Is Hamlet primarily a tragedy of revenge Essay

Within â€Å"Hamlet† by William Shakespeare there are numerous events of revenge. Starting with Claudius’s envy of King Hamlet and ending with the murder of the king. Hamlet tries to avenge his father’s death by murdering Claudius but mistakenly kills Polonius. Claudius tells the news to Laertes right after the death of his father. Claudius hopes that Laertes will take matter into his own hands and slaughter Hamlet. Claudius needs Laertes to go after Hamlet before he has the opportunity to successfully assassinate Claudius. The families suffer from constant thoughts of vengeance which ultimately leads to their demise. Claudius’ envy eventually gets the better of him and compels him to butcher his brother, Lord Hamlet. Claudius finds himself in the shadow of his brother. The ghost, Lord Hamlet, explains his murder in detail to his son. The Ghost’s point of his speech to Hamlet is for Hamlet to avenge his death; â€Å"If thou didst ever thy dear father love . . . / Revenge his foul and most unnatural murder† (http://www. shakespeare-navigators. com/hamlet/One5. html) after the talk with his father, Hamlet is determined to kill Claudius. As in the Ten Commandments, the third of Ten Commandments says â€Å"Honour your father and Mother. † Lord Hamlet tells his son to kill Claudius, and from that point it becomes Hamlet’s life mission. He would die just to complete this goal. Hamlet had to kill Claudius when he was doing something immoral. Hamlet believes if Claudius is performing something pleasant, he will go to heaven instead of going to hell where Hamlet demands him to finish off. Hamlet’s want of slaying King Claudius inaugurates payback. Hamlet takes his chance to kill Claudius but mistakenly murders Polonius instead. There was a chance for Hamlet to kill Claudius but Hamlet found him praying. If you were praying and are killed while doing so you will go to heaven as you are doing something holy. To this day they would do a baptism or confession right before someone dies to release them from all of their sins. This process is called the anointment of the sick. Hamlet waits for another chance to kill Claudius when he is doing something unmerited, to make sure he goes to hell instead of going to heaven. With vengeance on Hamlet’s mind, he talks to Gertrude but hears someone behind the curtains. He saw this man hiding listening to their conversion, he strikes at the man, after stabbing the man he sees it is Polonius, not Claudius. This misfortune creates more drama for Hamlet but creates an unintended opening for Claudius to save himself from Hamlet. Claudius runs off to inform Laertes that his father was slain by Hamlet. When Claudius finds out Hamlet murdered Polonius, he ran to find safety as he knows that should have been him talking to Gertrude, not Polonius. While rushing over to notify Laertes of the situation, he thinks it’s only a matter of time before Hamlet exterminates him. The only person that can help him with this problem is Laertes as he now has a reason to kill him rather than just killing him for fun. Laertes is outraged and wants to avenge his father’s death by killing Hamlet. Laertes devised a plan to snuff Hamlet by â€Å"Which Laertes can kill Hamlet in front of an audience, and it will appear to be an accident; no one will know it is murder. Laertes shares his own plan to dip his sword in a poison so lethal that a minor scratch will cause instant death. † (http://www. cliffsnotes. com/study_guide/literature/hamlet/summary-analysis/act-iv/scene-7. tml) Claudius has a back-up plan† Claudius intends to present Hamlet, if Hamlet scores the first â€Å"hit,† with a poisoned goblet of wine. This way, Hamlet will be killed even if he wins the match. † (http://utminers. utep. edu/ajkline/hamlet. htm#Act IV, Scene vii:) just in case a mistake happens when Laertes is battling Hamlet. When Laertes and Hamlet finally meet and Laertes challenges Hamlet to a duel, with no hesitation Hamlet agrees. Before the fight Hamlet’s mind is all over the place but kept remembering â€Å"King hold his purpose, I will win for him if I can; if not, I will gain nothing but my shame and the odd hits. (Book Act 5 scene 2 Lines 168-170) It gave Hamlet the motivation he needed for the battle versus Laertes. When the fight ended there were many deaths as no one lived from Hamlet stabbing Claudius to death. The eradication of King Claudius, Hamlet finally avenged Lord Hamlet’s death. Claudius’ death means Hamlet would assume the throne as he’s next in line to be king. While in battle though he was wounded by Laertes and is going to die as there isn’t medical treatment that could have healed him in time. Hamlet finishes himself off by drinking some poison to put an end to his pain and suffering.

How Technology Makes Life Easier Essay

Technology has made the way everyone communicates very easy . One specific way a person can easily communicate with another is with the use of a cell phone. Cell phones provide long distance calling for those who are out of the states or across the states. For instance I went to Disney Word for a few days and I was able to keep in touch with my family while I was there. My stay in Florida was long and I missed my mother because it was the first time we had ever been separated. I called her every morning I woke up to go somewhere and every night before I went to sleep. Cell phones are used for business calls. Personal calls, emergency calls, and everything in between. They are easy to function, and they have a lot of amenities on them. They have Facebook on phones so one can keep in touch with the people they either lost contact of, or they haven’t seen in years. I tend to try and keep up with all my new and old friends since I have moved around a lot recently. So all in all cell phones make it a whole lot easier to communicate with one another. GPS is also a very big helper when it comes to cell phones. When one is lost and he or she does not know where they are going, nine times out of ten one’s phone has GPS. I have used GPS quite a bit when I navigate around Louisiana. It is very easy to get lost and most of the time I don’t have time to get lost. So I use my GPS. GPS helps all those truck drivers who are driving from state to state. It helps a traveling family who is moving from one house to another. GPS help bus drivers that are carrying commuting passengers. I have family that lives in Tennessee and my family down here tends to travel up there during holidays. When we go we make sure the GPS system is set to the right address. So far we have never gotten lost or traveled onto the wrong interstate yet. In conclusion, Cell phones make it easier for people to communicate with one another whether it’s long distance or not. Cell phones help one keep in touch with people one has not seen in a while. Cell phones that have GPS also help navigate from state to state.

Research Paper Taxation Essay

Wage is the fixed amount of compensation for service rendered covering a fixed period of time, usually hours, or fixed amount of work. It is usually a compensation given to skilled and unskilled labor. Commission is usually a wage given to skilled and unskilled labor. Commission is usually a wage given to a salesperson based on the amount of his sales. This amount is usually added to basic salary. Bonus is given to simulate employees to work more efficiently and effectively (Valencia & Roxas, 2009) To make sure that employees comply with BIR regulation and local government laws, companies must include crucial employee and company information in their payroll systems. Setting up and running the different components that comprise a payroll system requires due diligence and adequate knowledge of tax legislation. Employee’s benefits In Philippine Accounting Standards (PAS) 19, paragraph 7 states that employees benefits are all forms of consideration given by an entity in exchange of services rendered by employees. These benefits may be paid directly to the employee’s or to their dependents, such as their children or spouses. These can be settled by payment in cash in form goods and services. Paragraph 4 of PSAS 19 enumerates the following four classes: (a) short term employee benefits; (b) post-employment benefits; (c) other term employee benefits; and, (d) termination. Employee information During the new hire process, companies must collect information such as medical insurance and W-2 forms to determine what should be deducted from an employee’s paycheck. These forms also provide employers which crucial information, such as the employee’s Social Security number and their withholding amount for government tax purposes. The systems must also track and process changes made to the employee’s tax exemption status, pensions, insurance plans or retirement funds. Salary information As part of the new hire process, payroll systems include a component that designates which employees are full time, part time and contractors. Classifying worker in a payroll system is important since the government levies high penalties on companies that categorize employees incorrectly. Applicable taxes and deductions The National internal Revenue Code (R. A 8424) requires the employer to withhold portion of the salaries earned by employees that will at least approximate an income tax due of the earner relative to the income earned. The monthly or semi-monthly withholding s taxable could be obtained from the BIR to serve as guide as to what amount to be withheld from the salary of the employee (http://www. ehow. com/list_6725482_components-payroll-system. html, 17 July 2010). In preparing a payroll, certain government mandated contributions needed to be deducted from the gross play of each employee. These include withholding taxes, PAG-IBIG, SSS (Social Security System) and PhilHealth contributions. Withholding taxes is remitted to BIR while PAG-IBIG is remitted to Home Development and Mutual Fund (HDMF) (Cabrera, Ledesma & Lupisan, 2009). Other payroll withholdings include employee contributions to benefits, retirement accounts, and charities, these are determined by the employee during the fringe benefits selection process offered by their employer and must be taken into account as well as any employer matches when reporting payroll . Methods of Payroll Computation A payroll system involves everything that has to do with the payment of employees and the filing of employment taxes. This includes keeping track of hours, calculating wages, withholding taxes and other deductions, thus appropriate methods must be applied in the computation to achieve a desirable output. More and more aspects of payroll are being handled electronically. Methods include direct paycheck deposit, debit cards, payroll and non-payroll, use Web-based information system to allow employees access, with a secure password, to their individual payroll records including pay stubs, an earnings record and in some cases, employer information, such as the company manual or health insurance plan overview (Banning, 2008) Giove (1993) stated the seven methods for computing payroll: Hourly Rate Plan Employees paid on an hourly rate plan receive a fixed amount for each hour they work. An employee’s regular earnings are equal to the employee’s hourly rate multiplied by the number of hours worked during the payroll period. Salary Plan Salaried employees receive a fixed amount for each payroll period, whether weekly, biweekly, semimonthly, or monthly. If an employee on the salary plan works less than the regular hours during a payroll period, the employer may deduct for the time lost, although in most cases the employer does not make such a deduction. Regular earnings would be determined by multiplying that hourly rate by the actual number of hours the employee worked during the payroll period. Overtime Pay All employees in all establishments and undertakings whether for profit or not are entitled to overtime pay for work rendered beyond eight (8) hours. But this does not apply to managerial employees, field personnel, and members of the family of the employer who are dependent on him for support, domestic helpers, person in the personal service of another, and workers who are paid by results. Employees in the government are also entitled to overtime pay but they are governed by Civil Service laws and rules. Only employees in the private sector are covered by the Labor Code. Guaranteed Wage It is a written agreement to pay an employee a guaranteed minimum amount regardless of the hours worked, with an extra half-hour premium for hours over 40. Piece – Rate Plan It is a compensation plan whereby employee earnings depend on the units produced. Commission Plan Sales commission plans vary greatly from company to company but are generally based on the sales made during payroll period. Combination Plan This is a compensation method whereby employees receive a fixed amount of salary for each payroll period plus an extra amount for production (piece-work) or sales (commission). Timekeeping Records Accurate timekeeping is an essential part of an efficient payroll system. Every business must have an orderly method of recording the hours employees worked during the payroll period. The time records show the date and the time the workweek starts, the number of hours worked each day, and the total hours worked during the week. Time records are filed after the payroll is prepared and, in accordance with the requirements of the law, retained up to three years. The most common methods of timekeeping use a time clock with timecards or a time sheet. There are two primary reasons to maintain accurate payroll records. First, is the collection of the data necessary to compute the compensation for each employee for each payroll period. Second, provision of information needed to complete the various government report-federal and state- required of all employees. All business enterprise both large and small are required by law to withhold certain amounts from employees’ pay for taxes, to make payment to government agencies by specific deadlines, and submit reports on official forms. (McQuaig & Bille, 2008). Other Aspects of Payroll Accounting System Payroll Register The payroll register summarizes employee earnings and deduction information in a journal entry that is inserted into the general ledger for accounting and general research purposes. Payroll registers are also used to create tax report. These documents are prepared by payroll staff or generated using payroll computer system. Payroll Services The meteoric success of payroll services is not accidental, but rather a reflection of the business community’s willingness to outsource the tedious and complex task of payroll accounting to outside specialists. The upside of outsourcing payroll is that payroll services ensure that the company complies with laws pertaining to payroll. That is a big deal considering the time investment it would take the payroll officer to stay current on payroll-related legislation. Another big plus is that payroll services are responsible for keeping track of each employee’s accumulated earning, tax withholding, and other information needed to issue W-2 forms at the end of the year. They also stay on top of things like direct deposits, salary adjustment, quarterly tax payments and all of the other details that can be distraction from the important job of leading the company (http://Gaebler. com/payroll-services, 8 Aug, 2010). In-house Payroll If contracting a payroll service does not sound like a good fit for a business, the management also has the option of doing it in-house. But if the management plans on saving money by personally administering the payroll, having more alternatives will be a better idea. Even if the company only has a few employees, dealing with payroll-related details can be a waste of time. Instead, designating the job to an employee who can give it the time it requires so precious time can be dedicated to other things (http://Gaebler. com/in-house-payroll, 8 Aug, 2010). Whoever ends up doing payroll in the company will be happy to know that there is a lot of software out there to help them. In fact, most accounting software solutions have payroll modules. Start by assessing the capability of their current accounting software program. If it does not have a built-in payroll function, chances are it is available from the manufacturer as an add-on. If it is not, then the company needed to decide whether to change accounting to one that does or attempt to find a payroll program that is compatible with the current system. Either way, it is worth the time to find a computerized system that meets the company’s needs rather than trying to do it the old-fashioned way. Internal Control A district’s accounting and payroll functions are critical for the maintenance of a solid financial foundation. Accurate and timely financial reports are crucial to administration and board decision-making. Payroll must be accurate, as it represents the district’s largest budgeted expenditure. Internal controls must safeguard the district’s assets from misappropriation. Payroll processing is an error prone activity. If organizations have just one or two employees it may seem relatively easy to compute salaries outstanding, taxes etc, but as small business starts adding employees they find spending more and more time in computation of salaries including variable pay. Errors are common in the full and final settlement and increases when employees join in the middle of a term as the processes are manual (http://ezinearticles. om/? expert=Mikael Anderson, 4 Aug, 2010). Waterhouse (2010) said in one of his studies that the objective of internal controls for payroll is to ensure that payroll disbursements are properly recorded and that related legal requirements (such as payroll tax deposits) are complied with. Segregation of duties is an effective internal control. The bank reconciliation clerk reconciles the bank accounts and is not involved in processing or approving items for payment. A payroll administrator, supervisor, specialist and six clerks perform the payroll function. The Human Resources Department (HRD) enters employee data into a database share by Personnel and Payroll and sets the rate of pay. The software system controls the ability of individuals to change information based on their access to the system. This prevents unauthorized individuals from changing this information (http://window. state. tx. us, 6 Aug, 2010). Gelinas, Sutton and Hunton (2005) included in their study some of the procedures that can be used to prevent or detect schemes. First is the direct deposit of payroll to eliminate alteration, forgery and theft of paper check. Second, is checking for duplicate names, addresses, and Social Security number in the employee data, finally is comparing actual to budgeted payroll. Expense Accounts are often an area of fraud and abuse. This include: (a) using legitimate documentation from personal expense for the business expenses; (b) overstating expenses by altering receipts; (c) submitting fictitious expenses by submitting copies of invoices. Such abuses can be minimized by formulating reasonable policies that compensate employees for their out-of-pocket expenses. Copies of invoices should only be accepted in extreme circumstances. Finally, expense account activities should be monitored on a regular basis to detect unusual patterns (Gelinas, Sutton & Hunton, 2005). Payroll Fraud Connection Payroll, similar to cash disbursements, is an area ripe with fraud potential. After all, large organizations will make thousands of payments to employees for payroll and expenses account reimbursement every payroll period. Firth (2006) expresses that Payroll Fraud is an important issue that needs to be addressed by both Finance and Payroll professionals. Some of the key activities need to be considered include: improving the quality of master file data, reviewing the end to end payroll process, and reviewing the people that are performing each step in the payroll function. It is worth remembering that improving each of these areas will not only reduce the risk of payroll fraud, it will also result in many other business improvements right across the organization. Here are some of the types of payroll frauds, along with the median loss for each to an employer: (a) Ghost Employee, employees do not actually work for the company but receives paychecks. These can be recently departed employees or made-up persons; (b) Falsified hours and salary, employees exaggerate the time that they work or are able to increase the salary in their employee date; (c) Commission Schemes, employees falsify the sales on which commissions are based or increase the commission rate in their employee date; and, (d) False worker’s compensation claims, employees fake injuries to collect disability payments (Gelinas, Sutton & Hunton 2005).

Kants Essay Example | Topics and Well Written Essays - 500 words

Kants - Essay Example But the only thing that could be an object of respect for me is something that is conjoined with my will purely as a ground and never as a consequence, something that does not serve my inclination but overpowers† (320). From the definition above of Kant’s categorical imperative, one can see that the categorical imperative aims to test whether the reason behind an action contradicts itself if one uses a rational basis for it. Kant actually explains it in this way: â€Å"Is it a necessary law for all rational beings to judge their actions always in accordance with those maxims which they can themselves will that they should serve as universal laws?†(332). The formula has a procedure that states what one is supposed to do. It therefore clearly distinguishes between what one has to do and what one wants to do. The basis of the categorical imperative is therefore not in the necessity of the action, not in the motivation of the desire or pleasure but in the rationality of the action. For a motivation to be acceptable, it must be purely rational and its being rational is for the greater good, or for what is good to all people without any exceptions. Based on Kant’s definition of the categorical imperative, the motivation for the first case is that if the action were to be made into a universal law, then no one would say such things because one would expect the other person to say it. Thus, it would contradict itself. For the second case, the motivation should be a situation which is debt free so that it would not contradict itself. As for the third case, it is similar to the first. In short, if the motivation would be getting something in return, and if this were to be converted to a universal law, then there is no one would give anything anymore. Thus, one should wait to be that second person. For the fourth case, the motivation would be to get a good grade. However, if everyone would do this, then there would be no

Teleology Research Paper Example | Topics and Well Written Essays - 250 words

Teleology - Research Paper Example The results, rational and impacts that such ethical issues pose to the sports industry explain the leading occurrences. Drug use and steroids instill unfairness in sports, as the users tend to possess boosted and comparable advantage of the non-users. The act negatively influences behavior and characters of the participants as many will resort to the unethical conducts to emerge victorious with the aided advantages. Human beings conduct themselves in a manner that the aftermaths rational dictate. The assertion relies on reference to the ends or goal attainment, this is teleology and the dependence of human conduct on it implies ethics. Ethics refers to the moral principles that administer an individual’s or group’s behavior. Teleology has helped the humans to understand the behavior as of either pursuing their ends or goals to fulfill a purpose that the mind determines or dictates. According to Aristotle, a comprehensive explanation of any phenomenon must consider its formal, efficient and final cause. The mind has to be present for a thing to act for an end (Woodfield,

GRoup think on SMall Group about how the class elaborates how people Essay

GRoup think on SMall Group about how the class elaborates how people go with the group - Essay Example Studies have proved that despite group’s decision on certain matters, individuals of the same group may have different opinions of their own. However, the group exerts certain amount of force on members to preserve unanimity, for which they might sacrifice personal opinions. Internal and external reasons force members to go with the group regardless of personal perspectives. Symptoms of groupthink In order to understand the factors causing groupthink, one should identify the symptoms of this threat. According to Freeman (1999), a group that is vulnerable to groupthink is less likely to seek alternatives in its decision making processes; moreover, it will heed little attention to distinctive ideas or external assistance (p. 249). This attitude is termed as the ‘illusion of infallibility’ due to which the group rebuffs the advice of experts and tends to flaw. Another reason that determines the intensity of groupthink is the size of the organization. According to exp erts, large groups are more likely to promote groupthink. To illustrate, in a comparatively bigger group, individuals are normally reluctant to take up initiatives; instead, they would join the common decision of the group. Fear is the root cause of this unanimity; and to avert flaws, members hide their personal views while they are in big groups. In contrast, a group’s unusually small size also can become a reason for groupthink. Minority groups often tend to maintain socially unfavorable levels of cohesiveness. In order to vie with the majority segments, many minority groups choose subversive activities. We can see such stereotypical ideologies that intensify domestic as well as international tensions across the globe. Political parties, ethnic groups, and even governmental bodies also can be affected by groupthink. As discussed earlier, the exceeding emphasis on unanimity compels individuals to sacrifice their personal opinions often regardless of their relevance to the co ntext. The paucity of multiple responses normally leads to immediate decisions presumably in favor of the group leadership. This really reminds us the significance of invoking personal perspectives during the process of decision making in groups. Furthermore, members’ overdependence is another notable symptom of groupthink. Most of the groups are basically vulnerable to this threat as members maintain higher degree of expectation on leadership. They rely on leader’s quality and skills and anticipate higher level of achievement from him. Once they come to realize the inability or limitation of the leadership, they would attribute group failure to the leadership. Strategic approach to groupthink Although modern organizations pay higher emphasis on teamwork and organizational cohesion as their competitive advantage, they are required to heed genuine effort to the formulation of strategies to meet the challenges of groupthink. The following part will discuss some of the po pular strategies that HR managers often apply in their groups to address groupthink. As Thompson (2006), purports, managers can invite varying perspectives into the decision making process because according to the author, the paucity of varying opinion was the cause of many governmental and organizational failures (p.177). Hence, as the group environment becomes more viable, members will get more opportunity to interact with experts which in turn will positively influence the decision making. The logic is that; the more a group is exposed to external

Foreign Investment Disputes Research Paper Example | Topics and Well Written Essays - 4000 words

Foreign Investment Disputes - Research Paper Example For the last two decades, increased technological and liberalization advances have resulted into increased growth in the flow of FDI. This means that FDI gained in share of domestic investment and GDP in many countries. It is done for numerous reasons that involve taking advantage of low cost wages or for exceptional investment privileges like rewards to obtain a link that is tariff-free towards the countries markets or the regional market through the use of tax holidays granted to the company. There are a several ad hoc arbitral rules and two arbitral institutions responsible for most of the arbitrated foreign investment disputes. The ICSID is the arbitral institution, which specifically deals with international investment disputes. The ICSID specifically deals with investment disputes. It has unique advantages. As an arbitrary institution, ICSID is an affiliate of foremost international lending institution and a division of world bank. It is enjoys the advantage of perception, where it is perceived that countries would always comply with the obligations of ICSID. ICSID is supported by the ICSID Convention, which is a multilateral treaty. This way, any violation an obligation of the ICSID is regarded as a treaty violation hence a violation of the international law. The ICSID center is responsible for administering three types of procedures: conciliation, binding arbitration and a fact finding procedure. The ICSID Convention states that whenever an arbitration procedure is adhered to, ICSID should be made an exclusive forum for any kind of dispute that is submitted to it. The annulment procedure that is provided before its second tribunal, is the recourse only against the ICSID award and no appeal regarding an award may be taken to any national court. Further, it provides that the host country can only enforce a final ICSID award but not any country, which is a party to ICSID convention. The ICSID Convention has special jurisdiction

The 1980s Crisis Essay Example | Topics and Well Written Essays - 2000 words

The 1980s Crisis - Essay Example This was caused by excessive and continous borrowings even at a negative interest rates and rising commodities which was aggravated by the the Organizationof Petroleum Exporting Countries (OPEC) decision to raise the price of fuel which drove the interest rate of repayment and made the Latin American countries, particularly Mexico unable to service its loans (Buerkle, 2007). II. Background In the 1960s and 1970s, Latin American countries likeArgentina, Brazil and Mexico was experiencing tremendous growth in their respective economies (Swan, 1992). They capitalized on this growth by embarking on an industrialization program and borrowed heavily from foreign creditors to finance their industrialization program particularly their infrastructure projects. Given the performance and the prospect of the economies of these Latin American countries, foreign creditors granted them loans. These loans continued that in the span of seven years (1975 to 1982) of continuous loans, it had a cumulati ve annual rate of 20.4 percent. This translated to the contiunous accumulation of debts. Latin American country’s loans which was only $75 in 1975 rose to a staggering amount of more than $315 in 1983. These loans already amounted half of the region’s GDP or Gross Domestic Product. As a consequence, debt payment, both on the principal and the interest, increased rapidly that it amounted to $66 billion in 1982 when debt service was only $12 billion back in 1975. The Oil Crisis When the Organizationof Petroleum Exporting Countries (OPEC) initiated in October of 1973 the increase of the world price of oil to as much as much as five times and backed by a selective embargo which was directed against the industrialized countries, Latin America and developing countries took the hit because of their vulnerability to external shocks (Street, 1978). Of the 19 countries that has to import oil, they have to pay OPEC’s increased price by an additional amount of $4.8 billion more in 1975 and added $5.2 billion in 1975 (Robichek, 1975:1). To make the matter worst, Latin American countries’ trade fell as a result of the global recession that was aggravated by the OPEC’s decision to increase the price of oil. As a result, the demand for Latin America’s primary products decreased while production cost increased because the price of imported materials from industrial nations also increased due to the increase of price in oil. This resulted to the region’s â€Å"deterioration of balance of payments current accounts of $2.5 billion above their expanded oil import costs in 1974, and of $2.9 billion in 1975† (Robichek, 1975:1). The Effect of the Oil Crisis OPEC’s decision to increase the price of oil contributed to the recession of the US economy in 1974 to 1975. This decreased the demand for loans in the domestic economy. These loans however was availed by Latin American countries which had a tremendous appetite for for eign loans (Hawkins And Maese, 1986). The global economy also slid into recession after the OPEC’s decision to increase its price in oil. The crisis that OPEC precipitated was however unusual as it transmitted even to countries that did not experience the â€Å"stagflation† of matured economies such as United States and Europe. â€Å"Until 1970, 15 Latin American countries enjoyed relative stability in the cost of living, and only 4 experienced price level increases in excess of 15 percent per year† (Inter-American Development Bank, 1977:6). Brazil which had always managed to decreased its inflation rate in the 1960s experienced an increase of 13% inflation in 1973 which increased further in 1976 to as much as 42% (International Financial Statistics, 1977:53). Its annual growth of over 10% from 1968 to 1974 fell dramatically to only 4.2% in 1975.

Research6 Essay Example | Topics and Well Written Essays - 500 words

Research6 - Essay Example The â€Å"Honeyed Nougat Miracle† is extremely significant in the Rainbows End since it highlights some of the delusions that will be part of the upcoming digital technologies that the reader may need to take caution upon (Vinge 4). Vinge highlights the reactions of Dr Xiuxiang and Robert Gu on the label â€Å"No user serviceable parts within†, boldly embedded on the black boxes (literally to imply the encapsulated forms of the technological devices hardware and software) that were complex and permanently fixed (they could not be altered or replaced). Gu and Xiuxiang were perplexed because the black boxes were not operating as they needed them to and still were unable to change or replace them(Vinge 58). Robert Gu was astounded by the life-prolonging technologies which restored his health back to normalcy after battling with Alzheimer (Vinge 52). The phrase â€Å"that was the genius insight of this dark morning, the conclusion he had evaded every day since he was brought back from the dead† reveal the convenience and intelligence accompanying the contemporaneous technologies was astounding. For instance, Robert Gu’s health was restored in a flash (which he calls magic), and he regained his youthful body once again. At the moment, many competent professionals have crowded the job market and, as a result, the selection criteria for selecting candidates for specific careers has diversified, leaving many qualified candidates below the expected cut off specifications. In addition, as many global activists push for minimal wage increase, vast employment seekers have key preferences for the careers they seek in the job market (such as the jobs which match what they studied in college). Their preferences may, unfortunately, be unavailable in the job market and therefore ending up being jobless. Also, most careers need diverse skills. These skills are constantly changing for distinct, unique careers. Most employees, unable to cope with the changing

Why I want to be a Nurse Essay Example for Free

Why I want to be a Nurse Essay I heard the familiar sound of the front door closing gently. My father was returning from work as a barber. Although he begins his day at 5:00 a.m. every morning, he usually returns at around 7:00 p.m. I never really questioned his schedule when I was a child, but as I entered high school I wondered how my dad could work so hard every day of the week and still enjoy what he does. The uncertainties of barbering are so great and so challenging. It never ceases to amaze me when my father wakes up every morning to start work, that he does so with gusto. The life of a barber can be laborious and stressful, yet my father continues to do his work with passionate enthusiasm. His dedication and pride mystified me throughout high school. Only after I entered college in my late 20s, did I start to understand how he could persevere and face the challenges of raising a family and running his business. I entered college like a small child wandering through a park. Never in my life had I been exposed to anything so grandiose and dominating. Born and raised in a rural town, I wasnt ready for the fast-paced life and crowds. I eventually grew into its lifestyle and learned to adapt to my new environment. I found my communication class, in which we discussed major issues in health care, especially interesting. The nurses dilemma particularly intrigued me: Doing everything to provide the best health care possible, but constrained by limited resources when the funds just are not available. These frustrating situations place a huge strain on nurses, and yet they persevere and continue to work long hours in hospitals, and clinics providing the best care they can. While thoroughly aware of the long hours a nurse must work and the challenges he or she faces, I am choosing medicine because of the unique satisfaction it provides the rewards of helping a sick human being. As I think about a nurses life, I also think of the many times I have watched my father sit silently at the dinner table, deep in thought, contemplating his options when his business was not bringing in enough income and the bills continue to arrive. I didnt hear him complain; I only heard him leave early in the morning and come home late in the evening to make sure that we had everything he did not as a child growing  up. I also saw determination and tenacity in my mother and father to never give up but to keep on trying to the achieve a higher goal. They both came from very large and poor families and were determined to not have me grow up without an education. I will harness that determination in my life and my quest to earn my degree in nursing. They showed me what it means to really enjoy a career. I can have that same enjoyment through nursing the same type of enjoyment my Parents had from tending to their jobs, and businesses. Becoming a nurse is a goal aspired to by many. As a barbers son, I have wakened early and returned home late from long days with my father. I have been able to experience uncertainties, challenges, and plain old hard work similar to that faced by nurses. But like the doctors in the hospitals and my parents in their work, I can find happiness and satisfaction in helping people through medicine. Despite all the hardship nurses face, I want to help people every day. Nursing is something worth stress and long hours. I finally understand my father. I now know how he can wake up every morning at 5:00 a.m. and work hard until 7:00 p.m. and now I will do the same for my family. I will heavily stress the importance of a college degree and a good work ethic. I feel that this is the reason more and more Hispanics are earning their college degrees; they dont want the hardships of their past generations to be placed on their children.

Care Of The Patient In Recovery Inadvertent Hypothermia Case Nursing Essay

Care Of The Patient In Recovery Inadvertent Hypothermia Case Nursing Essay Before the author can discuss hypothermia in regards to the patient above they must first review how the body regulates heat control within the body. Many sources, give varying definitions of what normal body temperature or normothermia is. For example Marieb (2004) defines this as a core temperature range from 35.6 °c and 37.8 °C. Meanwhile Kiekkas and Karga (2005) defined the normal temperature range of adult patients as between 36.5 °C and 37.5 °C. National Institute for Health and Clinical Excellence (NICE) 2008 guideline for the management of inadvertent perioperative hypothermia agree with this definition. Core temperature, defined by Kiekkas and Karga (2005), is the blood temperature of the central circulatory system, which can be measured for example at the pulmonary artery, rectum or via the tympanic membrane, which occurs in recovery at Hospital x. The hypothalamus is the central organ that acts as the bodys heat promoting and heat loss centre, then brains thermoregulatory centre. Body temperature is kept stable and regulated with the help of blood. The neuronal centre in the posterior hypothalamus is triggered when there is a decrease in temperature in the blood or the external temperature is low. Mechanisms for heat conservation and heat production are triggered such as, shivering, which is the bodys natural response to cold, constriction of blood vessels in the skin and increased metabolic activity to produce energy (Hatfield and Tronson, 1996; Marieb, 2004). As with the varying definitions of normothermia, there are also differing definitions in hypothermia. NICE (2008) guideline defines hypothermia as a core temperature of less than 36 °C. Similarly several authors agree with this definition, Aikenhead et al (2007), American Society of Peri Anesthesia Nurses (ASPAN) (2009); Clarke and Clark , 1997). Meanwhile Kiekkas and Karga state, hypothermia as a core temperature of more than 1 (standard deviation) less than the mean value under resting conditions in a thermoneutral environment (Kiekkas 2005, p444) There are 4 ways in which the body loses heat; conduction, convection, evaporation and radiation. Talk about these briefly! There are patients who are more at risk of developing hypothermia these include; older and younger patients. The size of the patient: thin, due to the lack of tissue mass and obese, due to the large surface area. The type of procedure: open thoracic, abdominal, gynaecological or genitourinary. Patients having a combined general and spinal anaesthesia (Welch, 2002) Patient A falls into some of these categories, because of the type of surgery, age and anaesthesia she will be having. As part of the pre operative check in Patient A was asked the last time she had eaten, this was 12 hours before the procedure. Advice of fasting for 6 hours plus is given to patients to prevent nausea and vomiting during and after the induction of anaesthesia, as this along with the spinal causes the constriction of the abdomen and stomach. This in turn deprives the body of the metabolic system of energy it needs from food digestion (Cobbold Money 2010; McNeil, 1997). Following administration of Propofol and Remifentanil via a TIVA syringe pump, the patient was intubated with a size 7 endotracheal tube. Anaesthetic medications such as those given to Patient A; Propofol, depress the central nervous system which mean the hypodermic thermoregulatory centre function is decreased. This occurs as there is an increase in conduction and radiation to the peripheral points of the skin, where heat loss is at most, as the skin has a large surface area. This loss of heat is difficult to manage after anaesthesia has been administered as heat distribution, which is the increase in peripheral temperature and a decrease of core temperature has taken place (Kiekkas Karga, 2005; Sasad Smith, 2000). With her airway secured, Patient X was positioned for the administering of a spinal. Her back was exposed and sprayed with chlorhexidine gluconate solution, for pre operative skin disinfection (BNF, 2008), a cold solution thus further contributing to the decrease in Patient As body temperature, via evaporation (Bellamy, 2007). The effect of administering Diamorphine and Marcain Heavy ® is that it causes the sympathetic nervous system to be compromised as vasodilatation occurs (Fallacaro et al, 1986). Patient A was taken into theatre, where the ambient temperature as recorded by the author was 21 °C, reason for the temperature being so low is to minimise the growth of bacteria. However such a low temperature would affect Patient A as her body temperature will vary according to the environments conditions (Bellamy, 2007). McNeil (1998), advocates that the temperature in theatre should be raised from 21 °C to 24 °C to maintain Patient As core temperature, which unfortunately was not taken until the procedure in the operating had started. Whilst the author agrees with the later point so that the patients temperature is taken into consideration, they have to agree with Bellamys (2007) point on minimising bacteria production. Patient A was exposed for catheterisation and for the Bair Hugger ® to be positioned. This is a forced air system used in Hospital X, which several sources agree, is the best form of preventing inadvertent hypothermia (Hegarty et al, 2009; NICE Guidelines, 2008; Welch, 2002). This was however switched on at 36.5 °C after Patient A had been prepped and draped. Fluids were firstly administered to Patient A in the anaesthetic room at room temperature; they were then transferred into a warming coil at a temperature of 37 °C. Whilst the NICE (2008) guidelines recommend warm fluids are administered in the operating room at the temperature stated, the author feels that warm fluids should have been started in the anaesthetic room. The monitoring of Patient As temperature occurred after draping and prepping, it was measured using an oesophageal temperature probe as this measures the core temperature accurately and documented every 15 minutes (Al-Shaikh and Stacey, 2002; NICE, 2008). NICE (2008) recommends that temperature of a patient should be 36 °C before a procedure should proceed, the temperature of Patient A on arrival to the anaesthetic room was not taken and the first temperature in theatre was 35.6 °C increasing to 36.0 °c at the end of the procedure. After the procedure, which had no surgical complications and Patient A was extubated, she was transferred to recovery where the tympanic temperature; which is associated with the brain temperature therefore reflects the core temperature (Al-Shaikh and Stacey, 2002), was taken in recover 10 minutes after the patient arrived and was recorded to be 35.4 °C. Handover to the recovery personnel included patients name, date of birth, procedure, what drugs had been administered and the anaesthetist made an emphasis on the patients temperature which they wanted to make sure was up to at least 36.0 °c before the patient was transferred to the ward, part of the NICE (2008) guidelines. Standard recovery monitoring including Oxygen saturation, electrocardiogram and blood pressure results were constantly observed, with results being documented every 15 minutes. The effects of hypothermia are not known until the patient comes into recovery for some time as the effects are masked by the anaesthetic drugs given to Patient A. (Kiekkas et al, 2005). To prevent this a Bair Hugger was placed on Patient A to continue the warming cycle. There are many complications associated post operatively with hypothermia, the most common is post anaesthetic shivering, which is an involuntary muscular activity. This is bought on by the body returning to normal Delayed emergence, where the metabolism of drugs is decreased, as it makes it more difficult for the anaesthesia to be reversed due to the hepatic and renal functions being impaired. Add liver metabolism of drugs to this section Pressure sore development Blood clots clotting cascade, platelets do not work increased bleeding Discharge criteria Patient A woke up fully after 20 minutes in the PACU with no complaints of pain, sickness or nausea but thirst. Her temperature was taken again and this was found to be 35.8 °C, a marked improvement on her original recovery temperature. Before the patient is transferred to the ward what scale used observations etc? Urine output from catheter Sats BP

Client Based Care Case Study: Elderly with Diabetes

Client Based Care Case Study: Elderly with Diabetes 215479 Client Based Care Study Introduction In this essay, the author will explore the care of a single patient, encountered in clinical practice, examining the impact on quality of care, and on the health and wellbeing of the individual, of key aspects of care. Case studies allow nurses to reflect on practice, examine critical elements of case and of clinical decisions made and actions taken, and to examine areas of care in more detail. This essay will explore the care of one patient, who shall be called Molly, an older, community dwelling adult with Type 2 diabetes, who was admitted to a medical admissions ward having been found unconscious at her home by neighbours. The essay will examine the aspects of her care that relate to the management of her condition, the assessment and management of her social, care and personal needs, and the planning of her future care and support needs. Reference will be made to governmental guidelines and policies, and to interprofessional working as a fundamental component of meeting patient needs in this case. Discussion Diabetes is a chronic disease which is known to impact significantly on the health, wellbeing and prosperity of individuals, of families, and of society as a whole[1]. More than 1.4 million in the UK are affected by diabetes[2]. Because of the great impact that this disease has on public health and on the use of NHS and social care resources and services, the Department of Health has published a National Service Framework for diabetes, which not only sets standards for management and diagnosis of the disease, but outlines best practice in the light of the latest available evidence on the condition[3]. There are two types of diabetes, Type 1 and Type 2, both of which are signified by a persistent high level of circulating blood glucose, due to a lack of insulin or a significantly impaired response to insulin, or to a combination of both factors[4]. Type 1 diabetes is due to the insulin-producing cells in the pancreas, called the Beta Cells, located in the Islets of Langerhans, failing to produce insulin, because the body’s own immune system has destroyed them[5]. Type 2 diabetes is usually caused by a reduced amount of insulin production by these cells, and by a degree of insulin resistance within the body, wherein the body’s metabolic responses to insulin are not as sensitive[6]. Type 2 Diabetes is the condition which Molly, the patient in this case study, has been affected by. Molly is a 66 year old woman who has had Type 2 diabetes for 17 years. She is treated by twice daily insulin, and, living independently still in her own home, she is visited once weekly by a district nurse to monitor her glycaemic control and check her insulin stocks and her general wellbeing. Molly has a BMI of 35, and also has a history of hypertension which is controlled by medication. She has her blood pressure checked weekly as well. Molly lives alone, never having married, and has no children. She has an active social life, attending a local book group, taking part in a local history and re-enactment society, and volunteering at a community library. She is known by the district nurses to be competent in administering her own insulin and measuring her own blood sugar, but she does not always adhere to her regimen and her recommended diet, because it can interfere with her social life. Molly was found unconscious by one of her neighbours at 9 pm, and the ambulance was called. Paramedics attending were told of her history by her neighbour, who waited with her, and suspected either Diabetic Ketoacidosis or hypoglycaemia. Diabetic ketoacidosis is a condition which can be life-threatening, and is usually due to a lack of insulin, which means that the cells of the body are unable to use glucose for energy, and so instead convert fat reserves to energy, which can produce ketone bodies which can adversely affect brain function[7],[8]. Hypoglycaemia can be caused by an overdose of insulin, or inadequate carbohydrate intake in a person who is taking insulin, or by the patient taking too much exercise, thus using up glucose, or by a combination of these Paramedics found her blood sugar to be 1.1 mmols, and administered glucagon to reverse the hypoglycaemia. She recovered consciousness quickly once her blood sugar improved, but was also given facial oxygen, and had full observations taken. Molly remained confused after insulin administration. She was taken to the medical admissions unit for a full assessment and, if necessary, in-patient admission and review of her diabetes. According to emergency care principles for the diabetic patient, the priorities are to save the patient’s life, alleviate their symptoms, prevent long-term complications of the disease and their current risk factors, and then to implement care that will help to reduce risk factors for their health, such as hypertension obesity, smoking, and hyperlipidemia, along with providing ongoing education and support for self-management of their condition[9]. In Molly’s case, the team evaluated her condition, because although the initial diagnosis was hypoglycaemia, suggested by her self-reported history of missing meals that day and being very busy, the differential diagnosis was diabetic ketoacidosis, which can be precipitated by physical or biological stress, including changes in endocrine function or other diseases, such as myocardial infarction[10]. Molly is pale as well, a finding suggestive of hypoglycaemia, along with her elevated blood pressure and dilated pupils[11]. As Molly was conscious, her Glasgow Coma Score was 13, and she had responded well to glucagon, according to established diabetic protocols, she needed to be stabilised and undergo a range of investigations to determine any other disease or factors precipitating her condition[12]. Blood pressure, temperature, pulse and respiration rate were monitored recorded via continuous telemetry, and an ECG was carried out, which ruled out myocardial infarction. Molly had blood sent for Full Blood Count, Liver Function Tests, Urea and Electrolytes and Glucose, as well as insulin levels, prothrombin time, clotting factors[13]. Prothrombin Time and Clotting Factors may also be tested, due to the risk of disseminated intravascular coagulation. Bloods were also sent to test HbA1c; Fructosamine; Urinary albumin excretion; Creatinine / urea; Proteinurea; and Plasma lipid profile[14]. Urine was dipped with reagent strips to test for glucose, protein (suggestive of kidney problems) and ketones. Because of her presentation, Molly was put on a continuous IV infusion of insulin, titrated hourly using a syringe driver against blood glucose, with an infusion of 5% glucose running in a different IV port. IV fluid therapy, and fluid balance, were also monitored closely[15]. Diabetes can cause kidney damage and impaired urinary function, so monitoring kidney function was an important part of care[16]. Once Molly was stabilised, ongoing care related to supporting her health and wellbeing, and minimising complications of her diabetes, became an important part of care. Diabetes is a significant public health issue, because it is not only associated with the ‘social’ disease of obesity, but also because as a disorder it is associated with a number of serious health implications[17]. These complications include macrovascular complications, including atherosclerosis and cardiovascular disease[18], [19], [20]; diabetic retinopathy and sight loss due to vascular damage which weakens the walls of the blood vessels in the eyes, causing microaneurysms and leakage of protein into the retina, vascular damage and scar tissue [21], peripheral neuropathy, peripheral vascular disease and gastrointestinal dysfunction, gomerular damage, and kidney failure[22]. The impact of this disease on public health relates to the fact that many people of working age are diabetic, and because the co ndition is chronic as well as serious, with acute exacerbations and so many complications, it presents a serious drain on health and social care resources. Therefore, it is imperative that individuals with diabetes are identified as early as possible, and are educated and supported in good self-management, and provided with ongoing care to maintain good glycaemic control[23]. Molly’s status as an older adult is also a public health issue, because older adults constitute the largest patient group in the UK, and the ones which consume the biggest proportion of healthcare services[24]. However, it was also important to avoid stereotyping Molly as an older person, and making assumptions about her needs and her health. Although she was obese and hypertensive, and had Type 2 diabetes, she was very active and had a very important social life, and was usually independent and self-caring. It was important to consider the social support that she had, and to ensure that she was aware of any services or support she might be able to access if she felt it necessary. However, some members of the multidisciplinary team, in particular, some of the medical staff, did appear to act in a way that suggested they were stereotyping Molly based on these factors (age, weight, health) and were discussing her case without really making clear reference to her as a whole perso n. This leads on to the need to evaluate the multidisciplinary input in Molly’s case, and the quality of the interprofessional working that took place, which is discussed below. As can be seen from the list above, diabetes can affect the individual and the body in complex ways, and so requires an holistic approach to care[25]. Care should also be based on evidence based, collaboratively agreed care pathways[26], as suggested by the NSF for diabetes[27]. Molly may need a comprehensive review of her management and her lifestyle, the patterns of care and the ongoing monitoring of her condition[28]. The National Institute for Clinical Excellence recommends a patient-centred approach to ongoing patient education and management, and also suggests a number of options for patients who might require different forms of insulin administration, such as continuous sub-cutaneous insulin[29], [30]. This, however, was not suitable for Molly, because it is usually for people with Type 1 diabetes. Health promotion and education is an important part of Molly’s care at this point, which is related to the fact that her current hospital admission is due to mismanagement of her condition herself. It was important to determine what factors about her lifestyle and behaviours had led to the lapse and the serious hypoglycaemia. Ongoing care, health promotion and education involved multi-professional collaboration and integration of care into a complex, detailed care plan. The aim was to provide Molly with the information, support and guidance that would allow her to view her diabetes management as a means of achieving a better quality of life, rather than viewing her diabetes as something which interfered with her quality of life. It was also important to view Molly in terms of supporting her to continue with her normal social activities. Research shows that making changes in lifestyle, and providing good, effective health education, helps to contribute to reducing rates of diab etic complications[31]. However, the kind of health education and support used is important, because different approaches have different levels of effectiveness. Some research examines the differences between health education that tries to persuade patients to be compliant with regimes and activities designed by health professionals, approaches which are usually generic, and health education that is client-centred[32]. Client centred approaches are usually more effective, as they are individualised. Research shows very clearly that patients with diabetes need to understand their disease fully, and be supported and empowered to make the lifestyle and behavioural changes that will enhance their wellbeing whilst enabling them to control their condition[33]. In this case, a diabetic nurse specialist was involved with Molly’s case, and a plan for health education and support drawn up, with clear guidelines and a tailored plan for managing her social life around her diabetes. Diabetes UK recommends a struc tured, tailored education programme for people with the condition[34]. Interprofessional and multidisciplinary working is a fundamental component of care for a patient with diabetes like Molly[35]. This means that diabetic patients should experience seamless care, addressing all needs, with access to all the professionals necessary to support her care[36]. Specialist involvement, including diabetic nurse specialists, was a feature of this care, and helped with a client centred focus[37]. The literature suggests that it is important for a lead professional to take charge[38], but in Molly’s case, her lead nurse was not present for the majority of her inpatient stay, and there was a lack of effective coordination of the complex number of professionals involved. In relation to multidisciplinary, interprofessional working Molly was referred to ophthalmic services for a check-up, to ensure that there was no diabetic retinopathy or glaucoma. She was referred to a dietician to support her in managing her dietary intake. She was also referred to a social worker. Diabetic specialist doctors were involved, and a report was sent to the diabetic nurse at her local surgery, as well as to her GP. Molly ended up staying in hospital, however, on a medical ward, for two weeks, even though her condition was stabilised rapidly, and she experienced no further complications. In this case, interprofessional working was not effective, because although the said referrals were made, or were recorded to have been made, Molly was not seen by the dietician or a social worker for over a week, and only when she began to threaten to take a discharge against medical advice did the dietician and social worker arrive and get involved. The doctors in charge of Mollyâ€℠¢s case however appeared to make judgements about plans for discharge and ongoing care without involving the nursing team and without considering some aspects of her social situation and Molly’s own preferences and wishes. It is apparent, from this case, that while Molly’s immediate medical needs were met, the interprofessional working element of her ongoing care failed in some way. There are a complex range of professionals and support workers who provide healthcare[39]. Because of this complexity, interprofessional education has become part of healthcare education programmes[40]. Interprofessional working is supposed to help with the provision of true patient-centred care, and the highest quality of care[41]. However, experience in this case, and some of the literature, cites ongoing problems with interprofessional working in a number of contexts. Some of this is to do with the professional boundaries and hegemonies which persist in healthcare professions, which continue to be defended rigorously by each profession[42]. Some literature shows that elitism, professional isolationism and professional defensiveness can have negative effects on health professionals themselves as well as on the qual ity of care delivery[43]. Yet there is ample government guidance, particularly from the Department of Health, which aims to improve service provision, and the NSF for Older People[44], identifies the most important elements of care and service provision which must be improved upon. Standard 2 of the NSF, ‘Person-Centred Care’, requires that health and care services are designed around the needs of the older patient (and their carers)[45]. However, this kind of needs-based care then demands . â€Å"an integrated approach to service provision†¦ regardless of professional or organisational boundaries, [which is] delivered by clinical governance, underpinned by professional self regulation and lifelong learning† .†[46] In Molly’s case, the fundamental role of the nurse in providing leadership and coordination for her care was not acknowledged or supported. Some researchers suggest that this can be due to medical hegemony[47]. Current approaches to offsetting such ingrained hierarchical thinking are very much focused on initial education of healthcare professionals, overcoming historical professional boundaries[48], [49], [50]. The research shows that there is a difference between multiprofessional working, which does not transcend the traditional hierarchies and boundaries , and inter-professional working, which is built on the desire to share care, support each other, and value each others’ expertise[51]. Government drivers continue to underpin strategies for better, ‘joined up working.’[52],[53]. The failures which occurred in Molly’s care were clearly linked to poor communication between the healthcare professionals, a lack of joined up working, and a lack of recognition, perhaps, of the importance of the social aspects of Molly’s case, and the health-education aspects, based on her individual needs. On reflection, the author believes that had there been better, collaborative working, then none of these needs would have been overlooked and they would have been dealt with more speedily. But another aspect of her care that could be improved upon was related to her own involvement in her case. Molly was not fully involved in her case discussions and in the medical decisions made about her care. While this can be a product of the medical hegemony mentioned before[54], it constitutes a serious oversight and is not in line with governmental guidance[55]. Research shows that the patient voice is the most important one in terms of collaborative care planning and manage ment[56]. Conclusion This case study has identified the case of Molly (a pseudonym), an older patient with Type 2 diabetes who received good quality clinical care in meeting her acute care needs and managing her medical condition and its potential consequences, but for whom interprofessional working failed in relation to ongoing care and multi-discinplinary involvement. Diabetes is a significant public health issue, and a range of governmental guidance and research evidence informs care for patients with the condition. The public health issues surround the serious morbidity and mortality associated with diabetes, and the fact that good management and glycaemic control can minimise these complications. In this case, the patient’s needs were prioritised medically, but interprofessional communication broke down. While the appropriate referrals were made, proper joined up working did not take place. Similarly, Molly was not fully involved in her case, and should have been. 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Critical Care Nursing Quarterly 27 (2) 113-125. Hankin, L. (2005) Diabetic Emergencies Nursing Standard 19 (52) 67. Hartley, H. (2002) The system of alignments challenging physician professional dominance: an elaborated theory of countervailing powers. Sociology of Health and Illness 24 (2) 178-207. Hilton, L. Digner, M. (2006) Developing a pathway of preoperative assessment and care planning for people with diabetes. Journal of Diabetes Nursing. 10(3) 89-94. Howe, A. (2006) Can the patient be on our team? An operational approach to patient involvement in interprofessional approaches to safe care. Journal of Interprofessional care 20 (5) 527-534. Keene, J., Swift, L., Bailey, S. Janacek, G. (2001) Shared patients: multiple health and social care contact. Health and Social Care in the Community 9 (4) 205-214. Keen, H. (2005) Diabetes and the quality and outcomes framework. British Medical Journal 331 1339 Kenny, G. (2002) Interprofessional working: opportunities and challenges. Nursing Standard 17 (6) 33-35. Kesby, S.G. (2002) Nursing care and collaborative practice Journal of Clinical Nursing 11 357-366. Krentz, A. (Ed). (2004) Emergencies in Diabetes : Diagnosis, Management and Prevention. USA: John Wiley Sons. Masterson, A. (2002) Cross-boundary working: a macro-political analysis of the impact on professional roles. Journal of Clinical Nursing 11 331-339. NICE (2003) Guidance on the use of patient-education models for diabetes www.nice.org.uk accessed 6-1-09. OBrien, S.V. Hardy, K.J. (2003) Developing and implementing diabetes care pathways. Journal of Diabetes Nursing. 7 (2) 53-6 OBrien, S., Michaels, S., Marsh, J. Hardy, K.(2004) The impact of an inpatient diabetes care pathway. Journal of Diabetes Nursing. 8(7) 253-6. O’Neill, A.E. Miranda, D. (2006) The right tools can help critical care nurses save more lives. Critical Care Nursing Quarterly 29 (4) 275-281. Pollard, K.C., Miers, M.E. Gilchrist, M. (2004) Collaborative learning for collaborative working? Initial findings from a longitudinal study of health and social care students. Health and Social Care in the Community 12 (4) 346-358. Pollom, R.K. Pollom, R.D. (2004) Utilization of a multidisciplinary team for inpatient diabetes care. Critical Care Nursing Quarterly 27 (2) 185-188. Price, B. (2006) Exploring person-centred care. Nursing Standard 20 (50) 49-56. Reinauer, H. (2002) Laboratory Diagnosis and Monitoring of Diabetes Mellitus. Geneva: World Health Organization. Robinson, F. (2006) Community programmes promote healthier living. Practice Nurse. 10 32 (8) 11, 13. Scott, A (2006) Leadership in diabetes nursing: Where is it? Journal of Diabetes Nursing 10(9) 324 Skinner, T.C., Cradocl, S., Arundel, F. Graham, W. (2003) Four theories and a philosophy: self-management education for individuals newly diagnosed with Type 2 diabetes. Diabetes Spectrum 16 (2) 75-80. Snow, T. (2006) A breath of fresh care in diabetes Nursing Standard 20 (37) 14-15. Soedmah-Muthu, S.S., Fuller, J.H., Mulner, H.E. et al (2006) High risk of cardiovascular disease in patients with type 1 Diabetes in the UK. Diabetes Care 20 (4) 798-804. Stanley, D., Reed, J. Brown, S. (1999) Older people, care management and interprofessional practice. Journal of Interprofessional Care 13 (3) 229-237. Suman, S. Lockington, T. (2003) Generic care pathways for acute geriatric care and rehabilitation as a tool for care management, discharge planning and continuous clinical audit. Journal of Integrated Care Pathways 7 (2) 75-79. Turina, M., Christ-Crain, M. Polk, H.C. (2006) Diabetes and Hyperglycaemia: strict glycaemic control. Critical Care Medicine 34 (9) 291-300. Watkins, P.J. (2003) ABC of Diabetes (Fifth edition). London: BMJ Publishing Group. 1 Footnotes [1] Department of Health (2002) [2] Hilton, L. Digner, M. (2006) p 89. [3] Department of Health (2002). [4] Department of Health (2002). [5] Watkins, P.J. (2003). [6] Watkins (ibid) [7] DoH (ibid) [8] Hankin, L.(2005) p 67. [9] Watkins (ibid). [10] Turina, M., Christ-Crain, M. Polk, H.C. (2006) p 291. [11] Guthrie, R.A. Guthrie, D.W. (2004) p 113. [12] Edge, J.A., Swift, P.G.F., Anderson, W. Turner, B. (2005) p 10005. [13] Hankin (ibid) [14] Reinauer, H. (2002) [15] Guthrie (ibid) [16] Guthrie (ibid) [17] DoH (2002); Department of Health, (2001). [18] Guthrie (ibid) [19] Bloomgarden, Z.T. (2006) [20] Soedmah-Muthu, S.S., Fuller, J.H., Mulner, H.E. et al (2006) [21] Guthrie (ibid) [22] DoH (2002). [23] DoH (2002) [24] Department of Health, (2001) [25] Collis, S. (2005) [26] Pollom, R.K. Pollom, R.D. (2004) [27] OBrien, S.V. Hardy, K.J. (2003) [28] Snow, T. (2006) [29] NICE (2003) [30] Diabetes UK (2006) [31] Anthony, S., Odgers, T. Kelly, W. (2004) [32] Skinner, T.C., Cradocl, S., Arundel, F. Graham, W. (2003) [33] Antony (ibid) [34] Diabetes UK (2006) [35] DoH (2002) [36] Keene, J., Swift, L., Bailey, S. Janacek, G. (2001) [37] Keen, H. (2005) [38] Scott, A (2006) [39] Masterson, A. (2002) [40] Pollard, K.C., Miers, M.E. Gilchrist, M. (2004) [41] Kenny, G. (2002) [42] Colyer, H.M. (2004) [43] Price (ibid)

Sleepwalking :: Biology Essays Research Papers

Sleepwalking Many people have heard of sleepwalking and even know about symptoms that surround the disorder, but is there more to the story than just waking up during the night and wandering around in an unaware state? What actually causes someone to sleepwalk? To try to understand the answers to these questions it is important to understand not only what kind of disorder it is, but who has the disorder, how frequently it occurs, what the symptoms are, as well as what the treatments are. By exploring these areas, it may be possible to better understand the disorder as well as dispel old notions about it. The Parasomnias are disorders that intrude into the sleep process and create disruptive sleep-related events. Arousal disorders are parasomnia disorders presumed to be due to an abnormal arousal mechanism. These arousals occur when a person is in a mixed state of being both asleep and awake, generally coming from the deepest stage of nondreaming sleep, stages 3 and 4. This means a person is awake enough to act out complex behaviors but still asleep and not aware or able to remember these actions (1). One of the most common types of arousal disorders is somnambulism, more commonly known as sleepwalking. Somnambulism affects children much more regularly than adults. In fact, sleepwalking affects approximately 1% to 17% of children and is more frequently seen in boys. Interestingly, 15% of children aged 5-12 years sleepwalk at least once, but only 3-6% sleepwalk more than once (5). It has been noted that the incidence of sleepwalking decreases with age. Although the exact prevalence of sleepwalking in adults is not known, it is estimated to be as high as 10%.(4). It has also been noted that those individuals who start to sleepwalk as adults are more prone to serious problems with it. Because it is found more commonly in children, who are undergoing many physical and chemical changes, if it is seen to start in adults it is thought to be linked to mental disturbances other than fatigue or anxiety. However, mental disturbances can be present without counting as a symptom(3). No one seems to know exactly what the cause of somnambulism is, but there are theories that have been suggested. Once asleep, it is thought that the part of the brain that controls muscle function is aroused and the "sleepwalker" begins to move even though he or she is still asleep (2).

Independent Reading Project: Creating a Museum of Living Literature Ess

Independent Reading Project: Creating a Museum of Living Literature 1. Problem Statement In preparation for the Advanced Placement Literature and Composition exam, high school students must read many kinds of literature during the year-long course to familiarize themselves with different time periods, movements, philosophies, and genres. Advanced Placement students must learn to think critically, and be ready to find, analyze, and express literary connections through written analysis. The biggest challenge of teaching and learning Advanced Placement English is the difficulty covering the entire scope of literature in two semesters. Twentieth century literature often gets neglected. The pace of the curriculum can also limit the creativity of lesson planning and evaluation. Many teachers rely heavily on lecture, discussion, and a traditional analysis paper. To add some variety to traditional teaching and learning strategies, a teacher might design an independent project where students work in teams and focus collaboratively on a single novel from the twentieth century. Each team would read a selected book and work together to create artifacts that would be shared with the other teams. Through collaborative work and sharing, students would be able to grasp the concepts and connections of several works of literature. The project outlined in section 5 will target twentieth century literature. 2. Target Audience The target audience is two sections of the Advanced Placement English Class. There are approximately 24 students in each class. These students are in their final year of high school at St. Pius X Catholic High School. The classes are coed, ranging in ages between 17-18 years old. The... ...to create. 7. Works Cited Blumenfeld, P. C., Solloway, E., Marx, R. W., Krajcik, J. S., Guzdial, M., & Palincsar, A. (1991). Motivating project‑based learning: Sustaining the doing, supporting the learning. Educational Psychologist, 26(3 & 4), 369‑398. Available October 17, 2002, from Professional Development Collection database: http://search.epnet.com Turner, J., & Paris, S. G. (1995). How literacy tasks influence childrenï ¿ ½s motivation for literacy. The Reading Teacher, 48(8), 662‑673. Available October 17, 2002, from Professional Database Collection database: http://search.epnet.com/ Wang, S.‑K., & Han, S. (2001). Six cï ¿ ½s of motivation. In M. Orey (Ed.), Learning, teaching, & technology. Retrieved September 15, 2002, from University of Georgia, Dept. of Instructional Technology Web site: http://itstudio.coe.uga.edu/ebook/6csmotivation.htm