Patient Risk Essay

This example of a reflective essay is presented in association with Price, B and Harrington, A (2013) Critical Thinking and Writing for Nursing Students, London, Learning Matters. Readers are introduced to the process of critical and reflective thinking and the translation of these into coursework that will help them to achieve better grades in nursing courses. Stewart, Raymet, Fatima and Gina are four students who share their learning journey throughout the chapters of the book. In this essay on the assessment of pain, Raymet demonstrates her reflective writing skills near the end of her course. Raymet had by this stage written several reflective practice essays and gained good marks. This time though she was encouraged to deepen her reflections, speculating selectively on how the account of pain experienced by a patient (Mrs Drew) might help her to work more creatively with patient perceptions and reported needs. N.B. Remember, copying essays such as this, submitting them as a whole or in part for assessment purposes, without attributing the source of the material, may leave you open to the charge of plagiarism. Significant sanctions may follow for nurses who do this, including referral to the Nursing and Midwifery Council. Assessing Mrs Drew’s Pain Mc Caffery and Pasero (1999) state that pain is what the patient says it is. If we accept that point, then nurses need to explore the patient’s perceptions of pain, as well as their report of experiences. The two are not quite the same. Patients may report their pain in a variety of ways, dependent on the nature and the intensity of pain and the context in which it is felt (e.g. whether they are ever distracted from the pain). Their perception of pain is a little more though and it includes the meaning that the pain has for them. It includes explanation of why the pain is there in the first place, what it indicates about their body and what it could  suggest might happen in the future (getting better, getting worse). The nurse assesses the account of pain shared by the patient, and this may be given in the form of a story. This is how it began, this is how it felt, this is what that meant to me and this is what I did about it (Mishler et al. 2006) In this essay I explore the assessment of pain as conducted with one 60 year old patient whom I will call Mrs Drew. Whilst the essay describes an assessment of pain with a single patient, I try to share too some ideas and questions that this provokes within me about pain assessment more generally. Mrs Drew made me think about other patients, future assessments and what I had to do as a nurse to help patients. To help structure this essay I use the framework described by Gibbs (1988). Whilst the episode concerned relates a stage in Mrs Drew’s illness when she challenged her treatment protocol, it also includes some of the memories and thoughts that this patient refers to regarding her earlier illness and past ways of coping with pain. In particular, it prompted me to question to what extent I as a nurse should recommend analgesia, drawing on what I had been taught about the effective control of pain. I had learned that it was better to control rather than to chase pain ( e.g. Mann and Carr, 2006; Forbes, 2007). Mrs Drew was diagnosed with lung cancer a year earlier and had initially had her illness treated by chemotherapy. This had helped her to achieve a remission that lasted for nearly ten months (Hunt et al, 2009 describe the prognosis of this disease). The cancer had returned though and spread to her spine and it was here that she experienced most of her pain.It was at this stage that the doctors explained that her care would now be directed towards her comfort rather than a cure—to which she had replied, ‘you mean palliative care’. Mrs Drew was supported at home by her husband Neil and visited on a regular basis by community based nurses to whom I was attached as part of my student nurse training. She was prescribed oral morphine and could decide within stated limits how many tablets she could take in any one 24 hour period. The situation I had visited Mrs Drew on several occasions over the period of a month when the community nurse and I were confronted by a tearful patient who announced that she did not wish to take the oral opiates quite as often as we were recommending. As she spoke she held her husband’s hand tightly, looking across to him as she described her experiences and feelings about the matter. Yes, there had been some bad nights when the pain had woken her and she had to sit up and watch television to try and distract herself. Yes, sometimes the pain made her feel nauseous, but she was alarmed at how frequently she was taking the ‘pain tablets’ and how this made her feel about herself. However well meant the medication was, it didn’t feel dignified to be so reliant on drugs, or quite so sleepy and unresponsive for such a high percentage of the day. Whilst the analgesia was working well when she took the tablets, the quality of life wasn’t what she wanted. The community nurse listened patiently to Mrs Drew and then explained that it was normal to have panic moments about such medication. Morphine had a reputation, one that people associated with misuse of drugs, rather than their therapeutic use. Used on a regular basis, the drug wouldn’t cause addiction and it would provide a great deal of reassurance to Mr Drew as well. The community nurse stated that she was quite sure that he respected his wife’s need to sleep when she wished and to build the rhythm of the day around her needs. At this point Mrs Drew shook her husband’s hand, and said, ‘tell her†¦tell her what we’ve talked about!’ Mr Drew then explained that his wife was used to dealing with pain, she had suffered recurrent pain in her neck and shoulder after a road traffic accident some years before. The pain had sometimes been severe, but he had massaged her shoulders and used heat packs that she found soothing. They had decided that they wished to use this technique now, keeping the morphine for absolute emergencies, when she was losing sleep and couldn’t eat as a result of the discomfort. The community nurse assured them that they were in charge of the analgesia and would be allowed to make their own decisions. She started to make notes though, and announced that she was making a referral to the cancer pain clinic, something that would help them to take stock of the situation. There was very good reason to suppose that this might be a problem associated with choosing the right dosage of the  morphine, rather than using supplemental pain relief measures. Mrs Drew responded sharply, ‘You’re not listening to me though Jane (the community nurse’s name—a pseudonym is used here), I want to use heat packs instead of morphine, at least during the day. I want to be more alive with my husband.’ The community nurse assured Mrs Drew that she had heard what she had said and respected her point of view. There would though be nothing lost by using the clinic to gain a further check on this matter. With that she excused us, explaining that we had a further appointment that morning and we left, having checked that Mrs Drew had a sufficient supply of her different medicines. As we walked to the car the community nurse empathised with Mrs Drew’s plight, saying that if she had lung cancer she would probably grasp at straws too. She would reach out for things that seemed more normal, and then observed, ‘but this isn’t normal is it, the pain she has isn’t normal. It’s not just a whip lash injury and old age.’ Feelings I remember that during this episode feeling a mixture of confusion, surprise, anger and impotence. Mrs Drew had surprised me by the way she had spoken, using what seemed to be a planned announcement. They had waited for and perhaps rehearsed this moment. Nothing in my experience to date had prepared me for such an encounter, at least in such circumstances, where we as nurses were so obviously working to support the patient. It was only later that I called the episode a confrontation. Mr and Mrs Drew had confronted the community nurse and I had been the largely silent witness to the event. As the discussion proceeded I remember making supportive noises, remarking how useful heat packs sometimes were and glancing across at Jane, who seemed to be signalling with her expression that I should leave this debate to her. I was trying to read her reactions to the Drew’s points and concluded that if I couldn’t support her arguments to the patient, then I should remain silent. The re were issues here that I perhaps hadn’t enough experience to deal with, at least, whilst ‘thinking on my feet’. My initial anger (with Mrs Drew for not acknowledging all that we were trying to do) quickly became displaced towards my colleague Jane. During the event I couldn’t explain why that was, but afterwards, when I made notes, I realised that it was because she seemed to have set the agenda in her own mind and to be requiring the patient to comply with concerns of her own. Put rather crudely, Jane seemed to be saying, listen I know about these things, this is a phase, an anxiety; you can work through all this. I believed at this point that she had missed the significance of the event, the way in which the Drew’s had arranged the conversation. For them, this was not a phase at all, but a considered and very important decision, one that they wanted the nurses to accept (Freshwater, 2002 and Edwards and Elwyn, 2009 emphasize the importance of negotiated care planning). My feelings of impotence were associated strongly with my lack of clinical experience. I have met this before. No matter how many placements I do, no matter how good the mentoring I receive, I keep meeting situations where I am unsure about how to respond next. I feel younger, less knowledgeable than I should be at this stage in my training. I want to reassure patients, to support colleagues and to give good advice, but there is not enough confidence to do that. If I felt unsettled and uncertain about Jane’s response to the Drew’s, right then I couldn’t easily explain that. I couldn’t offer a second opinion, couldn’t suggest an idea that might help support the patient. To my annoyance I couldn’t manage that either as we left the house. Jane had made some fair points, she  clearly seemed concerned about the patient’s needs, but perhaps she hadn’t spotted the right need—for Mrs Drew to determine in greater part how she de alt with her illness. Experience evaluated Afterwards, this short episode prompted doubts and debates about several important aspects of nursing for me. Setting aside the etiquette of learning in clinical practice, not challenging a qualified nurse in front of a  patient, there were problems here associated with supporting patient dignity, with my assumptions relating to analgesia and pain control strategies, and I realised, with my assumptions about types of pain and who had the expertise to define these. Dignity is more than simply using the appropriate terms of address, protecting the privacy of patients and attending to their expressed concerns (Price, 2004). It is about clarifying the ways in which they live and accommodate illness or treatment. It is about finding out what benchmarks they use to say that ‘yes, I am doing well here, this makes me feel good about myself’. Upon reflection, I sense that we on this occasion had not worked hard enough to discover how Mr and Mrs Drew define quality of life, or being in charge of their situation. We were more concerned with providing resources, sharing research or theory about medication and questioning the familiar misconceptions associated with morphine. To put it simply, we were ‘missing a trick’, reading the encounter as something that had happened many times before—the report of problems or anxieties, a request for help, rather than a decision that the patient and her carer had already come to. Reading situations well seemed, with the benefit of hindsight, to be the first basis for dignified care. ‘What is happening here, what will help the patient most?’ were questions that we perhaps assumed that we already knew the answer to. I realised that in my training I had already accepted the argument that patients would wish to remain pain free come what may and that the tackling of fears about prospective pain, was something that nurses engaged in. I assumed that because cancer pain represented such a major threat, because it was greater and more all encompassing, that there was little or no doubt that it should be removed. What was so unsettling, and took so much time to examine, was that Mrs Drew acknowledged the possible severity of metastatic cancer pain, but that she still preferred to respond to it using measures that had worked for her whiplash neck injury. Mrs Drew was willing to trade off a pain free state for something that gave her a greater sense of control and which perhaps enabled her husband to express his support for her in a very tangible way (preparing heat packs, massaging her back, rather than simply giving her the tablets). Mr and Mrs Drew questioned all my assumptions about best analgesia pr actice, and seemed to write a large  question mark on the textbooks I had read about chasing rather than controlling pain in palliative care situations (Mann and Carr, 2006). Reflections (learning opportunities) The episode with Mrs Drew left me uncomfortable because my past approach to pain management was theoretical. I (and I believe Jane too) regularly made use of science to decide what could be done as regards pain relief and to assume that patients would wish to achieve all of those benefits. This wasn’t about local applications of heat versus morphine, Mrs Drew could use both, it was about choice and how patients made choices—why they reached the decisions that they did. It was for me, about accepting very personally, that providing that patients are given all the relevant facts, alerted to the options, that they really are able to make choices that work for them. The very fact that Mrs Drew’s illness was now incurable, that she and her husband usually tackled pain together, meant that her solution to the challenge was different to those that many other patients arrived at. Having dealt with this pain for some time, knowing that it could and probably would get wors e, meant that she was better equipped than other less experienced patients to make a decision here. This took nothing away from the benefits of sharing further discussion with pain clinic experts. I thought, Mrs Drew will stand her ground, she will insist on doing things her way if her husband is strong too. What it did highlight though was the importance of listening to patients, hearing how they perceive pain, how they narrate not only the pain but what they did about it. In this instance the narration was all about dignity, and coping, and finding ways to help one another and how this enables us to feel in the face of such a terrible illness. So, in telling us about her pain, what she did about it, using morphine when it was ‘absolutely required’, Mrs Drew was not reporting her ignorance of what could be achieved if the medication was used differently, but what she preferred to do as it enabled her to achieve different goals. Mrs Drew’s goals were about liveliness, alertness and stoicism, showing that she could bear at least a measure of pain. I wondered why I hadn’t listened carefully enough to such a story? Was it because of time pressure, or perhaps complacency, that Jane and I felt that we already knew what account would be  shared? Did we think that the patient would ask for help, more help, as the pain continued? If so, then our guesses had prompted us to behave as experts, and problem solvers, on the patient’s behalf. Perhaps hearing a patient narrative is about discovering what sort of role they would like you to fulfil. If so, then it might be a difficult role. I thought hard about how hard this was for Jane. She was going to be asked to witness Mrs Drew’s future pain, one that was now less perfectly controlled. She was going to be asked to reassure, to suggest measures that might help, without reminding the patient that she ‘already knew that you couldn’t manage pain that way!’ When I think about it now, that is very stressful for a nurse. It is about caring and allowing patient’s to make choices that we personally might not make. Conclusions I have drawn then three conclusions from the above reflection. First, that being patient centred is never easy and requires real listening and interpretation skills. My criticism of what Jane chose to do, to try and dissuade Mrs Drew from a course of action, recommending further appraisal of the situation, is an easy one to make. Nurses confront situations such as this relatively unprepared and react as considerately as possible. It is easy in hindsight to recommend other responses, a further exploration of what motivated Mrs Drew’s pain management preferences. Second, that experience can be a valuable teacher, the equal of textbooks. If nurses are interested in care, then we should be concerned with the sense that patients make of their own illness, the treatment or support that they receive. We need to understand what patients have to teach us and have to acknowledge that this means that we won’t always seem in control ourselves, expert and knowledgeable. Our expertise might be elsewhere, helping patients to reach their own decisions. Third, that one way to understand patient perspectives on illness or treatment, on pain management in this example, is to hear how they talk  about the situation. How do they describe the pain, how do they refer to what they did about it? The way in which the story is shared, how we coped, how this made us feel, is as important as the facts related. Sometimes a patient needs to feel stalwart, even heroic in the face of illness. Future care It would be foolish and unprofessional to recommend to other patients that they might not wish to remove pain, or that overcoming pain doesn’t always mean we don’t continue to experience it. For every Mrs Drew there may be many other patients who would welcome the complete removal of pain, so that they can die calmly, quietly, with their own version of dignity. But it does seem to me, that it will be worth thinking about the diversity of patients and how they prefer to cope when I assess pain and help manage this problem in the future. I won’t be able to walk away from the responsibility of debating whether I have explained all that I could, detailed the strengths and limitations of different ways of coping. I will need to find reflection time to ponder what patients have said and if necessary to go back and say, ‘I’ve been thinking some more about your words last week..’ knowing that this doesn’t make me any the less professional. References Edwards, A and Elwyn, G (2009) Shared decision-making in health care: achieving evidencebased patient choice, 2nd ed. Oxford, Oxford University Press Forbes, K (2007) Opiods in cancer pain, Oxford, Oxford University Press Freshwater, D (2002) Therapeutic nursing: improving patient care through self awareness, London, Sage. Gibbs G (1988) Learning by doing: a guide to teaching and learning methods, Oxford, Oxford Polytechnic Further Education unit Hunt, I., Muers, M and Treasure, T (2009) ABC of lung cancer, Oxford, Wiley-Blackwell/BMJ Books Mann, E and Carr, E (2006) Pain management, Oxford, Blackwell McCaffery, M and Pasero, C (1999) Pain: Clinical manual, Mosby, Philadelphia Mishler, E., Rapport, F and Wainwright, P (2006) The self in health and illness: patients, professionals and narrative identity, Oxford, Radcliffe Publishing Ltd Price, B (2004) Demonstrating respect for patient dignity, Nursing Standard, 19(12), 45-51

Operating system with inputs, transformation process and outputs Essay

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The Inside Job Term Paper Example | Topics and Well Written Essays - 1000 words

The Inside Job - Term Paper Example The documentary is about the financial crisis experienced in 2007 and 2008 among other vital economical issues in the United States and on the globe in general. The 2007 global financial crisis was a result of poor loaning scheme to the real estate sector that led to the worst state of bankrupt ever recorded. The United States legislators, out of their own greed, ordered the banking institutions to provide unsecured loans, only for the real estate owners to become loan defaulters. The scheme affected the global economy causing the prices of basic necessities to rise by certain percentages. Ferguson uses the documentary to highlight some of the corrupt deals and changes in the banking industry that brought the global financial crisis among other economical limitations. This study analyzes the documentary, putting emphasis on the motive behind the entire casting. The documentary contains five parts which are in a sequential order as far as the cause and effects of the global financial crisis are concerned. All the five episodes make a summery of the causes and effects of the global financial crisis. This paragraph contains the main financial summery with regard to the late-2000 US financial crisis. It begins by highlighting the poor performance, then the collapse of some of the greatest banking institutions (Iceland) in the United States. Iceland collapsed the moment its main shareholders, Lehman Brothers and AIG, went bankrupt. The producer engages narration as one of the main styles to pass relevant information in the documentary. The documentary is ideal for general viewing, but it would make more sense to those with economical knowledge since some economical and financial jargon words are used to describe the causes and effects of the global financial crisis. The first episode begins as a history documentary where the audience is taken through the US and the global economical status from 1940 to 1980, during which the financial sector was regulated. The docum entary creates a comparison platform, where the audience is made to recognize the difference between the current financial status and that of 20 years ago. It requires good financial analytical skills to note the difference, but the producer broke the entire idea into simpler details. He also tries to use the ordinary language and not financial technical jargon to describe his findings. One learns that the documentary is some sort of financial research findings, but in a simpler language. However, more emphasis is put on the blunders committed by the financial sectors. After 1980, there is no record of regulating the financial sector, and this helped various individuals to establish giant firms on the taxpayers’ money. The documentary records that an estimate of $ 124 billion of taxpayers’ money was channeled from the national treasury to start the giant companies. Various banks later ventured in internet banking scheme, where huge amounts were invested despite those f irms being infeasible. The financial sector lost about $ 5 trillion on the failure of the internet companies. The sector introduced some derivatives that caused even more instability. Several financial studies were conducted, and derivatives regulation was considered one of the remedies to reverse the financial status. However, a good number of legislators supported the bill of Commodity Futures Modernization, which later became a bill and compromised derivative regulations. From the year 2000, the financial sector was dominated by five major companies, comprising Goldman Sachs, Morgan Stanley, Lehman Brothers, Merrill Lynch and Bear Stearns. The other team was made of two financial partners, Citigroup and JPMorgan Chase. AIG, MBIA, and AMBAC, which are insurance companies,

Case study Example | Topics and Well Written Essays - 3750 words

Case Study Example ?University (SSU) is a comprehensive teaching institution with 14,200 undergraduate and 3500 graduate students accompanied with 400 faculty and staff. SSU is situated in an attractive and relatively isolated setting in Lubbock, Texas. In the recent years, SSU has faced numerous challenges and difficulties. There has been considerable increase in the annual tuition fees but resources to meet the new initiatives have been limited. Although SSU has a few resources in order to meet capital improvement or for the commencement of new programs and initiative but these resources are not adequate. In the recent times, SSU has been able to provide only 1 percent rise across the board faculty and staff salary cost of living and standard promotion adjustment but it has witnessed no major increase in the number of staff for several years. Two programs namely a Staff  Performance  Excellence  Program  (SPEP) and a Faculty  Distinction program was initiated in the year 2000 and 2001 respe ctively which were framed to recognize and motivate outstanding  performance. However, since 2005 neither program was funded. The performance documentation and employee-supervisor discussion committee of the SPEP occupied a key role in deciding the eligibility and levels of merit based salary increase. SPEP was not tied with in any manner with the compensation rather it was totally an academic exercise. Besides, staffs within SSU have also not taken this program seriously as they believe that the program will have no significant impact on their promotion. At the same time, Faculty Distinction program has been paused for many years (Ruben & Jurow, 2012). There was no rigid plan to resolve this ongoing problem faced by the university and the faculty members in the university. As a consequence of this, faculty members in SSU felt increasing level of stress and they deemed to remain strapped for time to teach. Faculty members in SSU who are economically vulnerable remain disheartened about their

Participant Observation Assignment Essay Example | Topics and Well Written Essays - 1250 words

Participant Observation Assignment - Essay Example s â€Å"committed to approaching the modern world through the perspective of Halakah (transliterated as halacha) embracing religious Zionism, and growing in Jewish learning and observance† (www.emekberach.org). Halakah is a collection of Jewish laws that have been handed down from the biblical times. Thus Emek Beracha is a synagogue of Orthodox Jews who have promised to uphold the religious traditions of Orthodox Judaism. Orthodox Judaism has acquired a significant dimension as a social catalyst among the upwardly mobile Jews across the metropolitan US cities. This wave of pervasive religious behavior is a relatively newer phenomenon among the young Orthodox Jews who otherwise tend to regard religion as an ultra-conservative custom-centric behavioral tendency. When the writer appeared at the entrance to the shul it was just 8.00 am and being a Sunday there were quite a few congregants for the morning assembly guided by the Rabbi. The assembly in Judaism was being conducted as if it were another sermon. The first thing to strike the writer was the type of architecture of the shul. In fact as almost every other synagogue in the US Emek Beracha, has been highly influenced by the typically American architectural traditions. The divergent features from the Christian church aren’t many. In fact similarities tend to be closer and more or less shared between the two. Such common features include arches and domes. The windows and doors are designed in the same way as those in the church. The structure has a striking resemblance to an open study, with a large hall for prayer. The writer didn’t see a separate beth midrash (or house of study). However the significance of worship at a shul lies in the fact that the participants in prayer are well-intentioned in their effort to understand the â€Å"word of God†. Many of the participants at the shul were dressed according to the tradition and were in prayer posture. Their ages ranged from kids of threes and fours to elderly

Business Synoptic Essay Example | Topics and Well Written Essays - 4000 words

Business Synoptic - Essay Example It also helps define the optimal use of the resources in the changing business environment to meet the set objectives. A strategy defines the roles and responsibilities of the organization. According to the Harvard Policy Mode, strategy is a pattern of purposes and policies defining the company and its business (Carter, 1999). The strategy implementation involves several steps as follows: Source: Schraeder (2002). Globalization is a concept that speaks of one world with similar tastes and preferences. However, Nestle does not believe in globalization of consumer behavior and tastes. They follow the philosophy that consumers are individuals. They do not follow a set pattern and hence cannot be classified as global consumers. Thus, in clarification of their objectives, they evaluated the globalization trend and concluded that they wanted to have a customization approach rather than a globalization approach. However, the globalization principle did help in focusing on the emerging marke ts as they conducted an external and internal analysis. They could identify the gap in the services in the emerging markets and found tremendous potential. They could foresee the removal of trade barriers and the rising consumerism in these economies. This is the reason they adopted the early-mover principle in these markets. They could also analyse and find that they could achieve competitive advantage by fulfilling consumer needs in these markets. Link between the two concepts Strategy implementation involves several steps. Strategy implementation required them to evaluate the strengths and weaknesses of globalization. It also brought to light that removal of trade barriers had opened up the opportunities in the emerging markets. They thus first developed their corporate level strategy to approach the emerging markets. Strategy is drawn up at three levels – the corporate, business and the functional levels. This helps them decide on the choice of products, the choice of mar kets and the choice of competitors. To fulfill individual consumer needs or the local needs requires a strategy that differs from the globalization approach. They hence standardize wherever possible but adapted wherever necessary. This provided them with the competitive advantage and gain foothold in the emerging economies. To achieve success, they had to change their strategy of having global managers. Just as there can be no global consumers as per Nestle philosophy, they also believed that the workers should maintain their own cultures but follow the Nestle principles. Maintaining their own cultures enables them to understand the market needs better and make adaptation as necessary. Thus, as a part of their functional strategy, they provided complete autonomy to the local managers to function but in alignment with their overall philosophy, they maintained control having their own expatriate managers to oversee the operations in these nations. After careful evaluation they adopted the transnational approach to internationalization as it allows them control over the operations. They could understand that consumers are not global in their tastes and behavior and that local culture is important. The two concepts are interlined because strategy cannot be developed in isolation. Since the trend was towards globalization, Nestle evaluated the strategic options and concluded that it could gain competitive advan

Political perspective to decision making Essay Example | Topics and Well Written Essays - 2250 words

Political perspective to decision making - Essay Example Organizational decision making takes place at different levels. Most of the crucial organizational decisions entail distribution of limited resources in the various departments or segments. They are significant in the identification of the most appropriate way to share resources. Due to scarcity of resources, political actions arise making the decision making process to have a political perspective. Most of the competition is usually exhibited by the organizations while searching for leadership and personnel positions that influence decision making. Political influence in decision making creates differences in the organizational dynamics making power to become a significant resource. Power enables those who hold it in an organization to have a substantial control in decision making. This essay discusses the political perspectives in decision making and their main implications. Organizations are usually an alliance of several individuals who have personal dreams expectations, weaknesses and strengths. These alliances are the fundamentals of the political perspectives, whose existence is attributed to the presence of division of labor in the business. According to Pettigrew (1985 p. 42), â€Å"associated career, rewards and individual status are the core sources of the political perspectives†. In his view, the occurrence of interest groups usually originates from the existence matching objectives within the group members. On the other hand, the differences that exist in the organizational hierarchy amongst the different groups facilitate the occurrence of the political perspectives. Differences come as a result of issues such as the members who have been newly recruited in the group and the pioneers, and others such as the traditionalists and those who want changes to be made in the organizational structures. The variations in opinions between these groups lead to the presence of sub units that are charac1terized by

Discuss how evidence-based practice is applied in your practice Assignment

Discuss how evidence-based practice is applied in your practice setting and describe the desired patient outcome achieved through this approach - Assignment Example To start with, evidence based practice has led to the adoption of the best methods of releasing results to patients and their relatives. The inter-professional staff members in the Oncology department have different levels of education and preparation leading to some differences in managing some problems. For instance, at first any oncology staff in the department could release results to patients (Love & Rodrigue, 2013). But with time, the department realized that bad news released to patients by most doctors who had fewer interactions with the patients made them suffer psychologically and in most cases succumbed to malignancies too soon. On realizing this, most of the staff have attended some sessions in order to improve their techniques of handling patients. Consequently, better methods of releasing results have been introduced. Currently, dispatching results is often done by nurses who have much positive interaction with patients and also those who have time to explain to them on best treatment practices to be undertaken. Love and Rodrigue (2013), suggests that this has minimized the occurrence of early deaths in the unit by a large margin. EBR has also been employed in radiation treatments (Love & Rodrigue, 2013). Initially, the oncology department did not emphasis much on testing sensitivity of a patient to chemotherapy, but largely relied on the standard operating procedures for different stages of cancer. Later, the head of the department suggested on using tumor markers to determine individualized based sensitivity or resistance to chemotherapy to help manage cancer patients better. Upon adopting the above strategies, treatment methods such as selecting drugs were largely based on individual sensitivity and the analysis of tumor markers. This led to better response of patients to chemotherapy in the hospital and the practice was widely borrowed by neighboring hospitals. With time, it was discovered that some patients, especially those in

Marcus Ang Is A Member From The Field Sales Section Essay Example for Free

Marcus Ang Is A Member From The Field Sales Section Essay Marcus Ang is a member from the field sales section. His sales performance in the recent months has been below target in contrast to his outstanding sales in the past years. Marcus blames it on the poor economic situation, however the other sales staff seem to able meet their target. How should Madam May May attribute Marcus’s performance? First of all, Madam May May has to know about what happened to Marcus. What causes him to blame the poor economic situation while the other sales staff still be able to meet their target. As we learn from the organization behavior, we know that employee’s behavior will affect the performance of an organization. According to Fritz Heider and H.H. Kelly, they stated that people’s behavior is affected by internal and external factors. On the other hand, Kelley’s attribution theory refers to three types of factors which are distinctiveness, consensus and consistency. Distinctiveness is about whether the subordinate’s behavior occur during the performance of this task only? Next, consensus is like whether this behavior unusual for the subordinate’s peers? Then, consistency is about if this behavior unusual for the subordinate in other situations? In this situation, Madam May May should first consider about the factor of consensus. As Marcus cannot be able to hit the target while other are able to reach their target. Next Madam May May should consider about locus of control dimension, which mean whether the primary cause of the behavior is a characteristic of the subordinate, or a characteristic of the situation. Second ,stability dimension whether the subordinate is likely to remain stable or unstable? The crossing of the locus of control and stability dimensions produces four casual factor that a leader can utilize to explain a subordinate’s behavior, ability , task difficulty , luck ,chance, effort.

Media As Force Multiplier

Media As Force Multiplier Today media needs to be used in a more pro-active manner to shape the operational scheme of a commander. This can be done by more integration and engagement of the media, public relations officer and the men in uniform into two way communication looking after each others needs at the same time. One very important aspect is the education of the staff and subordinate commanders at operational level to realise the need and advantage of engaging media towards military operations. The fourth estate in this informational age gives commanders with vast opportunities to leverage towards own operations which should be exploited to the maximum. The media can be used as potent force multiplier in achieving the objective by boosting the morale of our own forces and people, as an agent of deception for the military, gathering valuable intelligence and enhancing better build up of situational awareness, sustained psychological operation and finally communicating the objective and end state to the international community. Maximizing the use of fourth estate Maximising and moulding the perception of the masses and adversary by the use of fourth estate and how the commander leverage the media to effectively achieve operational objective to his own advantage is what the commander should explore which obviously is the need of the hour. Before employing the media, a brief review of the nature of the media would be required to better understand its potential. Media covering any military operation ranges from novice in the field to the seasoned veteran. Thus employment of media by the commander should be in a judicious manner like not allowing the media to wander in the battlefield at free will due to the wide spectrum of their work experience. At operational level coverage of media can be divided into three main principles namely mobility, capability and responsibility. Mobility is considered as the center of gravity of the media which is reporting from the scene while safety is the medias critical vulnerability. This is evident from journalist getting stuck during operations not able to move due to lack of mobility. The units which are more mobile or the ones with freedom of mobility cover the operation in a much more realistic manner. Regarding the safety many a journalists have landed themselves in dangerous situa tions and few lost their lives while covering news from the crisis zone. With regards to capability, media is often ahead of military on information age battlefield being armed with sophisticated satellite communication technology. This mobility and capability have complicated the operational commanders challenge to be more proactive in winning or at least not loosing to the media coverage. Understanding the medias concerns, capabilities, strengths and weaknesses will help operational commanders in utilizing media towards the operational design and conduct of operations. Use of media by the commanders is enumerated below:- (i) Media as a platform. Media offers a platform for the operational commanders to transmit his operational objectives and goals. In many a cases during the operation when a commander is interviewed he communicates to general masses by giving his objective without divulging any intricacies which could jeopardise the operation. This way the people are aware as to what is happening and further their support towards the operation. This also keeps rest of the forces informed and they understand the goal. (ii) PSYOPS potential. The use of medias PSYOPS potential by the operational commander towards own advantage. Propaganda might get victory before the first shot is fired by merely demoralizing the adversary and breaking the will to fight. Using commercial broadcast would provide a heightened level of credibility with the enemy because its third party stature provides some assurance of truth, over military broadcast. Using commercial television for PSYOPS would have to be covertly subtle, done on a sublime level, and would require special authorization. The military might and capability can be projected to the adversary and people to play with their minds. Destructive images of the adversary, pumping in of more forces to the theatre and special training of our troops to take on the enemy will affect the way the operation will be conducted by the enemy. In short, to maximize the potential of PSYOPS the operational commander must consider the media as a primary means of influencing an o pponents actions. (iii) Media as a deception tool. The operational commander must consider using the media as part of the overall deception plan. Media can be utilized to inject information regarding a plan or designs however act on some other plan thus keep the adversary guessing on the course of action and delay his moves. (iv) Media for intelligence gathering. An area rich with possibilities for operational commander is harnessing the potential of media in gathering intelligence. Valuable intelligence like background information on people, terrain and facilities in a particular region can be provided by the reporters. Military may assign agencies/reporters to a particular geographic region to gain intimate knowledge of the social fabric and the culture. Military leaders need to exploit this intelligence asset when planning or entering a new theatre. Tapping into the media is an excellent open-source for gathering information about the adversary though it might be time consuming and challenging. Radical expansion and modernization of open-source exploitation is an important reform for the intelligence community these days. Commanders should develop innovative ways to penetrate and analyse the most difficult targets, the objective should be to strengthen analytic expertise, methods and practice. Exploit ing open-source information must be the priority and is one way operational commanders and intelligence staff can aide in this challenge. Day in and day out, there are new revelations about Muslim terrorist sleeper cells in India. Most of the suspects arrested and/or tried have links to Pakistan. Islamist extremism in India needs to be explored by recognised experts. Military forces are subjected to this extremism in day to day operations which needs to be addressed. Military has to look into the modus operandi, funding, support (state and non-state), recruiting pattern in terms of location, general populace, mode, means, etc to understand the enemy to maximize its operations. The internet, where a virtual caliphate has been created in cyberspace, is used to proselytize, recruit, radicalize, fund raise and plot act of terrorism. Military should be proactive in tapping the internet in conjunction with the state and friendly nation intelligence network to draw out inferences and intelligence to further their operations. Knowledge building and knowledge sharing should be the priority in this information age. Operational secrecy and media. Some secrecy is essential to both national security and democracy but excessive secrecy undermines accountability and decision-making, and sometimes national security itself. Disclosure decision in a democracy thus must balance the importance of public knowledge and deliberation against the risk of exposing and undermining desirable actions or damaging national security. But neither the military nor the press can be trusted to strike the balance, for both have asymmetric incentives. The military risks public criticism when it announces an audacious plan but risks little when it is secretive. Likewise, journalists have much to gain from publishing classified secret and little to loose. They almost fully internalize the benefits of publication, but may discount or inaccurately assess national security harms. A free press is essential to inform the public, but critic urge that reporters are less accountable than the military they seek to check. The press w ields vast power to undercut desirable classified information and to communicate the nations capabilities and vulnerabilities to the enemy. The military needs to look into unauthorized possession and disclosure of documents or information relating to the national defence by the press which could harm future operations. Operational security is paramount in any campaign be it a full scale war or handling internal crisis situation. Commanders at all times establish rapport with reporters so they develop trust in him and accept his explanation of events. General Schwartzkorf established four rules to engage the press, they are, dont let them intimidate you, there is no law that says you have to answer all their questions, dont answer any question that in your judgement would help the enemy and finally dont ever lie to the people of the nation you are fighting for. These rules apply and holds good to any commander. Press brief of any commander is transmitted via satellite to world wide audience which includes the adversary as well. Clear message can be sent across to the public and the adversary government and its military leaders. Information overload by the media. The rapid advancement in technology and the medias ability to report real time as they occur, military can no longer realistically hope to maintain operational security by denying information to the media. In the present context, to reduce the enemys military effectiveness is information overload. This entails providing the enemy more information than his ability to assimilate in any given point of time. A new military media construct, synergistic relationship with cooperation at all levels will ensure information overload and will force the enemy to focus on many diverse scenarios, making it impossible to discern valid intelligence data. These days media not only gathers information on preparation for the theatre of operation but have gone a step ahead by broadcasting possible strategies and tactics debated by military strategists. International community, general public and fighting forces will monitor these telecasts and contemplate scenarios an d reviews presented on global cable network and may be compelled to commit their scarce military resources to counter possible attacks. Thus the adversarys forces may be diluted and their overall military effectiveness reduced. The media has invariably become an indisputable ally in this process. Media for neutralizing propaganda. Media can be used to expose the untrue stories and the evil design of the adversary and thus making the propaganda machines of the parties involved ineffective. Media can aggressively hunt for the truth and fed with intelligence by various agencies to publish/broadcast the same thereby neutralizing the force multiplication effect of the propaganda by the adversary. Social dimensions Public and military morale. Public support, national morale and soldiers will are powerful force multiplier for a commander to have victory. Opinion creates a state of mind, which is what precisely what constitutes the will and in other words is known as morale. Many difficulties are overcome with a high state of morale. If the people in general are not supportive of the cause of the war or operations other than war and adopt a couldnt care less attitude towards it, the same attitude gets passed on to the soldiers which is detrimental to the cause. Commanders should use media to project a true and correct image to the public and once this is done, no matter what the odds are, a willing public support and response multiplies the chances of victory. The soldiers morale needs be boosted by the media as well and should peak just before the impending attacks sustaining it through the operations. Media serves as a forward as well as a backward link for the soldier with the people back home . Any wrong news or rumours traveling either way will affect the morale of the people as well as the troops which should be monitored by the commanders and negated by responsible journalism. Reaching the public. Today the commander should know the fact that the thrust which comes from the people of the nation when any operation takes place is due to the instant relay of situation to the masses by the media. The military thus have an advantage in reaching to the people as fast as possible to generate and harness the support. Military being known for a respected institution and profession in the country, the image maintenance if not enhancing should be the prime concern of the commanders. During any conventional war or operation other than war, the credibility of military action is seldom questioned due to the trust, confidence and respect which the military enjoys. Commanders need to be proactive in engaging the press rather than being reactive and thus loosing the opportunity to use the media rather than being used by the media. Accurate and correct reporting. Inaccurate reporting and depiction of the operations will have a negative and devastating effect on the conduct of operation there on in terms of likely changed perception of our own people and international opinion. This in turn will effect the decision making cycle from tactical to strategic level. Apart from the people of the nation and high level decision makers, one very important factor which comes into picture is that of our own troops, who are exposed to the same news, be it at the air bases, ships, harbours, communication chains, rear areas, etc will have an impact on the psychi. This again is going to have a telling effect on the way the troops are going to fight subsequently. Commanders should to be concerned of the said fact in this information age to keep the morale of the troops high. In fact the operations where our forces have given a valiant fight should be projected to each and every possible people by the fastest means. Our soldiers are the best and to maintain the image of this potent force especially in this fast pace materialistic world, Commanders must take every opportunity to showcase our outstanding airmen, soldiers and sailors. Image building when our armed forces are engaged in aid to civil power. Disgruntled armed forces personnel, rejected equipment suppliers or contractors, families and others seek justice through media and court. More worrying are court cases, some of which have been widely reported and sensationalised. These incidents are in an increasing trend and common to all the three services. Such adverse publicity has a bearing on the discipline and morale and cannot be simply ignored. Military commanders need to engage with the media and rationalise the news and not let the media to sensationalise the issue. The problem arises because of human rights violation, real, exaggerated or sometimes fabricated. These must be investigated and the findings made known to the public. Human rights commissions, NGO organisations and media can help redress the balance. These instrumentalities, therefore, need to be cultivated, not shunned. The commanders need to pay more attention to these issues and negate any adverse publicity which might bring down the morale of the troops and operation as such.

Essay --

B12 Deficiency What is Vitamin B12 Deficiency Vitamin B12 deficiency limits selenium methylation and excretion resulting in higher tissue selenium levels and subsequent toxicity. It occurs in people whose digestive systems do not adequately absorb the vitamin from the foods they eat. Vegetarians who eat eggs and milk products are the most at risk because, on average, they consume less than half the adult vitamin B12 Recommended Dietary Allowance (RDA) while strict vegans (who don't eat any animal products, including meat, eggs, or milk) are at an even greater risk. Vitamin B12 is important since it works with the vitamin folate to make the body’s genetic material and help keep levels of the amino acid homocysteine in check which helps to decrease heart disease risk. It is also essential in the production of red blood cells which carry oxygen through the blood to the body’s tissues. Life Extension gives offers some of selenium supplements. Babies who are born of parents with low selenium and vitamin B12 rich foods a re at risk of anaemia. Causes of Vitamin B12 Deficiency Selenium is a...

Bacons Rebellion Essay -- American History Nathaniel Bacon Papers

Bacon's Rebellion Sometimes there comes an event in American History in which no one knows exactly why it happened. What the motives of the event were are left to the interpretation of the historian doing the research. Bacon’s Rebellion in 1676 was on such event. Wilcomb E. Washburn’s view is precise when he states, â€Å" Bacon’s Rebellion. . .was an event on which observers could agree on the facts, but divide on the interpretation.† Historians have been picking into peoples’ accounts and versions of the legend for over 3 centuries, but never coming to a common conclusion. One fact is for sure and that is that the rebellion, known as Bacon’s, was what was going to pave the way towards Revolution of British Authority. In this paper I will look at one aspect that I feel was the motivation behind one individual's defiance to authority and the need to take matters regarding Indian relations into his own hands. Bacon was the kind of person to take what he thought was right into his own hands, even if it meant that he was breaking the law. In his eyes he was doing right and if he did not have the official support, he was going to do it anyway. On the other side was the feeble and zealous Governor of Virginia, Sir William Berkeley. The Rebellion was also called, â€Å" the first protest against royal authority in America.† Sir William Berkeley was the second cousin of Bacon. Not wanting for the relations with the Indians to deteriorate, Berkeley did not thirst for an all out war in order to control the growing Indian crisis. He believed that the Indians should be punished for killing the settlers and wreaking havoc on their lives, however, not in the magnitude that Bacon had ... ...ution-an HTML Project. Accessed on 7 October 2000. Available at http://odur.let.rug.n1/~usa/D/1651-1700/bacon_rebel/berke.htm Mooy, Age. â€Å"Bacon’s Declaration in the Name of the People (30 July 1676)†, The American Revolution-an HTML Project. Accessed on 7 October 2000. Available at http://odur.let.rug.n1/~us/D/1651-1700/bacon_rebel/bacon.htm Washburn, Wilcomb E. The Governor and The Rebel: A History of Bacon’s Rebellion in Virginia. North Carolina: The University of North Carolina Press, 1957. Webb, Stephen Saunders. 1676: The End of American Independence. New York: Alfred A. Knopf Inc., 1984. Wertenbaker, Thomas Jefferson. Torchbearer of the Revolution: The Story of Bacon’s Rebellion and its Leader. New Jersey: Princeton University Press, 1940. William & Mary College Historical Magazine. Vol. 9, Issue I. (July, 1900) Bacon's Rebellion Essay -- American History Nathaniel Bacon Papers Bacon's Rebellion Sometimes there comes an event in American History in which no one knows exactly why it happened. What the motives of the event were are left to the interpretation of the historian doing the research. Bacon’s Rebellion in 1676 was on such event. Wilcomb E. Washburn’s view is precise when he states, â€Å" Bacon’s Rebellion. . .was an event on which observers could agree on the facts, but divide on the interpretation.† Historians have been picking into peoples’ accounts and versions of the legend for over 3 centuries, but never coming to a common conclusion. One fact is for sure and that is that the rebellion, known as Bacon’s, was what was going to pave the way towards Revolution of British Authority. In this paper I will look at one aspect that I feel was the motivation behind one individual's defiance to authority and the need to take matters regarding Indian relations into his own hands. Bacon was the kind of person to take what he thought was right into his own hands, even if it meant that he was breaking the law. In his eyes he was doing right and if he did not have the official support, he was going to do it anyway. On the other side was the feeble and zealous Governor of Virginia, Sir William Berkeley. The Rebellion was also called, â€Å" the first protest against royal authority in America.† Sir William Berkeley was the second cousin of Bacon. Not wanting for the relations with the Indians to deteriorate, Berkeley did not thirst for an all out war in order to control the growing Indian crisis. He believed that the Indians should be punished for killing the settlers and wreaking havoc on their lives, however, not in the magnitude that Bacon had ... ...ution-an HTML Project. Accessed on 7 October 2000. Available at http://odur.let.rug.n1/~usa/D/1651-1700/bacon_rebel/berke.htm Mooy, Age. â€Å"Bacon’s Declaration in the Name of the People (30 July 1676)†, The American Revolution-an HTML Project. Accessed on 7 October 2000. Available at http://odur.let.rug.n1/~us/D/1651-1700/bacon_rebel/bacon.htm Washburn, Wilcomb E. The Governor and The Rebel: A History of Bacon’s Rebellion in Virginia. North Carolina: The University of North Carolina Press, 1957. Webb, Stephen Saunders. 1676: The End of American Independence. New York: Alfred A. Knopf Inc., 1984. Wertenbaker, Thomas Jefferson. Torchbearer of the Revolution: The Story of Bacon’s Rebellion and its Leader. New Jersey: Princeton University Press, 1940. William & Mary College Historical Magazine. Vol. 9, Issue I. (July, 1900)

Edgar Allan Poe :: essays research papers fc

Father of Mystery Literature is something that has been changing and developing for centuries. Without the writers of the past, who were creatively expressing themselves, literature would not be what it is today. Emily Dickinson, William Wordsworth, and T.S. Elliot are just a few authors who contributed to these developments. Perhaps one of the most influential was Edgar Allan Poe. Edgar Allan Poe’s life was not an easy one, which explains why poetry was so dark and disturbing. Poe’s father abandoned him when he was a baby, and his mother died of tuberculosis when he was only three years old. He was adopted by a couple named John and Frances Allan. Frances was very loving toward Poe, but sadly died of tuberculosis just before he went to college. Poe attended the University of Virginia, but then dropped out and enrolled at West Point. He was soon expelled and then began a life of drinking and gambling. Poe gained some credibility from his poems, stories, and book reviewing, but he never earned very much money. When Poe was 27 he then married his 13 year old cousin, only to watch her die of tuberculosis just like his mother and Frances Allan. Poe died three years later; he only lived to be 40 years old. During Poe’s short life he wrote nearly seventy short works of fiction. He is duly credited with creating the detective story genre, and with transforming the Gothic mystery tale of the Romantic Period into the modern horror or murder stories. But he also wrote several comic and satirical pieces, literary parodies, sketches, and experimental stories, including "A Descent into the Maelstrom," and The Narrative of Arthur Gordon Pym. His most famous poems, "The Raven," "Ulalume," "The Bells," "The City in the Sea", were enormously influential. A huge wave of enthusiasm and influence is what inspired Poe to write these famous poems. Most of his inspirations came from other writers of Europe during his lifetime. However, Poe also wrote three volumes of poetry during the first period of his literary career. The short story is something that Edgar Allan Poe deserves more credit for than any other writer. Poe transformed the short story into art. He helped establish the short story by using existing and innovative elements. By doing this he revolutionized short literature, practically created the detective story, and perfected the psychological thriller. When writing short stories, Poe believed that the author had to visualize the effect that they wanted to achieve.

Real Estate Reservation System Essay

And helps to easily check the availability status of various properties. The assence of system is really important to be realized by each and every business. Giving importance to it makes a big difference of somehow uplifting of improving the process of the company. Floyd and Allen (2008), In recent years, many economists have recognized that the lack of effective real estate laws can be a significant barrier to investigate in many developing countries. In most societies, rich and poor, a significant fraction of the total wealth is in the form of land and buildings. Real Estate is a piece of land, including the air above, the ground below, and any buildings of structures on it. Real Estate can include business and or residential properties and are generally sold either by a relator or directly by individual who owns property. In the Philippines, one of the growing businesses is Real Estate development. Aside from the development and rising of tall buildings and establishment in the metropolitan area, nearby provinces are now on the stage of land development with its continuous expansion in the provinces such as, Laguna, Cavite, Rizal, Bulacan, Pampanga and Batangas. Some people may benefits from knowing about Real Estate when faced with personal and business decisions relating to housing, investment and other business activities. The researchers chose this topic because it will help the Employed Citizen of †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦City to know the effectiveness of Online Reservation System. Theoretical/Conceptual Framework Roosevelt (2008), Every person who invests in well-selected real estate in a growing section of a prosperous community adopts the surest and safest method of becoming independent, for real estate is the basis of wealth. The researchers chose the paradigm thru Floyd and Allen (2008) words that coordinated with the problems of this study. In order to understand the flow of the study, the researchers prepared a research paradigm. Employed Citizen of †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. City Hall Yr. 2012-2013 Effectiveness Accessibility Availability Uses Investment Housing Business Activities Fig 1. Research Paradigm The purpose of this is to illustrate the effectiveness of Online Reservation System in the Employed Citizen of †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. City Hall. Statement of the Problem This study was aimed to evaluate the effectiveness of Online Reservation System to the Real Estate Company, especially this study is sought to answer the following questions. 1. What are the uses of Real Estate Online Reservation System in terms of: 1. 1 Investment; 1. 2 Housing; 1. 3 Business activities? 2. Does the effectiveness of the study corresponds with the following: 2. 1 Accessibility; 2. 2 Availability? 3. Is there an effectiveness in using Online Reservation system the Employed Citizen of †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. City Hall? Hypothesis

Society with Soul

A Society with Soul â€Å"As the soil, however rich it may be, cannot be productive without cultivation, so the mind without culture can never produce good fruit. † This quote by Seneca, a Roman philosopher, says that nothing good can ever come out of the absence of culture. Throughout history, many have argued that a society stripped of its culture is a society stripped of its soul. In the novel Things Fall Apart, the Ibo people are completely taken of their culture by the white colonialists.Despite a growing pattern of submission to new culture within the tribe, the people never truly lost their soul. The Ibo tribe was invaded by outsiders, their culture threatened with accusations on their way of life, worship, and customs, practically being forced into submission. The Ibo people may have been entirely stripped of their culture, but definitely not of their soul. Due to the colonialists attempting to assimilate the Ibo people, the tribe lost their culture but not the essence of who they are, allowing them to triumph against all odds.The white people pushed to assimilate the Africans, especially in their religion, ultimately tearing families apart and disconnecting the tribe. Obierika even says, â€Å"The white man is very clever. He came quietly and peaceably with his religion. We were amused at his foolishness and allowed him to stay. Now he has won our brothers, and our clan can no longer act like one. He has put a knife on things that held us together and we have fallen apart,† (Achebe 152). As the British colonized the Ibo tribes in Africa, they brought with them their new religion of Christianity.At first these new beliefs were not accepted by the Ibo people, but quickly became a major threat to their old way of life. The appeal of wealth and the flow of money into their village from British traders, in combination with support for the colonialists’ new government and judicial system, eventually attracted many Ibos to convert to Chri stianity. Ibo society was torn in half, with some being lured in by the British, and others staying faithful to traditional Ibo customs.In addition, by the white missionaries seeking to convert children into their religion, there was no one to carry on the tribe’s traditions, resulting in the falling apart of the tribal system. The attempts of the colonialists to assimilate the Africans in religion caused families and the tribe to be divided. Despite these challenges, the tribe did not lose the essence of who they are and stayed true to a lot of the beliefs of their culture. The Ibo people were stripped of their culture by the colonialists, but they never lost their soul.Amidst the invasion of the white people, the Africans still found ways to maintain their beliefs and the essence of who they were. When Okoli killed the sacred python, he clearly went against traditional Ibo customs, but at the same time, he inadvertently reinforced Ibo customs. The Ibo people always look bac k to their culture for guidance and believe in it regardless of outside threats. Because it is all they have ever known, the tribe maintains their peaceful ways by deciding not to drive the Christians out with acts of violence, but rather, by ostracizing them.Soon afterwards, Okoli dies of an illness, which reaffirms the tribe’s trust in their gods. â€Å"His death showed that the gods were still able to fight their own battles,† (Achebe 141) and would rightfully punish those who went against them. It made the tribe realize that the gods were still with them, causing them to repeal the new policy of ostracism towards the converts. Furthermore, n the end, the colonialists may have ultimately drove Okonkwo to kill himself, forcing him to go against his culture, but in doing so, Okonkwo also reminded the tribe of their culture.In taking his own life, he reasserted Ibo beliefs, one of the tribesman even saying, â€Å"It is against our custom,† (Achebe 178) when aske d by the District Commissioner why the tribe could not take Okonkwo down from the tree. The tribesman went on to say, â€Å"It is an abomination for a man to take his own life,† (Achebe 78). In spite of threats to their way of life and a growing disconnection of their tribe, the Ibos remained true to their culture no matter what. In conclusion, the Ibo people never lost what made them who they were despite challenges presented by the British colonialists.The white people’s attempt to assimilate Africans to the Christian faith resulted in the tearing apart of families, the disconnection of the tribe, and subsequently, the loss of the entire Ibo culture. Notwithstanding, the Ibo people did not lose their soul, or the essence of who they are. Regardless of accusations on their way of life and mounted submission to new culture, the Ibo people were undeterred by the threat of invaders. The Ibo tribe was a society entirely stripped of their culture that made it out on the ot her side not stripped of their soul.

Bullying and Marsh Et Al Essay

Everyday thousand of teens wake up terrified of attending school. About one in seven schools, a child is either a bully or a victim of bullying. Bullying is simply defined as a type of aggressive behavior that involves intent to cause harm and a power imbalance (Olweus, 1999). Bullying can range anywhere from psychological, physical (involving kicking and punching), verbal or cyber abuse. Bullying among children can be considered as a form of abuse’ (0-). It has been put forward that bullying is a division of aggressive behavior and has been further characterized as repetitive and ‘an inability on behalf of the victim to defend him or herself’ (Farrington, 1993, cited it Sapouna, 2008). We learn from Sapouna (2008) that bullying can take the form of ‘verbal (name calling), physical (hitting, kicking) or relational (deliberate exclusion from a group, spreading of malicious rumors). After extensive research in Scandinavia, Olweus(1993, cited in Kumpulainen et al.,1998) proposed that bullying can be carried out by one or more adolescents and usually occurs on repeated occasions, and to some extent, it occurs in all schools. Recently bullying amongst young people has gain notoriety in the press due to the extreme results it has had on certain young individuals. An example of this is Sian Yates, a 13 year old girl who committed suicide after repeated bullying (Daily Mail, 2007). Despite the press attention given to these cases, the extreme consequence of suicide does not occur in the majority of cases. Victims can suffer from a range of harmful effects such as humiliation, anxiety, depression, difficulty with interpersonal relationships, and emotional instability. This lead to the finding of Kumpulainen et al., (1998) that ‘bullying is a common phenomenon among children who are psychologically disturbed.’ The writer went on to say that there are ‘higher rates of psychological distress among both bullies and victims’ than those not involve. However, the literature is consistent in noting that the ‘bullied victims are the most troubled of the bully, victim, bully –vict im triad’ (Juvonen et al., 2003; Ma, 2001; Pellegrini, 2002; Pellegrini et al., 1999;Salmivalli & Nieminen, 2002, cited in Cunningham, 2007). Should these lead agencies to focus more on protecting the victim? Some schools have decided that the way forward is to have zero tolerance policies. This may include all students who bully. However, if certain researcher’s numbers are correct it could mean excluding from school, forty percent of the school aged population. Given the widespread nature of the problem can zero tolerance really mean, â€Å"Zero tolerance†? We learn from the NHS ‘website teens for health’ (2008) that ‘anyone can be singled out by bullies.’ The NSPCC found that 31 per cent of children had been bullied at some point (Teens for health, 2008). This being the case, can anyone be bullied? Black and Jackson (2007) have put forward that there lies and ‘an imbalance of power’ between the parties involved in bullying. ‘The bully is stronger through social status, physical prowess, age, cognitive abilities or skill.’ Is this imbalance of power the sa me across the genders? There is an extensive body of literature that suggests that boys are more likely than girls to be bullies as well as victims (Nansel et al.2001; Boulton & Smith, 1994; Boulton & Underwood, 1992, cited in Marsh, Parada, Craven, &Finger, 2004). This doesn’t mean girls cannot be bullies. Stephenson and Smith (1989, cited in Kumpulainen et al., 1998) found that girls as well as boys fitted into the ‘five main groups of people involved in bullying’. These are: ‘dominating bullies, anxious bullies, bully-victims, classical victims, and provocative victims.’ These traits were also found by Sourander,Helstelà ¤, Helenius and Piha (2000) to have clinical implications. Sourander et al., (2000) noted that ‘Bullying is especially associated with aggressive and antisocial behavior while victimization is associated with internalizing problems.’ Whitney and Smith, (1989, cited in Kumpulainen et al., 1998) found ‘bullies to be more prone to have criminal convictions later in life, and more likely to be involved in serious, recidivist crime’. Are criminal convections later in life a fair punishment for their actions? Or should something be done to help the bully? This leads to the question as what is the nature of these young people that make them prone to being a victim or a bully. In the search for a personality construct, many researchers have come to the agreement that ‘bullies are deficient in social information processing or may be intellectually disadvantaged’ (Besag, 1989, cited in Marsh et al., 2004). The work of Crick and Dodge (1994, cited in Marsh et al., 2004) explained that bullies responses to social situations are being met with a filtration process. This ‘cognitive filter’ is based on an aggressive individual interpreting neutral or ambiguous cues as hostile and therefore, making them more likely to engage in aggressive behaviors’ (Marsh et al., 2004). This was also seen to be the case in Bosworth, Espelage, and Simon (1999, cited in Marsh et al., 2004) when ‘a sample of adolescent high school students showed that misconduct, anger, and beliefs supportive of violence were significantly related to bullying behaviors’. Although bullying is an aggressive act, this does not imply that bullies and aggressive or conduct-disordered individuals are a homogenous group. Sutton et al (1999, cited in Marsh, 2004) put forward that bullies were part of a complex environment where they are require to ‘negotiate and attribute mental states to themselves and others to explain or predict their behavior.’ This idea contravenes the notion that ‘bullies are cognitively inept or simple in their inte ractions with peers’ (Sutton et al 1999, cited in Marsh, 2004). References â€Å"Bullying†. Violence Prevention. 1 Dec. 2012 http://www.violencepreventionworks.org/public/olweus_history.page Dawkins, J. L. (1996). Bullying, physical disability and the pediatric patient. Developmental Medicine and Child Neurology, 38 603-612. Espelage, D. L., Holt M. K., & Henkel, R. R. (2003). Examination of peer group contextuals effects on aggressive behavior during early adolescence. Child development, 74, 205-220. Pelligrini, A. D. (2002) Bullying and victimization in schools: A Dominance relations perspective . Educational Psychologist, 37, 151-163.

Alzheimer’s Essay

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear after age 60. Alzheimer’s disease is the most common cause of dementia among older people. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities, to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living. What are the stages of Alzheimer’s? There are five stages associated with Alzheimer’s disease: preclinical Alzheimer’s disease, mild cognitive impairment, mild dementia due to Alzheimer’s, moderate dementia due to Alzheimer’s and severe dementia due to Alzheimer’s. 1.Preclinical Alzheimer’s disease Alzheimer’s disease begins long before any symptoms become apparent. This stage is called preclinical Alzheimer’s disease. You won’t notice symptoms during this stage, nor will those around you. This stage of Alzheimer’s can last for years, possibly even decades. Although you won’t notice any changes, new imaging technologies can now identify deposits of a substance called amyloid beta that have been associated with Alzheimer’s disease. The ability to identify these early deposits may be especially important as new treatments are developed for Alzheimer’s disease. 2.Mild cognitive impairment (MCI) due to Alzheimer’s disease People with mild cognitive impairment have mild changes in their memory and thinking ability. These changes aren’t significant enough to affect work or relationships yet. People with MCI may have memory lapses when it comes to information that is usually easily remembered, such as conversations, recent events or appointments. People with MCI may also have trouble judging the amount of time needed for a task, or they may have difficulty correctly judging the number or sequence of steps needed to complete a task. The ability to make  sound decisions can become harder for people with MCI. Not everyone with mild cognitive impairment has Alzheimer’s disease. In some cases, MCI is due to depression or a temporary medical complication. The same procedures used to identify preclinical Alzheimer’s disease can help determine whether MCI is due to Alzheimer’s disease or something else. 3.Mild dementia due to Alzheimer’s disease Alzheimer’s disease is often diagnosed in the mild dementia stage, when it becomes clear to family and doctors that a person is having significant trouble with memory and thinking. In the mild Alzheimer’s stage, people may experience: Memory loss for recent events. Individuals may have an especially hard time remembering newly learned information and repeatedly ask the same question. Difficulty with problem-solving, complex tasks and sound judgments. Planning a family event or balancing a checkbook may become overwhelming. Many people experience lapses in judgment, such as when making financial decisions. Changes in personality. People may become subdued or withdrawn — especially in socially challenging situations — or show uncharacteristic irritability or anger. Decreased attention span and reduced motivation to complete tasks also are common. Difficulty organizing and expressing thoughts. Finding the right words to describe objects or clearly express ideas becomes increasingly challenging. Getting lost or misplacing belongings. Individuals have increasing trouble finding their way around, even in familiar places. It’s also common to lose or misplace things, including valuable items. 4.Moderate dementia due to Alzheimer’s disease During the moderate stage of Alzheimer’s, people grow more confused and forgetful and begin to need help with daily activities and self-care. People with moderate Alzheimer’s disease may: Show increasingly poor judgment and deepening confusion. Individuals lose track of where they are, the day of the week or the season. They often lose the ability to recognize their own belongings and may inadvertently take things that don’t belong to them. They may confuse family members or close friends with one another, or mistake strangers for family. They often  wander, possibly in search of surroundings that feel more familiar and â€Å"right.† These difficulties make it unsafe to leave those in the moderate Alzheimer’s stage on their own. Experience even greater memory loss. People may forget details of their personal history, such as their address or phone number, or where they attended school. They repeat favorite stories or make up stories to fill gaps in memory. Need help with some daily activities. Assistance may be required with choosing proper clothing for the occasion or the weather and with bathing, grooming, using the bathroom and other self-car e. Some individuals occasionally lose control of their urine or bowel movements. Undergo significant changes in personality and behavior. It’s not unusual for people with moderate Alzheimer’s to develop unfounded suspicions — for example, to become convinced that friends, family or professional caregivers are stealing from them or that a spouse is having an affair. Others may see or hear things that aren’t really there. Individuals often grow restless or agitated, especially late in the day. People may have outbursts of aggressive physical behavior. 5.Severe dementia due to Alzheimer’s disease In the severe (late) stage of Alzheimer’s, mental function continues to decline and the disease has a growing impact on movement and physical capabilities. In severe Alzheimer’s, people generally: Lose the ability to communicate coherently. An individual can no longer converse or speak coherently, although he or she may occasionally say words or phrases. Require daily assistance with personal care. This includes total assistance with eating, dressing, using the bathroom and all other daily self-care tasks. Experience a decline in physical abilities. A person may become unable to walk without assistance, then unable to sit or hold up his or her head without support. Muscles may become rigid and reflexes abnormal. Eventually, a person loses the ability to swallow and to control bladder and bowel functions. Treatment: Alzheimer’s disease is complex, and it is unlikely that any one intervention will be found to delay, prevent, or cure it. That’s why current approaches in treatment and research focus on several different aspects, including  helping people maintain mental function, managing behavioral symptoms, and slowing or delaying the symptoms of disease. Maintaining mental function Four medications are approved by the U.S. Food and Drug Administration to treat Alzheimer’s. They may help maintain thinking, memory, and speaking skills, and help with certain behavioral problems. However, these drugs don’t change the underlying disease process, are effective for some but not all people, and may help only for a limited time. Managing Behavioral Symptoms Common behavioral symptoms of Alzheimer’s include sleeplessness, agitation, wandering, anxiety, anger, and depression. Scientists are learning why these symptoms occur and are studying new treatments—drug and non-drug—to manage them. Treating behavioral symptoms often makes people with Alzheimer’s more comfortable and makes their care easier for caregivers. Slowing, Delaying, or Preventing Alzheimer’s Disease Alzheimer’s disease research has developed to a point where scientists can look beyond treating symptoms to think about addressing underlying disease processes. In ongoing clinical trials, scientists are looking at many possible interventions, such as immunization therapy, cognitive training, physical activity, antioxidants, and the effects of cardiovascular and diabetes treatments. Alzheimer’s References http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-stages/art-20048448?pg=1 https://www.alz.org/what-is-dementia.asp http://umm.edu/health/medical/reports/articles/alzheimers-disease

Policies to Enhance the Safety Measures Essay Example | Topics and Well Written Essays - 3000 words

Policies to Enhance the Safety Measures - Essay Example The health and social care organisations are often exposed to major health related risks. It is obvious that a workplace should possess its own set of schedules and norms to maintain standard health and safety practices for the service providers. Since, the health and the social workers work in a dynamic and hazardous environment, which is exposed to severe risk, the requirement for safety is at the maximum for these workers (Health and Social Care Board, 2011). Health & Safety measures adopted in health and social care workplace represents that the people working in hazardous situations are protected with negative or adverse consequences. The practitioners providing services are most exposed to the risks rising at the social as well as healthcare centres. It is worth mentioning that effective communication of information about such policies is one of the important practices, which has the potentiality to ensure greater health along with safety of the individuals working in a particu lar workplace. Again, in order to maintain safety at workplace, it should be mandatory for all the employees to follow the legislative regulations laid down by their respective companies to form as well as develop a secured environment (Health and Social Care Board, 2011).. In order to develop the health and safety measures in the healthcare organisations, the Director of such organisations must pass a mandate with written norms of health and safety measures, which need to be followed for enhancing safety at workplace. To maintain greater health and safety at the workplace, the Director should follow the systems and the procedures that entail implementing policies within his directorate, disseminating those within the staff by explaining the area of responsibility and including new staff as a part of induction plan. In order to enhance the overall performance, the policies would also incorporate the measures like providing leadership.

The difference in vegetation density in burnt and unburnt Assignment

The difference in vegetation density in burnt and unburnt - Assignment Example In this case, the mean ranks were compared but not the medians. The above table indicate the group with the highest density of plantation, overall; the group with the highest rank. In this regard, the un-burnt area is observed to have the highest density of plantation Basing on the data above, it can be concluded that plantation density in the un-burnt area was not statistically significantly higher than the burnt area(U=2,p=0.4).This implies that further studies need to be done to determine the repeatability of the results in order to confirm if the results are valid. According to literature it is clearly evident that frequent fires might have an impact on the young plants including higher size class (Trollope et al., 1998). The frequency of fire usually determines the length of time the plant is required to recover before the next fire occurs. The slower the rate of recovery, the more likely it is that the composition and structure of the vegetation will be changed, specifically where fires occurs often. Trollope W.S.W., Trollope L.A., Biggs H.C., Piennar D. and Potgieter A.L.F Longterm changes in the woody vegetation of the Kruger National Park, with special reference to the effects of elephants and fire, Koedoe, 41, pp103112.

MANAGEMENT APPLICATIONS Essay Example | Topics and Well Written Essays - 2500 words

MANAGEMENT APPLICATIONS - Essay Example It does not opt for any visual advertisement – print or media. Its organization structure is divisional in nature and it pays due attention to the environmental security and safety of its employees and non- employees. It is recommended that the company should pay more attention to advertising. It should launch itself into billboard and newspaper advertising which are cheaper and efficient ways of advertising to create brand recall. It should also make use of its website to spread the word of mouth. A major limitation of this project is the unavailability of the financial data. Inspite of repeated attempts to procure the data from the organization, the authors of this report were unable to fetch any data beyond 2004-2005. The report aims at highlighting particulars of the company with respect to its marketing, operations, finance and environmental aspects. It encompasses the background/history of the company, its present activities and its future business plans. Stone & Ceramic Ltd is involved in the design, fabrication, supply, installation & maintenance of natural stones, porcelain, mosaic, ceramic tiles & slab format. It has supplied its products and services in various business sectors such as transportation, hotels, residential, commercial, government, leisure, refurbishment and retail. Its exposure to various sectors speaks for its vast range of products/services. Their ‘objective is to develop into a Specialist dual trade, (Stonework & Tiling) Contractor that operates in the mid to high sector market for Primary repeat Clients’ ( Stone & Ceramic Ltd., 2009) To achieve its stated objectives, the company strives to make its contracts comprehensive enough to convey the range of services offered and maintain an acceptable clear price for the works in the contracts. It makes efforts to honour the contracts as per the agreed quality and time. The company believes that the contracts should reflect

Research proposal Essay Example | Topics and Well Written Essays - 2000 words - 2

Research proposal - Essay Example 1-14, 2007) are offering online banking services and online trading services to their customers and consumers around the globe. In addition, various financial institutions are involved in including new technological updates in their systems that is enabling them to provide efficient services to their customers. In the result, reports (Mannan, pp. 1-14, 2007) indicate enormous increment in the number of users of online banking services that show alteration in the consumer behavior, and thus, banking institutions are continuing their updates, and at the same time, endeavoring to ensure security and safety of customer’s money. In other words, one can converse from such analysis (Azari, pp. 55-60, 2003) that information technology has completely altered the notion of banking and trading in an obvious manner due to inclusion of automation in almost every process that has made lives easier. However, still, in midst of such extensive amount of technologies, experts and researchers (Yap, pp. 440-445, 2006) believe that financial institutions are still incapable of providing 100% security to their customers. Even marketing brochures and advertisement materials indicate high-level security; however, studies (Oyungerel, pp. 39-56, 2008) have indicated that even financial institutions are thems elves not sure about their claim in the advertisements. In addition, a number of reports (Mannan, pp .1-14, 2007) have shown cases of identity theft, credit card theft, bank account thefts, etc that indicates the vulnerability of online banking or online trading services. Although various experts (Mohay, pp. 23-39, 2003) have appreciated the impact of technological advancements in the form of online banking; however, scrutiny of resources has identified a number of reports (O’Gara, pp. 59-64, 2004) that have recognised vulnerable nature of online