurs along with type A chronic gastritis. 4. Discuss the pathophysiologic relationship between cirrhosis and portal hypertension. Cirrhosis is an inflammatory disease of the liver that disrupts its structure and function. Fibrous bands are formed causing nodular regeneration giving the liver a bumpy appearance. The liver is smaller or larger than normal and is hard when palpated. Parenchyma of the liver becomes distorted and the biliary channels become obstructed causing jaundice. Shunting is formed in new vascular channels bypassing blood from the liver. Obstruction in the portal veins also causes abnormal high blood pressure in the system from resistance of the blood flow from the obstruction. This is termed portal hypertension. Cirrhosis of the liver is the most common cause of portal hypertension.

A Visit to the Historical and Current Day Bermuda - 659 Words

Index.html: Sit back, relax and enjoy the warm ocean breeze. Welcome to Bermuda! Located only 640 miles west-northwest to North Carolina, Bermuda Is the place to be. Beautiful beaches, soft pink sand, historical sites that date back to the sixteen hundreds and friendly people are just some of the many things to experience whilst visiting Bermuda. History.html Bermuda was first discovered in 1505 by a Spanish navigator, Juan de Bermudez. He Named the island after him, hence the name Bermuda. He left and returned ten years later in 1515 and decided not to settle due to the bad weather. In 1609, a ship headed to Jamestown Virginia, got caught in a storm and then wrecked on the reefs of the Island. The crew of about 150, made its way to shore and was led by Sir. George Somers of England. They spent ten months on the island and built two ships, the Deliverance and the Patience. When completed, the crew would resume their journey to Jamestown Virginia. Somers returned to Bermuda to stock up on the roaming hogs, which would later be put on our currency, and died. His body was sent back to his hometown but his heart was buried on The Somers Isles. In 1612 Richard Moore, Bermuda’s first governor, and three others began construction on the Town of St. George. In 1620, the House of Assembly of Bermuda held its first session that introduced a representative government in which Bermuda became a self-Governing colony. This is just the start of Bermuda’s settlement. 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They use words such as ‘anticipate’, ‘estimate’, ‘expect’, ‘intend’, ‘will’, ‘project’, ‘plan’, ‘believe’ and other words and terms of similar meaning in connectionRead MoreManaging Information Technology (7th Edition)239873 Words   |  960 PagesIS and Business Goals 520 520 517 xi xii Contents Balancing the Trade-offs Between Standardization and Agility Obtaining IT Capital Investment Approvals 520 The Information Resources Planning Process 520 Assessing The Current Information Resources 521 Measuring IS Use and Attitudes 521 Reviewing the IS Organizational Mission 522 Assessing Performance versus Goals 523 Creating an Information Vision 524 Designing the IT Architecture 524 Formulating the Strategic

Essay on Claudius of Shakespeares Hamlet - 1872 Words

Claudius of Hamlet A close second in nobility to the protagonist in Shakespeare’s Hamlet is the incredible King Claudius. His superior qualities render him a worthy antagonist capable of a plummeting downfall at the climax. G. Wilson Knight in The Embassy of Death interprets the character of Claudius: Claudius, as he appears in the play, is not a criminal. He is - strange as it may seem - a good and gentle king, enmeshed by the chain of causality linking him with his crime. And this chain he might, perhaps, have broken except for Hamlet, and all would have been well. But, granted the presence of Hamlet - which Claudius at first genuinely desired, persuading him not to return to Wittenberg as he wished -†¦show more content†¦It would seem initially that Gertrude, rather than Claudius, is to blame for the protagonist’s â€Å"violent emotions† (Smith 80); thus in his first soliloquy Hamlet cries out, â€Å"Frailty, thy name is woman!† Claudius’ first appearance is at a court gathering where he very dishonestly laments the death of his brother: Though yet of Hamlet our dear brothers death The memory be green, and that it us befitted To bear our hearts in grief and our whole kingdom To be contracted in one brow of woe, Yet so far hath discretion fought with nature That we with wisest sorrow think on him, Together with remembrance of ourselves. (1.2) Claudius handles the affairs of state very confidently, regarding Norway and Fortinbras; and personal matters with familial concern, like Laertes’ return to studies in France and Hamlet’s dejection: â€Å"How is it that the clouds still hang on you?† The king is a â€Å"capable ruler and a resourceful man† (Boklund 120). Claudius shares the decision-making with Gertrude, and â€Å"perils his very soul for her†(Faucit 11). Claudius supports her wish that Hamlet remain at Elsinore rather than return to his studies: â€Å"Let not thy mother lose her prayers, Hamlet, / I pray thee stay with us, go not to Wittenberg.† Coleridge states regarding this scene: In theShow MoreRelated Shakespeares Hamlet - Claudius Essay2442 Words   |  10 PagesClaudius of Shakespeares Hamlet’s G. Wilson Knight in The Embassy of Death interprets the character of Claudius in Shakespeare’s Hamlet: Claudius, as he appears in the play, is not a criminal. 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Within the story, there are many characters who appear to be very â€Å"off†. Hamlet seemingly goes insane, The King is on a power trip, Ophelia goes insane and potentially kills herself, and the Queen remarries almost immediately. These are not behaviors normal humans show, and so I will be diagnosing King Claudius with Narc issistic Personality Disorder. King Claudius could have potentially been diagnosed with

Annotated Bibliography On Polycystic Kidney Disease

Assessment details: An Inherited Genetic Disease Title: Polycystic Kidney Disease Introduction Polycystic Kidney Disease (PKD) is a fairly common genetic disorder of the kidneys. It affects approximately 1in 750 people. There are 2 types, the autosomal dominant (ADPKD) and the autosomal recessive (ARPKD). Autosomal dominant (ADPKD) is far more common of the two. The disease presents with lots of cysts on the kidneys and can not be cured. Medication can manage the symptoms. The symptoms include urinary tract infections, high blood pressure and even renal failure as it progresses. Serial ultrasound scans are usually performed to monitor the cysts and to screen family members. How is the disease inherited? Most cases of this disease have an autosomal dominant pattern (ADPKD). These people with are born with a mutated copy of the PKD1 (85% of cases) or PKD2 (15% of cases) gene in each cell and this mutated gene is inherited from one of their affected parents in about 90% of the time. The other 10 percent of cases result from new mutations in people with no history of the disorder in their family. This is known as acquired polycystic kidney disease. The PKD1 gene is located on chromosome 16 and PKD2 gene is located on chromosome 4. Not only are there mutations in the DNA of these genes but there may also be large deletions that remove sometimes up to 10 genes. These mutations are also called germline mutations because they are present in the parent’s egg or spermShow MoreRelatedPCOS Essay4926 Words   |  20 PagesRESTORING OVULATION IN PCOS 2 RESTORING OVULATION IN PCOS Clomiphene Versus Metformin for Restoring Ovulation in Women with Polycystic Ovarian Syndrome Daniel Kendall DNP-S, Brandi Knierim DNP-S, Molly Hilzendeger DNP-S University of Mary NUR 720 Clomiphene Versus Metformin for Restoring Ovulation in Women with Polycystic Ovarian Syndrome Polycystic ovarian syndrome (PCOS) is a leading cause of infertility that is caused by anovulation (Baran, Api, Goksedef, Cetin, 2010). Anovulatory

Understanding and Supporting Behavior for MHD- myassignmenthelp

Question: Discuss about theUnderstanding and Supporting Behavior for MHD. Answer: Introduction: In this essay, I seek to interrogate the quote by Humphrey Wigelsworth, (2012, p. 339)"Childrens experience within school is crucial in determining their likelihood of experiencing MHD (Mental Health Disorders), but this experience is clearly individual in nature and individual differences in competencies, such as self-regulation and social success help to explain why children in similar environments may experience different levels of well-being. I have chosen to focus on this quote for my essay because it does not seem to use a blanket approach towards the effects of a childs experiences within school, but it recognizes that outside influences are playing a central role in the determination of the outcome of these experiences and how each individual child would handle the same or similar situations differently from each other. To align with this quote, I have chosen the Ecological Systems Theory as it analyses the childs surrounding levels of environment to determine how the child will develop. Based on this theory (EST), I intend to reflect on what behavior is by discussing different behaviors portrayed by students in learning environment (school) and formulating the reasons with example using the above chosen ecological system theory. To effectively approach the analysis of the above quote, it remains imperative for me to examine both the implications of mental health discussed in the quote and present possible ramifications of mental health escalations. The topic of resilience and positive psychology becomes a useful resource in informing my response and connection to the theory of ecological system. Define Behavior Based On the Theory You Have Chosen (EST) Ecological System Theory (EST) also known as Human Ecology Theory (HET) posit that human development is dictated by the different kinds of environmental systems (the microsystem, mesosystem, exosystem, macrosystem, and chronosystem). EST is helpful in understanding why people might differently behave when compared to our behavior in face of our family alongside our behaviors at school. EST is valuable based on the manner of examining individuals and impacts of various environmental system encountered by individuals (Lane Oakes, 2015). This theory has since become an important theory which is the foundation of the theorists work. According to EST, it is believed that an individuals development is affected by everything in their environment/surrounding environment. Thus behavior is defined as observable activity of an organism; anything an organism does that involves action/or response to stimulation Understanding Behavior as a Socio-Cultural Construct Behavior examination is based on a social constructionist viewpoint. The constructionism is initially defined and compared with a generic positive science image and then view the behavior from both perspective. The behavior analysis is more of positivist than constructionist perception (Skinner, 2012). The alignment between behavior examination and positivism arises more evidently where positivist and constructionist viewpoints are contrasted on relation between music and science. The behavior has been shown to anchor the environmental surrounding of an individual which dictates the social interactions. Thus behavior is influenced by everything in the surrounding which can be well understood by the EST five phases that influence the behavior. For example, the microsystems outline all people or social agents that dictate that behavior of the people whereas the macrosystem entails the real culture a persons has to conform to as he socially and culturally interact with fellow social agents. Thus, to understand the behavior of a person, like in this case, children, we need to comprehend this based on a given setting, school in the present case. Therefore, we can understand that children will behave based on the socio-cultural interactions in school via the available social agents (teachers, fellow students, parents, classmates and even neighbors). Because a school is a diverse context or setting, the social interactions of the children is affected not only by the student own culture but other subcultures or cultures of fellow social agents. Thus, by understanding the social-cultural construction, we need to understand the kind of behavior adopted doesnt come from vacuum but is strictly based on social and cultural construction within a given setting (Schulte-Krne, 2016). Quote Introduction and Identification of the Behaviors Exhibited By Students "Childrens experience within school is crucial in determining their likelihood of experiencing MHD (Mental Health Disorders), but this experience is clearly individual in nature and individual differences in competencies, such as self-regulation and social success help to explain why children in similar environments may experience different levels of well-being. From this quote, it is apparent that the behaviors demonstrated by the children in the school are individual-based. This determines the probability of children experiencing Mental Health Disorder. Childrens behaviors is based on their competences like self-regulation and social success. Some students have been shown to be more susceptible to MHD than others. The reason is that it is apparent that some students have better competences in terms of self-regulation and social success. Children who suffer mainly from MHD have the causes attached to parental neglects or even other issues associated with disjointed families. The school thus need to understand the experience in school should be one that is informed by deeper understanding of the background of a student. This is because where school is framed in such a manner that it escalates rather than mitigate the problems facing student at home, the children will be more vulnerable to MHD. Formulating Reasons Students Behaviors Based on EST Based on EST, the behaviors shown by the children can explained easily: The Microsystem: This context is direct environment people have in their lives. It includes friends, families, teachers, neighbors, classmates among other individuals who have direct contact with a person. It is the context whereby children have straight social interactions such social agents (Palmer, Saviet Tourish, 2016). EST posits that we are not just recipients of the experiences we have as we socialize with the social agents in the microsystem-environment. We are, however, great contributors of environments construction. This explains why some children who have competencies in self-regulation and social-success are at reduced risk of MHD than those students who lack such competencies. This means that despite being in one school, students with such competencies have higher ability to cope as they interact than those who lack the competencies The Mesosystem: This encompasses the correlation between the microsystems in a persons life. This means that a persons family experience could be linked to his school experience. For example, where a given child becomes neglected by his parents, he might have a low opportunity of developing desired attitude towards his tutors, classmates, and even neighbors. Further, such a child might feel obstinate in the face of classmates and might revert to withdrawal from a cohort of colleagues (Neal Neal, 20130. Such a withdrawal will lead to MHD. In this case, we can clearly attach the behavior to poor relationship between the microsystems which the lead to negative behavior because behavior is a social-cultural construct. The Exosystem: This is the context whereby there is a connection between the setting wherein the individual doesnt have any active role, and that wherein is participating actively. Supposing a child remains increasingly attached to her father than her mother. Where the father travels overseas to work for many months, there might be a conflict between her and mothers social relationship (Westley et al., 2013). On the other hand, such an event could lead to a tighter bond between the child and the mother. This is true where a given student is attached to one teacher who is then transferred to another school thus ruining his relationship with the remaining teachers. If this occurs, the possibility of the student being affected by MHD skyrockets. The Macrosystem: It is a setting of real culture of the child. A cultural setting encompass the socioeconomic status of an individual and/or his family, his race or ethnicity and living in advanced or developing nation. For instance, being born to a poor family can make a child work harder daily. In this sense, the child will be able to acquire such desired competencies like self-regulation and hence able to cope in school without suffering from MHD (Onwuegbuzie, Collins Frels, 2013). The Chronosystem: It encompasses the transition alongside shifts in the lifespan of a child. This could further entail the socio-historical settings which could dictate a child. For instance, a divorce is a major life transition that affect both couples relation and their childrens behavior. Children are adversely affected on 1st year following a divorce. The subsequent years following divorce unearth the interaction within family becomes increasingly agreeable and stable. Therefore, students who are highly impacted with divorce will be vulnerable to MHD. In this case, their competencies like self-regulation and social success will be hampered (DuPaul Jimerson, 2014). Conclusion To this end, Ecological System Theory (EST) has been very instrumental in helping me analyze the quote. It is apparent from the analysis that behavior is a socio-cultural construct. Within schools, it is true that childrens experience is crucial in determining their likelihood of experiencing MHD (Mental Health Disorders). Children with competencies like self-regulation and social success are resilient to MHD than those who lack such competencies. The implication from the revelation is that the school must understand every childs background in order to provide a customized-based service that promotes self-regulation and social success to help prevent MHD amongst students. References DuPaul, G. J., Jimerson, S. R. (2014). Assessing, understanding, and supporting students with ADHD at school: Contemporary science, practice, and policy. Lane, K. L., Oakes, W. P. (2015). Supporting behavior for school success: A step-by-step guide to key strategies. Guilford Publications. Neal, J. W., Neal, Z. P. (2013). Nested or networked? Future directions for ecological systems theory. Social Development, 22(4), 722-737. Onwuegbuzie, A. J., Collins, K. M., Frels, R. K. (2013). Foreword: Using Bronfenbrenners ecological systems theory to frame quantitative, qualitative, and mixed research. International journal of multiple research approaches, 7(1), 2-8. Palmer, M., Saviet, M., Tourish, J. (2016). Understanding and Supporting Grieving Adolescents and Young Adults. Pediatric Nursing, 42(6), 275. Schulte-Krne, G. (2016). Mental health problems in a school setting in children and adolescents. Deutsches rzteblatt International, 113(11), 183. Skinner, N. (2012). Ecological systems theory. Westley, F., Tjornbo, O., Schultz, L., Olsson, P., Folke, C., Crona, B., Bodin, . (2013). A theory of transformative agency in linked social-ecological systems. Ecology and Society, 18(3).