Advocacy for Equality: Empowering Voices for Change

by Herman Bailey | Jul 12, 2023 | Essays | 0 comments

Introduction

Advocacy apprehends active support for oneself or of another so that actions are taken on individual requirements. Every person requires recognition and worth despite class, gender, or health status. Advocacy concentrates on an individual’s objectives and goals besides being concerned with people’s respect, rights, and decision-making process on direct and indirect problems. The process of advocacy involves speaking, acting, or writing arguments in support of an action that defends human rights. Any prejudgment directed to persons with disabilities is a lack of respect in society. The notion of this essay is to explore the origin, history, types, and principles of advocacy and its application to the Ireland community.

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History of advocacy

Advocacy originated during an attempt to solve the issues of poverty, its causes, and consequences in the world. Addressing this problem was only possible through interventions to the poor by the charity organizations. Social work in Ireland began in the late 1770s when a legislative speaker, Grattan strongly argued out for the removal of limitations on Ireland’s rights to take part in the British Empire trade (Timberlake, 2012, Pp. 25-40). He aimed at defending society against constitutional and commercial restrictions. Later, Grattan inspired activists to demand the elimination of the existing trade regulations and to impose the government to amend the laws. The practice continued to exist in the Trade Unions and legal systems.

According to Bemak, Chung, and Pedersen (2003, p.140), the ancient social workers supported the need for advocacy in stimulating a series of deficiencies and scheme on differences. A movement that encouraged settlers arose in the nineteenth century, which tried to address ancient problems especially inadequate resources among the poor. The settlement movement organized youth programs and sponsored active social work for the poor. It marked the beginning of meaningful advocacy. The poor man’s lawyer system began in 1891 at Mansfield Settlement and extended to other regions (Stein, 2004, pp. 556-600). The movement launched a campaign demanding the government support in the provision of legally authorized services. Today, social work practice taking place involves campaigning association including the Claimants Union where individuals collectively organize a group to make a general decision about certain issues.

Types of advocacy

There are various types of advocacy, which include group, statutory, political, citizen, specialist, peer, and self-advocacy (Nolan, 2008, p. 40). Group advocacy is concerned with the issue of an organization or group of people. Those who make personal decisions, admit responsibilities and speak out for their rights practice self-advocacy. Citizen activism is when persons volunteer to assist people who are unable to defend themselves such as those with mental disabilities by totally being independent of individuals who give services like Age Action Ireland for old people. Also, statutory and specialist advocacy refers to a situation where one is legally selected to stand in for another. It comprises trained lawyers and therefore, is the best method to fight for the health demand of clients. The nation can also appoint public workers like the National disability Authority to advocate for people with various challenges. Lastly, family advocates address issues that concern peers and family members.

Principles of advocacy

The nation of Ireland adopted several principles of advocacy to facilitate public services that include empowerment, autonomy, social justice, citizenship, and social inclusion (Nolan, 2008, p. 40). Empowerment is the ability to work with others by encouraging them to be creative, active, and liberated to their responsibilities. This principle eliminates inequality of power and promotes sharing regarding collective activities and power. Social justice defies discrimination and oppression and stimulates the growth of a society that values the rights of every individual. It protects opportunities, social benefits, obligations, and rights of persons. Autonomy is a principle that supports people to take control of their responsibilities and take part in personal choices.

Advocates work to protect the privileges and rights of every citizen hence, assist to minimize barriers encountered by individuals with challenges. Social inclusion promotes complete participation for vulnerable individuals since everyone poses equal worth and value. Social exclusion affects the aged, refugees, asylum seekers, and people with disabilities by denying them meaningful choices. In Irish society, people with disabilities encounter exclusion in decision-making, segregation, negative attitudes, and limited privileges like employment opportunities. The principle of social work encourages clear communication, coordination, trust, and honesty between clients and advocates.

Reasons for advocacy

Advocacy is very crucial despite being rampant. The Society of Ireland and other countries in the world experience various development in the fight for justice, marginalization, seclusions, rights of individuals with disabilities, and misrepresentations. Supporters assist in sanctioning the community in accessing their needs. It encourages the attempt to inculcate self-confidence, accountability, and responsibility to individuals or organizations for the rebuilding of openness in the decision-making process and transparency and help people to exercise self-control. It can also work to alter the attitude of community members in regards to certain misconceptions. (Timberlake, 2012, Pp. 25-40). In fact, the process helps individuals to get access to community resources and knowledge and protect people’s rights including the opportunity to speak out opinions in public.

Advocacy is necessary for situations that demand public or personal assistance. The practice is vital in public health conditions such as when underaged individuals face illegal limitations in rehabilitation centers and prisons (Hickey, 2014, pp. 160). Clinical situations both in Ireland and everywhere in the world require social workers especially when health professionals conduct a clinical procedure on patients without their informed consent. Another case is child discrimination in society such as neglect, abuse, or any unauthorized actions that infringe on their rights. Support is crucial when checking damaged laws like the physical penalty for children and in situations when a certain community faces denial to access health services.

There are many people with mental illnesses locked in prisons and jails rather than getting appropriate medical care. Epilepsy is a condition of mental illness that can result from multiple sclerosis, brain tumors, trauma, genetic, or diseases like stroke meningitis. The lack of proper treatment in the correction institutions exposes them to abominable and promotes dangerous actions of this population in the society. They often become victims of drug abuse, sexual assault, suicides, and other aggressive behavior such as violence.

Social workers should be concerned with the rights of patients with mental problems and fight for the need to provide them with better health services than jailing them. For instance, the case of Marija, a woman who struggled with a mental complication for a long period. Her condition became work after spending much time in a locked room until Carol; a mental expert approached and listen to her side of view. She advocated for Marija’s opinion in her vulnerable and powerless situation. The story indicates that for advocacy to be successful, they should be many approaches to a critical situation that involve monitoring and evaluating social work. Negotiating and speaking out for people with mental disabilities was the major role played by Carol as a social worker.

Normalization process theory

Normalization process theory is a sociological aspect that explains the dynamics of implanting, instigating, and assimilating composite intervention. It focuses on embedding evolving technologies in health care services. The theory gives an account of changes that take place during a shift from a therapeutic approach to a personal-centered approach. The structure of the normalization procedure consists of dynamic, planned, and contingent interaction between objects, agents, or context (Hickey, 2014, pp. 160). Actors refer to those who meet one other in health care; context is organizational and physical that organize and resource individuals, while objects are recognized authorized methods in which procrastination of information takes place. NPT assists individuals to disassemble the social procedures that are at work when experiencing a new set of performance. It relates to a set of constructs that is planned information that explains processes in human life.

Role of social workers

Social workers have the responsibility of assisting groups, people, and families to adapt to the difficult situation in their life to change their patient’s lives. They perform this process by educating them on mechanisms and skills they might help them during the recovery period. Advocates also provide straight counseling services to patients. In most cases, communal personnel serve as links between dissimilar institutions and coordinate with health practitioners to promote the wellness of patients. They also address permitted problems that include helping in providing testimony and hearing connected to clients. Policy growth, research, and advocacy of service is another role of social workers. Also, they keep and prepare records and reports.

The field of social work comprises of several industries and specialization that requires professionals to pursue the foundations of services such as flexibility, empathy, respect, and persistence in different situations. They are expected to aid with problems, which originate from disability, trauma, mental or emotional issues, poverty, abuse, acute or chronic sicknesses, and addictions. They occur in three groups depending on their professional fields where they deal with public health, child, family, and institutions, and the mental health workforce is those who help patients suffering from unhealthy basic methods.

Social workers also collaborate with other health experts to assess the physical and medical status and needs of patients. They advocate for them in resolving crises through proper evaluation, monitoring, keeping reports of patient’s progress depending on their recovery objectives (Hickey, 2014, pp. 160). Another role they play is to refer family or clients to community assets to provide them financial assistance, education, job, housing, legal aid, and to help them throughout the recovery process. Patients’ supporters review health records or interviews to find out environmental obstructions to their recovery process. They investigate neglect cases and take legal actions in cases of child abuse or assault. Lastly, they organize discharge plans from hospitals to home care services and assign support groups to provide home-based counseling and appropriate educations.

Equality Act

The equality act refers to the most vital piece of parity legislation that streamlines, simplifies, and strengthens laws. The act sets a standard for individuals who provide public workers to treat the public with respect and dignity. It enables workers to understand their responsibilities and offers people protection from biased discriminations. Employment and equal pay Codes of Practice provide a clear explanation of the necessities in the Act to apply authorized concepts in every situation (Dalrymple, 2003, pp. 1048). The act helps tribunal and courts, which require applying the laws in interpreting the legislation and assist advisers, lawyers, human resources, and trade unions. Employment equality guidance supports workers’ right to equality regarding flexibility, payments, training, management, promotion, transfer, development, and benefits.

The legislation, constitution, and complainants Mechanism advocacy in Ireland relies on the background of equivalent rights for every individual and promotes laws. The Bill of Rights in the constitution of Irish offers persons political and civil support and relies on gratitude in the legislation of the rights and role of the social workers (Ratts, DeKruyf, and Chen-Hayes, 2007, pp. 90-97). The mandate guarantees several rights and equality to citizens especially asylum families who need exile orders. In Ireland, the legislations currently uphold social welfare and employment rights, and equality measures discernment in vocational teaching, employment, cooperative agreements, provision, and advertising.

Disability Act of 2005

It defines advocacy as services in which the vulnerable and the needy have their interest represented for assistance. Advocacy supports persons with disabilities to adapt meaningful lives by encouraging them to speak out their views. Personal advocacy is under the management of the Citizen Information Board as suggested by the Disability Act in Ireland. According to the board, the primary functions of an advocate are representing the public in need assessment, social services, and acts as appealing professionals to courts. The UN provides a convention for the moral consideration of individuals with disabilities in Ireland and globally (Timberlake, 2012, Pp. 25-40). The movement protest that persons with challenges have legal rights to lead an independent life in society. Advocacy is the primary technique for the mechanical living movement that enhances independence among disabled people. It also ensures that this group has similar human rights as the normal population.

Conclusion

Advocacy is very vital in the achievement of humanity and equality in Ireland and internationally. The Irish constitution focuses less on the recognition of social work in regards to the formation of policies and funding. Therefore, there is a need for the state of Ireland to facilitate crucial changes by appealing movements such as the National Disability Authority and those concerned with the Mental Hospitals, in the strengthening and founding of the rules governing advocacy in general especially the support for the disabilities

Bibliography

Bemak, F, Chung, R. C.-Y, & Pedersen, P. B, 2003, Counseling refugees: a psychosocial approach to innovative multicultural interventions. Westport, Conn, Greenwood Press. P. 140

Dalrymple, J, 2003, Professional Advocacy as a Force for Resistance in Child Welfare. The British Journal of Social Work, no. 33, vol. (8), Pp. 1043–1062.

Hickey, H, 2014, Indigenous People with Disabilities: The Missing Link. In M. Sabatello & M. Schulze (Eds.), Human Rights and Disability Advocacy (pp. 157–169). University of Pennsylvania Press.

Retrieved from http://www.jstor.org/stable/j.ctt5hjm1h.16

Justice, rights and capabilities, 2010, Justice, rights, and capabilities. People with intellectual disabilities: Towards a good life? (pp. 115–130). Policy Press at the University of Bristol.

Pedersen, P. B, 2013, Counseling refugees: a psychosocial approach to innovative multicultural interventions. Westport, Conn, Greenwood Press. 3^rd Ed. P. 34

Ratts, M. J, DeKruyf, L., and Chen-Hayes, S. F., 2007, The ACA Advocacy Competencies: A Social Justice Advocacy Framework for Professional School Counselors. Professional School Counseling, 11(2), 90–97.

Stein, T. J, 2004, The role of law in social work practice and administration. New York, Columbia University Press. http://site.ebrary.com/id/ no.10 pp. 540-670

Sweet & Maxwell, (2015), Equality Act 2005: IDS employment law handbook. London,

NOLAN, P. (2008). Dynamics of regulation in Ireland: advocacy, power, and institutional interests. Dublin, Ireland, Institute of Public Administration. P. 40

The Politics of Ideas, 2011, The Politics of Ideas. In Advocacy: Championing Ideas and Influencing Others (pp. 1–21). Yale University Press.

Timberlake, E. W, 2012, Origin and Development of Advocacy as a Profession. Virginia Law Review, 9(1), 25–40.

Herman Bailey

With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.

Shaping Early Childhood Education: Influential Factors and Impact

by Herman Bailey | Jul 12, 2023 | Essays | 0 comments

Introduction

You are a new employee of the teachers’ service commission as a commissioner of the early childhood development. Your first task is to lend a hand in enhancing the impact of the early childhood education. As such, the commission feels the public needs to understand more concerning individuals, theories, and events that have affected the role of modern early childhood educator, as well as, how these factors have impacted our contemporary learning environment.

Task

You are about to discover how various persons, theories, and events have influenced the early childhood education and subsequently create awareness through a periodical to the populace based on your findings. In so doing, you need to find out more about Education Theories by investigating the role of teachers, the needs of children, kindergarten education, technology and young children, the preschool years, the primary grades, parents and families involvement, and community participation. In addition, you should determine the means of meeting the special needs of children, the theories and history involved, and the professional development process of early childhood education. Are you prepared to explore more about these issues on early childhood development? As you study these factors, you ought to keep notes in your periodical. Your task is to investigate important information about the issues herein. Your periodical will go through documentation for your study and used as a tool for educating the community on early childhood education.

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Process

Part 1

Before you start, kindly search the following sites to obtain a general idea of Education Theories.

• History and Theories of Early Childhood Education
• Montessori- Education Theories
• Pestalozzi- Parents, Teachers, and Community Involvement in Early Childhood Education – you will require clicking on the early childhood button to obtain the available information.
• Professional Development Process of Early Childhood Education – click on the professional development button to access information

Part 2

For this section, you will need to explore a range of events, theories, and people who have influenced our contemporary childhood education and put records of your findings on the documentation sheet. To find out how the most suitable ways of enhancing early childhood education, have an exciting adventure about the following:

Write in your periodical –provide answers to the below questions using comprehensive sentences.

• What is the role of a teacher in the entire process of promoting child’s education and development?
• What are the sensitive periods when children are more vulnerable to some behaviors and have the potential to lean certain skills with ease?
• What are the educational theories in existence? What do they talk about in details?
• Does respect to children help in supporting their development?
• What are some of the important events that contribute to the development of a child?
• What are some of the important contributions from individuals that have helped to enhance the impact of early childhood education?

It will be important, as well, that you record the teachers’ responsibility in the implementation of the early childhood development and identify its impact on both the child and the present society. For this reason, learn more regarding the duty of educators in promoting early childhood development.

Making children the core of learning

• Teacher’s task
• A sequence of drives/motives for cultural action
• A special setting/environment for learning of a child

Motivating children in learning

• Giving children freedom in organized environment
• Observing children
• Diverting inappropriate behavior
• Identifying children’s sensitive periods
• Meaningful tasks

Preparation of the learning surroundings

• Orderly provision of learning materials
• Provision of appropriate experiences for every child

Respecting all children

• Modeling continuing respect for every child
• Respecting all children’s work

Introduction of learning resources

• Demonstration of learning resources
• Supporting learning of children
• Observing each child previous to introducing learning resources

Part 3

Now that gathering of your information is complete, make decision on which events, theories, and persons have made the greatest impact on the contemporary child education and development. You will need to put in order the periodical to enable the public have easy access to your collection, which in turn will enhance the impact of the child development in the society. Ensure that your decisions are the most considerable and that you have a proper presentation containing pictures with every success and impact of childhood education and development. Your work will be to offer the society with a periodical presentation.

Evaluation

Rubric for Web-Quest

Conclusion

Following all your investigation, at this moment is your chance to influence the public and the teachers’ service commission of the most important elements of improving children’s education and development. You will put in writing a well-ordered, sufficiently supported section defending your option or preference of the most significant childhood development events that promote a child’s education. Be certain to take account of a topic sentence, in support of details, and a summary.

Credits

Provision of clip art by-

• Jonathan Maxwell
• Steve Holland
• Timothy Kennedy
• Vincent White

Certain art authorized from the clip fine art gallery on creativitycenter.com

Permissions

In the present world, people benefit through generosity with their efforts. For this reason, I grant permission to other persons to make use of, revise, and adjust this Web-Quest for non-commercial, public education purposes, provided its original authorship remains unaffected and credited. Sharing of the modified Web-Quest should only transpire or take place under similar conditions. Spot the Artistic Commons Non-commercial-Attribution-Share-Alike authorization for details.

Creation of this web-Quest happened in XXXX (insert)

Personal Reflection on My Experience of Designing Web-Quest

Designing is one of the things I like most. Often, I like it when teachers ask us to develop a website, a blog, a social site, or any other thing that involves working on a computer and encompasses designing, since that has been my greatest area of interest. Nevertheless, I have never designed any Web-Quest previously and this has been my first experience. Being a new idea, it took me significant time exploring a variety of samples designed priory. Amazingly, when I took the imitative to complete this assignment, I developed a lot of interest in it and realized that there is nothing interesting as designing a Web-quest.

References

Cunningham, C. A., & Billingsley, M. (2006). Curriculum webs: Weaving the Web into teaching and learning. Boston, MA: Pearson/Allyn and Bacon.

Tomei, L. A. (2008). Encyclopedia of information technology curriculum integration. Hershey, PA: Information Science Reference.

Herman Bailey

With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.

Transformative Education at Loyola: Unlocking Leadership Potential and Global Interconnectedness

by Herman Bailey | Jul 12, 2023 | Essays | 0 comments

Reasons for selecting Loyola

The institution offers catered courses that allow for growth of leadership skills in the modern society. The college has been touted as one of the best in laying the foundation, bringing to fruition and production of excellent leaders who have progressed to make a major difference in society. Whereas other institutions may offer leadership training, few base their training on the development of value based leadership. Value based leaders are set apart by their own character based on honesty and integrity. In the current society, there is an increased desire and cry for value based leaders. Leaders who use their skills to bring about development to all individuals despite their race, social class and even gender. For this leader, focus is never on them but always on the people they are leading.

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Primary tools

Excellence: the university’s education is centered on excellence that is, being the best one can be at all times. There exist a variety of skills and knowledge which one can gain from various institutions. With this skills however, Loyola trains in excellence. Given two candidates with the same skills and knowledge, a candidate from this university will stand out in terms of pursuing excellence and doing more than is expected. In the university education, concern is not just given to pursuing education but also towards building of character, this is the fundamental concern for transformative education.

Global interrelatedness: the current world society exists in such a way that various global institutions, countries and people remain connected. It is important to understand the way such relationships can be used, exploited and developed in order to create a more united society. Through these relationships it is in fact possible to resolve majority of the problems such as poverty, famine and climate change in a sustainable manner.

Ignatian mission

Universities today and institutions governing universities are often very concerned with the content being delivered to students. Much emphasis is given to the specific course, the development of the course structure and course content. Loyola does this and much more. The ignatian mission emphasizes teaching through reflection. Students such as myself, will undergo various lessons that will guide towards internal transformation. Such transformation is vital towards academic success and accomplishment of personal goals in the following ways:

• Development of ideal goals: by understanding oneself, one is able to channel skills, passion and experience into realizable personal goals. These goals are based on the understanding of oneself and their abilities and are therefore achievable as well as challenging.
• Discipline: the ignatian mission focuses on enhancing personal values and discipline. There is a higher chance of success, when one is more focused and disciplined. Although one may have the skills and knowledge, a lack of discipline provides a remedy for failure.
• Understanding individual operations: that is, how I do things and accomplish tasks set before me. With this information, I can be able to develop sustainable tools to deal and overcome with challenges in academic studies and pursuit of personal goals.

Long term plans

To achieve long term success, long term plans are essential. They play a vital role in ensuring that the individual has a basis upon which to base the short term plans. Long term plans include:

• Goals and objectives; these are essentially general goals that will take time to achieve. For example, they may include pursuit of a specific career path. This requires gaining education, experience and pursuing the right job openings.
• Strategy: to meet the long term objectives, there is need to develop a form of general strategy that includes expected challenges and solutions to the same challenges. The strategy is mainly the path that will be followed to achieve the long term goals.
• Milestones: this are set targets which can be used to monitor the progress of the long term plan. Milestones are achievements identified within the long term, which will indicate progress and also allow for restructuring of the plan to address new challenges. Milestones are vital in the long term plan because they allow the individual to see what they have achieved in light of the steps taken and work done as compared to what they expect to achieve in the future.

Achieving of goals through Loyola

Guidance: Loyola professors can provide guidance in navigating the new path of transformational education. There are less chances of failure when the guidance and advice of the professors is taken into account. The professors not only possess the knowledge and experience in academia, they are also aware of some the challenges that one can encounter and therefore provide right advice.

Structured exploration: academia which includes research is based on the individual desire to explore various phenomenon. The university will provide a structured environment where such exploration can be pursued with higher chances of success.

The university also includes resources such as libraries and other vital components in the pursuit of success in academics. By outing together various programs directed at developing personal achievement, the university provides an ideal ground to explore these resources.

Herman Bailey

With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.

Empowering Healthcare Innovation: Oakville Open MRI Centre Business Plan

by Herman Bailey | Jul 12, 2023 | Essays | 0 comments

MRI business has been exceedingly increasing in the past decade. People are seeking out these services which in the past were too costly and quite difficult to find. However, it is important to note that MRI services have also not been as easy to access as they should. Opening an MRI business center therefore seems like a wise and enlightening decision especially where the demand is taken into account. Demand for MRI continues to increase, therefore necessitating the opening of such centers which provide quality decisions. However, like any other business there are other internal and external factors that may affect the business and profit. Often entrepreneurs focus too much on dealing with external factors such as competition and resource sourcing and simply forget the importance of other factors such as pricing and economic situations which are dire to the success of the business.

The strength of a new business is completely dependent on the ability of the entrepreneur to maneuver and factor in all factors that are directly or indirectly related to the business. Pricing of MRI services for example is not simply a matter of an amount that would generate significant profits. It is also important to consider and take into account, the customer needs, the state of the market and the competitor’s rate. When developing a business philosophy, it is important for DR. Hughes to consider the strengths of the business structure, the business idea and quality of product. Based on these strengths the structure of the new business can be easily identified and used to ensure guaranteed success. With the information presented in this report changes can be made to the structure and ideas easier entry into the market.

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Price Elasticity Versus Inelastic

The pricing strategy of the company plays a major role in determining the response of the consumers to the product being offered. The beginning of a pricing strategy requires that the company to engage in research to understand and evaluate the importance of the service being offered to the consumer. MRI services for example are not granted as some form of option, they are often a required necessity. This gives the company more space through which they can maneuver the costs of the services being offered. On the other hand, there are other competitors offering the same which means that guesswork in terms of pricing could indeed become quite costly to the business in terms of the target market and attracting the right clientele.

Perhaps the most important thing to note is that price is often used to communicate quality of the service being offered. On the one hand when a service is too costly according to the consumer standards the market may not be able to access the same service. On the other hand when MRI services become too cheap, consumers are likely to think that the quality is low according to the market standards. MRIs are related directly to the health of an individual which is the one area where people are often unwilling to compromise. When it comes to the health of a person, quality speaks much more than cost. People need to be able to afford the MRI services while at the same time getting quality for what they are spending. For this reason, pricing of the product needs to be based on the fundamentals of pricing elasticity.

Price elasticity

Price elasticity often works when the company seeks to determine how price will be affected by changes in demand. MRI services are not usually based much on demand since the demand is mainly based on the suspicion of disease. However, like with any services being offered there are often fluctuations are often present. The problem is that when fluctuations occur, the company can be caught off guard. These fluctuations often lead to increased losses and can provide loopholes for competition. In the case of demand, the biggest sensitivity is often towards price changes. Even for the most loyal of clients, any changes in price could lead to increased fluctuation of the demand with customers either creating an increased demand or reducing the demand. Price elasticity is the biggest and easiest way to regulate and determine the right price. It allows the company to adjust significantly to any changes in the demand. When calculating the elasticity, results of the calculation are often easy to identify and calculate.

For each company, including the MRI Company the important thing to note is that the products can remain inelastic. Inelasticity allows the products to increase demand even when significant changes are made to the pricing strategy. Whether the price increases or lowers, demand remains stagnant increasing because the product is ideally one that is a complete necessity. The basic element is that there is a desire to have clients who whether through simple marketing, advertising or pricing, the service offered by the company should be such that clients cannot survive without the services being offered. This means considering the needs of the different target markets and adjusting accordingly.

Considerations and advantages of price elasticity to the center

MRI is a necessity and not a luxury: this is an important consideration, where services are concerned. Elastic services include luxuries which one can do without. The MRI services fall into the two categories of both elastic and inelastic. On the one hand, MRI is often used to identify conditions which cannot be merely construed using simple x-rays and other methods of determining diseases. However, there has been an increase of lectures, articles and academic research which is determined to reduce the use of MRI in determining the nature of disease and injury. On the one hand therefore, MRI’s are quite the necessity while on the other they may be considered a slight albeit very slight luxury.

Another aspect to be considered is that the Oakville Open MRI clinic is not the first of its kind within the targeted market. There exists at least two other competitors offering quite similar services. This means that while the MRI services maybe a complete necessity, making the pricing more inelastic, the existence of completion means clients can opt for one or more centers making the demand more elastic and therefore the pricing. Through simple marketing strategies it is possible to set apart the MRI center from the competition. However, fluctuations in demand are more likely even though the product is a necessity. When it comes to provision of necessary services, entrepreneurs may fail to consider the slight chance of demand fluctuation brought on by changes in pricing. This could lead to detrimental pricing mistakes which in turn are quite costly to the growth and survival of an expensive venture such as MRI centers.

Competition and substitution: as mentioned above, demand is often fluctuating in necessary services simply because consumers and clients can either get the same service from competitors or in fact substitute the same service. (Mowen and Minor 1998) gives an example of sandwiches which are a popular lunch option for the working class. Majority of the working class are often eating sandwiches sometimes on a daily basis. The working class accounts for at least 85% of the target market of the sandwich chains. Despite this dependence which often translates to the sandwich being a necessity, when one chain increases the price of a sandwich by even a small margin, the consumers often do a massive shift to the substitute or alternative offered by the competition. This translates an inelastic market to one which is in fact quite fluid with the demand for a product being dictated by the pricing of the same product.

When it comes to the MRI services being offered by the clinic there is not only need for differentiation but also the desire to create a unique gap which competition may find hard to deal with. This unique niche gives the company more leeway when it comes to setting the price of the products. In addition, price increases and decreases should be well thought out. Increasing the price of MRI services may seem ideal but in the same way, it is most likely to drive consumers away. In this elastic market, the idea for Dr. Hughes is to find a unique standpoint, something that competition is not offering something that would either justify increasing costs or at least make the move of clients more costly.

What is the actual cost of an MRI: in the current market consumers are often faced with varying prices when seeking MRI services. In one place the services could be costly mainly because of the nature of machines used and even the ambience of the center. The important thing is to determine the actual cost of the product being offered in the market. With the actual cost, there are less chances of fluctuation.in considering the actual cost, it is important to take note of the psychological pricing. While the price of an MRI may not fluctuate by much, increase in cents on the purchase of necessary tools could easily make a significant change to the pricing. The change though small when distributed to the products, could easily become highly costly. Small changes make the product seem much more costly to the consumer. (Anderson and Poulfelt 2006) states that a product which costs $99.99 is usually attracting more consumers than one which costs $100 simply because the psychological notion informs the consumer than one is way much cheaper than it actually is.

All goods in the marketing during the lifetime of the business become elastic at one point or another. What is most important to note is that consumers will definitely and often in many cases find an alternative and substitute for the current product. For example an increase in the cost of an MRI may in fact cause allot of grumbling while consumers still continue to seek out the service. The dissatisfaction however will lead to seeking out alternatives that are much cheaper and more stable in terms of pricing.

Demand For Open MRI Services

(Reisman 2002) states clearly that when we are born we inherit a good amount of stock in terms of health. This stock can be equated to the simple assets that are bought. When an asset such as a car or even building is bought it comes with a stock of good health. It requires little if any maintenance or service. As it ages however the demand for maintenance services, repair and management increases. The same holds true for our own health, as we age the body begins to demand that the depreciated health factors are taken into consideration. This increases the level of demand for various healthcare services. Taking this into consideration therefore, it follows that as we age we begin to have a need for and seek out open MRI services which can be used to detect conditions and injuries that beginning to take over our bodies.

An analysis of the above theoretical assumption on the demand for healthcare services and as such open MRI services reveals the following:

• As a human being continues to age the rate of depreciation in terms of health increases. They become more susceptible to diseases and conditions which decrease their productivity and the body’s ability to heal itself.
• As the rate of health depreciation increases, people become more willing to invest high amounts of money to offset the process. The cost of treatment does not seem to matter with people moving heaven and earth for the simple hope that they can turn the clock.
• As the general income of the target market for open MRI increase, the more people are willing to spend on the service.

Factors affecting demand for MRI services

Income of the target market

When it comes to healthcare it is often common for entrepreneurs to make the wrong assumption that individuals will pay anything to get a cure. They simply ignore external factors to the business such as income of the target market. It is true that individuals are often more than willing to pay as much as is demanded in order to get a cure. However there are two factors to take into consideration when it comes to income and MRI demand:

• MRI services are often employed as a form of prognosis rather than treatment. Open MRI is often used to determine the condition which the individual seems to be suffering from. In many cases it is an option as opposed to other forms of detection. Based on this therefore, it is possible that many people may feel they cannot afford the cost of the diagnosis and therefore opt to do away with the same.
• MRI services occur before the individual is instilled fear of the rate of depreciation in the body. Without an MRI many people would go on and continue with life blissfully unaware of the rate at which their bodies are depreciating. Because they are unaware, they are often less willing to spend much when it comes to the service. In fact many consumers and patients often see the MRI as a service that has been forced on them by the doctors.
• MRI services are shrouded by a coat of ignorance with very few of the targeted consumers understanding the importance of the service. The lack of knowledge heavily influences the desire of consumers to spend their income on the service.

Complementary services

Normally, consumers do not in turn just walk into a center and demand MRI services. With this type of healthcare service knowledge is vital. In the past, during the first ages when MRI was used, the services were exclusive to specific large institutions which could afford to maintain and purchase the required machinery. In addition, there were very few if any individuals who could understand the results drawn from the MRI. As such consumers often remained in the dark, unaware of the importance and vital usage of the MRI services. Today, there is still a large number of consumers who remain unaware of the role that MRI services can play in diagnosis and early detection of diseases. Complementary services are services which must be used concurrently with the service being offered. The demand for one service is therefore directly related to the demand for another service. In the case for MRI services there are two distinguishable and important services.

• Doctor’s services are the first creator of demand. When patients feel unwell, they first go to the doctor where suggestions of an MRI are made. Doctors are therefore responsible for recommending the service and in some cases recommending the particular center where the MRI should be taken.
• Once the MRI has been done, there are experts who can interpret the results. Sometimes these are the doctors and sometimes they are not. Either way, a center which lacks someone who can skillfully decipher the information in the MRI is often left with little if any form of demand. The MRI makes no sense if no one is aware what it has brought forth.

Substitutes and competition

Oakville as a county lacks open centers and this will be the first open MRI center which in itself opens a high level of demand. However, just because it is the only open MRI center doesn’t mean that there is no competition. On the one hand, there has been increased focus on the dangers and possible challenges of being subjected to MRI. Studies have shown that sometimes MRIs can lead to the development of complications that were previously not there. There are those who indicate that the data and information from these studies is skewed. However, the fear created by such results has led patients to seek out alternatives. MRIs have become the last option rather than the first choice in terms of diagnosis. Doctors who are proponents of the dangers of MRIs are often influencing patients to learn and seek out alternative diagnosis measures.

Secondly, there exists a similar center although it’s is quite a distance. Unfortunately, the Memphis center itself is quite large and popular drawing clientele from all over the state. With the high demand, the center is often able to cut the costs of its services significantly something which the new Oakville open MRI center may not be able to sustain. Competition therefore becomes an important factor. Furthermore, there are tests which though best done in an open MRI center can also be accomplished in the many closed MRI centers which are all over the county. Such services are often more popular and in high demand throughout. When it comes to pricing and market share therefore competition will heavily influence demand for the product.

Available consumers

The healthcare industry is one which the number of available consumers is always present even though it is often fluctuating. Fluctuation is simply because of the nature of health. When people are more exposed to toxins the demand for healthcare services and therefore MRIs is quite significant. The Oakville County is one in which the baby boomers generation is in plenty. This aging population is susceptible to injury and illness. Considering that there is no other open MRI center the demand for the service seems to be already set. However there are several factors to take into consideration when determining the availability of consumers for MRI services:

• The already available consumers need to have the knowledge and awareness with regard to the importance of MRI services. For this generation MRI is a service they might as well do without. Without the right knowledge they become unwilling to spend on the service. In this case, the target market and consumers are available but they are not taking advantage of the product.
• The availability of the consumers today does not automatically translate to availability in ten years. There are chances that fewer people will need MRI services in the future and even greater chances that competition may open a center in the future further decreasing the demand for the services.
• The service itself must be such that consumers feel they cannot do without the service. This creates its own level of demand and allows for word of mouth marketing. Advertisements and marketing can only go so far, consumers who experience the product are better tools of educating others and making them aware of the availability of the service.

Factors Influencing The Supply

Price of the factors of production

It has already been established that Oakville County is an area ripe with demand for open MRI services. Since majority of people are often unwilling to compromise when it comes to their healthcare it follows therefore that they are more than willing to spend to ensure their won health. However, there have been few if any attempts to increase the supply of Open MRI despite the existing demand. (Leenders 2006) states that one of the most major considerations is the importance of inputs. The cost of inputs in providing a service can put off even the most willing of investors. Factors of production in the provision of MRI services can be divided to the following:

• Machinery and tools: MRI works best in diagnosis simply because of the machinery and tools employed to determine ailments. These machineries are often quite costly with many having to be imported. In the past for example, only large hospitals could afford the cost of machinery that would support an MRI center. The machinery and tools are highly differentiated for the diagnosis of various ailments. It follows therefore that the expected cost of investment would be very high. In some cases, it is often too high for individual investors to consider especially because the profits and return on the investment may not be quick, immediate and sustainable.
• Unlike other services which can be provided, executed and managed by any individual, MRI services require trained experts. There are doctors who though understanding the importance of the tests and often recommending them cannot attempt to successful diagnose an ailment with the MRI machinery and tools. Often they may also require help in understanding and interpreting the results in order to advice on the best method of treatment, medication of the ailment or therapy. Unfortunately, the demand for radiologists and such experts is quite high making provision of the service quite difficult. Even though the machinery maybe available, if there are not experts to make use of the same then the investment is null and void. Increased human resource flow due to the demand of the skill can also prove to be detrimental to the supply of the services.

It is clear that the input required for the provision of MRI services is not only costly, in terms of purchase of machinery and payment of experts, it is also low in terms of supply. This makes provision of MRI services quite difficult.

Government policies and regulations

The healthcare industry is one of the most heavily regulated and restricted industries in the country and globally today. There are more and more regulations which some up daily to protect the consumer. Concerns have been raised that whereas the consumer is heavily guarded the institutions themselves are not well protected and are often left to suffer many consequences which come from exposure. Restrictions are important because of the importance and value that is often placed on the health of human beings. However, this often means that investors who have spent greatly in terms of acquiring the right equipment, tools and expertise to run an MRI center may have to spend even more in terms of meeting the regulations and restrictions of the government. Restrictions are often placed with regard to:

• The number and type of employees who should be within the center as long as it is open. Should the entrepreneur e unable to support the number of employees, then they are not allowed to operate curtailing the supply of the service. Further, there are some skills which are difficult to come by with very few institutions providing training and therefore even fewer experts who are required according to law to be within the center. The cost and difficulty of finding these employees makes supply of the same product and service quite difficult.
• MRI services cannot just be provided from any premises. Due to the danger of the rays transmitted from the machinery, the government has laid out requirements in terms of space and design of the center. This often translates to increased cost especially in terms of space which is why many of the open MRI centers are often located in large hospitals which can afford the space. On the other hand, it is also quite difficult to meet the architectural requirements of the space often specified in government manuals. The space may have to have been built originally as an MRI center which is quite difficult or be re-designed to fit the purpose of the provision of MRI. Either way, the difficulty is accessing the right premises limits the desire to invest in MRI centers.
• Licensing and the constant need to upgrade in order to remain relevant and legal is an issue that limits the number of people willing to invest in this kind of business. If the requirements are not carefully considered, it is quite possible to be operating an illegal center.

Impact of utility on demand of MRI

Utility is interpreted with regard to how much satisfaction a consumer gets from a particular product. When a consumer experiences a product for the first time, this experience often provides a background , a foundation to which the consumer returns in order to make a choice for later use. Businesses often strive to give the consumer greatest satisfaction with the first trial. Utility is often the measure of satisfaction of wants and needs by the use of the product. In this case, consumers often try to access open MRI for the simple reason of diagnosis. A complete diagnosis, which includes all the facts therefore meets the utility demand for the services of the product. The following are some of the potential effects of utility:

Understanding the value of the product: to the business, MRI has great value and this is why they seek to provide the said service. However, it is also important to note that the consumer’s value and the value of the business can be completely different. In order to engage in productive marketing, it is important to understand the value of the service to the consumer. Utility allows the business to understand exactly what they can expect from the service, how close the service comes to meet their needs and the role that the service plays in the life of the consumer. When a product has great value to the consumer, they are more willing to pay for the same increasing demand and market for the product.

Explains demand: there are many factors that affect demand but the best in explaining demand is the utility theorem. When consumers are highly satisfied with the services of center, they are more willing to not only spend on the same product but also to encourage others to pay for the same services. The utility factor also explains the negative slope of demand. With the introduction of a new open MRI center, the first and only one in the region, demand will definitely be high. But as consumers make use of the product, the demand begins to decrease becoming lower. Continued use makes the demand and desire to use the service much lower, consumers begin to seek out alternatives and substitutes and indeed find ways through which they can probably avoid the service. This decreases demand significantly, a factor which the company should be prepared for.

Determination of optimum consumption: this is the highest level of demand, where the demand is not only sufficient but indeed ideal for the business. At this stage the business enjoys sufficient profit and income to not only manage costs but also to expand. Optimum demand can only be achieved when the products ideally address the needs of the consumer completely. This means that the consumer has no desire to seek out other alternatives but is indeed completely satisfied with the service offered by the company. Consumers therefore desire to consume the product which meets all their needs.

Management of profits: profit is created when the sales value is much higher than the input and cost of providing a service. For the MRI center the cost of providing a singular service can be quite costly, however as the service becomes useful, it creates its own demand increasing the probability of making profit from the same product. Profits are often managed through creation of increased demand which maintains the profit level. With increased demand growth becomes a reality rather than simply a goal. There is an increased chance of creating a niche with more profits. Where the peak demand for MRI services remains unchanged, the return on the investment though high is quite possible. On the same level, there is the possibility of using the peak demand to bring about greater growth and stabilizing the performance of the business. Profits during peak demand are maintained to be used during the times of low demand so that the business does not suffer unduly. In this way, during the low demand season quality services are still available to the consumer at the same cost without hurting or injuring the survival chances of the business.

Meeting consumer needs: when the utility of the business is high, it simply translates to the business being able to meet the consumer needs. A business that meets the needs of the consumer directly is able to maintain a high demand and create its own niche which completion cannot meet. A niche is often created to give the business greater advantage over the competition. A niche allows the business to get the advantage of higher income without investing as much as the competition. This is often known as the law of increased value for much less. What happens is the company invests more in the simple aspects of the business, those aspects which meet the specific MRI needs of the consumer. In doing so, profit is generated from the uniqueness of the service being offered.

Managed Care And Demand

Managed care is deigned to decrease the cost of healthcare while at the same time ensuring that all patients receive basic, quality healthcare. The demand for healthcare services in itself is quite high with consumers seeking to improve their health deficiency rate. However, the cost of healthcare has previously been a misguiding factor when it came to accessing healthcare. Majority of the people who need healthcare can barely afford basic care. MRI services for example are often found to be beyond the average affordability rate for a good portion of the population. For the MRI center, becoming a center of managed care is one of the ways to ensure a steady demand for services. While the payment maybe lower, it would be more efficient to increase demand and maintain the same even in the low demand season.

Lower costs: the managed care is often designed to ensure affordability of the services to every individual. MRI services have often been found to be quite costly. Being a first step in diagnosing illness, MRI is quite important. Despite the importance, it is possible that patients will not be able to access the service in good time. The lack of affordability on the other hand also ensures that the demand for the service is often low and continues to become lower as income decreases. Managed care allows the service to become affordable thereby increasing demand, (Harris 1998).

Accreditation: when the Oakville open MRI center successfully becomes part of the managed care system, it will gain free accreditation. Accreditation is the one way to gain publicity and therefore trust of the consumers. Consumers are more likely to engage with a service provider who has been accredited by the government. When it comes to health, individuals are less likely to rely on publicity and advertisement in selection of a place where they can be diagnosed and treated. The government is often partnering with centers that provide services which are of high quality. The process of vetting the clinic is quite long and tedious. Only the best of the best are allowed to partner with the government. Credentials are carefully analyzed not just for the clinic but also the employees within. The process gains trust of the consumers increasing the demand for the services offered within the clinic.

Management of the pricing: perhaps the biggest concern for the company and clinic is the pricing strategy. With MRI services guesswork cannot work, a simple but clear strategy needs to be employed to ensure success in attracting consumers. When the services become too costly, despite their importance and the availability of the services still many more will have a hard time accessing the same services. Managed care allows all people to have access to the services. Considering that the clinic is the first and only one offering open MRI services, it is likely that the ensuing demand from managed care will increase the income significantly. Such income increase will indeed justify the lower costs that are charged to through the managed care system. Pricing is already determined through the managed care system. Because the pricing agreement has been reached so that the clinic can continue to get profits while at the same time ensuring that all patients can afford, the continue to be competitive the clinic can continue to offer excellent quality services while maintaining affordability. Clients therefore have more reasons to visit the clinic.

Approval systems: the managed care system often relies heavily on approval. For a cost to be deductible, it must be approved. Two aspects of this affect the demand of the services being provided any the clinic. First, the process of approval sometimes may take much longer than expected. As such clients are more likely to move on to other centers where the payment maybe higher but the service will be provided immediately. There are cases where the patients are not willing to wait for the approval, especially where they have encountered a health scare which is often almost always. This means that demand will lower very greatly where the approval process is quite strict. Secondly, it is also important to note that despite the waiting, there are cases where the MRI scans may not be approved. In this case, patients often take out their anger on the clinic rather than the managed care institution.

Restrictions and privacy: there are cases where the individuals clearly do not want to visit the clinic simply because it is under managed care. This is especially the case where they feel roper restrictions have not been made to ensure the privacy of the information they will give to the clinic. The clinic must give details of the procedures the patients have undergone to the managing institution. Majority of the people feel that such information should be private. Demand therefore lowers as individuals attempt to protect their privacy.

Financial Analysis

The financial analysis of the company includes some assumptions which have been made with regard to the proposed MRI business. To begin with, the past decade has seen a sharp increase in interest rates. Borrowing of capital, mortgage and general financing of the business investments has become a very costly measure. It is expected that even though there was a significant increase, the analysts and business experts indicate that measures taken by the government to reduce the interest rate are working and will indeed lead to a stabilization of interest rates. The current interest rate stands at 10% and it is expected that the long term interest rate required to finance the business will stand at the same for a long time. Secondly, the government and especially state governments have been striving to create an atmosphere where investment is likely to yield higher profits. To encourage new entrepreneurs and also boost the growth of the economy through business ventures such governments have focused on stabilization of taxation rate. Currently, the Memphis center pays at least 30% of the total income to taxes. The same is expected of the Oakville center although the percentage is expected to decrease by year five of operations.

Projected profit

(Forsyth 2002) states that no new business will be able to make any plans and indeed prepare for the unexpected if there is no significant idea as to what they are working towards. Project profit allows the entrepreneur in this case Dr. Hughes to determine what amount of income is sufficient to reach the breakeven point and surpass it. According to the financial reviews provided by the Memphis center, sales have decreases in the past few years. The decrease in income suggests that reaching the point of break-even maybe more difficult. However, even with decreased sales, the proximity of the center which is much nearer than Memphis is likely to attract the right clients. Income sales projections are therefore expected to increase in the next few years. In the first year, the business does not expect to make any profit, in fact the business projections cushion against expected loss. The loss is mainly due to the fact that much investment will be made in terms of purchasing tools and machinery and hiring the right expertise. The expenses will therefore supersede the expected income. However for the next few years, the company is expected to make some profit, sufficient enough to increase growth and make the MRI Company quite competitive.

Administrative costs as seen in the table above will be quite high in the first year. The projection is based on the costs that will be needed to begin providing MRI services. These include hiring new staff, making stationery purchases and registering for the required licenses. These administrative costs could also include training for the new staff in management of an MRI clinic. As such, the projected loss for the first year can be accounted for by the expected expenditure. During the second year, majority of the costs will be based mostly on replenishing what was first purchased. The cost therefore significantly decreases to 60% allowing for the first profits of 3.2% to be experienced.

Future expected investments

The Memphis open MRI center boasts more assets and publicity as compared to the center opening in Oakville. The state of technology continues to change especially when it comes to managing health care. It is expected and projected that changes will continue, with new and fancier ways of completing MRIs being discovered. At the current state, the pursuit is for faster and cheaper MRIs for each institution. With such discoveries there are several investments expected in the future and that will impact significantly on the financial status of the clinic:

• Purchase of new tools and machinery: in the next five years the machinery required for MRIs may remain the same, however the simpler tools for day to day operations are expected to change significantly. With the changes, clients will be drawn to the clinic that is a leader is adopting the changing policies and as such providing better and more unique services.
• Training for staff: a significant error has been noted in the operations of the Memphis MRI clinic. Much of the staff remains with the original training, having not updated or even improved their skills. The result is that the services are almost always of lower quality and tasks are pricing difficult to perform especially where changes in tools have been made. Instead of hiring now staff every time there is a change, the Oakville center will instead focus on training the current staff to ensure they are highly equipped and strategically placed to manage any changes.
• Software: perhaps the biggest and most significant investment to be made will be in terms of software used to deliver services to the clients. Whereas the current software is highly placed within the market, there are newer and better software being produced daily. It is expected that the business will indeed need to invest periodically in changing the software. This will allow the clinic to serve clients much better and faster. With high quality delivery of services, the clinic can expect to rank highly, attract a variety of new clients and make significant increases in income and profit.

Valuation of the business

This is mainly highlighting some of the strengths that the business has which can have a financial advantage to the business. Although there exists another open MRI center and several closed MRI centers within the proximity of Oakville center, there are several advantages that the center has in comparison, these include:

• Proximity: the new Oakville open MRI center will be the first of its kind within the county. There exists another center but it is 200 miles away. This center will therefore have the advantage of being the nearest and therefore most recommendable center for the residents.
• State of the art machinery: the Memphis center continues to rely on machinery that has not been recently updated. The Oakville center has the advantage of starting out with high quality, state of the art machinery. This will allow for faster and more efficient delivery of services.
• Expertise: having worked and held a career as a doctor for a long time, Dr. Hughes brings with him a wealth of expertise upon which the success of the center will be based. Clients and customers are more likely to trust a center run by a doctor. This provides free publicity for the clinic ensuring its success in generating income almost from the start.

References

Andersen, M. M., & Poulfelt, F. (2006). Discount business strategy: How the new market leaders are redefining business strategy. Hoboken, NJ: John Wiley & Sons. Bottom of Form

Forsyth, P. (2002). Business planning. Oxford: Capstone Pub.

Harris, J. S. (1998). Managed care. Philadelphia, PA: Hanley & Belfus.

Leenders, M. R. (2006). Purchasing and supply management: With 50 supply chain cases. New York, N.Y: McGraw-Hill.

Mowen, J. C., & Minor, M. (1998). Consumer behavior. Upper Saddle River, N.J: Prentice-Hall.

Reisman, D. A. (2002). The institutional economy: Demand and supply. Cheltenham, UK: Edward Elgar.

Herman Bailey

With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.

Navigating the Emotional Journey: Spinal Cord Injury and Grief

by Herman Bailey | Jul 12, 2023 | Essays | 0 comments

1.0 Introduction

Spinal Cord Injury (SCI) can be a devastating and sudden event that changes an individual’s life forever. It sometimes results in permanent neurological injury coupled with other related consequences such loss of functional abilities like walking, sexual and bladder function, changes to bowel, Loss of sensation and paralysis (Harvey 2008). Additionally, SCI does affect not only the physical function of an individual but also their psychological wellbeing. Several studies have indicated that after SCI, people have reduced their quality of life, life participation, subjective wellbeing and have increased their likelihood of developing depressive or anxiety disorders (Van and Kayes 2014). This shows that employing physical interventions only may not be enough for comprehensive and successful rehabilitation outcomes. According to Van and Kayes (2014), one SCI rehabilitation aspect that is challenging is the uncertainty that surrounds recovery. Depending on the SCI level and impairment level, some patients will have a much higher chances of improving compared to others; with the patients having incomplete injuries tending to gain more (Vazquez et al 2008). However, very few SCI patients recover fully. Despite the fact that an increasing number will walk again in some ways, courtesy to the improving acute and emergency care.In most instances, patients ask the healthcare workers, and in particular the physiotherapists, about the prognosis: “will I be able to use my limbs?,” “will I ever walk again?” no one can answer these questions from the SCI patients with absolute certainty, because of the SCI variable nature during recovery. The aim of this paper will be to outlining the typical stages of bereavement after sustaining a spinal cord injury.

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2.0 Bereavement and grief theories

Spinal Cord injuries are situations that are frequently encountered by healthcare workers in the course of their duties. It is significant that the healthcare professionals have a good understanding of the responses and reactions to bereavement and grief so that they are in a better position in supporting the patients, relatives and family members during the process of bereavement and grieving (Van and Kayes, 2014).

Grief is a natural response by humans to loss, bereavement or separation, in particular, the loss of the family members or the l0oved ones. The term bereavement, mourning and grief are often used interchangeably, despite the fact that they have different meanings. According to Greenstreet (2004), grief describes a person’s response to his or her loss and has spiritual, social, cognitive, behavioral, physical and emotional dimensions. On the other hand, mourning is the active and outward expression of that grief. Greenstreet (2004) stated that it is through the mourning process that grief is resolved. Similarly, Bereavement is the period after loss whereby mourning and grief occur. It is the state after experiencing loss. According to Greenstreet (2004), a bereavement is a depression form that normally resolves over time spontaneously. The bereaved person may experience the feeling of helplessness, hyperactivity, inertia, insomnia or anxiety.

Bereavement, Mourning and grief may be affected by nature of the relationship with the individual traumatized or deceased and the way he or she was traumatized or died, religion, culture and personality. On the other hand, bereavement was defined by Stroebe et al (1993) as a state of loss, that triggers reaction which manifests in different behaviors referred to as mourning.

Many models or theories of grief have common stages or themes (Worden, 1991; Bowlby, 1980; Parkes, 1975; Kübler-Ross, 1969; Lindemann, 1944,). Diagrammatic presentations like the grief wheel are usually used in describing the process and the involved stages in grief, to suggest that it is rarely a process that is static. However, other theories or models, for instance, the dual process model of how to cope with bereavement, offer approaches to the grief interpretation and management that are more flexible (Stroebe and Schut 1999). The dual process model describes how a person who is bereaved copes with the loss in his or her daily life, along with other changes in lifestyle that develop due to that loss. Buglass (2010) stated that the dual process model is founded on the principle that when an individual is grieving, the way of coping is a two-way process. That is the individual moves between grieving and attempting to come to terms with his or her loss.

2.1 Freud’s Model of Bereavement

The study of grief and bereavement began with Freud, who for many decades has been credited with establishing the psychology of grief in the 20th century? Freud developed the grief work concept in 1917 based on the premise that the precise task of mourning is to function in detaching the survivor’s hopes and memories from the dead (Freud, 1961, pp. 253).

On the other hand, Freud (1961) regarded grief as a solitary process, in which the mourners withdrew from the world so that their letting go from their loss of the deceased could be in a process that is gradual. The griefs psychological function was believed to release the person from his or her bond with the loss of the deceased. This was realized by reflecting back at the past and forgetting the memories of the person deceased. Getting detached from the deceased person entailed working through the loss for the grief to be overcome. The process was referred to as “grief work.” According to Payne et al (1999), the focus of detaching from or letting go of the deceased accommodate grief is still a matter being debated among many theorists. Freud’s theory of grief came up as a result of clinical experience with the depressed people. Therefore, the understanding of Freud on loss and grief may be limited to his specific clinical group and may not be generalized to the population at large. However, Buglass (2010) indicated that the ideas of Freud about loss and grief, and most significantly, the need for confronting grief to let detachment have remained a characteristic of subsequent practice and theory.

Based on this model, the emphasis on the ideas of Freud about grief is on personal attachment. This theory emphasizes that the individuals who are grieving are searching for a lost attachment. Freud described mourning as the detachment from the people who are loved. According to Freud, Mourning is the melancholia state that suggests that when mourning goes wrong, the state of melancholia rises. The state of melancholia is viewed as a profound depression presentation that involves a complete loss of pleasure in almost or everything (Freud, 1961).

The mourning process is viewed as the task of rebuilding individuals inner world by experiencing the pain of loss that is intense that reawakens the effect of loving of what has been lost, which to the spinal cord injury patients are the lost functionalities due to the spinal cord injury. It is suggested that during the process of grieving, the bereaved is letting go of the several involved attachments in the relationship formation. When the individual have accepted the loss, the ego then accommodates the loss, and this enables the individual bereaving to look for new attachments (APS, 2016).

2.2 Kübler-ross model- five stages of grief

Elisabeth Kübler-Ross proposed pioneer methods for supporting and counselling grief and grieving, personal trauma, associated with dying and death. Moreover, she improved the practices and understanding with hospice care and bereavement. Her ideas and most importantly, the five stages of grief are transferable in different ways and to varying degrees, to emotional upset and personal change resulting from factors other than dying and death (KüBler-Ross & Kessler, 2005).

In most instances, alike reactions to the ones described by the grief theory are often witnessed in people who are facing less severe traumas than bereavement and death, such as enforced relocation, work redundancy, disability and injury like spinal cord injury, crime and punishment, bankruptcy, financial despair, and relationship break-up among others. This makes the Kübler-Ross’s grief model worthy of reference and study far outside bereavement and death. Actually, the grief model is a model of change for helping in understanding and dealing or counselling personal reaction to trauma like the spinal cord injury trauma, and not just for dying and death (Williams, 2007). This is because emotional shock and trauma are relative regarding effect on individuals. Whereas dying and death are the ultimate trauma to many people, people can experience emotional upsets that are similar when dealing with several challenges to life, especially if for the first time one is confronting something difficult, or if the challenge being confronted happened to threaten psychological weakness area, which every person possess in different ways.

The five stages of grief also referred to as the grief cycle, was intended by Kübler-Ross to be uniformly timed steps or a rigid series of the sequence. It is a framework or a model and not a process as such. A process means something that is quite consistent and fixed, while the model is less specific, that is more of a guide or shape. For instance, people do not always experience all of the five stages of the grief cycle. Some stages might not be experienced while other stages might be revisited. Moreover, the transition from one stage to the other can be more of a flow and ebb, instead of a progression. The five grief stages are not linear and are not also equal in their experience. The grief of people and other reactions to emotional trauma are personal to every individual just like a fingerprint (Van & Nel, 2011).

From the description, one might wonder what the models purpose is if it varies from person to person. The answer to that is that the grief cycle model acknowledges the existence of an individual pattern of emotional responses that are reactive that people feel when facing bereavement, death, trauma or great loss among others. The grief cycle model recognizes that individuals have to pass through their individual ways when coming to terms with bereavement and death among others, after which, they accept reality, which makes the person cope (Sánchez, 2007).

Moreover, whereas the focus of Kübler-Ross’s grief model was on death and bereavement, it is a useful perspective for understanding other peoples and own emotional reaction to change and personal trauma, irrespective of its cause.

The five stages of Kübler-Ross’s grief model include the following:

2.2. 1. Denial

This is a refusal to admit reality, information, facts among others that relate to the concerned situation either unconsciously or consciously. It is a mechanism for defence and is naturally percept. Some individuals can lock themselves in this stage when facing a traumatic change that can be ignored. Of course, death is not easy to evade or to avoid indefinitely. According to Sánchez (2007), the denial stage helps people in surviving the loss. At this phase, the world of the person who has spinal cord injury becomes overwhelming and meaningless. Life does not make sense, and the person is in the state of denial and shock. The person goes number and wonders how they can go on, and if he or she can go on, why they should continue going on. The traumatised individual try finding a way of going through every day. Shock and denial help the person in coping and making survival possible. Denial helps the traumatised people in pacing their feelings of grief. Cleiren & Clairen (1993) stated that in denial there is grace and it’s a way of nature of letting in only what an individual can handle. As an individual accept the reality of his or her loss and asking themselves questions, they are beginning the process of healing unknowingly. They become stronger, and the denial begins to fade. However, as they proceed, all the feelings an individual denied begin o surface.

2.2.2. Anger

This can manifest in various ways. Individuals that deals with emotional upsets sometimes can be angry with others and themselves, especially the people who are close to them. Understanding this helps in keeping non-judgemental and detached when experiencing someone’s anger which is very upset. Anger is an essential stage in the process of healing. A traumatised person or an individual who have had a spinal cord injury should be willing to feel their anger, despite the fact that the anger feeling may seem endless. The more they truly feel the anger, the more it will start dissipating and the more they will heal. According to KüBler-Ross & Kessler (2005), there exist other emotions during this stage, and the individual will get to them in time. However, most people are used to managing anger emotion. Moreover, there are no limits to anger, and it can extend to the doctors, friends, individually, the family, to God and to the loved ones who passed away. A person may as whether God exists and why He let everything happen. However, underneath anger is a person’s pain. Moreover, it is natural for a person at this stage to feel abandoned and deserted. However, people live in societies that fear anger. Williams (2007) asserted that anger is strength and can also act as an anchor, providing temporary structure to the loss.

According to Van & Nel (2011), grief, at first, feels like being at a sea and lost with no connection to anything. Then an individual get angry to some people, may be a person who is not around, maybe a person who has not visited him in the hospital, or may be a person who has started acting differently given that the individual is traumatised, immobile or is bedridden. Suddenly, the individual develops a structure that is channelling his or her anger to them. Having anger becomes the bridge that creates the connection from the open sea where the patient with the spinal cord injury is to the other people. It is something that they can hold onto, and the connection created from the strength of anger to them is better than nothing. Human beings understand better how to suppress their anger rather than feeling it. After all, anger feeling is just another indication of a person’s intensity of their love.

2.2.3. Bargaining

Traditionally the stage of bargaining for the individuals facing death involves an attempt to bargain with their Gods whom they believe. On the other hand, the people facing trauma that are less severe can seek negotiation or bargain for a compromise. According to Sánchez (2007), bargaining rarely offers a solution that is sustainable, especially if it’s a life or death matter

Similarly, APS (2016) pointed out that before a loss, it seems that an individual will do anything if only what they love, or the people they love will be spared. The patient with spinal cord injury will bargain, “please God,” “I will always do good if you let me live a normal life again.” Bargaining after the loss takes the form of a temporary truce. The individual get lost in a maze of “what if…” or “if only…” statements. The individuals want to be returned to what it was before; they want what they lost to be restored like their mobility. They want to go back in time to find what is causing them pain sooner, to stop the accident from occurring, to get healed quickly.

Dell & Power (2007) stated that guilt, in most instances, is often the companion of bargaining. The “if only…”makes the individuals find faults in themselves and what they think they could have done in a different way. The spinal cord injury patients may even start bargaining with pain. They will do anything so as not to feel the pain of the loss. The individuals will remain in the past, making attempts at negotiating their way out of the hurt.

People usually think that the stages last weeks or even moths. In reality, the stages are responses to an individual’s feelings that can last for hours or even minutes as they flip in and out of one stage to the other. Moreover, people do not linearly enter and leave each stage. They may feel on stage, and then the next one and back again to the initial one.

2.2.4. Depression

This stage is also referred to as the preparatory grieving stage. In some ways, this stage is the rehearsal or the preparation or the practice in readiness for the aftermath. However, Winokuer & Harris (2012) indicated that this stage means different things depending on the individual who is involved. It’s also a form of emotional attachment acceptance. It is also natural for the traumatized individual to feel regret, sadness, uncertainty, or fear since it shows that the individual, at least, has begun accepting the reality.

According to Wilson (2014), at the depression stage which is after bargaining, the attention of the spinal cord patient squarely moves into the present. Empty feelings get in and grief enters into their lives deeper than they ever imagined. This stage of depression feels as if it will last forever. Sanders (1989) stated that it is significant to understand that the depression that sets in is not a mental illness sign. It is simply the appropriate response to the patents great loss.

The spinal cord injury patients often are left in an intense sadness, withdraw from life, wondering perhaps, if is there any strong reason for going on, and even why continue going on at all? In most cases depression after a loss is seen as unnatural. The first question that the depressed patient should ask himself or herself is whether the situation they are going through is depressing. The loss of a body functionality like the mobility of the limbs is a situation that is very depressing, and depression is an appropriate and normal response. By not experiencing depression after losing a vital body functionality would be very unusual. When the loss fully settles in the soul of the spinal cord injury patient, their realization that their condition did not improve this time, and their main body functionality is gone forever is reasonably depressing. If grief is a therapeutic process, then despair is one of the essential footsteps during the journey (Van and Kayes, 2014).

2.2.5. Acceptance

This stage also varies according to the individual’s situation, despite the fact that generally it is an indication that there are some objectivity and emotional detachment. According to Ribbens (2006), the people dying can enter into the acceptance stage a long time even before their loved ones left behind, who necessarily must pass through their individual stages on how to deal with grief. The acceptance stage is sometimes confused with the notion that everything is “ok” or alright with what occurred, which is not the case. According to Stroebe (2008), most people do not ever feel alright about their loss. The acceptance stage is about accepting and living with the reality that what the individual loved, or the loved ones, or the core functions of the spinal cord are gone and recognizing that the new reality will be permanent. The spinal cord injury patients will never make it OK or like it, but eventually, they will accept it. They will learn to live with the aftermath of their spinal cord injury. It is the new norm that they must learn to live. They must try living in a world where their former abilities like mobility are missing. In trying to resist this new norm, at first, most of the patients want to continue maintaining their lives the way it was before they lose their spinal cord functionalities. In time, through pieces and bits of acceptance, however, they realize that they cannot maintain their past intact. It has been permanently changed and. Therefore, they must readjust (Sanders, 1989).

Additionally, KüBler-Ross & Kessler (2005) indicated that the spinal cord injury patients must learn to recognize roles, take them themselves or reassign them to others. As the people beginning living again and enjoying their lives, they will feel like they are betraying what they lost. People can never replace what they have lost, but they can try making new connections, new inter-dependencies and new relationships that are meaningful. They should listen to their needs rather than denying their feelings; people evolve, grow, change, and move. They may start by reaching out to others and becoming involved in their lives. The traumatised individuals invest in their relationships and friendships with themselves. They begin living again, but that cannot be done until grief has been given its time.

2.3 Attachment Model of Bereavement

The research on Grief and bereavement was spearheaded by John Bowlby and Colin Murray Parkes. The study by Bowlby on infant attachment assisted in informing the research on bereavement and grief. According to the researchers, an adult who is grieving is less like an infant experiencing separation anxiety when their parents disappear from view. They further indicated that as human beings evolved, they learn to form attachments and also protest when the people they love leave (Bowlby, 1969).

Bowlby took all his theories and observations about separation and attachment and applied them to bereavement ad grief. He stated that there existed a relational system in these relationships of attachment. These attachments create a system at this moment the individuals are impacting each other constantly, trying to maintain their relationships in various ways. Bowlby suggested that when a loss occurs, for instance, loss of mobility due to spinal cord injury, the normal adaptive response was grief. According to Cassidy & Shaver (1999), Bowlby felt that the response was grounded on the psychological and environmental makeup of the person grieving and that there were some usual reactions an individual might expect. The bond of affection has been broken which leads to grief

Being an ethologist, Bowlby regarded grief to be attachment behavioural system’s natural part which natural selection designed to discourage prolonged infant separation from his or her primary figure if attachment to increase survival chances and hence reproduction (Parkes, Hinde, & Marris, 1991).

Bowlby believed that since the many species infants need older individual’s protection for them to survive, they evolved both behavioural and physical adaptations so as to capture and get the attention of and also to maintain the proximity of their parents or potential caregivers. When the infant judges that the attachment figure is not available, the infant starts experiencing anxiety and tries to re-establish contacts using behaviours such as clinging, approaching, crying and searching. Bowlby believed that the infants “protest” against their separation served the adaptive function of the evolution of keeping nearby the protective attachment figures.

According to Leick & Davidsen-Nielsen (1991), Bowlby though that these similar psycho-behavioural tendencies by the infants to protest their loss to seek for a reunion with a figure f attachment get expressed when an adult loses a person he or she loves. This implies that the Bowlby believed that the similar psycho-behavioural phenomena are underlying both permanent and temporary separations from the attachment figures with no regarded to the age of the individual who is experiencing the loss.

Young & Dowling (2012) pointed out that Bowlby suggested that with the reaction of infant to separation from his or her caregiver, the grief of an adult generally also follows the predictable phases which involve first the intense protest, followed by despaired and then hopelessness when their protests are not bringing about their desired reunion with the people they love. Stroebe et al (2001) indicated that after the protest, typically there is a phase of reorganization that involve the renewal of interest gradually in other relationships and activities. Despite the fact that these phases are experienced sequentially in most instances, they are not necessary or always and may sometimes be experienced in a different order or even in a cyclical manner depending on the circumstances and the person.

According to Neimeyer (2011), Bowlby indicated that grief involved moving through the emotional reaction sequence. However, despite the fact that it is difficult to experience them, it is necessary for the bereaved wellbeing. He further stated that for a grieving individual not to experience these emotions after a significant loss, can result in physical and psychological ill health. Therefore, he considered both unresolved (unending) and the suppressed (unexperienced) grief as pathogenic.

The attachment model of bereavement by Bowlby and Parkes gives a description to the four predominant reactions to the death of the persons loved. These are the four phases that were broken down by the natural adaptive grief response. Pearlman et al (2014) indicated that the researchers pointed out that the reactions may overlap each other and should not be viewed as linear stages where one progresses through from one to the next. These reactions included numbness, yearning, disorganization and despair and reorganization

2.3.1. Numbness and shock

This is a stage where the sense of loss seems impossible to accept and not real. During this phase, Payne, Horn & Relf (1999) indicated that there is physical distress that can lead to somatic symptoms. If the person is grieving, like the spinal cord injury patient, do not progress through the numbness and shock stage, they will struggle to accept and to understand their emotions and to communicate them. Finally, they will shut down emotionally and not move on through the other grief phases.

Similarly, this phase represents the first few hours after an individual have been involved in a spinal cord injury; they are numb. They tend to have the feeling of disbelief and at the same time the emptiness. The full weight of losing some of his functionalities due to spinal cord injury have not yet been registered with him.

2.3.2. Yearning and searching

During this stage, the individual grieving is acutely aware of the void left in his or her life from the loss. Van and Kayes (2014) stated that the future these people imagined is no longer possible. For instance, in the case of the spinal cord injury patients, the future they imagine for instance being the best athlete, dancer, swimmer or any other activities that involved mobility is no longer a possibility. They try searching for the comfort from what they used to have from what they lost and also try filling the void of their absence.

The grieving individuals will continue identifying with the person who passed away or from they lost, constantly looking for the reminders of them and the ways of being close to them. Fr the spinal cord injury patients, their constant reminders could be watching their photos or videos of the past while doing what they loved.

Moreover, as the numbness wore off in the next few days, the spinal cord injury patient will be in agony. The grief will be coming in waves and typically yearning lasts between five and fourteen days after suffering the loss or the injury. The grieving individual will have feelings of panic, could not sleep and will also be unable to concentrate. Bowlby also indicated that a person in this phase will keep thinking that he felt ok, but it is always other people walking around or going about their businesses (Ribbens, 2006). Moreover, during the yearning stage, the bereaving spinal cord injury patients may experience anger and guilt and be irritable. The patient may feel guilty for not playing safely or not taking precaution to avoid his spinal cord injury. Similarly, they may also express their anger towards the doctors for not being able to save his spinal cord or being able to treat him fully to his recovery.

Parkes and Bowlby observed that if the grieving persons cannot progress through the yearning and searching phase, they will spend their whole life trying filling the void from their loss and remain preoccupied with what they lost or with the person thy lost.

2.3.3 Despair and disorganization

According to Bowlby (1969), during this phase, the grieving persons have accepted that everything has changed totally and will never go back to the way they imagine or the way it was. There are despair and hopelessness that comes with this phase as well as questioning and anger for the spinal cord injury patients in this phase, and they have accepted that everything has changed, and they will probably be confined to a wheelchair and life will not go the way they imagine or the way it was. The feeling of despair and hopelessness slowly creeps in as well as questioning and anger with their current condition. To them, life feels as though it will never make sense or improve again without the presence of what they lose or the person who passed away. The grieving person way also withdraw from the others

For the case of the spinal cord injury patients in this phase, as time passes, they will feel less intense pangs of yearning and guilt. The reality will sink that some of the functionalities of their spinal cord was good forever. They then become depressed and apathetic. This response, according to Bowlby may last even up to a year and more for some grieving people abo their loss or for losing their loved ones. Moreover, some people may lose in outside activities, work and friends and emotionally shut down (Stroebe, 2008).

According to Bowlby and Parkes, if the grieving individuals do not progress through the despair and disorganization phase, they will continue to be consumed by depression, anger and their attitude towards life will remain hopeless and negative.

2.3.4. Re-organization and recovery

The faith in life for the grieving persons who have reached this phase starts to be restored. They establish new patterns and goals of the day to day life. They start rebuilding slowly, and they come to realize that their life even after the loss can still be positive. Their trust is restored slowly. According to Cassidy & Shaver (1999), in this phase, the grief of the bereaving persons is neither fully resolved nor go away. However, Bowlby indicated that the loss shifts and recede to a hidden part of the brain, where it continues influencing the person but is not at the minds forefront.

For the spinal cord injury individuals in this phase, they will be able to compose themselves eventually. They will devote less energy to their attachment and their loss of spinal cord functionalities, and more energy to their other abilities and friends. The loss may still be hard dealing with from time to time, but with time, but they will be able to remember their former life and still move forward with their lives (Young & Dowling, 2012).

2.4 Erich Lindemann’s grief work

The work of grief was a term coined by Erich Lindemann back in the 1940s when conducting some studies on the grieving survivors of the tragedy of coconut grove. According to Lindemann (1979), many researchers and authors have cited his work on trauma as one of the vital early studies that revealed long-term impact of trauma and grief. Similarly, Lindemann later influenced other grief theorists like Kubler-Ross and Bowlby.

According to Lindemann (1944), the interest of Lineman was in understanding grief symptomology. Through his studies, he established some symptoms of grief that are common which included:

I. Somatic distress-

These included things like losing appetite, difficulty breathing, lack of motivation and exhaustion among others. Somatic distress can also be seen amongst the spinal cord patients, and these symptoms physically manifest themselves (Stroebe et al, 2001).

II. Preoccupation with the deceased images–

According to Lindemann, these included fixating on particular images of the individual who just passed away. Sometimes these were difficult memories or images and sometimes they are positive memories or images. This could also include the grieving person continuing to talk or see the deceased person. For the spinal cord injury individuals showing this symptom, the individual will preoccupy himself or herself with memories or images of himself before when he or she was able to function well using his or her spinal cord. These memories can either be positive or negative (Neimeyer, 2011).

III. Guilt-

In his research, Lindemann also reported that his patients reported guilt often, fixating on any event whereby they believe that they should have done something or could have done something to prevent the death. For the spinal cord injury patients, the guilt may manifest in different scenarios. The patients will preoccupy himself or herself with an event which they believe they could have done something or could have done something to prevent their spinal cord injury. For instance, if the patient injured his or her spinal cord due to the vehicle over speeding, engaging in extreme sports or engaging in violent activities, they will regret doing so. Majorly, they will fixate and wish that they did not engage in these activities (Pearlman et al, 2014).

IV. Reactions that are hostile–

Lindemann observed that that the next symptom was hostile reactions of the grieving persons towards others. He noted that despite the fact that when people are trying to be supportive and thoughtful, he is grieving individuals often feel hostile and irritable towards others (Payne, Horn & Relf, 1999).

Hostile reactions from the spinal cord injury patients towards others is also a symptom when they are grieving. These individuals will be harsh to their people even to the people who are supportive or taking care of them. They feel despair since they are immobilized, are in a sorry state and cannot do anything from their location

V. Loss of conduct pattern–

Despite the fact that the loss of conduct pattern looks strange, it is something that most grieving individuals relate to easily. This is the experience that even the tasks and activities that are most basic become a chore. The grieving individuals in showing this symptom are restless often, and yet the activities do not look meaningful, and even the activities of every day to them needs much effort to finish (Buglass, 2010).

For the grieving spinal cord injury patients showing this sign, it can be as a result of the inability of them to do it. Similarly, it can be a manifestation of the symptom of loss of conduct pattern.

VI. Moreover, Lindemann noted the sixth and the reaction that is less common, whereby the deceased person’s traits would appear in the person bereaving. Lindemann provided numerous examples that range from adopting the hobbies and interest, walking like the individual or seeing resemblances in their appearance to the deceased. For this symptom is not common among the spinal cord injury patients but is sometimes evident in grieving persons who have lost their loved ones (Lindemann, 1979).

The most significant thing in the work of Lindemann was his evidence that grief has both physical and psychological impact. He indicated that these symptoms can start manifesting immediately, may be absent, be exaggerated or be delayed. Also significant to the theory by Lindemann was the idea that grief can take either a morbid or normal trajectory and lastly that professionals of mental health can assist in getting an individual back to the normal grief reaction trajectory.

By doing the grief work, Lindemann understood how individuals progress through grief and eventually reduce the grief symptoms. He explained that grief work for different people will take different times, but ultimately will need the same three tasks. According to Lindemann, grief work involved the following: Emancipation from bondage from the deceased, readjusting to the new environment whereby the deceased is absent, and Creation of new relationships (Lindemann, 1944).

2.4.1. Emancipation from bondage from the deceased

To begin with the emancipation from the bondage from the deceased, people do have attachments that are a string to the person they lost or anything that they lose. These connections are connected to the people negative reactions and incredible pain. Lindemann explained that people need to move on, that is to emancipate from the bondage, for people to proceed with the grief that is normal and continue and form new relationships. He further clarified that this is different that a person forgetting about the people they lost (Dell & Power, 2007).

For the spinal cord injury individuals, they have strong attachments to their spinal cord and their crucial functionalities that come with it. However, when a person loses the functionalities of the spinal cord due to injury which they have strong attachments, these connections are linked to their negative reactions and incredible pain. According to Lindemann, an individual need to emancipate from the bondage and this requires the spinal cord injury patient to move on for him or her to proceed with the normal grief and form new relationships. This implies that they should forget about what they loved doing when they were able to use their spinal cord, like walking or engaging in activities things and start forming new relationships due to their condition (Winokuer & Harris, 2012).

2.4.2. Readjusting to the new environment whereby the deceased is absent

In this phase, Landman indicated that it is also evident in other grief theories and is also straightforward. After an individual has lost someone, to them, the world becomes totally different, yet it is the same. The grieving person’s need to find a way of making sense of the world that their loved one is gone and is no longer part of them physically (Cleiren & Clairen, 1993).

For the spinal cord injury patients who have lost their spinal cord functionalities, during this phase, they need to readjust to their new environment whereby their spinal cord abilities are absent. These patients who have lost their spinal cord abilities, the world, is totally different, yet it is utterly the same. Therefore, they need to find ways of making sense to the world that their mobility is no longer possible. So they can readjust to using wheelchair, or living with a carer who will be taking care of their needs for the remaining part of their lives

2.4.3. Creation of new relationships

This is the last bit, where the grieving individuals need to form new relationships. According to Lindemann, by the grieving persons letting go of their attachments is an important part of creating new relationships.

For the spinal cord injury patients in this phase, they will create new relationships by being dependent on others for support or help, or adapt to using a wheel chair or having a carer at his or her disposal (Wilson, 2014).

2.5 Rando’s six “R” Model

Rando conceptualized the processes in her model that an individual must accomplish throughout the mourning phases. The processes in Rando’s six “R” Model are broken down into three phases of mourning. According to Wilson (2014), Rando suggested that the six “Rs” fall within the three mourning phases. It is of great importance to point out that Rando was careful in differentiating mourning from grief. She described grief as more of an involuntary reaction to an individual’s loss. On the other hand, Rando described mourning as an active, ongoing process of accommodation. The three mourning pass are the phase of avoidance, the phase of confrontation and the accommodation phase. During each of the phases, there is an “R” process that gets accomplished.

2.5.1. Avoidance Phase

1. Recognize the loss– this implies acknowledging and understanding death. This takes place in the avoidance phase. According to Rando, mourning that is normal will mean completing the six processes described above successfully. For Rando, when an individual recognizes the loss, it means understanding the loss cause as well as accepting the loss reality. For certain types of losses, Rando (1984) pointed out that the understanding can be difficult especially disenfranchised deaths, overdosed and suicides among others.

For the spinal cord injury patients experiencing this process, he or she has recognized his or her loss and what caused it. Moreover, they have accepted the reality of their loss. If their spinal cord injury was caused by accidents in a vehicle crash, extreme sports accidents or any other violent activity that resulted in their spinal cord injury, the patient under this process can recognize it and accept the reality that he or she has lost some the spinal cord functionalities.

2.5.2. Confrontation Phase

2. React to the separation– according to Rando (1986), this process involves experiencing the pain, identifying, and feeling, expressing and accepting reaction to the loss. It also includes identification and reaction to secondary losses. This process takes places in the confrontation phase

Rando (1984) elaborated that reacting to the loss implies that the that the individual is feeling, accepting, identifying and expressing reactions to his or her loss, but also expressing and identifying reactions to any other secondary losses related to the death or trauma. This could be the loss of the role (husband, mother, sibling or wife), loss of financial security, loss of faith in human nature, God among others. These secondary losses impact can often be underestimated or ignored. But, must be addressed as part of the process of reaction.

To the spinal cord injury patients reacting to loss, they will be feeling, identifying, accepting and expressing their reactions to their loss of spinal cord functionalities. Moreover, these patients will identify and express their reactions to other associated secondary reactions with their trauma or spinal injury. The bedridden or immobile spinal cord injury patients will have lost their financial security, sometimes their faith in God and also their roles as wives, mother or husbands. Therefore, as a reaction process, all these factors should be addressed (Sanders, 1989).

3. Recollect and re-experience the relationship and the deceased- this needs reviewing and remembering realistically the deceased, as well as re-experiencing and reviving feelings. This also occurs in the confrontation phase.

Recollecting and re-experiencing the person who has passed away is the third “R”, is a significant step to incorporate memories into the present. This is because the memories will be a significant part of integrating the mourning individuals relationship with the person who dies into the present.In this step, an important point is recollecting, addressing honestly the good and bad memories and the relationship (Ribbens, 2006).

For the spinal cord injury patients recollecting and re-experiencing their loss will incorporate their memories into the present. These memories will become a significant part when they are integrating their relationship with what they lost into the present. The spinal cord injury patients should recollect and address with honesty the bad and good of their memories for proper mourning.

4. Relinquish old attachments to the old supportive world and the deceased- this takes place in the confrontational phase. This process according to Rando (1986) sounds unpleasant and harsh. This process’ reality is an acknowledgement that there exist certain things that a grieving individual will need to let go for him or her to move forward. Despite the fact that the process sounds like its severing abruptly, the actual process takes place over an extended period and allows a person to let go of things will taking their time to be comfortable with the idea that in the new world they will be okay without their loss or the deceased. Dell & Power (2007) asserted that it is of great importance to understand that this process is not letting everything go, but instead things that an individual must relinquish to continue going forward to the new world.

Similarly, the spinal cord injury patients in this process need also to relinquish their old attachments to the spinal cord functionalities they lost and their old assumptive world. The spinal cord injury patients need to acknowledge that for them to move forward, there are certain things in their life that they will need to let go. These things could include their old secondary roles at work or in the house, their jobs, and their sporting activities among others. This does not imply that they will need to let go everything they used to do, but just relinquishing things that are compulsory for them to continue moving forward with their recovery to a new better world (Stroebe, 2008).

2.5.3. Accommodation Phase

5. Readjust to move into the new world adaptively without forgetting the old world- this implies forming a new relationship with the deceased, adopting new ways of living and being in the world, and re-creating a new identity. This process takes place in the accommodation phase.

Readjusting as the fifth “R” according to Winokuer & Harris (2012) comes naturally after relinquishing the old attachments. This is the process where the grieving person has also moved to the third phase of accommodation. The grieving person after relinquishing the old attachments and embracing the new world with new ideas without their loss or the deceased establishes a new identity in the new world while still remembering and integrating the world before the loss or the death of the deceased. This is also an important time for the grieving person to find new ways in the new world of being comfortable and creating a new identity.

Similarly, for the spinal cord injury patients who are readjusting after relinquishing their old attachments, should be comfortable in the new world without the lost things due to their spinal cord injury. The grieving spinal cord injury patients readjusting should also establish a new identity in the world while still remembering and integrating their world before they lost their spinal cord functionalities and other secondary abilities. This also the time for them to find new ways of becoming comfortable in their new world and forming their new identity.

6. Reinvest- this implies putting the emotional energy into new goals, people among others. This takes place in the accommodation phase. This is the last process under Rando’s six “R” Model. A grieving person, like a spinal cord injury patient, who is in the process of reinvesting must invest emotional energy ultimately into new life experiences, goals and new people in the new world without what they lost or the deceased. Cleiren & Clairen (1993) pointed out that it is important to note that according to Rando, the phase of accommodation does not imply reinvesting in finding new things to replace the deceased. Instead, it implies creating space for new things in the new world while also marinating space for the different and new type of relationship with the deceased or what they lost. Rando in her Rando’s six “R” Model, wants grieving people to remember that the goals are to learn how to live with their losses and not finding someone time closure.

3.0 Conclusion

In conclusion, the paper discussed the typical stages of bereavement after sustaining a spinal cord injury. To understand the stages of bereavement, the paper applied different theories and models of grief and bereavement to apply them to a bereaving spinal cord injury patient. The bereavement and grief theories used in the paper included; Freud’s model of bereavement, Kubler-ross model-five stage grief, attachment model of bereavement, Erich Lindemann’s grief and finally Rando’s six “R” Model.

Freud’s model of bereavement was based on getting detached from the deceased person to overcome grief. On Kubler-ross model-five stage grief also referred to as the grief cycle also elaborates on its five phases of bereavement that apply to spinal cord injury patients; denial, anger, bargaining, depression, and acceptance.

Attachment model of bereavement by John Bowlby and Colin Murray Parkes gives a description to the four predominant reactions to the death of the persons loved. These are the four phases that were broken down by the natural adaptive grief response. These reactions included numbness, yearning, disorganization and despair and reorganization. On the other hand, Erich Lindemann’s grief which was based on some symptoms of grief that are common included somatic distress, preoccupation with the images of the deceased, guilt, hostile reactions, loss of conduct pattern and lastly the deceased person’s traits appearing in the person bereaving.

Finally, Rando’s six “R” Model is broken down into three phases of mourning. The three mourning pass are the phase of avoidance, the phase of confrontation and the accommodation phase. During each of the phases, there are an “R” process that gets accomplished which includes; recognizing the loss; reacting to the separation, recollecting and re-experiencing the relationship and the deceased; Relinquish old attachments to the old supportive world and the deceased; Readjusting to move into the new world adaptively without forgetting the old world; and finally Reinvesting.

4.0 References

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Herman Bailey

With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.