Complications Of Care: Kangaroo Care Premature
Kangaroo Care
Brianna Jacobson
JCBBRI009
Psychology 2009F
19 March 2015
Dr. Lauren Wild
Infants born prematurely or at a low birth weight are at a higher risk for medical and developmental complications than full-term infants. Complications can affect the growing infant and family drastically with problems ranging from chronic lung disease to neurodevelopmental problems (Browne, 2003). Neonatal Intensive Care Units (NICU) and health care providers attempt to provide around-the-clock care to sick, premature, or low birth weight infants via special training and equipment. Another method of care for preterm infants involves skin-to-skin contact, exclusive breastfeeding, and support to the dyad; this is referred to as Kangaroo Care …show more content…
or Kangaroo Mother Care. Research evidence relating to the benefits of using Kangaroo Care for premature and/or low birth weight infants suggests that the best overall environment for the stable preterm baby is his or her parents’ body (Browne, 2003), but it is understood that health care is compulsory at times, so an individualized care program with a collaboration of Kangaroo Care and medical care is best for the infant and the family.
Globally, prematurity is the leading cause of death in children under the age of five, and preterm birth rates are steadily rising. The term “premature” or “preterm” is defined as babies born alive prior to thirty-seven weeks of pregnancy; with sub-categories of premature infants based on gestational age. (Blencowe et al., 2012) An extremely preterm infant would be born alive before twenty-eight weeks of pregnancy are complete, a very preterm is considered to be within twenty-eight weeks to thirty-two weeks, and a moderate preterm would be born alive prior to thirty-two through thirty-seven weeks (Blencowe et al., 2012).
Moreover, the majority of premature infants are considered low birth weight infants; however, some full-term infants may be born with a low birth weight. There are many causes that may attribute to the birth of a low birth weight infant such as, maternal hypertension, substance use, lack of maternal weight gain (Browne, 2003). Older mothers, young mothers, and mothers with unhealthy lifestyles or insufficient prenatal care have greater risks for delivering a baby with a low birth weight. An infant born weighing 1,000 through 2,500 grams is considered to have an extremely low, very low, or a low birth weight. (Browne, 2003)
Premature or low birth weight infants have high chances of facing many difficulties and disabilities.
These may include neurodevelopmental problems such as neurosensory impairment, cognitive delays, neuro-behavioral and socio-emotional problems, and motor deficits (Brown, 2003). Furthermore, since the lungs mature later than most organ systems, preterm babies may struggle breathing independently (Blencowe et al., 2012). This leaves the infant vulnerable to acute complications including bronchopulmonary, respiratory distress syndrome, apnea, and so on. Akin to the lungs, the infant’s immune system is also immature, leaving the baby susceptible to bacteria, viruses, and other pathogens. (Webb, Passmore, Cline, & Maguire, …show more content…
2014)
In effort to combat and defeat some of these complications, there was an explosion of technological, pharmacological, and hospi-centric care in the 1960’s (Browne, 2003). The aforementioned NICU’s implemented and kept up with these advances in effort to improve survival rates among premature and low birth weight infants. While survival rates are improving, many premature and low birth weight infants are still experiencing long-lasting developmental and behavioral problems (Browne, 2003). This is because a preterm birth interferes with specific developmental events, compromising maturation and successful development. However, Kangaroo Mother Care involves early environmental stimulation, which may influence brain maturation post-birth, coinciding with the third-trimester. (Schneider, Cahrpak, Ruiz-Pelaez, & Tessier, 2012)
Kangaroo Care or Kangaroo Mother Care was introduced in South Africa in the mid-1990’s and is practiced in over half of the country’s hospitals. Kangaroo Care is a model of care which facilitates low-birthweight infant’ transition from intra- to extra-uterine life, as well as supports parental roles within neonatal care (Blomqvist, Frolund, Rubertsson, & Nyqyist, 2013). Kangaroo Care involves skin-to-skin contact between infant and parent as much as possible, while Kangaroo Mother Care involves skin-to-skin contact as early and often as possible, as well as breastfeeding. Kangaroo Care was first practiced in Columbia in the 1970’s as an attempt to reduce infant abandonment and mortality. The NICU in Bogota, Columbia was overcrowded, incubators were in short supply, and there were more than one infant to an incubator. This was directly correlated to the high rate of infant/child abandonment, morality, and infection in Columbia. (Stikes, & Barbier 2013) It was then discovered that stable premature infants could be placed skin-to-skin, primarily between the mother’s breasts assuming the role of a natural incubator. Once this method became more popular, clinical studies were conducted, showing that Kangaroo Care is a safe alternative to incubator care with no increase in mortality or morbidity rates, along with findings of improved lactation and decreased rates of infant abandonment. (Stikes, & Barbier, 2013) Using the parents’ body as the infant’s natural environment has positive impacts. Studies demonstrate that Kangaroo Care improves cardiorespiratory stability and thermoregulation organically. It meets the infant’s need for breast feeding, warmth, and love, as well as protection from infection and sensorimotor stimulation. (Schneider, Charpak, Ruiz-Pealaez, & Tessier, 2012) Both in and out of the womb, infants need to be warm, fed, and protected; a mother’s chest is one place where these things are best available, resulting in less psychological and physiological stresses (Browne, 2003). It was previously believed that premature or low birth weight babies should not be handled or held because of their frailness. Conversely, it has been proven that laying upright on a mother or father’s bare chest results in more organized sleep patterns, improved cardiorespiratory stability, thermoregulation, and a positive parent-child relationship later on. (Browne, 2003) Electroencephalogram (EEG) recordings have illustrated that skin-to-skin contact positively affects the neuronal networks, improving sleep outcomes and enhancing physiological maturation, while preventing motor and cognitive impairments in preterm children (Schneider, Charpak, Ruiz-Pealaex, & Tessier, 2012). The aforementioned positive impact Kangaroo Care has on parent-child relationships begins instantly. The separation of parent and child can cause immediate protest behavior, for the infant craves to be back in a familiar, safe place. Stress hormones will increase, body temperature will lower, and the heartrate will slow, all in attempt to prolong survival until the separation ceases and the infant is back with a parent. However, this can have negative effects such as, “intracranial hemorrhages in newborn period, behavioral disorder in childhood, and higher likelihood of illness later in life”. (Bergman, 2003) Kangaroo Care has been established as a technique that improves parent-infant bonding.
Kangaroo Care does things such as reduces maternal stress, decreases postpartum depression, and improves lactation amongst other things, yet the effect that Kangaroo Care has on father-infant cannot be overlooked. The majority of information on Kangaroo Care focuses on mothers and infants, but becoming active in caring for the infant will enhance the father’s paternal feelings, as well as increase their confidence in their paternal role (Blomqvist, Frolund, Rbertsson, & Nyqvist, 2013). Control is a large issue among fathers, often time fathers feel as if they are lacking control or struggling to gain control, so being separated from the infant is stressful, thus making Kangaroo Care a viable option with many benefits. Skin-to-skin contact instigates a sense of importance for the father, making him feel like a crucial participant in the infant’s care (Blomqvist et al, 2013). Fathers’ ability to be touching the infant facilitates attainment, and fathers who practice Kangaroo Care spoke about their infant with respect and pride, as well as felt closer to the infant faster with feelings of joy and passion (Blomqvist et al,
2013). Kangaroo Care albeit beneficial, does have its inconveniences and disadvantages. In relation to the parents, current parental leave policies in most countries do not offer viable options for the parents of premature infants. Parents must make the decision of whether they take leave to be with infant in the NICU, or save the leave until infant is discharged. This may result in emotional, physical, and financial tolls that affect relationships. Prematurity itself and the NICU experience may also have long-term effects on parents and children, such as parents being over-protective and children experiencing physical, cognitive, or socio-emotional challenges. (Browne, 2003) Furthermore, there are many concerns regarding Kangaroo Care and infant safety. Concerns decrease significantly if the infant is stable on room air, but preterm infants on ventilators have more physiological trepidations. For health care providers, it is difficult to determine the infant’s readiness and what strategies to use, so the lack of specific guidelines for Kangaroo Care makes it challenging for some physicians to support it. Specific criteria would address infants’ eligibility for Kangaroo Care, determining equipment needs, transfer techniques, optimal positioning, monitoring of vital signs, and so on. (Stike & Barbier, 2013) To resolve some of these issues, the use of Kangaroo Care should be consistent among all care providers, with Kangaroo Care policies being revised annually based on new evidence, as well as parent and staff feedback. NICU’s are beginning to provide family-centered and environmentally supportive care to parents and siblings of premature infants. An individualized, relationship-based experience in the NICU is crucial, focusing on medical care, along with the safety, privacy, confidentiality, comfort, and togetherness for the family. (Browne, 2003) Infants’ brain is sensitive to sensory input early in gestation, and during gestation, the migration, connection, and communication of neurons begin a process of organization in the brain, so the environment has a powerful effect on this process, which effects later development (Browne, 2003). NICU’s are recognizing how important incoming sensory stimuli and are working with new technology to provide infants protection from light and sound, altered bedding providing boundaries, timed caregiving and medical interventions to minimize stress, and NICU’s are endorsing the inclusion of family members in care. With Kangaroo Care, parents are not visitors, but essential providers of physiological stability for the infant. (Webb, Cline, & Maguire, 2014) Studies have documented the impact of the environmental sound and light on the emergence of circadian rhythms, sleep, early relationships, and the developing brain itself (Browne, 2003). Infants need predictable darkness and light, as well as quiet, calm, and restful interactions with parents, so the constant and invasive lights in the NICU accompanied with the loud, unpredictable sounds disturb infants’ physiological and behavioral organization. Yet, support to the dyad is mandatory. Meaning, the medical, emotion, psychological, and emotional well-being of parent and baby is taken care of, but this should be done without separating the parents from the infant. The NICU’s efforts and advancements paired with implementing Kangaroo Care will support infants’ proper, healthy development and create a positive parent-infant relationship from the beginning.
References
Bergman, N. (2003). KANGAROO MOTHER CARE: Rediscover the Natural Way to Care for
Newborn Baby. International Journal Of Childbirth Education, 18(1), 26-27.
Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler A, Garcia CV,
Rohde S, Say L, Lawn JE. National, regional and worldwide estimates of preterm birth.
The Lancet, June 2012. 9;379(9832):2162-72. Estimates from 2010.
Blomqvist, Y. T., Rubertsson, C., Kylberg, E., Jöreskog, K., & Nyqvist, K. H. (2012). Kangaroo mother care helps fathers of preterm infants gain confidence in the paternal role.
Journal Of Advanced Nursing, 68(9), 1988-1996. doi:10.1111/j.1365-2648.2011.05886.x
Blomqvist, Y. T., Frölund, L., Rubertsson, C., & Nyqvist, K. H. (2013). Provision of Kangaroo
Mother Care: Supportive factors and barriers perceived by parents. Scandinavian
Journal Of Caring Sciences, 27(2), 345-353. doi:10.1111/j.1471-6712.2012.01040.x
Browne, J.V. (2003). New perspectives on premature infants and their parents. Zero to Three,
24(2), 4-12. Retrieved from http://main.zerotothree.org/site/DocServer/vol24-
2a.pdf?docID=2301
Schneider, C., Charpak, N., Ruiz‐Peláez, J. G., & Tessier, R. (2012). Cerebral motor function in very premature-at-birth adolescents: A brain stimulation exploration of kangaroo mother care effects. Acta Paediatrica, 101(10), 1045-1053. doi:10.1111/j.1651-
2227.2012.02770.x
Stikes, R., & Barbier, D. (2013). Applying the plan‐do‐study‐act model to increase the use of kangaroo care. Journal Of Nursing Management, 21(1), 70-78. doi:10.1111/jonm.12021
Webb, M. S., Passmore, D., Cline, G., & Maguire, D. (2014). Ethical issues related to caring for low birth weight infants. Nursing Ethics, 21(6), 731-741. doi:10.1177/0969733013513919
PLAGIARISM DECLARATION
PLAGIARISM
This means that you present substantial portions or elements of another’s work, ideas or data as your own, even if the original author is cited occasionally. A signed photocopy or other copy of the Declaration below must accompany every piece of work that you hand in.
DECLARATION
1. I know that Plagiarism is wrong. Plagiarism is to use another’s work and pretend that it is one’s own.
2. I have used the American Psychological Association formatting for citation and referencing. Each significant contribution to, and quotation in, this essay/report/project from the work or works, of other people has been attributed, cited and referenced.
3. This essay/report/project is my own work.
4. I have not allowed, and will not allow anyone to copy my work with the intention of passing it off as his or her own work.
NAME: Brianna Jacobson
SIGNATURE:
STUDENT NUMBER: JCBBRI009
TUTOR’S NAME: Juan Teixeira
TUT GROUP NUMBER: 1
Brianna Jacobson
JCBBRI009
Psychology 2009F
19 March 2015
Dr. Lauren Wild
Infants born prematurely or at a low birth weight are at a higher risk for medical and developmental complications than full-term infants. Complications can affect the growing infant and family drastically with problems ranging from chronic lung disease to neurodevelopmental problems (Browne, 2003). Neonatal Intensive Care Units (NICU) and health care providers attempt to provide around-the-clock care to sick, premature, or low birth weight infants via special training and equipment. Another method of care for preterm infants involves skin-to-skin contact, exclusive breastfeeding, and support to the dyad; this is referred to as Kangaroo Care …show more content…
or Kangaroo Mother Care. Research evidence relating to the benefits of using Kangaroo Care for premature and/or low birth weight infants suggests that the best overall environment for the stable preterm baby is his or her parents’ body (Browne, 2003), but it is understood that health care is compulsory at times, so an individualized care program with a collaboration of Kangaroo Care and medical care is best for the infant and the family.
Globally, prematurity is the leading cause of death in children under the age of five, and preterm birth rates are steadily rising. The term “premature” or “preterm” is defined as babies born alive prior to thirty-seven weeks of pregnancy; with sub-categories of premature infants based on gestational age. (Blencowe et al., 2012) An extremely preterm infant would be born alive before twenty-eight weeks of pregnancy are complete, a very preterm is considered to be within twenty-eight weeks to thirty-two weeks, and a moderate preterm would be born alive prior to thirty-two through thirty-seven weeks (Blencowe et al., 2012).
Moreover, the majority of premature infants are considered low birth weight infants; however, some full-term infants may be born with a low birth weight. There are many causes that may attribute to the birth of a low birth weight infant such as, maternal hypertension, substance use, lack of maternal weight gain (Browne, 2003). Older mothers, young mothers, and mothers with unhealthy lifestyles or insufficient prenatal care have greater risks for delivering a baby with a low birth weight. An infant born weighing 1,000 through 2,500 grams is considered to have an extremely low, very low, or a low birth weight. (Browne, 2003)
Premature or low birth weight infants have high chances of facing many difficulties and disabilities.
These may include neurodevelopmental problems such as neurosensory impairment, cognitive delays, neuro-behavioral and socio-emotional problems, and motor deficits (Brown, 2003). Furthermore, since the lungs mature later than most organ systems, preterm babies may struggle breathing independently (Blencowe et al., 2012). This leaves the infant vulnerable to acute complications including bronchopulmonary, respiratory distress syndrome, apnea, and so on. Akin to the lungs, the infant’s immune system is also immature, leaving the baby susceptible to bacteria, viruses, and other pathogens. (Webb, Passmore, Cline, & Maguire, …show more content…
2014)
In effort to combat and defeat some of these complications, there was an explosion of technological, pharmacological, and hospi-centric care in the 1960’s (Browne, 2003). The aforementioned NICU’s implemented and kept up with these advances in effort to improve survival rates among premature and low birth weight infants. While survival rates are improving, many premature and low birth weight infants are still experiencing long-lasting developmental and behavioral problems (Browne, 2003). This is because a preterm birth interferes with specific developmental events, compromising maturation and successful development. However, Kangaroo Mother Care involves early environmental stimulation, which may influence brain maturation post-birth, coinciding with the third-trimester. (Schneider, Cahrpak, Ruiz-Pelaez, & Tessier, 2012)
Kangaroo Care or Kangaroo Mother Care was introduced in South Africa in the mid-1990’s and is practiced in over half of the country’s hospitals. Kangaroo Care is a model of care which facilitates low-birthweight infant’ transition from intra- to extra-uterine life, as well as supports parental roles within neonatal care (Blomqvist, Frolund, Rubertsson, & Nyqyist, 2013). Kangaroo Care involves skin-to-skin contact between infant and parent as much as possible, while Kangaroo Mother Care involves skin-to-skin contact as early and often as possible, as well as breastfeeding. Kangaroo Care was first practiced in Columbia in the 1970’s as an attempt to reduce infant abandonment and mortality. The NICU in Bogota, Columbia was overcrowded, incubators were in short supply, and there were more than one infant to an incubator. This was directly correlated to the high rate of infant/child abandonment, morality, and infection in Columbia. (Stikes, & Barbier 2013) It was then discovered that stable premature infants could be placed skin-to-skin, primarily between the mother’s breasts assuming the role of a natural incubator. Once this method became more popular, clinical studies were conducted, showing that Kangaroo Care is a safe alternative to incubator care with no increase in mortality or morbidity rates, along with findings of improved lactation and decreased rates of infant abandonment. (Stikes, & Barbier, 2013) Using the parents’ body as the infant’s natural environment has positive impacts. Studies demonstrate that Kangaroo Care improves cardiorespiratory stability and thermoregulation organically. It meets the infant’s need for breast feeding, warmth, and love, as well as protection from infection and sensorimotor stimulation. (Schneider, Charpak, Ruiz-Pealaez, & Tessier, 2012) Both in and out of the womb, infants need to be warm, fed, and protected; a mother’s chest is one place where these things are best available, resulting in less psychological and physiological stresses (Browne, 2003). It was previously believed that premature or low birth weight babies should not be handled or held because of their frailness. Conversely, it has been proven that laying upright on a mother or father’s bare chest results in more organized sleep patterns, improved cardiorespiratory stability, thermoregulation, and a positive parent-child relationship later on. (Browne, 2003) Electroencephalogram (EEG) recordings have illustrated that skin-to-skin contact positively affects the neuronal networks, improving sleep outcomes and enhancing physiological maturation, while preventing motor and cognitive impairments in preterm children (Schneider, Charpak, Ruiz-Pealaex, & Tessier, 2012). The aforementioned positive impact Kangaroo Care has on parent-child relationships begins instantly. The separation of parent and child can cause immediate protest behavior, for the infant craves to be back in a familiar, safe place. Stress hormones will increase, body temperature will lower, and the heartrate will slow, all in attempt to prolong survival until the separation ceases and the infant is back with a parent. However, this can have negative effects such as, “intracranial hemorrhages in newborn period, behavioral disorder in childhood, and higher likelihood of illness later in life”. (Bergman, 2003) Kangaroo Care has been established as a technique that improves parent-infant bonding.
Kangaroo Care does things such as reduces maternal stress, decreases postpartum depression, and improves lactation amongst other things, yet the effect that Kangaroo Care has on father-infant cannot be overlooked. The majority of information on Kangaroo Care focuses on mothers and infants, but becoming active in caring for the infant will enhance the father’s paternal feelings, as well as increase their confidence in their paternal role (Blomqvist, Frolund, Rbertsson, & Nyqvist, 2013). Control is a large issue among fathers, often time fathers feel as if they are lacking control or struggling to gain control, so being separated from the infant is stressful, thus making Kangaroo Care a viable option with many benefits. Skin-to-skin contact instigates a sense of importance for the father, making him feel like a crucial participant in the infant’s care (Blomqvist et al, 2013). Fathers’ ability to be touching the infant facilitates attainment, and fathers who practice Kangaroo Care spoke about their infant with respect and pride, as well as felt closer to the infant faster with feelings of joy and passion (Blomqvist et al,
2013). Kangaroo Care albeit beneficial, does have its inconveniences and disadvantages. In relation to the parents, current parental leave policies in most countries do not offer viable options for the parents of premature infants. Parents must make the decision of whether they take leave to be with infant in the NICU, or save the leave until infant is discharged. This may result in emotional, physical, and financial tolls that affect relationships. Prematurity itself and the NICU experience may also have long-term effects on parents and children, such as parents being over-protective and children experiencing physical, cognitive, or socio-emotional challenges. (Browne, 2003) Furthermore, there are many concerns regarding Kangaroo Care and infant safety. Concerns decrease significantly if the infant is stable on room air, but preterm infants on ventilators have more physiological trepidations. For health care providers, it is difficult to determine the infant’s readiness and what strategies to use, so the lack of specific guidelines for Kangaroo Care makes it challenging for some physicians to support it. Specific criteria would address infants’ eligibility for Kangaroo Care, determining equipment needs, transfer techniques, optimal positioning, monitoring of vital signs, and so on. (Stike & Barbier, 2013) To resolve some of these issues, the use of Kangaroo Care should be consistent among all care providers, with Kangaroo Care policies being revised annually based on new evidence, as well as parent and staff feedback. NICU’s are beginning to provide family-centered and environmentally supportive care to parents and siblings of premature infants. An individualized, relationship-based experience in the NICU is crucial, focusing on medical care, along with the safety, privacy, confidentiality, comfort, and togetherness for the family. (Browne, 2003) Infants’ brain is sensitive to sensory input early in gestation, and during gestation, the migration, connection, and communication of neurons begin a process of organization in the brain, so the environment has a powerful effect on this process, which effects later development (Browne, 2003). NICU’s are recognizing how important incoming sensory stimuli and are working with new technology to provide infants protection from light and sound, altered bedding providing boundaries, timed caregiving and medical interventions to minimize stress, and NICU’s are endorsing the inclusion of family members in care. With Kangaroo Care, parents are not visitors, but essential providers of physiological stability for the infant. (Webb, Cline, & Maguire, 2014) Studies have documented the impact of the environmental sound and light on the emergence of circadian rhythms, sleep, early relationships, and the developing brain itself (Browne, 2003). Infants need predictable darkness and light, as well as quiet, calm, and restful interactions with parents, so the constant and invasive lights in the NICU accompanied with the loud, unpredictable sounds disturb infants’ physiological and behavioral organization. Yet, support to the dyad is mandatory. Meaning, the medical, emotion, psychological, and emotional well-being of parent and baby is taken care of, but this should be done without separating the parents from the infant. The NICU’s efforts and advancements paired with implementing Kangaroo Care will support infants’ proper, healthy development and create a positive parent-infant relationship from the beginning.
References
Bergman, N. (2003). KANGAROO MOTHER CARE: Rediscover the Natural Way to Care for
Newborn Baby. International Journal Of Childbirth Education, 18(1), 26-27.
Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler A, Garcia CV,
Rohde S, Say L, Lawn JE. National, regional and worldwide estimates of preterm birth.
The Lancet, June 2012. 9;379(9832):2162-72. Estimates from 2010.
Blomqvist, Y. T., Rubertsson, C., Kylberg, E., Jöreskog, K., & Nyqvist, K. H. (2012). Kangaroo mother care helps fathers of preterm infants gain confidence in the paternal role.
Journal Of Advanced Nursing, 68(9), 1988-1996. doi:10.1111/j.1365-2648.2011.05886.x
Blomqvist, Y. T., Frölund, L., Rubertsson, C., & Nyqvist, K. H. (2013). Provision of Kangaroo
Mother Care: Supportive factors and barriers perceived by parents. Scandinavian
Journal Of Caring Sciences, 27(2), 345-353. doi:10.1111/j.1471-6712.2012.01040.x
Browne, J.V. (2003). New perspectives on premature infants and their parents. Zero to Three,
24(2), 4-12. Retrieved from http://main.zerotothree.org/site/DocServer/vol24-
2a.pdf?docID=2301
Schneider, C., Charpak, N., Ruiz‐Peláez, J. G., & Tessier, R. (2012). Cerebral motor function in very premature-at-birth adolescents: A brain stimulation exploration of kangaroo mother care effects. Acta Paediatrica, 101(10), 1045-1053. doi:10.1111/j.1651-
2227.2012.02770.x
Stikes, R., & Barbier, D. (2013). Applying the plan‐do‐study‐act model to increase the use of kangaroo care. Journal Of Nursing Management, 21(1), 70-78. doi:10.1111/jonm.12021
Webb, M. S., Passmore, D., Cline, G., & Maguire, D. (2014). Ethical issues related to caring for low birth weight infants. Nursing Ethics, 21(6), 731-741. doi:10.1177/0969733013513919
PLAGIARISM DECLARATION
PLAGIARISM
This means that you present substantial portions or elements of another’s work, ideas or data as your own, even if the original author is cited occasionally. A signed photocopy or other copy of the Declaration below must accompany every piece of work that you hand in.
DECLARATION
1. I know that Plagiarism is wrong. Plagiarism is to use another’s work and pretend that it is one’s own.
2. I have used the American Psychological Association formatting for citation and referencing. Each significant contribution to, and quotation in, this essay/report/project from the work or works, of other people has been attributed, cited and referenced.
3. This essay/report/project is my own work.
4. I have not allowed, and will not allow anyone to copy my work with the intention of passing it off as his or her own work.
NAME: Brianna Jacobson
SIGNATURE:
STUDENT NUMBER: JCBBRI009
TUTOR’S NAME: Juan Teixeira
TUT GROUP NUMBER: 1