Response Essay Example | Topics and Well Written Essays - 250 words - 28

Response - Essay Example Amusing enough there has never been a record of a buffalo infecting cattle with brucellosis. Webster is concerned about the animals where she lives. This is the reason she is against individuals building their big houses where the animals live. She says,† The home builders are as large a danger to wildlife just as hunters are." She is not concerned as much with homebuilders that construct what they require for their family; rather she is more concerned with homebuilders who are overbuilding. Even when they are educated concerning what they are doing, the homebuilders keep wrecking the animals habitat. Other than teaching the home builders, the main other move activists can make is by asking the administration to establishing moratorium on building permits. She requests Americans to wind up more dependable with their activities and asks Americans to change their dialect. Webster believes that Americans substitute the words "harvest" with "slaughter" and "environment" with "home, they will embrace the habit of conserving the environment for the wild animals instead of harming them and exploiting their habitat. in response to The Fashion Punk Paradox by Andrew Hyde, the author tries to portray the real picture in the united states in the course of the instabilities of the time. The united state had experiences enormous and dangerous activities in fight for mutual understanding. Responding to the book, "Warfare Is Only an Invention-Not a Biological Necessity by Margaret Mead." The author discharged the conception that war is the inevitable consequence of â€Å"basic, competitive, aggressive, warring human nature." Her theory is challenged, she illustrated, by the plain fact that not all societies wage war. For instance, she utters that war has never been experimental among a Himalayan people called the Lepchas or the Eskimos. Actuality, neither of these groups, when questioned by early ethnographers, was

P&G Essay Example | Topics and Well Written Essays - 1750 words

P&G - Essay Example It is equally important, if not more so, that innovation is cost-effective, aligned with consumer demands and addresses a perceived gap in the market. In other words, not only is the strategy for corporate survival continued product development and innovation, but the cost-effective development of innovative products which market research indicates will attract the consumer market. Proctor and Gamble has resolved the seemingly complex equation of cost-effective continued product development and equation through its "connect and develop" strategy. Indeed, P&G's approach to product development and innovation has the potential to serve as a critically valuable lesson to corporations across the world. The hurdles to new product development are cost and innovation. As Huston and Sakkab (2006, p. 60) write, "Most companies are still clinging to what we call the invention model, centered on a bricks-and-mortar R&D infrastructure and the idea that their innovation must principally reside within their own four walls." Confining product development to the company and to individuals working in the company often means that development will be a costly and time-consuming process. The reason, as Huston and Sakkab (2006) illustrate through reference to a case study, is that when a company begins the R&D process with an idea for a new product or an innovation to an existing product, it may not have the technology to translate the idea into a reality. The company's in-house Research and Development team will then have to experiment with several technologies to bring the idea to life and, of course, may and may not succeed. Even if they succeed, success comes at high financial cost. Furthermor e, as Brown and Eisenhardt (1995) argue, because the process is often a length one, there is always the risk that a competitor may beat them to the market with the technology and product. In this case, the return on the new product research and development investment may not be realized. Hence, a financial risk factor enters into the equation. Proctor and Gamble stumbled across a high radical approach for new product development and innovation when it found itself confronting numerous technological obstacles to the manufacturing of their innovative Pringle line of imprinted chips. Initially relying on in-house talent for the development of the required technology, Proctor and Gamble soon found the process excessively costly, unrealistic and unfeasible in terms of implementation. It was at this point that P&G decided to look outside its walls for a solution and, with that in mind, developed and circulated a technology brief which outlined the problem. The response was positive and the company was approach by a baker in Italy who had already developed the technology in question. Proctor and gamble obtained the rights to the use of the technology, developed it to suit their specific needs and were, as a result, able to successfully produce their new line of Pringle chips at a fraction of the cost they would have otherwise run into. Huston and Sakkab (2006) concede to the fact that the approach adopted by Procter and Gamble is a radical one. As new product development, inclusive of research and development, often functions as a firm's competitive edge, corporations generally tend to prefer to keep all research, development and product

Taking a Stance on Capital Punishment Essay Example for Free

Taking a Stance on Capital Punishment Essay Who are we to decide who should live and who should die? Who are we to decide that the punishment should not fit the crime? Who are we to consider mercy for the merciless? These are just a few questions I would love to be able to ask someone like Carrie Marie Scott, Janna Bruce, or Sheila Whalen but I can not, they all were murdered by Stephen Peter Morin. Stephen was one of the â€Å"botched† executions by lethal injection. It took the technicians almost 45 minutes to find a suitable vein to administer the sentence. I wonder how long it took his three victims to die as he raped and tortured them in a van he sound proofed. As for the time he suffered on the table getting needles stuck in him, I hope it does not happen to anyone that did not torture and kill three innocent people. Where is the humanity for the victims? Then there is the botched execution of John Wayne Gacy. This man tortured and killed over 25 people after his first conviction of child molestation in 1968; yet it is inhumane that his execution took 18 minutes longer to complete than normal because of a clogged IV tube? Perhaps we should ask the family of his victims if it took longer than 18 minutes for them to get over the death of their loved ones. Where is the humanity for the victims? What of the Hodges family? Richard Hodges and his 75 year old mother Mildred were both murdered by suffocation by Bert Leroy Hunter and Tomas Ervin. On December 15th, 1988; Hunter and Ervin broke into the Hodges’ family home at gun point to rob them. The Hodges’ were bound with duct tape and had plastic bags put over their heads causing them to suffocate. Death by suffocation can take upwards of eight minutes to happen; try holding your breath for a minute and you will realize the agony of this death. When hunter was executed his body convulsed violently; but this is the inhumane aspect of this entire ordeal. I feel that I would be cheating the family if I did not mention that this crime was committed after Hunter got out of jail for his first conviction of murder and in jail is where he met his accomplice Ervin. Where is the humanity for the victims? What is a lethal injection? It is a very basic process where Sodium Thiopental is used to put the person to sleep, then Pancuronium is administered to paralyze the muscles, and Potassium Chloride is used to stop the heart; if this is not given the person would die of asphyxiation from the Pancuronium. The person has an IV in both arms although one is only used as a backup in case the main fails. The person on the execution table will always have one right that he or she did not allow their victim to have; the right to die with their dignity. When you look at the very basic facts of this, that no one should take a life; everything is very simple. When people say that â€Å"this poor person died on the execution table in a horrible way;† it is really easy to take a stance and say that it is wrong. The problem is that this is a heavily flawed perspective based on initial reactions without digging further and finding the details about how the ended up on that execution table in the first place. It all comes down to protecting the ones we are supposed to protect; the people who do NOT break the law and their rights have far been overlooked for rights of the ones who victimized them. So you ask for a stance and I will take one: Killing people is wrong, but the people who have killed people should not have a voice in their treatment of way they die; their victims did not. I support lethal injection and capital punishment. So long as people are willing to kill other people in cold blood; I am willing to see them off to their demise and not stand in the way.

Personal Reflection on Learning Outcomes of Professional Practice

Personal Reflection on Learning Outcomes of Professional Practice In order to reflect upon my learning throughout this module, I will identify and critically discuss three Module Learning outcomes that reflect the range of possible issues of the Nursing and Midwifery Council (NMC) Proficiencies (2004). I will then identify appropriate literature and reflect on my learning and experience. This will enable me to identify personal strengths and areas for further development. The first learning outcome is: Recognise the importance of reflective practice and understand the process of reflection. The second outcome chosen is: Discuss the difference between data and information?. The third outcome is: Demonstrate appropriate non-verbal and verbal skills, including the use of silence, open and closed questions and summarising, to gather information. *Please note that the names of the patients mentioned in this essay have been changed in order to protect their identity for confidentiality reasons. 1 Recognise the importance of reflective practice and understand the process of reflection This outcome relates to the NMC Proficiency of Demonstrate the responsibility for ones own learning through the development of a Record of Achievement of practice and recognise when further learning is required. Reflection is a new method of learning for me. With regard to nursing, the term reflection and reflective practice has been defined by many academics, resulting in various models and theories being developed. The Oxford Mini-dictionary for Nurses (2008) describes reflection as the careful consideration of personal actions, including the ability to review, analyse and evaluate situations during or after events. It is an essential part of the learning process that will result in new methods of approaching and understanding nursing practice. Johns (2000) defines reflection as a window through which the practitioner can view and focus self within the context of his/her own lived experience in ways that enable him/her to confront, understand and work towards resolving the contradictions within his/her practice between what is desirable and actual practice. Schon (1983) proposed that reflection occurs on action or in action. The first occurs after the incident whereas the latter occurs during the incident and is said to be the hallmark of the experienced professional (Somerville Keeling, 2004). The more traditional theories and models base reflection on critical incidents. Love (1996) states that a critical incident does not have to be negative or dramatic but should provide deep thought and raise a professional issue. Gibbs (1988) developed The Reflective Cycle. The model divides the reflective process into sections; Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan (see Appendix 1). Johns (2000) developed a Model of Structured Reflection (MSR) (see Appendix 2) As with Gibbs (1988) Reflective Cycle, the MSR uses a series of questions to guide an individual through the reflective process. Johns model is based on five cue questions; Description, Reflection, Influencing Factors, Could I have dealt with it better? and Learning. The volume of studies and models on reflection demonstrates the value that is placed on this tool. Newell (1992) described the process of reflection to be a cornerstone of nursing professionalism. Gustafsson and Fagerberg (2004) support the notion that reflection is a vital tool and advantageous in terms of the improvement of a nurses professional development and patient care. Many consider journal writing to be an effective reflection strategy (Johns 2000; Paterson, 1995; Cameron Mitchell, 1993; Lauterbach Becker, 1996). Journal writing is considered to offer writers the opportunity to become participants/observers of their own learning, to describe a significant experience and to reflect on that experience to see what they can learn from having had it (Weisberg and Duffin, 1995). While in clinical practice, I have written a journal of my experiences. I recognise its value to aid reflection as I feel that the act of writing things down is important. This is supported by Somerville and Keeling (2004). To demonstrate my understanding of reflective practice, I will now reflect on an incident that occurred while on placement when I was feeding a patient, named Tom*. I will utilise Gibbs (1988) model as this is my first experience of using reflection and feel that it is concise and appropriate at this stage. Tom had dementia and had recently suffered a stroke, which had left him confined to bed. As Tom had difficulty feeding himself, I offered to assist him; he smiled, agreed and appeared to recognise me. Halfway through the meal, Tom became agitated and asked if the food was mackerel. I told him that it was turkey. He shouted aggressively that he wanted mackerel and then became verbally abusive towards me. I was unable to calm him so I left the room with an assurance that I would be back soon. I then asked a senior nurse for help. This was the first time that I had fed a patient but felt comfortable. I knew Tom well and felt that I had built up a rapport with him. I was pleased that he seemed happy and relaxed. When he shouted I felt shocked, worried and conscious of other peoples reactions; they may think that I had done something wrong. Even though Tom was disabled he did have some use of one arm so I was afraid that he might become violent. I was upset that I had to stop feeding him and leave the room. When I left I felt relieved but also anxious that I may have contributed to the way Tom was feeling. When evaluating and analysing the incident, I was pleased initially with the way the task started as on admission he had a poor appetite. The negative side of the situation was that Tom became angry and didnt finish his meal. I realise that dementia is a complex progressive illness and there may be times when a patient experiences sudden mood changes. I believe that I would now do things differently if a similar situation arose. With hindsight, I questioned whether I should have just agreed with Tom that the turkey was mackerel then this incident may not have occurred. However, this raises ethical issues such as whether it can be acceptable to not tell the truth. A report published by the Nuffield Council on Bioethics (2009) discusses the ethics of dementia care and states that ethical dilemmas arise on a daily basis for all those providing care for people with dementia. Research suggests that challenging someone with dementia could be detrimental and cause unnecessary distress (Shellenberger, 2004). Naomi Feil developed validation therapy between 1963 and 1980 as a technique to communicate with patients with dementia by recognising and accepting their view of reality of people with dementia in order to provide them with empathy and respect (The Validation Training Institute, Inc). In the future I could use this technique; for exa mple, when Tom asked if it was mackerel he was eating I could have replied by asking him if he liked mackerel which would have avoided giving a direct answer. With regard to strengths and areas of development, I feel that I have reflected successfully on this incident. However I would like to strive to reflect in action as opposed to on action as this is the most effective. In terms of development, I believe that it would be beneficial to patients and myself to learn more about caring for patients with dementia. The Dementia UK Report (2007) published by The Alzheimers Society states that there are currently 700,000 people with dementia in the UK. The report also predicts that by 2025 there will be over 1 million people with dementia so it is inevitable that I will be caring for many dementia patients in my career. In summary, although the models of reflection span over 20 years and vary slightly, the principle of reflection is very similar, which implies that reflection is a robust tool and still applies to modern nursing. I have learnt that reflective practice is a vital tool, particularly when associated with journal writing. Continuous reflection will allow me to develop skills and knowledge to enable me to provide the best care possible for patients and their families. 2 Discuss the difference between data and information This learning outcome links to the NMC proficiency of Demonstrate literacy, numeracy and computer skills needed to record, enter, store, retrieve and organise data essential for care delivery. As a student Im not involved in using my computer skills on the ward but eventually will be involved in audit and data entry. My literacy and computer skills are demonstrated throughout my portfolio and assignment. I demonstrate my literacy and numeracy skills when writing patient evaluations, calculating fluid balance and assisting with drug calculations. There are many examples of data and information used within nursing care. Due to the broad nature of this area I have focused on a particular type of data and information to demonstrate my understanding of these terms. My focus is data collected from patients vital signs and the information that relates to this. I will demonstrate how the process of giving information to patients rather than just data is an essential part of nursing. Gathering, giving and recording both data and information accurately is vital. Data can be described as facts and statistics used for reference or analysis. The term information can be defined as the meaning applied to the data (Concise Oxford English Dictionary, 2008). Observation data collected from patients includes pulse rate and rhythm, blood pressure, respiration rate, temperature and oxygen saturate percentage. These measurements are taken on admission as it is important to gain base-line readings to which future readings can be compared. It is necessary to apply meaning to this data to form information to be able to judge a patients condition. Throughout the module I have learnt what data means in terms of acceptable values. As I now have the information about the data I can make judgments about data. For example, I now know that the information I can get from the blood pressure data of 160/110 mmHg is high (Blood Pressure Association). However, this information needs to be put into context to allow use of the information to make a judgement. For example, if a patient has just completed cardiovascular exercise, this may account for a high blood pressure reading. With this information, the plan would be to wait for 30 minutes before repeating to gain more accurate data. Readings can vary temporarily due to a number of reasons; for example, medication, an existing health condition, fluid intake, exercise and alcohol consumption. However, a change in blood pressure can indicate deterioration in condition, which alerts health care professionals to investigate. In order to show my understanding of the difference between data and information I will now give an example of an incident that occurred while on placement. During observations of a 70 year-old lady named Eileen*, I noticed that her systolic blood pressure had dropped from 127 to 90 mmHg. Her other observations remained consistent. I informed a senior nurse who asked a doctor to review the patient. I discussed her fluid intake with her as this could have had an adverse effect on her blood pressure. As she had only drank a small amount I encouraged her to drink more and continued monitoring. Eileens blood pressure eventually returned to her baseline. This example shows how data, such as blood pressure readings, prompts gathering information which, in turn, enables problem solving. As demonstrated, I need to have an understanding of the information gathered from the data but additionally I feel that it is important that patients understand what the data means. Bastable (2006) defined patient education as the process of assisting people to learn health related behaviours so that they can incorporate those behaviours into everyday life and achieve a goal of optimal health and independence in self care. I will now provide an example of my experience of patient education: During a blood pressure check on Paul*, who was hypertensive and took multiple medications, I asked him whether he would like to learn about blood pressures. He gladly agreed so I explained what the reading was and what can affect blood pressure. I explained that exercise, healthy eating, low salt intake and weight control would have a beneficial effect on his blood pressure. He was unaware of how his current lifestyle could have a detrimental effect on blood pressure and said that he now intended to make some lifestyle changes. Research supports my thoughts about the benefits of giving patients information about aspects of their health rather than just the data. Florence Nightingale, who has been described as the founder of modern nursing, recognised the importance of educating about adequate nutrition, personal hygiene and exercise in order to improve well-being (Bastable, 2006). The Department of Health (2009) states that giving people relevant, reliable information enables them to understand their health requirements and make the right choice for themselves and their families. (Bastable, 2008). Partridge and Hill (2000) found that patients who are well informed are better able to manage their health, have improved psychological outcomes, have fewer exacerbations of their condition and less hospital admissions. Glanville (2000) states that if clients cannot maintain or improve their health status when on their own, we have failed to help them reach their potential. Abbott (1998) reported that by involving patients in their state of health by keeping them informed has been proved to improve patient satisfaction and concordance. However, there is research to suggest that providing information may not result in a change in health outcomes (Kole, 1995; Sherer et al. 1998). They found these reasons to be that patients dont understand the information, are unable to absorb it due to pain, anxiety, or that they choose not to act upon it. Additionally, absorption of information is decreased when there is too much information; therefore health outcomes remain unchanged. The question is how much is too much information? This is difficult to determine. In terms of personal strengths, I felt very satisfied that I had initiated this conversation which resulted in Paul considering lifestyle changes. On reflection, this incident highlighted the importance of patient understanding and has encouraged me to take time to educate patients where possible. It has emphasised the need for continuous learning so that I am able to answer questions and educate patients. Additionally, I am aware of my limitations and when to seek advice or refer patients to others. I also need to develop confidence in speaking to patients about sensitive issues such as weight management by researching this area. 3 Demonstrate appropriate non-verbal and verbal skills, including the use of silence, open and closed questions and summarising, to gather information This outcome relates to the NMC Proficiency of Engage in, develop and disengage from therapeutic relationships through the use of appropriate communication and interpersonal skills. Communication is a reciprocal process that involves the exchange of both verbal and non verbal messages to convey feelings, information, ideas and knowledge (Wilkinson 1999; Wallace 2001). In nursing, communication and information gathering is essential to provide quality care. Sheldon, Barrett Ellington (2006) report that Communication is a cornerstone of the nurse-patient relationship. Information gathering commences from when the nurse greets the patient. In order to communicate non-verbal and verbal cues are used. Non-verbal skills are portrayed with body language and impact on communication (Hargie Dickson 2004). These include posture, facial expressions, head movement, eye contact and hand gestures showing active listening. Verbal skills include the use of silence, open and closed questions and summarising. The tone of voice and rate of response are significant. The emphasis is on effective communication; the way we communicate can hinder or enhance the information we gather. Sheldon et al. (2006) state that the power of effective nursing care is strengthened and enriched by good communication. Maguire and Pitceathly (2002) suggest that clinicians with good communication skills identify patients problems more accurately, patients are more satisfied with their care and are less anxious. It has been reported that that ineffective communication can lead to patients not engaging with the healthcare system, refusing to follow recommended advice and failing to cope with the psychological consequences of their illness (Berry, 2007). The scenario below demonstrates my understanding of appropriate verbal and non-verbal cues. It is part of a conversation with a patient on admission regarding current medical history. When meeting Arthur*, a 78 year old, I smiled, introduced myself and explained the purpose of our conversation. I asked Arthur Do you have any chest problems? he answered Yes. I then asked What chest problems do you have and how do they affect you? he answered I have emphysema causing wheezing and a cough. I also get breathless when walking and have oxygen at night I left a brief silence at this point. Arthur then disclosed I cough up a lot of horrible phlegm in the morning which is embarrassing. He then asked will I get a chest x-ray. I asked Have you any particular worries about your chest? to which he replied well I am quite worried about lung cancer. I told him that I would pass on his concern to the doctor and then summarised our conversation. With regard to verbal responses, I initially asked a closed question as I wanted a specific answer. Silverman et al. (2005) supports the theory that closed questions are appropriate when wanting to narrow the potential answer. Due to Arthurs response I asked an open question to encourage him to go into more detail. An open question often results in a lengthy answer, so I used fillers such as mmm throughout, to show active listening and to encourage him to continue. The brief pause was successful as it enabled Arthur to disclose his embarrassment. I summarised his response in order to clarify what Arthur had said for my own benefit but also to give the patient confidence that I had understood and opportunity to correct me if not. With regard to my non-verbal communication, I kept an open posture with eye contact and leant forward slightly to show that I was listening. I also ensured that my facial expressions were appropriate. For example, when greeting Arthur I smiled, but during descriptions of distressing symptoms my facial expression was one of concern. Egan (2002) supports the notion that conveying these non-verbal cues in this way will facilitate emotional disclosure and encourage the patient to talk more freely. Egan derived the acronym SOLER to portray awareness of the non-verbal responses; facing squarely, maintaining an open posture, leaning slightly forward, having appropriate eye contact and being relaxed. There are approximately 700,000 different non-verbal cues that may or may not have meaning (Birdwhistell, 1970; Pei, 1997). As nurses, we must be aware of our use of non-verbal cues as they can convey unintentional meaning. In addition to awareness of our responses it is imperative to be aware of patient cues, as this is part of the information gathering process. Arthurs hesitancy indicated to me to remain silent to encourage further disclosure. Being aware of patients verbal responses is more straightforward than what their non-verbal responses convey and it may be that patients body language contradict the spoken word (Miller, 1995). Barriers to communication include anxiety, language, hearing, sight or speech impairment. During communication, I would like to think that I am non judgemental. According to Underman Boggs (1999) most of us have personal biases regarding others that are based on previous experiences. In relation to my scenario, Fuller (1995) suggests that health care professionals may underestimate the verbal capacity or abilities of older people, which results in their conversations being undervalued. In terms of personal strengths, I feel fairly confident with the use of verbal and non-verbal cues and how these can deter or catalyse communication. I feel that I used silence successfully as Arthur disclosed embarrassment and mentioned about an x-ray, which he may not have done otherwise. I was able to reassure him that we would provide a disposable sputum pot and acknowledged his fear of cancer. I realise that it can be difficult communicating about sensitive information and this is an area of development for me, which I feel will improve with experience. Although at this stage of training I would not be expected to lead consultations for diagnostic purposes, it was informative to research consultation models. I intend to become more familiar with these models in order to utilise some of the communication skills (Newell, 1994). To form an overall conclusion, I feel that through theoretical learning and clinical experience I have demonstrated my achievement of the NMC Proficiencies (2004). I have critically discussed and concluded each learning outcome in turn throughout the essay but to summarise; patient focus and effective communication are paramount. I feel that in terms of reflection, self-awareness is key (Rowe, 1999). This will enable me to look at my skills to recognise strengths and areas of development to ultimately provide best practice in patient care. I realise that I will gain experience and confidence as my training progresses. Word Count: 3289 References Abbott, S. A.(1998) The benefits of patient education Gastroenterol Nursing. 1998 Sep-Oct;21(5):207-9. Bastable, S. (2006) Essentials of Patient Education. London. Jones and Bartlett Publishers. Bastable, S. (2008) Nurse as Educator: Principles of Teaching and Learning for Nursing Practice. Third Edition. London: Jones and Bartlett Publishers. Berry, D. (2007) as cited in Health Communication: Theory and Practice (Health Psychology). Berkshire: Open University Press. Birdwhistell, R. (1970) as cited in Nursing knowledge and Practice; foundations for decision making. London: Bailliere Tindall. Blood Pressure Association www.bpassoc.org.uk. [11th November 2009] Cameron, B. Mitchell, A. (1993) Reflective peer journals: developing authentic nurses. Journal of Advanced Nursing. 18, 290 297. Concise Oxford English Dictionary (2008) Eleventh Edition Revised. Oxford: Oxford University Press. Dementia: Ethical Issues Report (October 2009) published by Nuffield Council on Bioethics (http://www.nuffieldbioethics.org) [13th December 2009] Dementia UK Report (Feb 2007) published on The Alzheimers Society (http://www.alzheimers.org.uk/site/scripts/documents_info.php?categoryID=200120documentID=341) [7th December 2009] Department of Health (2009) Better information, better choices, better health. London. Department of Health. Egan, G. (2002) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London: Wiley-Blackwell. Fuller, D. (1995) Challenging ageism through our speech. Nursing Times. 91, 21, 29-31. As cited by Miller, L. (2002) Effective communication with older people. Nursing Standard. 17, 9, 45-50. Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Oxford Polytechnic. Oxford. Gibbs, G. (1988) Reflective Cycle. Queen Mary University http://www.qmu.ac.uk/els/docs/reflection1.pdf. [20th October 2009] Glanville, I. (2000) Moving Towards Health Oriented Patient Education (HOPE). Holistic Nursing Practice. 14(2) 57-66. Gustafsson, C. Fagerberg, I. (2004) Reflection, the way to professional development?. Journal of Clinical Nursing, 13, 271-280. Hargie, O. Dickson, D .(2004) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London: Wiley-Blackwell. Johns, C. (2000) Becoming a reflective practitioner. Oxford: Blackwell Science. Kole, L. (1995) A lot of knowledge is not enough: compliance and a positive outcome with asthma require more than knowledge. Journal of the American Academy of Physician Assistants. 8, 3, 8 11. As cited by Caress, A. L. (2003) Giving information to patients. Nursing Standard. 17, 43, 47-54. Lauterbach, S. Becker, P. (1996) Caring for self: becoming a self-reflective nurse. Holistic Nurse Practitioner 10(2) 57-68. Love, C. (1996) Critical Incidents and Post Registration Education and Practice. Professional Nurse. 11(9) 576. Maguire, P. Pitceathly, C. (2002) Key communication skills and how to acquire them. British Medical Journal. September 28; 325(7366): 697-700. Miller, L. (1995) The human face of elderly care? Complementary Therapies in Nursing and Midwifery.1, 4, 103-105. Ac cited by Miller, L. (2002) Effective communication with older people. Nursing Standard. 17, 9, 45-50. Naomi Feil http://www.vfvalidation.org/web.php?request=Naomi_Feil_Bio [7th December 2009]. Newell, R. (1992) Anxiety, accuracy and reflection: the limits of professional development. Journal of Advanced Nursing. 17, 1326-1333. Newell, R. (1994) Interviewing skills for nurses and other health care professionals. London: Routledge, Oxford Mini-dictionary for Nurses (2008). Royal College of Nursing. Sixth Edition. Oxford: Oxford University Press. Partridge, M. Hill, S. (2000) Enhancing care for people with asthma: the role of communication, education, training and self-management. European Respiratory Journal. 16, 2, 333-348. As cited by Caress, A. L. (2003) Giving information to patients. Nursing Standard. 17, 43, 47-54. Paterson, B. (1995) Developing and maintaining reflection in clinical journals. Nurse Education Today. 15, 211-220. Pei, M. (1997) as cited in Nursing knowledge and Practice; foundations for decision making. London: Bailliere Tindall. Rowe, J. (1999) Self-awareness: improving nurse-client interactions. Nursing Standard. 14, 8, 37-40. Scherer, Y.K., Schmieder, L.E., and Shimmel, S. (1998)The effects of education alone and in combination with pulmonary rehabilitation on self-efficacy in patients with COPD. Rehabilitation Nursing 23: 2, 71-76. As cited by Caress, A. L. (2003) Giving information to patients. Nursing Standard. 17, 43, 47-54. Schà ¶n, D. (1987) Educating the Reflective Practitioner. San Francisco: Jossey-Bass. Sheldon, L. K., Barrett, R. Ellington, L (2006) as cited in Nursing knowledge and Practice; foundations for decision making. London: Bailliere Tindall. Shellenberger, S. (2004) Therapeutic Lying and Other Ways To Handle Patients With Dementia. Wall Street Journal, November 11. Silverman, J., Kurtz, S. Draper, J. (2005) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London: Wiley-Blackwell. Somerville, D Keeling, J. (2004) as cited in Nursing Times http://www.nursingtimes.net/nursing-practice-clinical-research/a-practical-approach-to-promote-reflective-practice-within-nursing/204502.article [30th October 2009] Underman Boggs, K. (1999) Communication styles. Interpersonal Relationships: Professional Communication Skills for Nursing. Third edition. Philadelphia PA, WB Saunders. Validation Training Institute Inc. http://www.vfvalidation.org/web.php?request=index [10th December 2009] Wallace, P. R. (2001) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London: Wiley-Blackwell. Weisberg, M. Duffin, J. (1995) Evoking the moral imagination: using stories to teach ethics and professionalism to nursing, medical and law students. Change, 22. Wilkinson, S. (1999) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London: Wiley-Blackwell. APPENDIX 1 Gibbs (1988) model of reflection

Immigrants :: essays research papers

The first glimpse of the Statue of Liberty was an emotional experience remembered for life for the immigrants approaching New York Harbor. Engraved on the base of the Statue of Liberty are the words from Emma Lazarus's poem, "Give me your tired, your poor, your huddled masses yearning to breathe free." The French sculptor, Frederic-Auguste Bartholdi, designed the statue. It was intended as a monument to the freedom found lacking in his own country of France. Bartholdi said, "I will try to glorify the Republic and Liberty over there, in the hope that someday I will find it again here." Bartholdi used his own mother as the model for the statue and devoted 21 years of his life to the making of the monument. Gustave Eiffel, who later designed the Eiffel Tower, designed the frame. The Statue of Liberty was a gift from the French commemorating the American Revolution. President Grover Cleveland made the statue public on October 28, 1886. Previously, the statue had been a fixture in Paris before it was brought to Bedloe's Island, now known as Liberty Island. In 1986 the statue underwent extensive restoration at a cost of $69.8 million dollars. A new gold torch was added replacing the corroded original (the original is on display in the main lobby). The torch was coated with 24-carat gold leaf. The Statue of Liberty is recognized as a symbol of freedom throughout the world. When immigrants from Southern Italy came to New York, they found themselves in "dumbbell" apartments. These apartments were so close together that no sunlight ever reached the lower windows or back yards. During the late 1800s over 40,000 people were crowded into this small 17-block area. Diseases, such as tuberculosis, were a part of daily life. Even with these hardships, the residents of Little Italy built a lively and colorful community with the sights, sounds, and flavors of their homeland. The Italian population of New York City's "Little Italy" has dwindled to fewer than 5,000 residents. Chinatown has expanded and replaced many of the original "Little Italy" neighborhoods. The Feast of San Gennaro (Fiesta di San Gennaro) is the most exciting annual event in the neighborhood, beginning on September 19th and continuing for nine days. During this celebration, Mulberry Street is renamed Via San Gennaro and the shrines and relics of this saint are paraded through the streets. The crowds enjoy Italian foods of all types, as well as other ethnic dishes, and there is much singing and dancing.

The Name of War Essay -- Essays Papers

The Name of War In this historical and culturally divided book, Jill Lepore examines and tries to define the King Philips War and how people wrote about it. At the beginning of the colonies it was a start of a â€Å"New England" and after the King Philip’s War with all of the religious conflicts and war stories, a new American identity was born. Throughout this book she tells gruesome tales about murders, massacres, and battles. Even thought his book jumps a lot in chronically order she successfully tells the tales for both sides pretty accurately. I enjoyed reading some parts of this book. Especially the beginning and the middle because I thought the End dropped off and slowed down. Starting even before the war begins, she tells the tale of John Sassamon which she uses as the basis of ideas. This is a center point of the first part of her book. Why Sassamon was either killed for no reason or assassinated? New England Indians at the time were to become accustom to English goods and some were even converting to Christianity. Soon after the war begins she shows how the Indians use Christianity as a part of their war. Also after the war begins she writes about how many writers try to capture the war in words so that the colonies don't loose their "Englishness". This is ironic because by trying not to loose their "Englishness" they form an American identity. Inside the John Sassamon story lays the true reason why he was killed. Sassamon was an educated man, which was very rare considering he was a Native American. Even though he was growing apart from some of his friends in the colonies he still had strong ties with them. There are many reasons why he would be killed but none as strong as turning on your own people. Treason is considered a great offence to our country, imagine the offence taken by the Native Americans. Reading this book I found great similarities with the Native American culture and one with a gang or a mob family. All of them seem to have great penalties for one of their own turning against them. The major difference would be that the Native Americans religion was also a great deal of their culture. A mob family’s religion (catholic or instance) would conflict with the killing of another human. But the Native Americans were not that way, if one was killed and they took hostages then the one killed could be reveng ed by killing a hostage.... ...re not doing any of the torturing and only watching they don’t loose their ties with the mother land. This was completely wrong, the Colonists were there not the English. The English might have read about it somewhere in a newspaper or a book but the Colonists had to live through it. This is the reason why the Colonists lost their Englishness and began a new American identity. Lepore also used writers of that time to distinguish between how they told their truth and what she thought was the truth. This was a very useful part of the book, it showed to us the reader, that not all the stories that we read about the in history books or books from that time are entirely correct. That in every writing there is some type of biases ness. She did a very good job on representing both sides very well. This book was the study of war and how people wrote about it. But also the book makes it apparently clear that this was the start of a new American identity. Throughout the writings, stories, and all of the religious battles that were fought one true thing remained the colonist’s Englishness was gone. This was not New England any more this was something new. This was a â€Å"New† New England.

A Book Review On: Nothing To Fear By Adam Cohen

Cohen, an editorial writer at The New York Times, makes extensive use of both primary and secondary sources to unmask the clear, compelling story of how the prevailing circumstances of the nation – together with the attitude of its political leaders – reshaped American society in so brief period of time.Franklin Delano Roosevelt faced extraordinary economic challenges when he assumed the presidency of the United States in March 1933.Nothing to fear reveals by Adam Cohen explains in vivid prose of the decisive first 100 days of Franklin delevaro Roosevelt in office at the worst moments of America which coincidentally was the era of great depression. A remarkable, timely and informative blue print for political firststarts, it shows how 5 inner-circle liberals jumpstarted those remarkably historic first 100 days of Roosevelt in office.He and the inner circle members initiated the new deal and launched the delivery of modern America. The book is simply the evaluation of th e watershed in the modern America and it is a reality of the pivotal days in modern America; the crisis-ridden first 100 days of FDR in office .FDR and the inner circle wiped the old order and replaced it with new order i.e. the government acceptance and execution of her responsibilities.At this time in history, , there was 85% drop in stock market,25% of Americans had lost their jobs and banks had gone on holidays to prevent further crises ,farmers were openly angry and hungry men and women were eaten from refuse and garbages.40% of Americans at this point were living on agriculture and   farm income had decreased by 40%.Those who had jobs   were struggling for sustainace on their wages.Those who picked cotton in Arizona were reportedly collecting 30 cents after a week’s job excluding the food and housing payment. The period also witnessed close to 90% of school children being underweight while another percentage being malnourished.Radicalism and â€Å"hunger matchesâ⠂¬  by the jobless were on the increase both in the urban and the sacred rural American farm belt.Rooselvelt on assuming office charted a different pathway from that of his predecessor-Herbert Hoover. Hoover had turned deaf ears to the hues and cries of Americans.His approach was an absolute privatization of all sectors of the economy with no favor to the poor .His wickedness was later revenged by Americans when they made epithet of his name. Hoover lost the 1932 election to Roosevelt and managed to win only 6 states.In his introduction, Cohen tactically gave a summary of the first Hundred Days:While the public story line of the Hundred Days was about how Roosevelt, through his eloquent public statements and legislative initiatives rallied a desperate nation, behind the scenes his advisers were battling over what shape the New Deal would take. Perkins, Wallace, and Hopkins worked with members of Congress, farm leaders, union officials, and other progressives to promote their agenda .Douglas worked with business leaders and other conservatives to pull Roosevelt in the opposite direction. In the first month of the Hundred Days, through the passage of the Economy Act, Douglas’s side prevailed. For the rest of the Hundred Days, Perkins’s side did. While Douglas won the early battles, Perkins, Wallace, and Hopkins won the war.America According to Cohen in the early part of the book, there is a gradual metamorphosis of the great depression into a real and full blown financial and social collapse .After these 100days, FDR had reached a full blown acceptance of responsibilities to the needs and warfare of Americans.He worked with the 5 members of the inner circle to bring transformation to America. He relied on their pieces of advice and preferred if it is conflicting so as to be able to choose the best.   On assuming office, FDR came with few plans to combat the great depression. The inner circle encouraged FDR to embrace activist agendas.FDR was a fi scal conservative as well as a pragmatic politician .For this, he had close relationship with Frances Perkin and Lewis Douglas who were advocate of social warfare programs and cutter of budget respectively. In most cases, Douglas was at odds with other FDR’s members .FDR being not ideological, preferred varieties and a policy that is â€Å"bold, persistent experimental.† He featured in the most feverish and agitated period of America history that brings about the modern America.Nothing to fear is an attention holding, fascinating account of the personal dynamics that realign the catastrophic early period of FDR’s relationship and a character X-ray of one of America’s distinctive leaders in a period of crises. However, Cohen points us to the political blunders of this period over warfare situation, government laws, agricultural policy, and according to him they are still with us till today.