Fleet planing (AVIATION) Essay Example | Topics and Well Written Essays - 2500 words - 1

Fleet planing (AVIATION) - Essay Example They committed to honoring tickets as usual and not altering their frequent flying program during the whole process. That same month that the company had applied for bankruptcy protection, it was approached by US Airways about a possible merger. US Airways had put forward plans to take over American Airlines while it was in the process of restructuring its operations through bankruptcy. It is possible that the plans for the merger are as a result of the wave of mergers that has hit the industry since the year 2008. In 2008, Delta Airlines signed a merger deal with Northwest Airlines while in 2010, United Airlines and Continental airlines joined forces. It would therefore follow that the companies that have merged are in a better position to have a larger market share as compared to the other companies. Therefore in support of the merger proposal, US Airways has been of the opinion that a merger would make the two companies a stronger force in the market as opposed to operating as sin gle airline units (Jones, 2011). This essay will be assessing the fleets of the two airlines and recommend changes of fleets, where necessary, assuming that the merger between the two companies will be successful. A comparison of the fleet of the two companies is imperative and this will be the first area that this essay will explore. The first fleet that will be analysed is the American Airlines fleet. American Airlines was formed in 1930 after 82 small airlines conglomerated through acquisitions. Having being in business for over 70 years, it is evident that the company is well established in terms of fleet size and information. The active fleet count as of December 2011 stood at 898

Business Statistics Essay Example | Topics and Well Written Essays - 250 words

Business Statistics - Essay Example All activities within the business will be evaluated and implemented in a unified manner. Third, quality management ensures all employees are involved in the running of the business, thereby guaranteeing that their abilities and unique talents are used for the benefit of the business. This helps to grow a motivated, creative and innovative workforce that helps in the full realization of the goals and objectives. In addition, by involving every member of the organization, accountability is enhanced since people are held accountable for their own performance. Forth, through this process, organizations ensure that the available resources are utilized in the most efficient and effective manner, thereby limiting wastage. This helps guarantee consistent and high quality results. Fifth, quality management promotes a culture of continuous improvement (Knowles, 29). As a business strives to meet the demands of the customers, there are improvements made across all the departments in an organiz ation. Through such improvements, the organization becomes well prepared to react swiftly to new opportunities. Finally, businesses are able to base their decisions on facts using the available data and information. This ensures that the organization develops policies and procures that promote the overall growth of the

Perceived Effectiveness of Sports Massage Therapy

Perceived Effectiveness of Sports Massage Therapy Massage therapy has been used ancient times. There is evidence that the Chinese used therapeutic massage more than 3,000 years ago. Massage has fallen in and out of favour over time. One of the newest forms of massage therapy is sports massage. Famous athletes have publicly expressed their great satisfaction with sports massage. They claim that it has increased their athletic performance and helped speed their recovery after strenuous exercise. Non-professional athletes and their trainers has also become increasingly interested in sports massage, partly because of the acclaim it has received from elite athletes. This has led to even more interest in the therapy by non-athletes. Some of the popularity of sports massage can be attributed to the increasing acceptance of all forms of alternative therapies. Despite all of the intense interest, there is a lack of accurate information about massage. There are many widely held perceptions about the effectiveness of pre-event sports massage, including that it can prevent injury and provide an edge over the competition. However, there is no published research that suggests pre-event massage has a positive impact on performance or injury prevention. There is some evidence that massage after an athletic event can help reduce pain, but the results remain inconclusive. There has also been research that concluded that regular, or maintenance, massages can alleviate some symptoms. In 2004, a research team published A Meta-Analysis of Massage Therapy, which provided comprehensive look at the actual effectiveness of sports massage. Among other findings, they concluded that massage may reduce pain. However, the study debunked many of the widely held perceptions about the effectiveness of sports massage. Massage therapy does seem to have an impressive ability to reduce anxiety and depression. While the exact science behind the benefits sports massage remains elusive, many athletes, coaches, and massage therapists continue to believe that it can have a tremendous positive effect if used both before and after sporting events and during periods of training. Introduction Massage is one of the oldest and widely used therapies in the history of mankind. The American Heritage Dictionary of the English Language defines massage as: â€Å"the rubbing or kneading of parts of the body especially to aid circulation, relax the muscles, or provide sensual stimulation.† These benefits have been enjoyed since ancient times and almost all cultures have used some version of therapeutic massage(Vickers, Zelman, 1999). However, in more recent history, massage has become an important tool for athletes. Sports massage is now considered powerful way to help maximize athletic performance (Davidson, 2001). The prevalence of this type of massage has rapidly increased over the last two decades and the perceived effectiveness of sports massages given before and after athletic events has become widespread. Massage may have become more en vogue recently, but it is certainly not new. The first evidence of massage can be seen in the Chinese Cong-Fou, written around 2700 B.C. The text makes references to the manipulation of soft tissue. The ancient Chinese massage techniques involved applying pressure to muscles and meridian points. There is evidence that the ancient Chinese practitioners believed their massage not only relaxed muscles, but also improved the function of internal organs(Calvert, 2001). Ancient Indian texts also described various massage techniques that were believed to promote spiritual and physical healing (Pike, p.viii). Even Hippocrates taught a form of massage to his students around500 B.C. Another famous Greek medical practitioner, Asclepiads, was so impressed by the perceived benefits of massage that the stopped using all other medicines and treatments and only used massage therapy for healing. He believed that massage techniques could increase and restore nutritive fluids (Calvert, 2001). However, over time, Western cultures gradually abandoned the Greek beliefs about massage. During the middle ages, massage was still used as a folk remedy, but established medical scientists discounted it and the use of massage was no longer considered part of regular medical treatment. (Calvert, 2001). About 150 years ago, a French translation of the Cong-Four appeared. Historians believe the text served as the foundation for the development of the now-popular Swedish massage (Davidson, 2001). There is some dispute over the origins of Swedish massage, but many credit Per Hendrix Ling for its development during the early 18th century. Ling promoted the idea that massage could heal the body by boosting circulation of the blood and limp systems. Ling’s massage technique was very vigorous and he prescribed a standardized treatment. He suffered from gout and developed the system to improve his condition and later to help others. He did not equate massage with relaxation or any other psychological benefit. In fact, he called it the â€Å"Swedish Movement Cure† (Cates, 1998). Current Swedish massage has evolved somewhat from Ling’s ideas and is now more gentle, although the focus is still on increasing the flow of oxygen in the blood and to assist the muscles in releasing toxins. In the last few decades, Swedish massage therapists have placed greater emphasis on the psychological benefits of massage and they strive to provide a sense of calmness and well-being.(Vickers, Zelman, 1999) Historically, the interest in massage has been cyclical. Massage fallout of favour, only to once again regain acceptance, many times over the last 500 years. Currently, massage has become far less important tour culture than medical drugs and surgery, but it is again becoming more popular as an alternative therapy (Cates, 1998). There are still many forms of massage found throughout the world, including Hawaiian, deep tissue, and Tue. Na. One of the newest forms of massage is sports massage. Although it is considered a separate form of massage, it shares strong similarities with Swedish Massage and the most of the techniques employed in Swedish massage are used in sports massage(Davidson, 2001). However, sports massage also incorporates Shiatsu massage techniques. Sports massage was largely developed by Jack Meagher. Meagher was the massage therapist for the US Olympic Equestrian Team. He developed sports massage based on the theory that there are a dozen body postures that form the axis of all athletic movement. Meagher said that because each sport requires that the athlete maintain certain postures, it is possible to identify potential overuse injuries before they occur and help prevent them through sports massage. Meagher wrote that athletic performance could be improved by 20% with the introduction of sports massage (Dion, 2001). Although sports massage encompasses many techniques, all sports massages geared toward generating the maximum performance from an athlete. The effects of sports massage are achieved through a combination of mechanical, physiological, and psychological processes. Research has demonstrated that the compression caused by correctly-applied sports massage can improve lymphatic and venous drainage in the body and boost circulation (Hollis, 1997). Under the general heading of sports massage, there are three distinctly different types of massage. Each has a different goal and employs different strokes. The three categories of sports massage are pre-event, post-event, and maintenance massage. Although sports massage has recently become more sophisticated, modern athletics have been using forms of pre-event and post-event massage for decades. For example, baseball pitchers have long used massage as an attempt to extend the length of their career by maintaining range of motion and flexibility. For many decades, boxing coaches and trainers have been seen giving boxers â€Å"rubdowns† before a fight in an effort toward-up the body by boosting circulation. This is an early form fore-event massage (Pike, p.viii). Modern sports massage first became integrated as part some teams ‘standard athletic training in the former Soviet Union, East Germany, and other Eastern European countries during the 1960s. Soviet teams were the first to employ dedicated massage therapists that traveled with them. In the 1970s, the trend became more widespread, as more European countries and teams in the United States began to take interest in sports massage (Davidson, 2001). However, it is only since the 1980s that sports massage has become truly mainstream. Now, it is a common practice for teams to integrate sports massage as part of their standard training regimen. Certified sports massage therapists have been seen at many major sporting events, including Ironman competitions, the Goodwill and Pan-American games, marathons, the Olympics, and professional bike races (Latina, 2000).When the U.S women’s soccer team defeated China, winning the World Cup, the players publicly thanked their sports massage therapist, Wynn Clinton and Jim Fayola. Goalkeeper Tracy Ducat said, â€Å"Clinton and Jim Fayola, who worked with him during the World Cup, were invaluable in the treatment they provided for us, testified Tracy Ducat, a goalkeeper on the team. We could not have been at our best without their help every day. Goalie Saki Webber agreed, saying, Without Clinton I think that it would have been a much different story. I think that he kept us healthy and kept us together during the World Cup† (Hued, 2002). Sports massage has also infiltrated smaller sports. For example, even some Canadian cowboys are receiving massages before and after rodeos, thanks to new mobile massage rooms are traveling with them (Visconti,p.54). Although professional sports teams have lead the way in incorporating sports massage, college, some secondary schools, and amateur teams are also exploring massage as a way to enhance performance. The public’s perceived value of the effectiveness of sports massage has been fuelled by public statements from well-known professional athletes who say their extraordinary skills have improved after undergoing regular massage therapy. For example, tennis champion, Martina Navratilova said, â€Å"I started getting massages and realized what wonderful thing it is for your body† (Sports Massage: Taking the Field ). Former professional football quarterback, Joe Montana, has said, â€Å"I’ve been working with massage for a few years now, and I found it helps you to recover a little quicker. The bumps and bruises seem Togo away a lot faster† (Sports Massage: Taking the Field). Canadian National Swim Team member, Marianne Limpet, agrees: â€Å"I find that massage is very beneficial in helping with a quicker recovery from hard training or racing, and it prevents me from getting tight muscles and injuring myself. I am one of few athletes at my age(30), and Im sure that massage has played a major role in helping to keep my body in shape to continue to this level† (Warren, 2003). Even Marjorie Album, the Chief Athletic Trainer of the 1996 Atlanta Olympic Games, once commented, â€Å"I would not provide sports medicine services for any major athletic event without massage therapists.†(Sports Massage: The Athlete’s Trainer’s Edge ) With glowing testimonials from esteemed athletes and sports professionals, it is not surprising that more amateur and college athletes are now becoming interested in sports massage. After all, our society places great emphasis and value on athletics, and the financial and emotional rewards can be great to those who excel in their chosen sport. It is not surprising that sports massage is popular among those searching for competitive edge. This relatively new appreciation for sports massage has increased as part of a larger trend toward ergogenic aids to boost all types of athletic performance. Ergogenic aids include a wide variety of tools and therapies, such as visualization, meditation, and pre-event stretching. Advocates of sports massage say it is valuable ergogenic tool that can improve circulation, reduce stress, promote muscle efficiency and healing, and even prevent injuries (Pike, p. vii). The perceived benefits of massage have also become more wide-spread as the general acceptance of alternative medicines has increased. In a1997 random sample of 1,500 households in the United States, 42% of adults reported using some type of alternative therapy in the last year. Nearly 45% said they would be willing to pay more each month for alternative care. Additionally, when choosing healthcare, nearly 70% of respondents said having access to alternative therapies is an important factor in choosing a health insurance plan (Landmark Healthcare Inc.,1997). Alternative medicine is even more popular in the United Kingdom, where in studies, nearly 47% of respondents have reported they are using alternative therapies. Also in the U.K., of those undergoing complementary medicine, nearly nine out of ten are paying for their treatment (Thomas et al. p. 2 -11 ). Massage therapy is one of the fasting growing forms of alternative medicine. In 1999, The American Massage Therapy Association (AMTA)conducted a nationwide survey in the United States. Researchers found that 27% of adults had therapeutic massage in the last five years, compared to only 17% in a 1997 study who said they had a massage in the previous five years (Massage: Much-Kneaded Complementary Health Care). Another study conducted the previous year found that visits to massage therapists increased by nearly 36% in the years between 1990 and 1997(Eisenberg et al. p. 1569). Furthermore, in 2004, the National Centerior Complementary and Alternative Medicine in the United States reported that massage has become the ninth most popular alternative therapy treatment. In the study, 5% of respondents said they had received massage therapy at least one time in the previous year (Boneset al.). This translates into big business for the massage industry, as American consumers are spending up to $6 billion dollars a year on massage therapy (Eisenberg et al., p. 1569). This increasing interesting massage has created a surge in massage school educational facilities and applicants. As of 2002, there were more than 950 state-licensed massage schools in the U.S., which is 14% more school than existed in2000. In 2001, massage schools turned out an estimated 30,000 new graduates (Lacombe, p. 49). There are other significant signs that the perceived benefits of massage is having a strong effect on public policy. In the United States, The National Institutes of Health is currently sponsoring three studies in an attempt to clarify the medical benefits of massage. Additionally, a national survey of employer-sponsored healthcare plans found that 15% of HMOs cover massage therapy. Cigna and Blue Cross BlueShield also cover some forms of massage (Lacombe, p. 49).Furthermore, a 1995 study found that more than half of family doctors in the United States said they would recommend some form of massage therapy to their clients (Hedwig, p.1). This is a concern to some researchers who wonder if the benefits of massage are worth the price of the therapy. In their meta-analysis of massage therapy research, Moyer, Rounds, and Hanno wrote, â€Å"For these trends to continue (indeed, to determine if they even should continue),what is needed is a more rigorous and quantitative examination of MT’s(massage therapy’s) effectiveness that that which currently exists†(Moyer et al.). The perceived, yet often unexplained, effects of massage (including sports massage) have even created interested within the White House. In2004, the White House Commission on Complementary and Alternative Medicine Policy called for more research and funding for public education on massage therapy. The commission’s chairman, James Gordon, did not offer an explanation of the actual benefits of massage, but he did allude to the widespread perceived effectiveness of the alternative treatment. He said: We shouldnt put too much weight on its benefits, but at the same time we should make it available to everyone. Massage does decrease anxiety, reliably. It does decrease pain in a number of people with chronic-pain syndrome. It does improve mood. Exactly how it does it, I don’t think we know (Lacombe, p. 50). AMTA researchers say as more people accept massage therapy as a viable treatment option, more athletes are becoming interested in sports massage. The AMATA now recognizes sports massage as a unique specialty field within the massage industry. There has also been increased interest in sports massage among the so-called â€Å"weekend warriors†(people who only exercise on the weekends) and those do not consider themselves athletes or exercise regularly. No matter how little time they spend taking part in athletics, some people want to enjoy the perceived benefits of sports massage. Licensed massage therapist John Balletto said, â€Å"Anyone who exercises or works in an active job or even has to constantly bend down to pick up a child can benefit from sports massage. This type of massage helps muscles deal with the repetitive motions inherent to these activities (Latina, 2000). In the past, there was a public perception that only elite athletes and wealthy, pampered women received regular massages. As sports massage becomes more mainstream and begins to be embraced by the general public, there is an increased perception that sports massage is not only a luxury, but a new necessity. This trend can be seen in many forms of mainstream media. For example, a college newspaper in Texas, The University Daily, recently ran an article that stated that more financially strained college students were paying for massages as a way to combat stress. It also explained how deep tissue massage can help relieve pain associated with carrying heavy book bags and suggested that students ask their parents to pay for a massage session. A massage therapist in the article was quoted as saying, â€Å"It is very therapeutic. It’s not a luxury like people think. If more people think of it as therapy, then more people could justify it that way (Aaron). However, despite the widespread interest in sports massage, there is a lack of reliable information on its benefits and effects. Using a search engine like Goolgle.com to search under the â€Å"benefits of sports massage† will turn up hundreds of websites offering glowing testimonials about the therapy and claims that are not backed up by current scientific research. For instance, SportsInjuryClinic.net claims that regular sports massage treatments will â€Å"maintain the body, prevent injuries and loss of mobility, cure and restore mobility to injured muscle tissue, boost performance, and extend the overall life of your sporting career† (Sports Injury Clinic). Another website for massage centre in Connecticut bluntly states, â€Å"Massage is beneficial when starting a conditioning program because it helps you get into good shape faster† (Buckland Massage Neuromuscular Centre). With so many websites making fantastic claims about the benefits of sports massage, it is easy to understand why the perceived benefits of sports massage currently held by the general public do not always match current scientific research. As previously mentioned, sports massage is broken down into three main categories: pre-event, post-event, and routine maintenance. Each of these forms of sports massage uses a combination of stroke techniques. In order to understand the research and perceived benefits of sports massage, it is important to understand the various stroke styles. The most common stroke strokes are effleurage, petrissage, and cupping(Davidson, 2001). Other common strokes include friction, range of motion movements, trigger point, and compression (which some massage therapists classify as a type of petrissage) (Pike, p. 26-31). Effleurage utilizes long, gentle strokes. This is the most basic type of stroke and warms the area for the work to come by increasing blood flow to the muscle (Pike, p. 26). This is the main stroke for creating relaxation and is often used most frequently at the start and end of massage therapy session, although it is useful throughout the therapy(Cates, 1998). Petrissage is a firmer, two handed kneading technique that includes blows to the muscle. Both hands grab the muscle and compress it. Massage therapists use petrissage to loosen tight muscles and squeeze blood out from deeper structures (Davidson, 2001). Cupping involves hitting the muscles with cupped hands. This stroke technique is used to break down scar tissue, relieve tension and tone the muscles (Davidson, 2001). Friction strokes are used only during deep tissue massage to relax the muscles and reduce adhesions. These circular strokes generate heat by increasing blood flow to the area being worked on (Pike, p. 32) Range of motion movements are assisted exercises that the massage therapist uses to increase the mobility of joints. The massage therapist moves the body while the athlete stays relaxed. Massage therapists report that this technique can extremely helpful for athletes, who usually need to have the maximum range of movement possible in order to excel at their sport (Pike, p. 34). Trigger points are parts of the muscle that are tight and painful. When massage therapist applies pressure to a trigger point, the athlete will often cry out in pain. Correctly massaging a trigger point will help release tight muscles and â€Å"break the pain cycle so the tissue can get blood and nutrients to heal and relax itself† (Pike, p. 31) Compression strokes are used on muscle bellies, generally in large areas, like the adductors. Massage therapists use compression, which Isa squeezing movement, to feel the tissues under the skin. Compression can stimulate and warm the tissue or relax the athlete, depending on the firmness of the stroke (Pike, p. 30). Many people mistakenly think that sports massage is beneficial because it is somehow â€Å"deeper† than other massages. However, that is not always the case. Sports massage is any massage technique that allows â€Å"active people to stay active, to keep the body in working order, and to aid rehabilitation following injury.. Thus it can also involve gentle rubbing, or even no rubbing at all. In fact, there are times when rubbing may be harmful and in this instance, stretching may be more beneficial† (Famous Therapies). Literature Review Many massage therapists believe that pre-event sports massage can help prevent serious injury by warming-up the muscles and improve performance during a competition. Meagre was strong advocate for-event massages. In his book, Sports massage, he wrote: Whatever sport you play, Sports massage will give you 20 per cent extraextra performance, extra protection, (and) extra time per game, per season, (and) per career.With Sports massage you can do what you do better, longer, and more easily, raising your performance level at the same time that you lower the stress level it places on your body†¦. Sports massage before (problems) reach the critical stage is the only sensible way to keep your entire muscular structure in top form(Massage Before, or After?). Pre-event massage is not intended to replace traditional warm-up methods. It is usually performed just before the athlete’s standard warm-up. Rapid effleurage stimulates and warms the muscles andpetrissage encourages the release of tension. It is common for the massage therapist to use shaking and stretching techniques. Deep tissue and friction are avoided. The part of the body that is massaged depends on the sport, but usually includes leg and back muscles (Davidson,2001). Pre-event massage generally only lasts about ten minutes. The goal Isa reduction in tension, but not total relaxation. Sports massage therapist, James Weslaco, says that most athlete want to feel stimulated, not overly relaxed, by a pre-event massage because being too relaxed can adversely affect performance (Vanderbilt, 2001). â€Å"(Pre-event massage) objectives are to increase circulation, increase range of motion of the joints, decrease tightness and hyper tonicity of major joints and muscles, and to relax and then invigorate the body to get it ready for the competition† (Pike, p. 19) The perceived benefit of fully prepared muscles is important to many athletes, who are well-aware of the many career-ending injuries that have been blamed on not properly warming-up. There is a widely-held belief that overuse injuries can be avoided if the athlete is warmed-up with a combination of massage and standard warm-up practices. However, many studies have suggested that the benefits of pre-event sports massage are mostly psychological and there is no evidence theatre-event massage can decrease the risk of injuries (Harmer, p.55). Some athletes say they perform better on the field after receiving pre-event massage. However, again, the benefits appear to be purely psychological. Research shows that massage, which is part of passive warm-up techniques that can also include saunas and hot showers, have little positive effect on performance (Volant’s, et al., 2001). In one study, members of a group of athletes who received pre-event massage each reported feeling that they could perform better on the field because of the therapy. Yet, their performance, heart rate and arteriovenous oxygen responses were not noticeable different than those of a control group that did not receive massage (Boone, et al., 1991). Although there are many widely embraced perceived benefits to pre-event sports massage, there has not been enough research to back up the antidotal evidence given by athletes and their massage therapists. Some studies have indicated that there can be physiological responses that result in improved outcome for the athlete. However, much of the research has not quantified the technique and pressure used by the massage therapist.. No study to date has examined how stroke forms and pressure (light touch versus firm) as an independent variable can affect athletic performance (Moyer et al.). Even though the benefits of pre-event massage are still unknown, it continues to increase in popularity, not just in athletics but also another performance-driven industries. Robert King, president and-founder of Chicago School of Massage Therapy, says Its a debatable subject in terms of actual research that substantiates it.† Yet, he continues to see the demand for pre-event message grow. Ive worked on runners, actors and actresses before performances, boxers and swimmers, and again it depends on the type of muscle youre going to encounter and the condition and goals of the athlete. The approach is geared toward the needs of that particular event (Vanderbilt, 2001). Unlike pre-event massage, post-event massage may have measurable benefits. Post-event massage is performed one to two hours after the athlete has finished taking part in a sporting event, in order to allow time for blood vessels dilated by exercise to return to their normal state. The goal of this type of massage is to reduce the trauma caused by strenuous exercise. Light effleurage is used to minimize swelling. Practitioners believe light petrissage will promotes cellular waste removal and clear toxins from the body. (Pike, p. 20). â€Å"The goals are to relax tight muscles, decrease muscle soreness, facilitate faster recovery time, relieve cramping, increase lymphatic circulation and removal of post activity metabolites, and relax the nervous system† (Pike, p. 20). Other perceived benefits of post-event massage therapy include the lessening of muscle spasms and an increase in flexibility which may prevent future injuries. Although receiving a massage after a strenuous workout can feel very pleasurable, practitioners should limit sessions to under 30 minutes because tired muscles may be more prone to injury. In fact, some therapists believe that the longer the athletic event is, the shorter the post-event massage should be (Cates, 1998). The perceived effectiveness of post-event massage is pervasive among professional athletes. There is a strong belief that the therapy can speed recovery after extreme exertion. For example, Butch Reynolds, the400 meter world record holder was quoted as saying that because of massage, â€Å"If [a muscle pull or strain] does occur, it’s easy to heal. The healing process is cut in half.† Professional football linebacker Al Smith has also heralded the benefits of post-event massage. He said, â€Å"It helps me quite a bit. It helps my recovery time from the game. Athletes are using it quite a bit.† (Sports Massage: Taking the Field)Perhaps the most famous advocate of post-event massage is Michael Jordan. In talking about his physical problems after a performance, the basketball player said, â€Å"I was a little concerned, because I couldn’t really walk welland my mobility was very, very limited. But two days of electros Tim, massaging and heat treatments really loosened things up (How Massage Aides Athletic Performance). Despite scepticism that massage has physiological benefits, Davidson advocates the use of post-event massage to speed recovery (2001). She writes that sports massage can reduce the swelling of micro-traumas. Micro-traumas are small tears that occur in muscles during strenuous exercise. Davidson claims that post-event massage will also remove lactic acid and waste build-up in the muscles, help maintain flexibility, and reduce cramping. However, while Davidson’s theories may be popular, there are studies that dispute the claims. For instance, the blood pressure, cardiac output, heart rate, and lactic acid levels of ten men were compared during a recent study. Lactic acid is a by-product of exercise that occurs during exercise when there is a lack of oxygen in the body’s tissues. Some massage practitioners have made the claim that massage can help the body eliminate waste products, including lactic acid. However, the men in the study who received massage had similar levels of lactic acid to the men who were not treated with a massage(Callaghan, p. 31). Furthermore, the group that received massages performed no better than the control group. The idea the lactic acid can (and should) be flushed from the body during post-event massage is a good example of how the perceived effectiveness of massage does not always match current scientific research. For many years, massage therapists believed that they could help athletes get rid of lactic acid. They passed this belief onto clients, including many athletes, who accepted the theory as fact. The false assumptions about lactic acid were even taught in massage schools. Even though scientific studies have debunked this belief, many athletes still think they need post-event massage to rid their bodies of lactic acid (Vanderbilt, 2001). Despite the critics, many massage therapists are convinced of the benefits of post-event massage. They say post-event massage can help determine why an athlete did not perform up to expectations. A massage therapist for the Los Angeles Dodgers, William Leisure, said he uses post-event massage in the same way a detective might search for clues. Leisure described his work not only in terms of keeping the players ‘muscles loose and relaxed, but also keeping constant watch on their bodies. Even if someones not injured, if the performance wasnt quite right, I do a palpation to see if any muscles are tight. It has a lot to do with how good your hands are. Your brain and your thumbs have to be as one†¦ Its not just a rub. Its the information I can get from the body and turn it into something else to try to make a cohesive plan. Scanning the tissue and checking for deviations is kind of diagnostic, actually. That helps them to stay at peak performance (Vanderbilt,2001). The third category of sports massage, maintenance, is not administered on days of competition or performance. Instead it is done between events (Pike, p. 21). Usually, maintenance massages are given once week as part of Perceived Effectiveness of Sports Massage Therapy Perceived Effectiveness of Sports Massage Therapy Massage therapy has been used ancient times. There is evidence that the Chinese used therapeutic massage more than 3,000 years ago. Massage has fallen in and out of favour over time. One of the newest forms of massage therapy is sports massage. Famous athletes have publicly expressed their great satisfaction with sports massage. They claim that it has increased their athletic performance and helped speed their recovery after strenuous exercise. Non-professional athletes and their trainers has also become increasingly interested in sports massage, partly because of the acclaim it has received from elite athletes. This has led to even more interest in the therapy by non-athletes. Some of the popularity of sports massage can be attributed to the increasing acceptance of all forms of alternative therapies. Despite all of the intense interest, there is a lack of accurate information about massage. There are many widely held perceptions about the effectiveness of pre-event sports massage, including that it can prevent injury and provide an edge over the competition. However, there is no published research that suggests pre-event massage has a positive impact on performance or injury prevention. There is some evidence that massage after an athletic event can help reduce pain, but the results remain inconclusive. There has also been research that concluded that regular, or maintenance, massages can alleviate some symptoms. In 2004, a research team published A Meta-Analysis of Massage Therapy, which provided comprehensive look at the actual effectiveness of sports massage. Among other findings, they concluded that massage may reduce pain. However, the study debunked many of the widely held perceptions about the effectiveness of sports massage. Massage therapy does seem to have an impressive ability to reduce anxiety and depression. While the exact science behind the benefits sports massage remains elusive, many athletes, coaches, and massage therapists continue to believe that it can have a tremendous positive effect if used both before and after sporting events and during periods of training. Introduction Massage is one of the oldest and widely used therapies in the history of mankind. The American Heritage Dictionary of the English Language defines massage as: â€Å"the rubbing or kneading of parts of the body especially to aid circulation, relax the muscles, or provide sensual stimulation.† These benefits have been enjoyed since ancient times and almost all cultures have used some version of therapeutic massage(Vickers, Zelman, 1999). However, in more recent history, massage has become an important tool for athletes. Sports massage is now considered powerful way to help maximize athletic performance (Davidson, 2001). The prevalence of this type of massage has rapidly increased over the last two decades and the perceived effectiveness of sports massages given before and after athletic events has become widespread. Massage may have become more en vogue recently, but it is certainly not new. The first evidence of massage can be seen in the Chinese Cong-Fou, written around 2700 B.C. The text makes references to the manipulation of soft tissue. The ancient Chinese massage techniques involved applying pressure to muscles and meridian points. There is evidence that the ancient Chinese practitioners believed their massage not only relaxed muscles, but also improved the function of internal organs(Calvert, 2001). Ancient Indian texts also described various massage techniques that were believed to promote spiritual and physical healing (Pike, p.viii). Even Hippocrates taught a form of massage to his students around500 B.C. Another famous Greek medical practitioner, Asclepiads, was so impressed by the perceived benefits of massage that the stopped using all other medicines and treatments and only used massage therapy for healing. He believed that massage techniques could increase and restore nutritive fluids (Calvert, 2001). However, over time, Western cultures gradually abandoned the Greek beliefs about massage. During the middle ages, massage was still used as a folk remedy, but established medical scientists discounted it and the use of massage was no longer considered part of regular medical treatment. (Calvert, 2001). About 150 years ago, a French translation of the Cong-Four appeared. Historians believe the text served as the foundation for the development of the now-popular Swedish massage (Davidson, 2001). There is some dispute over the origins of Swedish massage, but many credit Per Hendrix Ling for its development during the early 18th century. Ling promoted the idea that massage could heal the body by boosting circulation of the blood and limp systems. Ling’s massage technique was very vigorous and he prescribed a standardized treatment. He suffered from gout and developed the system to improve his condition and later to help others. He did not equate massage with relaxation or any other psychological benefit. In fact, he called it the â€Å"Swedish Movement Cure† (Cates, 1998). Current Swedish massage has evolved somewhat from Ling’s ideas and is now more gentle, although the focus is still on increasing the flow of oxygen in the blood and to assist the muscles in releasing toxins. In the last few decades, Swedish massage therapists have placed greater emphasis on the psychological benefits of massage and they strive to provide a sense of calmness and well-being.(Vickers, Zelman, 1999) Historically, the interest in massage has been cyclical. Massage fallout of favour, only to once again regain acceptance, many times over the last 500 years. Currently, massage has become far less important tour culture than medical drugs and surgery, but it is again becoming more popular as an alternative therapy (Cates, 1998). There are still many forms of massage found throughout the world, including Hawaiian, deep tissue, and Tue. Na. One of the newest forms of massage is sports massage. Although it is considered a separate form of massage, it shares strong similarities with Swedish Massage and the most of the techniques employed in Swedish massage are used in sports massage(Davidson, 2001). However, sports massage also incorporates Shiatsu massage techniques. Sports massage was largely developed by Jack Meagher. Meagher was the massage therapist for the US Olympic Equestrian Team. He developed sports massage based on the theory that there are a dozen body postures that form the axis of all athletic movement. Meagher said that because each sport requires that the athlete maintain certain postures, it is possible to identify potential overuse injuries before they occur and help prevent them through sports massage. Meagher wrote that athletic performance could be improved by 20% with the introduction of sports massage (Dion, 2001). Although sports massage encompasses many techniques, all sports massages geared toward generating the maximum performance from an athlete. The effects of sports massage are achieved through a combination of mechanical, physiological, and psychological processes. Research has demonstrated that the compression caused by correctly-applied sports massage can improve lymphatic and venous drainage in the body and boost circulation (Hollis, 1997). Under the general heading of sports massage, there are three distinctly different types of massage. Each has a different goal and employs different strokes. The three categories of sports massage are pre-event, post-event, and maintenance massage. Although sports massage has recently become more sophisticated, modern athletics have been using forms of pre-event and post-event massage for decades. For example, baseball pitchers have long used massage as an attempt to extend the length of their career by maintaining range of motion and flexibility. For many decades, boxing coaches and trainers have been seen giving boxers â€Å"rubdowns† before a fight in an effort toward-up the body by boosting circulation. This is an early form fore-event massage (Pike, p.viii). Modern sports massage first became integrated as part some teams ‘standard athletic training in the former Soviet Union, East Germany, and other Eastern European countries during the 1960s. Soviet teams were the first to employ dedicated massage therapists that traveled with them. In the 1970s, the trend became more widespread, as more European countries and teams in the United States began to take interest in sports massage (Davidson, 2001). However, it is only since the 1980s that sports massage has become truly mainstream. Now, it is a common practice for teams to integrate sports massage as part of their standard training regimen. Certified sports massage therapists have been seen at many major sporting events, including Ironman competitions, the Goodwill and Pan-American games, marathons, the Olympics, and professional bike races (Latina, 2000).When the U.S women’s soccer team defeated China, winning the World Cup, the players publicly thanked their sports massage therapist, Wynn Clinton and Jim Fayola. Goalkeeper Tracy Ducat said, â€Å"Clinton and Jim Fayola, who worked with him during the World Cup, were invaluable in the treatment they provided for us, testified Tracy Ducat, a goalkeeper on the team. We could not have been at our best without their help every day. Goalie Saki Webber agreed, saying, Without Clinton I think that it would have been a much different story. I think that he kept us healthy and kept us together during the World Cup† (Hued, 2002). Sports massage has also infiltrated smaller sports. For example, even some Canadian cowboys are receiving massages before and after rodeos, thanks to new mobile massage rooms are traveling with them (Visconti,p.54). Although professional sports teams have lead the way in incorporating sports massage, college, some secondary schools, and amateur teams are also exploring massage as a way to enhance performance. The public’s perceived value of the effectiveness of sports massage has been fuelled by public statements from well-known professional athletes who say their extraordinary skills have improved after undergoing regular massage therapy. For example, tennis champion, Martina Navratilova said, â€Å"I started getting massages and realized what wonderful thing it is for your body† (Sports Massage: Taking the Field ). Former professional football quarterback, Joe Montana, has said, â€Å"I’ve been working with massage for a few years now, and I found it helps you to recover a little quicker. The bumps and bruises seem Togo away a lot faster† (Sports Massage: Taking the Field). Canadian National Swim Team member, Marianne Limpet, agrees: â€Å"I find that massage is very beneficial in helping with a quicker recovery from hard training or racing, and it prevents me from getting tight muscles and injuring myself. I am one of few athletes at my age(30), and Im sure that massage has played a major role in helping to keep my body in shape to continue to this level† (Warren, 2003). Even Marjorie Album, the Chief Athletic Trainer of the 1996 Atlanta Olympic Games, once commented, â€Å"I would not provide sports medicine services for any major athletic event without massage therapists.†(Sports Massage: The Athlete’s Trainer’s Edge ) With glowing testimonials from esteemed athletes and sports professionals, it is not surprising that more amateur and college athletes are now becoming interested in sports massage. After all, our society places great emphasis and value on athletics, and the financial and emotional rewards can be great to those who excel in their chosen sport. It is not surprising that sports massage is popular among those searching for competitive edge. This relatively new appreciation for sports massage has increased as part of a larger trend toward ergogenic aids to boost all types of athletic performance. Ergogenic aids include a wide variety of tools and therapies, such as visualization, meditation, and pre-event stretching. Advocates of sports massage say it is valuable ergogenic tool that can improve circulation, reduce stress, promote muscle efficiency and healing, and even prevent injuries (Pike, p. vii). The perceived benefits of massage have also become more wide-spread as the general acceptance of alternative medicines has increased. In a1997 random sample of 1,500 households in the United States, 42% of adults reported using some type of alternative therapy in the last year. Nearly 45% said they would be willing to pay more each month for alternative care. Additionally, when choosing healthcare, nearly 70% of respondents said having access to alternative therapies is an important factor in choosing a health insurance plan (Landmark Healthcare Inc.,1997). Alternative medicine is even more popular in the United Kingdom, where in studies, nearly 47% of respondents have reported they are using alternative therapies. Also in the U.K., of those undergoing complementary medicine, nearly nine out of ten are paying for their treatment (Thomas et al. p. 2 -11 ). Massage therapy is one of the fasting growing forms of alternative medicine. In 1999, The American Massage Therapy Association (AMTA)conducted a nationwide survey in the United States. Researchers found that 27% of adults had therapeutic massage in the last five years, compared to only 17% in a 1997 study who said they had a massage in the previous five years (Massage: Much-Kneaded Complementary Health Care). Another study conducted the previous year found that visits to massage therapists increased by nearly 36% in the years between 1990 and 1997(Eisenberg et al. p. 1569). Furthermore, in 2004, the National Centerior Complementary and Alternative Medicine in the United States reported that massage has become the ninth most popular alternative therapy treatment. In the study, 5% of respondents said they had received massage therapy at least one time in the previous year (Boneset al.). This translates into big business for the massage industry, as American consumers are spending up to $6 billion dollars a year on massage therapy (Eisenberg et al., p. 1569). This increasing interesting massage has created a surge in massage school educational facilities and applicants. As of 2002, there were more than 950 state-licensed massage schools in the U.S., which is 14% more school than existed in2000. In 2001, massage schools turned out an estimated 30,000 new graduates (Lacombe, p. 49). There are other significant signs that the perceived benefits of massage is having a strong effect on public policy. In the United States, The National Institutes of Health is currently sponsoring three studies in an attempt to clarify the medical benefits of massage. Additionally, a national survey of employer-sponsored healthcare plans found that 15% of HMOs cover massage therapy. Cigna and Blue Cross BlueShield also cover some forms of massage (Lacombe, p. 49).Furthermore, a 1995 study found that more than half of family doctors in the United States said they would recommend some form of massage therapy to their clients (Hedwig, p.1). This is a concern to some researchers who wonder if the benefits of massage are worth the price of the therapy. In their meta-analysis of massage therapy research, Moyer, Rounds, and Hanno wrote, â€Å"For these trends to continue (indeed, to determine if they even should continue),what is needed is a more rigorous and quantitative examination of MT’s(massage therapy’s) effectiveness that that which currently exists†(Moyer et al.). The perceived, yet often unexplained, effects of massage (including sports massage) have even created interested within the White House. In2004, the White House Commission on Complementary and Alternative Medicine Policy called for more research and funding for public education on massage therapy. The commission’s chairman, James Gordon, did not offer an explanation of the actual benefits of massage, but he did allude to the widespread perceived effectiveness of the alternative treatment. He said: We shouldnt put too much weight on its benefits, but at the same time we should make it available to everyone. Massage does decrease anxiety, reliably. It does decrease pain in a number of people with chronic-pain syndrome. It does improve mood. Exactly how it does it, I don’t think we know (Lacombe, p. 50). AMTA researchers say as more people accept massage therapy as a viable treatment option, more athletes are becoming interested in sports massage. The AMATA now recognizes sports massage as a unique specialty field within the massage industry. There has also been increased interest in sports massage among the so-called â€Å"weekend warriors†(people who only exercise on the weekends) and those do not consider themselves athletes or exercise regularly. No matter how little time they spend taking part in athletics, some people want to enjoy the perceived benefits of sports massage. Licensed massage therapist John Balletto said, â€Å"Anyone who exercises or works in an active job or even has to constantly bend down to pick up a child can benefit from sports massage. This type of massage helps muscles deal with the repetitive motions inherent to these activities (Latina, 2000). In the past, there was a public perception that only elite athletes and wealthy, pampered women received regular massages. As sports massage becomes more mainstream and begins to be embraced by the general public, there is an increased perception that sports massage is not only a luxury, but a new necessity. This trend can be seen in many forms of mainstream media. For example, a college newspaper in Texas, The University Daily, recently ran an article that stated that more financially strained college students were paying for massages as a way to combat stress. It also explained how deep tissue massage can help relieve pain associated with carrying heavy book bags and suggested that students ask their parents to pay for a massage session. A massage therapist in the article was quoted as saying, â€Å"It is very therapeutic. It’s not a luxury like people think. If more people think of it as therapy, then more people could justify it that way (Aaron). However, despite the widespread interest in sports massage, there is a lack of reliable information on its benefits and effects. Using a search engine like Goolgle.com to search under the â€Å"benefits of sports massage† will turn up hundreds of websites offering glowing testimonials about the therapy and claims that are not backed up by current scientific research. For instance, SportsInjuryClinic.net claims that regular sports massage treatments will â€Å"maintain the body, prevent injuries and loss of mobility, cure and restore mobility to injured muscle tissue, boost performance, and extend the overall life of your sporting career† (Sports Injury Clinic). Another website for massage centre in Connecticut bluntly states, â€Å"Massage is beneficial when starting a conditioning program because it helps you get into good shape faster† (Buckland Massage Neuromuscular Centre). With so many websites making fantastic claims about the benefits of sports massage, it is easy to understand why the perceived benefits of sports massage currently held by the general public do not always match current scientific research. As previously mentioned, sports massage is broken down into three main categories: pre-event, post-event, and routine maintenance. Each of these forms of sports massage uses a combination of stroke techniques. In order to understand the research and perceived benefits of sports massage, it is important to understand the various stroke styles. The most common stroke strokes are effleurage, petrissage, and cupping(Davidson, 2001). Other common strokes include friction, range of motion movements, trigger point, and compression (which some massage therapists classify as a type of petrissage) (Pike, p. 26-31). Effleurage utilizes long, gentle strokes. This is the most basic type of stroke and warms the area for the work to come by increasing blood flow to the muscle (Pike, p. 26). This is the main stroke for creating relaxation and is often used most frequently at the start and end of massage therapy session, although it is useful throughout the therapy(Cates, 1998). Petrissage is a firmer, two handed kneading technique that includes blows to the muscle. Both hands grab the muscle and compress it. Massage therapists use petrissage to loosen tight muscles and squeeze blood out from deeper structures (Davidson, 2001). Cupping involves hitting the muscles with cupped hands. This stroke technique is used to break down scar tissue, relieve tension and tone the muscles (Davidson, 2001). Friction strokes are used only during deep tissue massage to relax the muscles and reduce adhesions. These circular strokes generate heat by increasing blood flow to the area being worked on (Pike, p. 32) Range of motion movements are assisted exercises that the massage therapist uses to increase the mobility of joints. The massage therapist moves the body while the athlete stays relaxed. Massage therapists report that this technique can extremely helpful for athletes, who usually need to have the maximum range of movement possible in order to excel at their sport (Pike, p. 34). Trigger points are parts of the muscle that are tight and painful. When massage therapist applies pressure to a trigger point, the athlete will often cry out in pain. Correctly massaging a trigger point will help release tight muscles and â€Å"break the pain cycle so the tissue can get blood and nutrients to heal and relax itself† (Pike, p. 31) Compression strokes are used on muscle bellies, generally in large areas, like the adductors. Massage therapists use compression, which Isa squeezing movement, to feel the tissues under the skin. Compression can stimulate and warm the tissue or relax the athlete, depending on the firmness of the stroke (Pike, p. 30). Many people mistakenly think that sports massage is beneficial because it is somehow â€Å"deeper† than other massages. However, that is not always the case. Sports massage is any massage technique that allows â€Å"active people to stay active, to keep the body in working order, and to aid rehabilitation following injury.. Thus it can also involve gentle rubbing, or even no rubbing at all. In fact, there are times when rubbing may be harmful and in this instance, stretching may be more beneficial† (Famous Therapies). Literature Review Many massage therapists believe that pre-event sports massage can help prevent serious injury by warming-up the muscles and improve performance during a competition. Meagre was strong advocate for-event massages. In his book, Sports massage, he wrote: Whatever sport you play, Sports massage will give you 20 per cent extraextra performance, extra protection, (and) extra time per game, per season, (and) per career.With Sports massage you can do what you do better, longer, and more easily, raising your performance level at the same time that you lower the stress level it places on your body†¦. Sports massage before (problems) reach the critical stage is the only sensible way to keep your entire muscular structure in top form(Massage Before, or After?). Pre-event massage is not intended to replace traditional warm-up methods. It is usually performed just before the athlete’s standard warm-up. Rapid effleurage stimulates and warms the muscles andpetrissage encourages the release of tension. It is common for the massage therapist to use shaking and stretching techniques. Deep tissue and friction are avoided. The part of the body that is massaged depends on the sport, but usually includes leg and back muscles (Davidson,2001). Pre-event massage generally only lasts about ten minutes. The goal Isa reduction in tension, but not total relaxation. Sports massage therapist, James Weslaco, says that most athlete want to feel stimulated, not overly relaxed, by a pre-event massage because being too relaxed can adversely affect performance (Vanderbilt, 2001). â€Å"(Pre-event massage) objectives are to increase circulation, increase range of motion of the joints, decrease tightness and hyper tonicity of major joints and muscles, and to relax and then invigorate the body to get it ready for the competition† (Pike, p. 19) The perceived benefit of fully prepared muscles is important to many athletes, who are well-aware of the many career-ending injuries that have been blamed on not properly warming-up. There is a widely-held belief that overuse injuries can be avoided if the athlete is warmed-up with a combination of massage and standard warm-up practices. However, many studies have suggested that the benefits of pre-event sports massage are mostly psychological and there is no evidence theatre-event massage can decrease the risk of injuries (Harmer, p.55). Some athletes say they perform better on the field after receiving pre-event massage. However, again, the benefits appear to be purely psychological. Research shows that massage, which is part of passive warm-up techniques that can also include saunas and hot showers, have little positive effect on performance (Volant’s, et al., 2001). In one study, members of a group of athletes who received pre-event massage each reported feeling that they could perform better on the field because of the therapy. Yet, their performance, heart rate and arteriovenous oxygen responses were not noticeable different than those of a control group that did not receive massage (Boone, et al., 1991). Although there are many widely embraced perceived benefits to pre-event sports massage, there has not been enough research to back up the antidotal evidence given by athletes and their massage therapists. Some studies have indicated that there can be physiological responses that result in improved outcome for the athlete. However, much of the research has not quantified the technique and pressure used by the massage therapist.. No study to date has examined how stroke forms and pressure (light touch versus firm) as an independent variable can affect athletic performance (Moyer et al.). Even though the benefits of pre-event massage are still unknown, it continues to increase in popularity, not just in athletics but also another performance-driven industries. Robert King, president and-founder of Chicago School of Massage Therapy, says Its a debatable subject in terms of actual research that substantiates it.† Yet, he continues to see the demand for pre-event message grow. Ive worked on runners, actors and actresses before performances, boxers and swimmers, and again it depends on the type of muscle youre going to encounter and the condition and goals of the athlete. The approach is geared toward the needs of that particular event (Vanderbilt, 2001). Unlike pre-event massage, post-event massage may have measurable benefits. Post-event massage is performed one to two hours after the athlete has finished taking part in a sporting event, in order to allow time for blood vessels dilated by exercise to return to their normal state. The goal of this type of massage is to reduce the trauma caused by strenuous exercise. Light effleurage is used to minimize swelling. Practitioners believe light petrissage will promotes cellular waste removal and clear toxins from the body. (Pike, p. 20). â€Å"The goals are to relax tight muscles, decrease muscle soreness, facilitate faster recovery time, relieve cramping, increase lymphatic circulation and removal of post activity metabolites, and relax the nervous system† (Pike, p. 20). Other perceived benefits of post-event massage therapy include the lessening of muscle spasms and an increase in flexibility which may prevent future injuries. Although receiving a massage after a strenuous workout can feel very pleasurable, practitioners should limit sessions to under 30 minutes because tired muscles may be more prone to injury. In fact, some therapists believe that the longer the athletic event is, the shorter the post-event massage should be (Cates, 1998). The perceived effectiveness of post-event massage is pervasive among professional athletes. There is a strong belief that the therapy can speed recovery after extreme exertion. For example, Butch Reynolds, the400 meter world record holder was quoted as saying that because of massage, â€Å"If [a muscle pull or strain] does occur, it’s easy to heal. The healing process is cut in half.† Professional football linebacker Al Smith has also heralded the benefits of post-event massage. He said, â€Å"It helps me quite a bit. It helps my recovery time from the game. Athletes are using it quite a bit.† (Sports Massage: Taking the Field)Perhaps the most famous advocate of post-event massage is Michael Jordan. In talking about his physical problems after a performance, the basketball player said, â€Å"I was a little concerned, because I couldn’t really walk welland my mobility was very, very limited. But two days of electros Tim, massaging and heat treatments really loosened things up (How Massage Aides Athletic Performance). Despite scepticism that massage has physiological benefits, Davidson advocates the use of post-event massage to speed recovery (2001). She writes that sports massage can reduce the swelling of micro-traumas. Micro-traumas are small tears that occur in muscles during strenuous exercise. Davidson claims that post-event massage will also remove lactic acid and waste build-up in the muscles, help maintain flexibility, and reduce cramping. However, while Davidson’s theories may be popular, there are studies that dispute the claims. For instance, the blood pressure, cardiac output, heart rate, and lactic acid levels of ten men were compared during a recent study. Lactic acid is a by-product of exercise that occurs during exercise when there is a lack of oxygen in the body’s tissues. Some massage practitioners have made the claim that massage can help the body eliminate waste products, including lactic acid. However, the men in the study who received massage had similar levels of lactic acid to the men who were not treated with a massage(Callaghan, p. 31). Furthermore, the group that received massages performed no better than the control group. The idea the lactic acid can (and should) be flushed from the body during post-event massage is a good example of how the perceived effectiveness of massage does not always match current scientific research. For many years, massage therapists believed that they could help athletes get rid of lactic acid. They passed this belief onto clients, including many athletes, who accepted the theory as fact. The false assumptions about lactic acid were even taught in massage schools. Even though scientific studies have debunked this belief, many athletes still think they need post-event massage to rid their bodies of lactic acid (Vanderbilt, 2001). Despite the critics, many massage therapists are convinced of the benefits of post-event massage. They say post-event massage can help determine why an athlete did not perform up to expectations. A massage therapist for the Los Angeles Dodgers, William Leisure, said he uses post-event massage in the same way a detective might search for clues. Leisure described his work not only in terms of keeping the players ‘muscles loose and relaxed, but also keeping constant watch on their bodies. Even if someones not injured, if the performance wasnt quite right, I do a palpation to see if any muscles are tight. It has a lot to do with how good your hands are. Your brain and your thumbs have to be as one†¦ Its not just a rub. Its the information I can get from the body and turn it into something else to try to make a cohesive plan. Scanning the tissue and checking for deviations is kind of diagnostic, actually. That helps them to stay at peak performance (Vanderbilt,2001). The third category of sports massage, maintenance, is not administered on days of competition or performance. Instead it is done between events (Pike, p. 21). Usually, maintenance massages are given once week as part of

Gregory Efimovich Rasputin Essay -- Papers

Gregory Efimovich Rasputin No other figure in recent Russian history has received the amount of vilification and contempt heaped upon Gregory Rasputin. The self-styled monk, who received practically little education in the intricacies of the Russian Orthodox faith, came from the rural areas of Russiaand achieved great recognition as a "staretz," or holy man in the highest circles of St. Petersburgsociety. From rags to social prominence the life of Gregory Rasputin holds many of the events leading to the eventual overthrow of the Russian imperial system, the dethronement of the House of Romanov and the assassination of the Imperial Family. Gregory Efimovich Rasputin came from solid peasant stock. Gregory Efimovich was born on January 10, 1869, in Prokovskoe, a small village in Siberiaon the banks of the TuraRiver. As a young lad, Rasputin shocked his village by constantly finding ways to get into trouble with the authorities. Drunkenness, stealing and womanizing were activities particularly enjoyed by the dissolute young man. Rasputin in fact was developing into a rake, a man with a debauched, and endless, sexual appetite. It was while on one of his escapades that Rasputin was first impacted by the mystical powers of the Russian Orthodox religion. At Verkhoturye Monastery Rasputin was fascinated by a renegade sect within the Orthodox faith, the Skopsty. Followers of the Skopsty firmly believed that the only way to reach God was through sinful actions. Once the sin was committed and confessed, the penitent could achieve forgiveness. In reality, what the S... ...iks during the revolution. Within three months of Rasputin's death, Nicholas lost his throne, the imperial family were imprisoned and many of the Romanov cousins arrested. In then end almost twenty members of the Romanov family were massacred by Bolshevik firing squads. No other epitaph to Rasputin's death better exemplifies the repercussions of the monk's death than that written by Grand Duchess Maria Pavlova, sister, in her Memoirs: "His death came to late to change the course of events. His dreadful name had become too thoroughly a symbol of disaster. The daring of those who killed him to save their country was miscalculated. All of the participants in the plot, with the exception of Prince Youssoupov later understood that in raising their hands to preserve the old regime they struck it, in reality, its final blow."

Is Play Learning Essay

Learning through play is a vital part of your Childs development. It includes playing with different toys or activities for different areas of development in order to help them develop. According to Squire. G (2007), play is pleasurable and enjoyable, has no extrinsic goals, play is spontaneous and voluntary, involves some active management. Not only is it fun and interactive for both children and parents, but it enhances the development of all aspects needed including social, Physical, Intellectual, communication and emotional development. Why? Although it seems like your child is simply playing with a toy or object, the child is actually developing and learning so much. That simple teddy bear that you first bought them as a baby, can actually develop their intellectual and emotional development by helping to create an imaginative mind and if the child is talking to the teddy bear, then it’s developing speech and language. 0-3 years old. Your child, from aged 0—3 are learning so much already, even though you might not know it. Your child needs to develop socially, physically, intellectually, their communication and their emotions. This is actually done through play. For a child aged 0-3 you should be encouraging development through play. Toys such as hanging mobiles actually increase your Childs physical development by giving them a target to reach for, stretching out their arms. This increases their hand-eye co-ordination and gross motor skills. Reading your child books every day, whether it’s just to calm them down before bed or for bonding time can influence their learning. This encourages their intellectually development as children pick up different words by listening and being involved. If you involve the child, there is more possibility they will learn more as well as enjoy it more. If you’re reading a colourful, touchy-feely book to an under 1 year old, this can stimulate their development to different textures, colours and making them more aware. Reading topical books can also influence their knowledge of the world, such as books about shopping or religions. Early years settings are good at providing opportunities for children to develop. Nurseries play groups and mum and toddler groups develop your child, not only socially by interacting with other children and adults, but in all other aspects as well. By allowing them to play on, for example, a slide, cars, push trolleys/cars/bikes, they can practice moving around, walking, crawling etc, as they should provide stimulating activities, developing their physical skills and their fine and gross motor skills. Early years settings for this age will develop your child intellectually by giving them an understanding as well as developing knowledge by watching different scenarios, such as having a role play â€Å"home area† which allows them to copy things they might have seen at home such as ironing, play kitchens, etc. Their communication will increase as they are constantly interacting with others and being spoken to as well as listening to others interact. Emotion development will be promoted in the way that children can develop friendships and bonds with other people and start to develop feelings such as empathy as they can offer group activities, play dates and just by being around other children. 3-5 years old. At the age of 3-5 years old, as a parent, you should be offering them a wide range of activities through play. Your child has come on a lot already but the development continues with encouragement from you. Your child will be walking and needing to develop their physical development and gross motor skills (larger muscles such as throwing and catching etc. ) Outside activities are good at encouraging physical development. This can just involve rolling a ball to your child and encouraging them to catch it, kick it, pick it up or chase it. It’s involving for you and the child has fun whilst playing. Their hand eye co-ordination improves and their gross motor skills. As they get older, you could decrease the size of the ball, making it smaller to a tennis ball for example so it becomes harder for the child to catch so they develop their fine motor skills with a pincer grip and tests their hand eye co-ordination. Games such as piggy in the middle, football or just a simple game of throwing and catching. If this isn’t possible, or even if you can, taking your child to a park or play area is fun for them and if you get involved, it can be fun too. Apparatus such as monkey bars and climbing ropes strengthen the Childs muscles and balance. They develop their physical development by allowing them to exercise and experience new activities that they might not get too at home. It’s also a good way to socialize with other children and adults in a public place. This can teach them life skills such as sharing and turn-taking. Your child will start to talk in full and extended sentences around this age. They would have picked up their vocabulary from listening and copying so far. Play can often encourage talking by getting them to communicate their ideas on the game such as role play, but literacy games can extend vocabulary and help with phrasing. Games such as â€Å"I went to the shop and I bought†¦ † This is a good memory game and helps them think about every day things that they could get from a shop. Alphabet games, jigsaws and activities can encourage a child to use their knowledge and extend it. 5-8 years old At this age, your child should be attending school full time. Just because their learning and developing at school, doesn’t mean you have to stop! You should continue to play with your children and encourage them to develop physically, intellectually, socially and emotionally. It might be easy to just to sit them in front of the TV or computer. Statistically, Kidshealth. com (1) shows that; â€Å"As kids get older, too much screen time can interfere with activities such as being physically active, reading, doing homework, playing with friends, and spending time with family. † Also kidpointz. com (2) suggests â€Å"ADD or ADHD was 2 times as likely to have been diagnosed in children addicted to video games. † So if you’re going to give your child computer time, you should use learning game websites such as the BBC or ask the school teacher for resources. This will help build intellectual development and also ITC skills of how to use a computer. Before allowing the children, read and teach the children E-Safety and how to stay safe on the internet. You should also monitor what your children are doing on the computer. You should be encouraging your child to develop socially. Although they are communicating with children at their school, you should encourage them to have a social life outside of school too. Arranging play dates or allowing them to join after school clubs or other activities such as a dancing school, gymnastics, karate or swimming. Making these physical activities will increase development even further, and they might even find a hidden talent! At 5-8 years old, children will want to be reading books, even if they can’t and to be read too. When reading a book to a child, the best ones to choose are ones with extended vocabulary. Choose books with a range of new words, good and interesting illustrations and obviously, a good story line. Children will enjoy talking about the book also, so ask them lots of questions and get them to think about the book. Questions such as â€Å"why is that character doing what they’re doing? † Or â€Å"what do you think is going to happen next? † this allows children to develop their thoughts and imagination. This also allows you to assess the child’s understanding of the book, for example if they don’t understand it, you can do more on the story and allow them to learn about it and why. This is good bonding time for you and the child too, so it’s enjoyable for both of you. Another fun activity for 5-8 year old children, that parents, siblings, friends and other family could be involved in, is making dens. Making dens extend a child’s imagination and creativity, by allowing them to think about different objects to use and ways of creating it. Offer them a range of materials to use so they can experiment. This can teach them patience and trial and error. In fact, although you might not realise it, dens can increase a child’s knowledge on a range of subjects. The maths aspect of teaching them measurements and how much they material they need, how big it’s going to be. Their creative development is obviously supported and to extend even further, it could help with knowledge of the world. For example, ask your child to make a tee-pee. And extend their cultural knowledge by explaining and teaching about the cultures that live in huts like what they’ve just made. Or extend it even further by doing it outside in a woodlands area. This makes them think about the natural resources available and how best to do it, using harder, heavier logs for support. Make this a fun day out and take a picnic to share under your den/shelter. Role of the Adult As a parent or guardian for children, you should be involved in playing with your children to encourage development. If adults are involved and engaged in play, it influences the child to be involved too and shows them the value of play. You can have the power to make a difference to your child by teaching them how to play correctly and properly by offering praise and discipline. Supporting your child with praise such as â€Å"you’re playing with that so well! † This can help a child build their self-esteem and feel good about them self whilst playing and having fun. You can just be someone to play with to a child. Acting as a friend and just company whilst they play, accourding to Lindon J. 2001 (3) â€Å"Children often invite adults to join in or may direct them to take a particular action or support play. This is positive reinforcement because you can observe their play whilst they’re having fun and learning. You being there actually encourages social development and their communication. They can pick up words they ask you and are forced into situations where they might have to speak to you such as wanting you to do something. Adults can often model how to play correctly and sensibly. Children will copy adults and try to do things themselves, such as drawing the same thing as you, making the same thing with playdough or role play games like cooking, which they will have seen you do. You can give them instructions to help them with an activity, such as a arts and craft activity that perhaps you’ve found in a book. The childen can’t yet read the instructions so you read it for them, telling them the best thing to do and rephrasing so they can understand. Even doing it with them to make a model for them, allowing them to copy what and how you do the activity. This encourages fine motor skills because it’s an arts and crafts activity, often including scissors and cutting or colouring with a pincer grip. It encourages creative development and imagination. Interlectually, you’re helping them develop their instructions and about the order and general knowledge. However, you could just be there to ensure your Childs safety. Watching over them on a park or play area. The play equipment will encourage their physical aspects of their learning and development as well as intellectually, often having to problem solve such as finding out the best way to get across to a different area, or how best to play with this object. If you take your child to a public area, social skills are improved as they are around children and come into contact with other. Morally, children learn the values of turn-taking and sharing whilst playing in a public area. You also teach them safety regarding how to play correctly as well as giving them independence. This is a good idea for a play date idea or a group activity as you get some socialising done with other parents whilst your children are safely learning and constantly developing through fun. Your child will often come into conflict. This is where you, as a parent, can act as a mediator. You can teach those morals such as sharing, turn-taking and ensure that these are put in place through play whilst ensuring your child is developing socially as well as other aspects that the activity may focus on. You can be involved with your children’s play just as much as they are in different ways; either hands on approach or just a sit back and relax activity. Your children will learn through play with your help as you are the people they look up to and are influenced by the most. And finally, enjoy your children and their company. They won’t be young forever.

Assessment and Nurses Essay

The aim of this assignment is to explore the four stages of APIE, explaining their importance in nursing, as well as identifying possible problems within the stages, in relation to the videos of Joe. These issues will then be anaylsed using theory, to create possible explanations and consequences for the behaviour and actions shown by Joe and the nurses. APIE is a nursing process which guides health professionals through the problem solving approach, which promotes the individualised, holistic delivery of care. It is tailored around the patient’s needs and allows nurses to holistically assess the patient, then plan and set goals according to the information gathered. These plans and goals are then implemented into the care delivery and evaluated for effectiveness (Wilson, 2012). Assessment Assessment requires looking at the patient holistically and establishing what the patient was like before being admitted and what they are like now. If there is any change between the two, then the cause of this change must be identified. Once this is established, a detailed plan can be derived to tackle the actual problem and potential problems which may arise as a result. Assessment is important because it views the person as an individual (Barrett, Wilson and Woollands, 2009). The consequences of wrongly assessing a patient are that at the planning stage, care may be tailored incorrectly to their gender, religion and other factors which are paramount to that individual. This will in turn affect the way care is implemented. An individual’s culture, values and beliefs are highly influential in establishing what the carer may do for them and what they prefer to do themselves (Baldwin, Longhurst, Smith, et al, 2003). Information collected may be objective or subjective. Objective data is measurable and verifiable whereas subjective data is determined by the individual in order to understand their experience (Long, Phipps and Cassmeyer, 1995). In order to validate and verify the information collected during assessment, it is crucial to relay the information collected back to the patient (Lippincott, Williams and Wilkins, 2007). One explanation of Joe’s behaviour is the Cognitive Dissonance Theory (Festinger, 1954) in the sense that he expresses an idealistic view by saying that he would not change anything about the implementation of his care and stating that all the nurses are lovely. These statements are contradicted by the fact the nurses do not acknowledge him when he repeatedly asks for his glasses, and they talk over him and ignore him as he is getting out of bed. He makes excuses for their bad practice by stating that the nurses are busy and that it does not matter anyway because he does not have anywhere to go. Joe may be using cognitive dissonance as a coping strategy to maintain harmony and avoid the truth (McLeod, 2008). Coping strategies are a way of the individual dealing with their problem to make it more manageable. These strategies, whether adaptive or maladaptive, should be identified though patient interaction in the assessment stage. If the coping strategy is maladaptive thenit should be identified by the nurses and then plans and goals should be set out to find the cause of this behaviour and how to rectify it. Joe may be using a coping strategy to cope with hisdeterioration in independence, since becoming immobile and incontinent. The reasons behind these problems occurring should be identified at this stage, before moving on to the planning stage (Barrett et al, 2009). Physiologically, Joe is at Stage Eight of Erikson’s (1980) Development which means he should be at a stage where he is evaluating his life and passing on his wisdom to others, however Joe is not able to communicate in the home as he is sat alone at meal times and is not listened to by the carers. Erikson (1980) states that we continue developing until we die and that by Joe’s stage, all the ego strengths from the past seven stages come together and are used to evaluate one’s life. On observation however, it seems clear that some of the ego strengths are being damaged – will power, purpose and confidence and fidelity are undermined by the fact he is called â€Å"silly thing† and ignored when he repeatedly asks for his glasses. Stage Two autonomy is also undermined as he is not given the independence of choosing him own meals or choosing what time he wakes up or eats breakfast. This shows that Joe was not assessed in accordance with his age. To rectify this problem, Joe needs to be made more autonomous, given encouragement to use  the urinal instead of a catheter and allowing him to make his own choices. The government White Paper (2006) focuses on the need for individualised care and calls for service to be tailored around the needs of the individual and not the service provider. It aims to place the individual in control of their life and promote independence, by providing a more flexible service, with a view to a reaching and fulfilling a healthy old age. In addition, violence, stress and abuse which pose a threat to an individual’s overall well being, must be identified and addressed. The nurses did not view Joe as an individual because they did not give him the opportunity to choose what he wanted to eat, or allow him to get dressed before leaving his room. To adopt a more individualised approach, the nurses should have let him choose what tine to get up in a morning, allowing him to get dressed and further choose what he wanted to eat for breakfast, therefore adhering to The White Paper guidelines. Planning Planning is important because it clearly sets out SMART Goals which are patient centered and therefore involve the patient directly, when the goals are being established (Barrett et al, 2009). A consequence of not involving the patient directly or clarifying details to the patient is that the goals will not be met, or goals will be set which are irrelevant. Important goals may be omitted or set goals will not be beneficial to the individual. A Systematic Nursing Diagnosis should gather information from the patient about the consequences of living with their particular condition and the impact it has on their life. A way of doing so, is establishing a baseline – what was the patient like before the condition arose, and what are they like now. In addition to this, it should be identified how the patient copes with this change. For example, Joe should have been asked what it is like for him having a catheter. Joe’s daily continence routine before wearing a catheter should have been established, in order to compare it to his current daily routine. Then Joe should be asked how he is coping with this change and how this change affects his life. The same method should also have been used to assess his immobility, so that a needs statement may be written, along with a baseline, in order to make progress measurable (Barrett et al, 2009). Joe used to be able to walk when he was admitted, now he is in a wheelchair. He says he cannot get to the bathroom on his own, and because of this, his independence has been compromised. The nurses should take into account the psychological, sociological and biological implications of this change in mobility. If APIE, was done correctly, the cause of Joe’s impaired mobility should be established, as well as what can be done to avoid any potential problems arising from immobility such as constipation, oedema, decreased muscle mass and compromised circulation(Carpenito-Moyet, 2009). A further goal which was not identified at this stage was to maintain Joe’s identity and masculinity by letting him wear his own clothes and asking what he wanted to wear, as oppose to sitting in pyjamas all day. This is bad practice because sitting in pyjamas all day assumes Joe into The Sick Role, a Functionalist role identified by Talcott Parsons (1951)as withdrawing from normal social behaviour and adopting a more deviant role, which deems them excluded from the social responsibilities and normal day to day functioning(Bilton, Bonnett, Jones, Lawson, Skinner, Stanworth and Webster,2002). The nurses further show signs of this behaviour because they seat Joe alone at breakfast, thus excluding him from social interaction. An explanation of this may be that the nurses gain a sense of power if they are able to assume someone into a passive role, because the sick role gives the health professional authority over a patient’s health, plus the right to gain personal information from them. A consequence of the nurses behaving in this way, may lead to the self-fulfilling prophecy whereby Joe adapts and begins to conform to the sick role which is assumed of him. This process of conforming to deviance is also known as deviance amplification (Bilton et al, 2002). The reasons for the carers not setting a goal for this aspect of Joe’s life may be due to the nurses not being aware of the implications of sitting someone in pyjamas all day. Another explanation may be that the nurses automatically ‘labelled’ Joe as being ill, thus assuming him into a sick role without pre meditation of doing so. Joe may not feel comfortable asking to wear his own clothes in case he is seen as being a difficult patient, due to sociological cognition that the practitioner is dominant and  the patient must conform to their rulings (Bilton et al, 2002). A suggestion to alleviate this problem may be to put a goal in place for Joe to wear his own clothes. Implementation Implementation is important because it puts into action what has been set out in the care plan and in the goal setting process. The consequence of not implementing care properly is that a standardised method of care may be implemented as oppose to a holistic method, which respects individual needs and cultural diversity (Barrett et al, 2009). The NMC Code (2008) supports this by emphasising the need to treat patients as individuals as well as listening to them and responding accordingly. The nurses did not implement Joe’s care properly because they did not respond to his request for his glasses, which he asked for several times. A possible explanation for their behaviour may be due to ageist views. To support this theory, studies have highlighted a preference amongst care workers to work with children or young adults – an ageist view which has resulted in older people often not properly assessed or receiving thorough care. Overall, this age group often do not benefit from the up most efforts of medical staff (Gross, 1992). Another theory to explain Joe’s and the nurses’ behaviour may be explained by the Social Disengagement Theory which illustrates co-operation of the elderly individual in the process of disengagement between them and society. Erikson (1951)guides an individual through life up until old age, from which point, the individual is left to mature and develop by reflecting on their past, thus disengaging with their role in society and conforming to a more submissive role. (Cumming, Dean and Newell, 1960). Some argue that the ageist view is justified. A. B. Shaw, of Bradford Royal Infirmary (1994) argues that in an age of limited healthcare, ageism towards the elderly is a positive method in reserving healthcare facilities for those who will most benefit, i. e. the younger generation. This argument however is not in keeping with the NMC Code (2008) which states that you must not offer care which is discriminatory in any way. A. B. Shaw’s view however, may be the same view adopted by the nurses, which could explain their behaviour. The nurses could possibly have implemented his care better by taking a holistic approach to Joe, and not simply viewing him as another statistic. If the assessment and planning stages had been one correctly then the implementation of his care would have been at a higher standard and more patient centered. Joe’s undesirable learned behaviour is to keep quiet and shut up. He has learnt this by the fact that every time he speaks, he is ignored. Learning is a process which results in permanent changes in behaviour. Joe’s catheter (also mentioned in the planning stage) was not checked in the morning. Joe complains that his catheter often gets full and pulls. The consequences of not checking his catheter regularly are that signs of dehydration or infection may go unnoticed. The amount of urine should also be checked because if the amount is low, it may be that that the catheter is blocked or obstructed (McMillen and Pitcher, 2010). Normal urinary output should be around 30ml per hour. (Colvin, Guffey, Hoelscher and Smith, 2011). The nurses should be familiar with catheter care and should initiate learning of such procedures, in order to benefit the patient and promote Joe’s wellbeing. Evaluation There are two types of evaluation: summative evaluation and formative evaluation. Summative evaluations evaluate how effective the general approach to care and the process of care were. It determines whether a holistic approach to care was used and how effective the assessment process was in defining the nursing diagnosis; in order to lead to patient centered planning regards their needs statements and baselines. Goals are also assessed in terms of relevance and how realistic they were. Formative evaluations rely on direct nurse to patient interaction to determine whether the problem has got better or worse. For this to be effective, a baseline must be in place for each goal, in order to assess whether the patient has moved away from or towards the goal. Patient activity and behaviour also are scrutinised to fulfill this evaluation. Interaction with the patient, in order to learn about their experiences, is key to this type of evaluation as they know themselves better than anyone Evaluation is important because it reviews the effectiveness of the current plan. If the current plan is not deemed to be beneficial to the patient then it is important to return to the assessment stage and correct any problems (Barrett et al, 2009). The consequence of not evaluating correctly is that the process has therefore been ineffective in establishing any potential problems with the previous stages. The elderly have different nutritional requirements to younger adults due to age related biological changes such as changes in metabolism, digestive enzyme ability and changes in the gastrointestinal tract (Long et. al. , 1995). On admission, Joe was asked to write down which foods he liked to eat, yet he is given porridge every day and was told it was his ‘favourite’. The Evaluation Stage should involve interaction with Joe to identify whether his needs were met in the previous three stages(Long et. al. , 1995). The Evaluation stage here has therefore been unsuccessful because it has not identified that the assessment process has failed to produce a patient centered nursing diagnosis for his diet and fluid intake. The consequences of feeding someone that same food every day is that Joe is at risk of Protein Energy Malnutrition, onset by inadequate protein, carbohydrates and fats in the diet, or vitamin deficiencies (Waugh and Grant, 2010). The consequences of malnutrition in the elderly, if sustained are fatigue, muscle loss due to the body using muscle for energy, impaired immune response and organ function (due to lack of the nutrients required to perform) and eventually death (Cope, 1996). Joe mentions that all he would like is a lovely cup of tea, because when they do give him a drink, it is lukewarm, so he probably does not wish to drink it. The consequences of Joe not been given a drink with his breakfast is that he may become dehydrated. The elderly are at an increased risk of dehydration due to biological factors such as reduced thirst perception, body water mass, reduced kidney ability and vasopressin, so it is even more important to evaluate fluid intake in this age group, therefore the nurses should be ensuring Joe’s fluid intake meets the recommended guidelines (Lavizzo-Mourey, 1997). Becoming dehydrated may also lead to Joe experiencing mental confusion, fatigue, constipation, loss of appetite (which will contribute to malnutrition), concentrated urine, fatigue and irritability (Denby, Baic and Rinzler, 2006). Oedema is a further manifestation of dehydration, a problem which may be made worse by Joe’s immobility. Other manifestations include confusion (which will be heightened by the fact Joe cannot see properly without his glasses) and if not treated may lead to coma. Untreated, dehydration leads to shock were tissues begin to malfunction and major organs such as the liver and kidney become damaged due to a reduction in circulating blood volume (Rosdahl and Kowalski, 2007). Nurses should be aware of these signs in order to recognise when a patient is suffering from dehydration and malnutrition, in order to rectify the problem within a safe timescale. Tea is also not a recommended drink to give older adults with a meal because it inhibits iron absorption. Low iron levels may cause anaemia, as well as memory loss and fatigue. His diet should therefore be evaluated to include more red meat, oily fish, eggs and breakfast cereals which are fortified with iron. Finding a substitute to drinking tea at mealtimes may also be considered at this stage (Denby, Baic and Rinzler, 2006). As supported by the evidence shown above, it can be concluded that the behaviour of the nurses does not support the guidelines illustrated in the stages of A. P. I. E, therefore the nurses have failed to successfully use a problem solving process. Information gathered during the assessment stage was not sufficient enough to devise suitable plans and goals, therefore the implementation stage failed. Evaluation was also unsuccessful as it did not identify were the previous stages had gone wrong. Because all of the stages are interrelated, failure in one stage has a knock on effect to the other stages (Barrett et al, 2009). Because the nurses failed at the assessment stage, it automatically affected the rest of the process. 201101791.