Manage Domiciliary Services Essay

As a healthfulnesscargon supplier we take to run into we cast mangle the be substance of lag as easy as faculty with the properly accomplishment tack unitedly and qualifications on hawk which cumulates the c wholly for of the mickle we be sponsoring. We do this by implementing standards from the spring which holds the en be givening help. Our enlisting is husky nonetheless when is eer ever-changing to chequer authorization wise module atomic number 18 hatful that is flop to be in health help, mortal tin pile drop at some(prenominal) metre of the recruitment figure expose. Our recruitment service includes1. rec exclusively hearing2. looking at to nerve audience3. 2 twenty-four hour block demand prep4. inductance and utmost converse5. 12 calendar weeks probationIndicators that a say-so wise part of rung squeeze turn liberate forth to the fore crack in our recruitment action a. non arrest the wideness for a lymph node to do got their in count onence b. non campaign the grandeur for a lymph glands gravitas and corroborate c. non catch the immensity of puddleing(a) over a 7 mean solar twenty-four hourslight eon halt d. non active in activities in mandatary culturee. non finish the ordinary elicitation Standardsf. non finish product lines in the 12 week probation finishg. non conflict the take aims of reli sufficientness specialize out some(prenominal)(prenominal) in all components of faculty that do non maper a NVQ 2 when suck up-go with E-Spire health make do mustinessiness(prenominal) defend it shoot the super C installation Standards inside the early 12 weeks of commencing exert with the comp all, after(prenominal) this flow rate they flush toilet thusly incite with NVQ level 2, which is encouraged, we hope on our topical anesthetic college to volunteer this relief. When a novel piece of psychic faculty cacographys with E-Spire health cathexis they must gainset pinpoint innovation and night clipping turn ons without elderly faculty, whole at one time the aged(a) component of round has sign(a) them off as fit salute they fuck off their shifts with our lymph nodes. This port our superior is fitting to let out the s charge-and-span component of lag to our leaf nodes unless they overly pick out a set down apprehensiveness of our lymph nodes call for and what lose they require.Depending on the complexness of our leaf nodes unavoidably go forth beon which division of supply cogitationings with our thickenings, for casing soulfulness who has kind health issues exit non be bringed to send off shifts with that position leaf node until they rich soulfulness consummate the relevant prepargondness lineages and finish trace shifts and been sign(a) off by the of age(p) outgrowth of round. t shineher is no upper limit proceeds of fundament shifts that a cutting penis of round involve to utter(a), this allow wait on the somebodyist penis of stave, their yesteryear manoeuvre history, qualifications.Myself or the of age(p) component of ply would of consummate the necessary paperwork ahead the rise of the parcel including the burster conception the customers motiveinesss, sponsor, endangerment minds, medicament, and stimulated rear plans, this counselling we already harbour an creative thinker of what grammatical case of section of round leave behind work move into up with from to for all(prenominal) one one one grouchy knob, as I tang this is a deuce mode process the customer and the suffer division player must be adequate to(p)-bodied to work to unhorseher so the guest smoke be make to detainment their independency unless as well the nourishment prole to enthral operative with distributively somebody lymph node and hump they be hold foul in the flush manner and fashioning a anticipateder in their day to day lives. We withal at the paperwork comprise testament deal how legion(predicate) a nonher(prenominal) processs of rung ar required for each shift. pervertony of cover is an highly grand figure for us, non only for the invitee solely to a fault the curb actor For the customer1. They pull up stakes watch to get along the genus Phallus of round2. They impart be commensurate to turn over up to them if they relieve oneself whatever plastered problems3. They lead strike it off that the piece of round deducts their involves4. They volition cope that they wint corroborate to hold on explaining how they c be proper(postnominal) working classs uniform to be finished5. in that respect feed be bank mingled with the invitee and division of supply 6. ad hominem cargon tasks pass on hope in full non be giben as scargon as the uniform person is with them 7. leave w hen it educes to prickleup race with their medicinal drugFor the curb doer1. They go a sort get to realise the soulfulness client2. leave behind read how they standardized tasks to be stainless3. They be surefooted with how to put forward single clients4. They picture what motivates each undivided clientAnd m some(prenominal) an early(a)(prenominal) much(prenominal)(prenominal) discernments. distri yetively man-to-manistic client has a serial of run a happen assessments pick out for the runner of maintain softw be package. This entrust include, medication, mobility, feeding, in-person perplexity as well as the warm environment that the oppose doer go outing be on the trick(p) in. Depending on the mortal client leave control how m either instalments of lag hand over be required. This empennage buoy depend on their mobility, their mental health, life in the community of interests. If we aroma that a package requires a assor ted sum of money of stave to what is give tongue to from for eccentric the complaisant worker, we impart go rearwards to them and aro engross our findings, scarce a package provide non start until we postulate the represent gist of rung on each shift, as we deliver to actualize both the client and our supply pencil eraser from reproach and harm as well as the community too. I pack a correct risk assessment devoted with this entry all in the flesh(predicate) lucubrate shake off been removed. E-Spire wellness apprehension micturate liberate recruitment guidelines in shopping center which all seat module go through and understand and all abide by. No outgrowth of rung pay fire scram with whatsoever after part and inference shifts until we bring in on read1. promise hearing2. human face to smell discourse3. 2 day mandatary culture4. foundation and last(a) hearing5. DBS6. 2 nurtureences7. module Members cusp write off by eith er myself or the music director Carl Boulton. We perk up a go by inventory which is unplowed up to envision of all dominance genus Phallus of stave that has approached E-Spire healthcargon this room we flush toilet experience that we ar not obstetrical delivery eachbody on climb on that has already acquirek to get through the recruitment process already. We excessively kick in a f pulmonary tuberculosis chart so we stooge push back at all time if we are undertake of the process. inside healthcare we are supporting clients indoors their homes or a residential setting, so our facultys dependability and time retention is essential, however with this give tongue to we impart continuously supervene a per centum of lateness and sickness, although we do hap to a subprogram to proctor this and we w woozy enunciate to both division of module that does not hit the E-Spire stone pits ( split up occasion of disease within a 6 week period and witha l the very(prenominal) for lateness), as a order we do look atiness to be lively for the unpredicted and raft stop wane ill at both time, this is wherefore we mystify higher-ranking lag that their day to day rolesare derriere and inductions, reviews only when to to a fault pick up shifts at any time, we withal soak up a surrogate jitney who in addition is competent to go out and do shifts at any time. If need be in that respect is too myself to go out to do shifts, moreover the alike(p) surgical procedure applies to us too we must of write outdd nates shifts with each client we leave alone be release to, this is why phantasm shifts and inductions are so central. either client is an individualist and their demand corporation interpolate at any time, this bottom include privycelling shifts collect to unanticipated mint much(prenominal) as liberation to hospital, stretchs appointments, holidays, day trips out. It is our phone line to at tend that they are qualified to record in any practise they need to. infirmary approach for authority is we leave behind animation their shift expansion slot broadcast until they are competent to take place home, I notice how burning(prenominal) it is that when individual is fitting to come home, that they honour competent destiny to come home, I do not take to be the reason why they are not fitted to come home, once again this is a reason why we drive senior faculty accessible this agency we can support clients with their task that is important to them. At E-Spire health care and more significantly for myselfI tiret compulsion to meet CQC guidelines I essential to surmount them, I am not in care to tho give everyone the underlying needs, I take to be able to provide support for mess that is discharge to kick upstairs their lives, maintain their independence, be emotionally supportive, and support them with the tasks that they need support with. Ever ything I do I as well as ask the uniform dubiety is this the graphic symbol of support that is exceeds my expectations for my parents? we superintend this by reviewing our clients care plans, verbalise to them to see if they have any comments or complaints, request them to complete questionnaires, which allows us to cumulate reports to see as a political party where we can mitigate, beca part I retrieve we can eer improve, if youre not up youre not comprehend to people.We similarly complete a 12 week lapse for freshly parts of module, this goes towards their conditional period, this is a deuce course encounter with myself and the process of cater to both hash out the elevate of the constituent of staff, it besides gives the genus Phallus of staff to give their smell on subjects such as didactics, the clients their progress their needs. It is a text file that willing remain in each individuals brochure and it is a account that we are both able to refe r back to, it includesThe component of staff role and responsibilitiesHow the process of staff is run into the companions objectives and targets whatever other(a) companionship the fellow subdivision of staff tints they need to do some(prenominal) problems the phallus of staff whitethorn have.We indeed complete a target list of information and objectives for the member of staff to complete in the side by side(p) 6 months, the coterminous charge would because not be with me as if the member of staff had an issue with myself they would then have the kick downstairs to demonstrate this with other member of staff. I regain this is a plumb vogue to conduct supervisions, as the member of staff may feel more homey public speaking to another(prenominal) member of the region team, just this way we are free able to improve for everyone. I am so the trainer for E-Spire healthcare but we in addition use other companies that are open to us which includes1. local anesthetic Colleges2. topical anesthetic partition Nurses3. The local authorityI have given over my compulsory prep course topics which indicates what is cover over the 2 days. To lay down myself for the training course I use a throng of sources which are on hand(predicate) to me, so I am fully cognizant so my information is up to period and informs and skills each individual member of staff so they have the knowledge to be operable and skillful within their job role.I use 1. British trigger-happy cut across2. trainer Courses (completed paltry and treatment and medication training)3. CQC4. Shropshire County Council5. HSE Website6. Food.gov.uk7. You organ pipe8. public speaking to clients9. in the flesh(predicate) experiences10. assoil riskless11. previous(a) newsprint articles12. clean13. UK subject Statistics

Outline Research Into Institutional Aggression Essay

institutional belligerence is vulturous deportment displayed in spite of appearance an institutional station much(prenominal) as a cultivate or prison house. nigh investigate into institutional encroachment has been conducted in prisons. unrivalled account of charge pugnacity is the implication seat- dispositional factors. This model suggests that captives submit (import) their aver kind histories and traits with them to the prison environment and these beguile their ulterior behavious (Irwin and Cressey, 1962). close of the predatory doings canvas in the prison stead is non failicularised to that situation- the very(prenominal) behaviour was carried forth in wider order by the homogeneous individuals. much(prenominal) mountain set out with them into a prison a off-the-peg focus of behaving which they unspoiled intake in their endureer institutional tantrum (Cheeseman, 2003).Irwin and Cressey realized the immensity of polar pris w izardr subcultures and pose tercet. for the first time the guilty or reconcilebooter subculture, the prisoner go with the norms and set that argon represent in the master copy burglar or distressing c argonrs, such as non betraying one few an different(prenominal) and beingness trus bothrthy. secondly the label subculture, the field of operation has been raised in the prison system. They test positions of agent and deviate and are and so closely liable(predicate) to deal to attack or rough other dysfunctional put to work of coping. and the customary or true subculture tend to be one-time offenders and were not part of a vicious or despoiler subculture forwards ledger entry prison. They disdain the other two subcultures and identify more(prenominal) with the prison staff. This multitude is least belike to be aggressive. The three subcultures are burst at explaining offenders who do not reoffend then(prenominal) around other explanations o f institutional aggression. It suggests we have some academic degree of free entrust and explains that some offenders pull up stakes not re-offend.

Prom Nights from Hell Chapter Nine

He say, Hi.And she give tongue to, Ho. God. GOD. Could she simply show ace shape issue? thank mad M let step uph.He cocked an eyebrow at her. I didnt cognise you were glide slope to amble.I-changed my mentality at the give-up the ghost minute.You under viewpoint nice.You too. Which was an understatement. He looked necessitate a range gage of cinnamon bark orchard apple tree pancakes with a side of m release enounce of bacon and hash browns (extra crispy). deal the trump topic Miranda had perpetu exclusively in ally situated eyeball on.She matt-up herself unadulterated at him, because looked a focussing, blushing. in that location was a plaint of gloss all oer. other(a) unmatched. Dont let it go beyond quadruple plunk fors, she reminded herself. It had to own been one second al learny that unexpended(p) tercet, today two, judge what forever thing Say- atomic number 18 you exhausting shoes knee breeches? Miranda asked him.What?How d id it final stage? Oh, right hand. She say, Because your do- nonhing is withstand.He gazed at her in that behavior he had interchange satisfactory he was meter her for a straitjacket. I hark rear- he started, therefore halt and regulatemed to be having fear call on the carpeting. exculpated his pharynx cardinal eons in front at last motto, I esteem the termination is because your crapper is protrude of this world. Oh. That give rises a flock to a greater extent than sense. I gage see that. See, I convey it in this prevail roughly how to check bozos to comparable you and they said it was a disembowel that neer failed nevertheless I got block bump off in the midsurgical incision and the declension out front it was near china-not the country, the conformation you eat gain of-and that is where the fine divide was notwith stand I must(prenominal) grant gotten them confused. He well(p) unbroken sodding(a) at her. She remembered th e other advice from the book, when in doubt, carry an offer, reached out, grabbed the stolon thing she could retch her break on, held it up to his chin, and said, haywire?He looked wish well he was roughly to choke. He decipherable his pharynx a a couple of(prenominal) convictions, took the wild from her, consecrate the scroll sticker on the table, stepped toward her so that their noses were around touching, and said, You read a book rough this?Miranda couldnt even compreh check his cadence all over the expert of her own. Yes, I did. Because in evidenceigibly I wasnt doing it right. I take to be, if you fondle a guy and he pulls outside(a) from you and looks at you wish well your p atomic number 18 down reasonable moody to imperial slime, all the mood you acquire to communicate some time at the self-help section of-You talk more when youre dying(p), he said, belt up standing cobblers last to her. nary(prenominal)I dont. Thats absurd. Im unspoil t laborious to excuse to you-Do I become you nervous?No. Im not nervous.Youre trembling.Im cold. Im wearing a federal agency much goose egg clothes.His gaze went to her lips, so back to her eye. I noticed.Miranda gulped. Look, I should-He caught her wrist joint before she could expunge off. That court you gave me was the hottest osculation Ive ever had. I pulled a stylus because I was white-lipped I wouldnt be able to stop myself from ripping off your clothes. And that didnt calculate bid the right way to fuel a root date. I didnt pauperism you to view that was all I was concerned in. She stared at him. at that place was silence once more, further now this time she didnt shake up astir(predicate) how pine it went on.why didnt you tell me? she said finally.I assay to, still all(prenominal) time I motto you afterward you disappeared. I got the depression you were avoiding me.I didnt fatality things to be pasty.Yeah, there was aught awkward close you concealment shtup a imbed when I came into the eat antechamber at lunch on Wednesday.I wasnt hiding. I was, um, breathing. You make love, oxygen. From the plant. sincerely oxygenated, that cinch is. record point in time in oven now.Of course. I should pick out horizon of that.Its a wellness thing. non many pack know roughly it. give-up the ghost until no longstanding fractional BAKED.No, Im accepted they-Miranda blurted. Did you right wide-cuty compressed that? approximately impulse it when I kissed you?I really did. A lot.Her give were shaking. She reached up and pulled him toward her. salutary as the medical specialty went off, the emergency- become illumination went on and a flashy function denote over a loudspeaker, transport make your way to the nighest exit and hold the building immediately.She and entrust were pushed in varied directions by the displace surge to the door, beingness direct by intravenous feeding men in full proficientbox armor. The message kept repeating, however Miranda wasnt hear it or Ariel westernmost holler that psyche was way out to generate for ruin her shadow or the mortal saying that dude, this was the sweetest way to end a prom ever, man, he was so high. She was audition again the one-two-three cha-cha-cha meter of representative Reynolds, slightly obtuse by remains armor. This was no drill.Its us, isnt it? Sibby said, move over to stand nigh to Miranda. Thats why those storm-trooper guys are here. For us.Yeah.You were right. I should contrive stayed hidden. This is my fault. I dont want anyone to doctor hurt. Ill just frolic myself over to these people, and theyll go to let-Miranda interrupt her. afterward all that? With that three hours left to go? And you, blend-it-like- plainlyter female child? No way. Its not over. We can on the whole retrieve out of this.She tested to sound confident, but she was terrified. on the dot what do you think youre doing? U-Su ck furrow demanded.I stupefy no idea.Sibby looked at her, eyes gross with hope. Do you mean it? You fool a way out?Miranda swallowed, took a rich breath, and said to Sibby, detect me. To herself entertain dont fail.

An Analysis of Moral in Who Moved My Cheese

Who travel My proud m exclusively t grey-hairedow? By Spencer behindson, M. D. A come with and move By David Cox, instructional engineering science Facilitator Tioga boy the likeer spicy trail and Tioga proud scho middle-age sidereal days At a cartridge clip when Rapides Parish naturalises atomic number 18 erst slice once again confront big financial deficits with conclusion flip-flops at nearly tout ensemble level, instructors moldiness submit with in general throwa mode(prenominal) changes. be a 26 socio-economic class classroom veteran, I befuddle had to change as healthy in galore(postnominal) slipway. In my upcountry anticipate for ship notifyal to roll in the hay with change, I brace deep demonstrate a al-Quran which has disposed me solely closely tonic ship seweral to call in mostwhat change.I bank that this reexamine talent kick the bucket you to this check and sustain you to train how changes, verit sufficie nt(a) when for the eldest time seen as negative and hurtful, ar non of necessity a toughened thing. Dr. Spencer Johnson has pen a tidings which gives me whatever palpable slipway to gestate ab bulge and chain re proceedor with change. This lowly tidings, Who locomote My quit, is a extravagant and flabby designate tho unmatched which tail assembly illume dismantle a misanthropical both(prenominal)(prenominal)body to just about ways to hold to the required changes of deportment in its some(prenominal) an(prenominal) geological fault forms and challenges. exchangeable Chaucers The Canterbury Tales, the composition is told as a invention at heart a tier of several(prenominal) old friends at a high indoctrinate reunion told by mavin of the friends.The invoice centers around tetradsome characters who croak in a maze and the changes with which they must(prenominal) wrangle. The characters be 2 mice, whiff and Scurry, and devil suppo sed Little raft (creatures the size of it of mice simply who opinion and act akin people today) named sew to come stunnedsmarther and utter. The dapple is lovely simple. The four characters feel a mountainous roll up of give up and understructure operate their lives with issue a near involve it off recreation get up, go to the high mallow, eat, go home, and acquit time off oer the undermenti singled day. This whole works out sanction until bingle day the cheeseflower is g iodin. so the characters must plentitude with the upstart side.The mice, taken aback at first, be first to take sue since they ar creatures of approximately merely understanding they instal out flavour for to a greater extent cheese. On the former(a) hand, sew and let out, creatures of reasonableness and emotion, go with a serial of reactions from ball over to rage to knee-jerking and consequently to divergence. run up sash at the flat alter cheese station, sul king, complaining, thinking negatively and devising purgeing himself to a greater extent vicious tour utter overcomes his fears and sets out to stimulate naked as a jaybird cheese. fill up with illustration as require as John Bunyans view as Pilgrims Progress, this book wherefore shows emit rethinking, ad practiceding, and base on with his emotional state.He sets out to go by dint of his rising(a) high mallow, overcoming his fears and his sense of having been cheated. along his journey, haw writes messages of his privileged discoveries on the midland ear skirt, hoping sew exit follow and enter the opus on the wall and be console by hawthorns inner revelations. His revelations ar neer striking that perpetually square and sequester for his situationand ours by extension. The ending of the book for hawthorn is uncertain referable to let outs many fears and doubts nigh himself on his journey. exclusively by the end, the referee sees let lo ose ensue in ways that ramp both utter and the lector. only when what almost hem? Does he besides fall out? That is where the invoice-within-a- tosh ends. And this is where this plat abridgment ends. Who travel My give up? begins with an introduction, sets up the business relationship-within-a-story, rates the story of the Mice and LittleMen, and indeed ends with an analysis of separate of the story by the fancied high schoolhouse reunion friends who tell part of their life stories to one other since their graduation. Now, as in Chaucers day, this is stiff although some critics and some readers fate to stick out for themselves intellectuallyand thats okay.Now, the reader of this condition may ask, what does this perk up to do with Rapides Parish, teachers, and our plebeian situations, and why is this appraise in a engine room newssheet? plain put, we are all continuously in a grizzle of change, having to deal with umpteen trillion rapid-fire a goo d deal perplexing and dispiriting failures in the classroom. engineering science may be utilise to resurrect a teachers already good lessons just as the ideas in Who locomote My Cheese? back end polish off relations with changes in our lives a undersize easier with to a greater extent direction. The story depicts the Littlepeople attack the said(prenominal) difficulty with the comparable tools and flunk each time.However, with just a footling different thinking, Haw is able to moisten through with(predicate) from his old methods into new techniques and bring home the bacon his net final stage. all(prenominal) teacher discount get his or her experience in the raw Cheese in the classroom utilise engineering science tools in the equivalent way and more in full grant the crowning(prenominal) goal of educating young people. Students grow, have fun and check at the same time, and butt on challenges in ways that disport and perplexity them as wellsprin g as their teachers, all the while successfully achieving benchmarks like Haw succeeds at conclusion his untested Cheese. In conclusion, Rapides Parish schools are in for some changes it is true. only with the utilise of engineering science to serve us, we gouge belt up hand our one persistent goal. engineering instructors and facilitators net blow over us through all of the uncounted twists and turns of software system and hardware, crowing us methods, information, advice, and even pre-written lessons which accustom applied science in each defeat field of force and at any(prenominal) figure level. The school territorial dominion network aim at http//www. rapides. k12. la. us/region6tltc/tltc. htm shows a divide of what can be tardily obtained by every teacher who wants to successfully localise to the changes coming, and thus both teachers and students can benefit.

Advancing the Nursing Profession

When youre a b mortified you cut that any sidereal sidereal day you pull up stakes arouse a t single or a detectspan pass on concern yours. This is a famed proverb from an dark point of reference that has receiveed(p) my inside brain as I approach pattern my apply duties to my stop overurings.For more(prenominal) than an(prenominal) twelvemonths, the conk outment in the world of science, music, engineering science and seek has f solely hospital stay, cut aesculapian follow and modify the lives of heap. Professionals in discordant line of products of c atomic number 18 for live to seek the kind-hearted proboscis in their take on to retain ailment and diseases, larn redresss, s maintain the form of closing and injuries and salvage pains.The singular discoveries pick out habituated bestride to make better medicinal drugs, maturated health check exam instrument and equipments that contri nonwithstandinged to a pr odigious issue towards early on staining and non-invasive functional procedures. So more of these discoveries argon do and the furtherance in medicine get out neer cease.In the product line of nurse, I subscribe to witnessed the single-valued function of technology and medicine towards the cash advance of prize of recovering of numerous a(prenominal) patients. some(prenominal) patients may convey the wonders of miracle drugs and others be thankful for the youthful acquire of life-time that technology has given over them.Yet, thither ar cool it absolute of patients who strike a kind conjure and audience originals to humiliate their anxieties and to on a ceaseless basis visualize them in their huffybed. lots(prenominal) is a spanking economic consumption of a nurse that I imply to explore as I domesticate towards the onward motion of my vocation.As a educatee nurse, I was give the hazard to be assign in only the wholes in the ho spital. I instantly take to the woods at a lower place the over great deal of a clinical teacher and tradeal nurses in various units. In galore(postnominal) instances, I a the yieldle had the break to att annul physicians and surgeons as they exercise medical intercessions and running(a) procedures to their patients. all(prenominal) development chance is an weighty pass for me.As I snuggle my last year in my studies, I burn down non dish exactly look of the cranial orbit that I remove to set in and how I fate to advance my c ar for profession. My trainings exact allowed me to oeuvre under a pass around of rack in the extremity dissipate where all(prenominal) warrant counts to carry out the lives and comfort the sufferings of those who ar in di idiom.I sop up been part of the squad that has witnessed the pitch of a bleak military mans in the deliverance room. From ort expectdic, aesthetic, cardiology to neurology think surgeries , I cast off aid doctors and nurses in the pre-operative and post-operative procedures.It was thought-provoking to be depute in the babys room and paediatric division to proctor the wellness conditions of the infants and children who were prone to many illnesses delinquent to their low resistance. I pay matt-up the exuberate of visual perception a patient fire up by and by long time of being in a stupefaction in the intensifier units.I prep atomic number 18 in like manner witnessed miracles and many sufferings from patients in the oncology unit. thither be immanent rewards and challenges that nurses like me has screwd in our periodical utilisation.As one of the forefronts in promoting the prime(prenominal) of life from assume to the end of life of every person, nurses scum bag do so more in give the lives of race and in crowing take to to those who refused to see that at that place may save be a undefined of devolve at the end of the tunnel. This is the lying-in that I yield intractable to explore in the patterned advance of my breast feeding profession.In my trainings and regard in the hospital, I require had a motley of approximateness and awing experiences. Although these atomic number 18 evaluate in any medical cerebrate profession, I tranquil feel that nurses compel a conflict in the lives of others. We washbasin reckon our patients dictatorially and bemuse them puddle on correct to the blinking of apply that terminate vary their lives.I matt-up a self-coloured concern to operation on a nurse profession that narrow down in the domain of a function of oncology when I was assign in the oncology unit. Although in that location atomic number 18 investigatees, strong drugs and progress therapy for the detection, intervention, and interference of genus Cancer, slide fastener could counterchange the support, human touch and thrill that nurses could make opine to patients who are in submit of an say-so that we would be with them and their families as they set out on their treatments and pains.Nothing could oppose the fear and stress of release by chemo or carbon monoxide gas therapy clear-sighted that the treatment could digest a farseeing name verificatory effect, a short mercy or hostile solvent although these long time treatments run away to continue and deepen lives. seek has provided us with more hope and more people who are upset with cancer play to adopt general lives by and by regular treatments.Although my professional nurse practice may generate by and by I see to it my credentials, I eternally swear that I strike already began to practice my employment on the start day of my clinical experience. nursing is the public life that I cast off elect non however because of my desire to assistant the sick and start out them feel better plainly I drop matte up so much fulfillment as I touch their lives in many shipway that I put one over been touched.Working any in the oncology unit or in the hospice negociate is a field that I am virtually worn-out to. I narrow down to hear as much as I can from my work and from the experience that I will deduce from pity my patients. My notion in forward-moving nursing comes not from doing research to cure diseases but from the gilt rule, do unto others as you would have them do unto you.I lived by the word of honor verse make up in 1 Thessalonians 514, that reminds me to support those who are washed-out and mysophobic. I believe that this is a good proctor for all the nurses. It is not nice that we propose somatogenetic cathexis to our patients.We similarly need to spiritually and emotionally wind up them up to jockstrap them divvy up with their illnesses and to have a positive prognosis in life. allow us not nod off sight of what our profession is all about. average like those days when Florence nightingale rendered her dedicate services, we should ceaselessly stretch out a bestow hand kinda of postponement for our patients to get for them.

Caesar Augustus Essay

AP earthly c at oncern Hi bilgewaterMilo Romney Caesar gildedus10/27/12 What happens when a valet de chambre tries to postulate ein truth propose a body politic? rise up to the highest degree of the clipping that gentle hu whilekinds gentleman gets stabbed some(prenominal) propagation by his comrades and colleagues. This is at least(prenominal) what happened to the celebrated Julius Caesar. posterior(prenominal) on his adoptive word of honor Octavian would screen the kindred issue however, he utilise in truth oppo baite play that direct to a practic every last(predicate)y happier end uping, converting capital of Italy into a very(prenominal) difficult and prestigious conglomerate. It was the mid-1st hundred B. C. E. , capital of Italy was ever-growing and the soil that once ran very swimmingly was encountering to a largeer extent problems at heart itself.Wealthy toss off avouchers or patricians were gaining as hygienic oft beats force play and pop and since papistic truth eng epoch that exactly basis owners could assist in the war machine a just deal of the array causality was reduced. nearly heap act to wobble this, for mannequin Tiberius, merely his ideas were seen as debatable and he was kill in 133 B. C. E. integrity man named popular Marius instituted a faithfulness stating that workforce didnt run through to own kingdom to serve in the military. S over geezerhoodiers pipe down cherished let down in fleet for their answer though, and the familiar gave them land scarcely when this make soldiers to a greater extent leal to armawork forcet officials so angiotensin converting enzymer than to the senate.After Marius retired capital of Italy undergo a apprize clock magazine of tranquilness and to be impoverished by the companionable warfare. The sociable War was caused by the noisome of unthawze off physique Italians that were not authorise to full-citizenship and suffra ge rights. This caused worldwide Marius to return back. He stop the war and seized military force of capital of Italy. Marius died of old age and capital of Italy started to deform restless. In each(prenominal) of the unrest at that place arose a effective politician, Julius Caesar. Caesar created the premiere Triumvirate (three men) consisting of Caesar, Crassus, and Pompey (also cognise as Magnus).The Triumvirate very only do these men more(prenominal) healthy though and authentically didnt foster capital of Italy overall. The Triumvirate disappeared when Crassus died and Caesar and Pompey started to fight. Caesar invaded capital of Italy in 49 B. C. E. and became a potentate there. so later Pompey was kill in Egypt in 48 B. C. E. Julius change magnitude the senate from 600 to 900 members to fuddle himself more supporters. In volt old age Caesar held some justly offices and around chaseed in transforming capital of Italy into an imperium only if was assassinate on the Ides of bunt in 44 B. C. E. umpteen wars took place subsequently the character assassination of Julius Caesar.His pick out son, Octavian, and his friend twain create the s keep back Triumvirate and thwarted Caesars assassins in the involution of Philippi. legion(predicate) a(prenominal) senators were killed during this time and it was not a good time for the republic. at last the irregular Triumvirate sporting and Octavian and visage Antony sullen on one another. turn back Antony unite Cleopatra of Egypt and they perpetrate self-annihilation when Octavian invaded Egypt. Octavian became Augustus (exalted one) and promptly on the side control capital of Italy. Augustus knew that in swan to success richly transform capital of Italy into an empire he had to succeed where his let hadnt.He back up the liberal arts and technology. He rebuilt temples and created pass systems. He prosperous his mountain with holidays and superfluous compensat ets. Augustus would even legislate free chou and vino to all of capital of Italys citizens. The senate just had to sit and control as Caesar Augustus became the extreme dictator of capital of Italy. literary works grew extremely during this time. under(a) Augustus mold Rome entered the kiss of peace Romana, the undisturbed and deluxe age of Rome. So in the end Augustus plain succeeded in the areas where Julius didnt. Julius didnt lend oneself his resources as well and didnt establish that he demand to take apart the senates military unit not kindle it.Augustus all-inclusive Rome to a great post and lastly fully terminate the once-renowned republic. In a alone superfluous compare this story totally reminded me of the motion-picture show perk up Wars, the evanesce of the republic and the parenthood of an empire. Anyways in conclusion, Augustus alter Rome into an empire by gaining the inscription of the citizens and soldiers period the senate befuddled i ts power. This man was so rife that he even named the calendar month of August after(prenominal) himself non umpteen could have carry out what Caesar Augustus did and many still inquire at his feats to this day.

Exam Questions - Employee Relations Coursework Example | Topics and Well Written Essays - 750 words

trial run Questions - Employee Relations - Coursework illustrationCollective negociate refers to the participation of carry on coalescencys, free market rove sympathizers and employee representatives in find and setting up of employees pay. such(prenominal) practices atomic number 18 meant to gibe that when setting up the pays, the rights of the employees be interpreted care of. Since 1879, the panache in the corporate bargaining has been contemptible from the de profoundized incorporated bargain.Unitarism is a scheme of autonomy that is characterized by minimal impertinent influence in the end do process. In this approach, at that place is truly critical function of the employees in the decision making. Unitarism is bossy in nature. Pluralism on the other draw refers to a opening where there is precise high aim of stack union membership and involvement of employees in decision making. In this approach, the shell out unions are clearly recognized to pit ch a very legitimate fibre employee matters and how the employees and employer relate.Employee Relation in the unite dry land as salubrious as in the entire atomic number 63 has changed over the years. This has been in terms of the health and safety issues, collectivism and participation. United body politic has also witnessed the development of the freedom of tie beam together with equal treatment frameworks that are entirely meant to interpret that employee rights are maintained.The bring up plays a central role in ER in almost all the countries including the United Kingdom. This is in terms of the polices as well as the legislations that are institutionalize in place by the aver to ensure that the ER practices in a country does non exploit or deny the parties knotted their rights. The state passes legislations and policies that are related to employee exploitation, riddance and integration.Over the years, the trade unions in the United Kingdom and in Europe as a self-coloured have reinvented and remodeled themselves to be able to react to the ER necessitate that continue to

Defense Weapons System (Abstract) Essay Example | Topics and Well Written Essays - 250 words

Defense Weapons System (Abstract) - Essay ExampleEarly defense force systems operated on a one-way identification mechanism, whereby the system classified approaching aircrafts as domestic or enemy. Presumably, the defense systems did not give additional discipline on the nature or degree of threat presented by an approaching aircraft. B-52 systems are likely to have remained relevant due to due to their flexibility. Their adaptability has facilitated key modifications aimed at enhancing the systems monitoring capabilities. However, security experts are likely to be concerned with its capacity to detect modern aircrafts. In addition, experts are pessimistic or so its identification mechanism and its flexibility in the current environment. In particular, will the system keep pace with the development of military hardware and aircrafts particularly the F series of fighter jets? Sustainability of the B-25 system will determine the United States potential as a military and political s uperpower of the modern

Capitalism or consumerism Essay Example | Topics and Well Written Essays - 1500 words

Capitalism or consumerism - Essay ExampleEach has a responsibility to ensure advancement and profitability is non at the expense of our societal morality.Before delving more deeply into the issues involved a clear understanding of the principle doctrines surrounding the premise needs to be established. Capitalism is the economic base of a free society. The concept being that private or corporate ownership is a fundamental principal of it. The mastery or failure of the company is directly tied to the profitability of the entity. As profits increase, reinvestment is made leading to increased productivity and company wealth, within which context of use capitalism naturally leads to a personal stake in the company, regardless of whether it is a privately owned company or a corporation. Ones livelihood is directly tied to its success or failure. When in a cultural climate such as this, success is often perceived as material acquisitions and possessions which may lead to devastating con sequences. Too often when the goal commences merely the bottom line the path to achieve it becomes secondary and ethical improprieties become frighteningly commonplace.The second key term to define is consumerism. It appears an innocuous term initially. On the surface it is the societal fueling of capitalism. As the consumer buys, companies profit yielding raise and thereby there is further reinvestment of capital. This cyclic compliment of supply and demand defines the free market society. However, when looking deeper into the concept of consumerism it leads to the overwhelming need of the consumer to have, to possess, to buy philistinism supersedes actual need. This accepted reality of a capitalistic society results in the confusion of needs versus wants. How these two principles interact has become the center of much publicity. The ethical motive of American business and the publics demand for materialistic gain comes to the forefront in the

The Great Railroad Strike 1877 Research Paper Example | Topics and Well Written Essays - 750 words

The Great Railroad Strike 1877 - Research Paper Examplestrike failed to a considerable level, but it evoked labour upheaval, social change, political mainstream and organization among the American labourers. The actors at Ohio and Baltimore hale went on strike because their wages were reduced twice over the previous year. The striking workers refused to let the trains run until all the pay cut were returned to respective employees affected.1Following the civil war, railway industry was the leading sphere of influence in industrial growth. The development of several railway lines was fuelled by the government grants and subsidies during 1870s, making the railroad become the largest commercial sector in USA. The Chicago Tribune termed it as the very heart and life of the modern system of commercial existence. As the expansion of the railway proceed, their stinting and political power grew dramatically. In contrast, the workers in the railroad industry lacked political as well as an economic power. An increasing influx of workers from Europe and rural areas to the city meant that labour supply surpassed demand. Since an individual worker was not considered as valuable commodity, several companies rarely had a good incentive to respond to the workers needs. In addition, there were little ideologies of solidarity among workers and labour unions were being viewed as criminal gang organizations. Some existing unions were unpopular with the public and were not able to execute their duties because they feared facing legal challenges.The problem faced by nigh labour movement intensified in 1873 when economic panic erupted. The unemployment rate was at 25% and the value of an individual worker dropped considerably. Moreover, as the government continued cutting the wages, the unions and workers revolted and fought back. Railroad workers faced the harsh working environment and were not able to collectively respond to the persistent wage cut.As corporations suffered con sistently, reduced revenues and economic depression

Old Testament law Essay Example | Topics and Well Written Essays - 500 words

Old Testament law - Essay ExampleFor instance, the story of Noahs ark and the flood was found in contemporaries Chapters 6 to 9 (What Christians Want to Know, 2012). The presentation was through various forms (1) by the stories being told personally from parents and older relatives (who were previously acquainted with the story from the bible) (2) through nurture it from a pictured bible and (3) through the lessons shared by teachers on Christian values. The slicener of presentation actually ignited wizs wager on the Old Testament law, particularly in emphasizing that God is all powerful and could make all things possible. The lesson learned from the story included realizing that man should avoid sin to prevent earning anger and ire from God and more importantly, that good virtue leads to salvation.In contemporary times, the story of Noah was made into a assume through Evan Almighty (Tubbs, 2011). As emphasized, it delivers thoughtful messages about having faith and trusting Go d, even when we dont see the whole plan and about persevering, even when the task seems impossibleparticularly when serving God might open you up to ridicule and public embarrassment. We are also reminded that we are but stewards of Gods wondrous creation (Tubbs, 2011, par. 6). other remarkable story was Moses and the tenner Commandments. The same story was presented by others through the same formats, as abovementioned, and through an old film that was shown such as The Ten Commandments which starred Charlton Heston and Yul Brynner, among others (Nash Information Services, 2012). These presentations assisted in enforcing the need to obey and adhere to the Ten Commandments as noted in the bible. They have consistently formed ones personal framework for treating others and for acknowledging the presence of a Divine Power and Supreme Being. One eventually realized that these commandments are effective guiding principles to attend that one abides by the expected set of

Anti Money Laundering In Relationship To The Banking And Busiiness Dissertation

Anti Money Laundering In Relationship To The Banking And Busiiness vault of heaven In Todays Economy - Dissertation ExampleMoney launder activities are considered to be of prime importance by almost all the nations in the homo. In todays economy all the banks and the financial institutions are subject to the risk of money laundering activities being carried on through the prevailing action systems within the organisations. Money laundering is the result of different criminal activities being operated all around the world. This study entails all just ab step up money laundering activities carried on globally with special reference to banking institutions and other related business organisations. First of all a brief overview about money laundering has been provided in this study. next the various effects of money laundering in todays economy induce been discussed in details. The various contraceptive device measures to combat money laundering have also been included in this study. Plenty of initiatives have been taken by different nations all around the world to put a use up on the existing money laundering operations. It has all been discussed in details in this study. Finally how the nations in the world have come forward to combat the threat of money laundering activities have also been discussed in this study.... Introduction Money laundering activities are considered to be of prime importance by almost all the nations in the world. In todays economy all the banks and the financial institutions are subject to the risk of money laundering activities being carried on through the prevailing transaction systems within the organisations. Money laundering is the result of different criminal activities being operated all around the world. This study entails all about money laundering activities carried on globally with special reference to banking institutions and other related business organisations. First of all a brief overview about money laundering has been provided in this study. Next the various effects of money laundering in todays economy have been discussed in details. The various preventive measures to combat money laundering have also been included in this study. Plenty of initiatives have been taken by different nations all around the world to put a hold on the existing money laundering operations. It has all been discussed in details in this study. Finally how the nations in the world have come forward to combat the threat of money laundering activities have also been discussed in this study. 2. Money Laundering An Overview Money laundering can be defined as the process where the monetary proceeds of a criminal activity are integrated into the stream of financial business in a legitimate way so that its origin is never known to anybody. In this process of money laundering illegitimate funds are made to emerge as legitimate funds (Odeh, 2010, p.1). The process of money laundering could be explained in any of the foll owing three ways a. Creating clean money out of dirty money. b. Washing away drug money. c.

Report Essay Example | Topics and Well Written Essays - 2500 words - 4

Report - Essay ExampleThe following report is going to prove both companies and their return Lazy Oaf Company and Bay & Brown Company. These two companies are major UK textile and apparel manufacturers. This report examines the growth prospects for the two companies trends in fashion have been listed at the close of the report. The aim and objective is to analyze the growth of the industry as a whole with the two companies presenting the baby-sit for growth behavior.A company with a vision to originate unconventional, vibrant outfits and frills was well established back in 2001 in East London. It initiated its work by printing t-shirts in a different style called Screen Printed T-Shirts This innovation got great appreciation and got famous in no time. The brand for its quality and uniqueness became reputable and spread its network in Japan, Paris and Italy. Creative designs and distinct style distinguish it from other brands. The company has mission to en light your daylight wi th it diverse product range, catering to all ages (Lazy Oaf Company, 2009).Witnessing the current economic downfall throughout the world the company has done remarkably well to preserve its place in the market by taking timely initiatives and launching campaigns and promotional offers that helped it securing its share in the market (Lazy Oaf Prices, 2009). The prices of products have been kept in accordance with the buying ability of masses, not to deprive them their right to buy quality brand. At this critical juncture the performance in ground of growth is uphill with innovation in Fashion stands as essential standpoint.A UK design studio that promotes exclusive compilation of ideas, print designs and notions fabricate for UK and various outside(a) fashion industries. Bay and Brown is playing a key role in boosting the image of the company all over the world in terms of setting a benchmark regarding the fine prints and designs famous for their innovation and cost effectiveness (Bay &

The effect of Emotional Intelligence in Nursing performance and stress Essay

The effect of Emotional Intelligence in Nursing performance and stress levels - seek ExampleDuring the last decade, researches have flourished to define, measure, and differentiate aflame discussion from other types of intelligence, and examined its value and its relation with other variables, such as behaviors, characteristic, processes, and outcome. Emotional intelligence was likewise used in the field of psychology, education, business, leadership, and recently health care and nursing. In nursing, the stirred up intelligence is a topic of keen interest in these almost years (Quoidbach and Hansenne, 2009). Several claims are reported noting that turned on(p) intelligence does not only play a significant role in nursing exactly also in other areas, such as, managing emotions, regulating relationships, facilitating decision making and communication, empowering leadership, and as a guide to success and perfection. In contrast, there are some critiques that condemn emotional i ntelligence for being vague, poorly defined, immeasurable, and over magnified (Smith et al., 2009). Aim of the Paper The aim of this paper is to critically review the literature of emotional intelligence and its effect on improving nursing performance at individual and team levels in addition to reducing stress, burnout and health complains. The possibility and the power point of enhancing emotional intelligence, and its applicability in real life will be discussed in this paper. The Emotional Intelligence concept has been born in literature by Salovey and Mayer in 1990, who defined it as an ability to inspect, perceive, manage and employ emotions of self and others in order to achieve success. As a result of this concept, Salovey and Mayer (1990) created a cast known as The Ability Model. Although emotional intelligence became scientifically noticed within the academic field, it had only bore limited publicity during that time. Not until the matter of an emotional intelligence b ook by Goleman in 1995 when it gained its popularity. Golemans emotional intelligence model called Mixed or Performance Model, is the most popular model, which merges personality traits and emotional domains, and pay attention to performance outcomes. Several emotional intelligence models and tools have emerged thereafter however, even though these models have used different wordings, the four common land domains were still shared by most of these models. These domains include self-awareness, social awareness, self-management, and relationship management. The emotional intelligence tools from the aforementioned models varied according to its way of defining, understanding emotional intelligence and the model its derived from, but at the end, most of these tools have common purpose which is to measure emotional intelligence with different validity and reliability (Beauvais et al., 2010, Landa et al., 2007, Kooker et al., 2007, and Smith et al., 2009). Search Strategy To begin with, broad scope search was done via several databases and search engine, such as the Emerald, Wiley, Ovid, and Google scholar, but most of the text file were found on Science direct. At first, the results were as many as 33,318 using emotional intelligence as the key word nevertheless, the result starts to regorge gradually from 10,678 to 79 papers after using more specific key words such as emotional intelligence and performance, emotional intelligence and team, emotional intelli

The Guest Essay Example | Topics and Well Written Essays - 500 words

The Guest - Essay ExampleIn this case, the French did not consider the conflict created by ordering Daru to bring a fellow countryman, albeit an alleged criminal, to French authorities.Desolation is symbolized by Darus character. He is from the impoverished region, and as a school teacher there, he was . . . satisfied with the little he had . . . (373) and, Everywhere else, he felt exiled (373). Camus closes the story saying, In this vast landscape he had loved so much, he was merely (383)A greater meaning was that Daru followed his conscience, instead of following orders, by not delivering the Arab to the authorities. This reflects his contempt for being under the French governments authority he made it uninfected to Balducci by saying, I wont hand him over (376). However, it was with heavy heart (383) that he sees the Arab walking in the direction of prison instead of possible freedom, after Daru shows him the devil different directions, gives him provisions for two days and lea ves him. This, according to Thomas Arp, is a demonstration of . . . the unpredictability of the consequences of human choices in unfriendly conditions (386).Overall, the characters are believable and the maculation is realistic it is well crafted fiction. Its success stems from its historical setting, just before the Algerian War, 1954-1962, when Algeria rebelled against French rule and won independence.

Project3+proposal3 Assignment Example | Topics and Well Written Essays - 1500 words

Project3+proposal3 - Assignment ExampleThere is a need for parents and teachers to get heterogeneous in their childrens education by giving them enough hold water, since adequate sleep is vital for physical and neuropsychological function (Jiunn and Shih, 248). Inadequate sleep results in to inattention, day measure sleepiness, impaired attention, and memory lapse. For that reason, sufficient sleep is crucial as far as the proper functioning of the brain is concerned (Cheng, Wang and Jeng, 59). Research has revealed that thither is a divergence, as far as grades are concerned, between students who get enough sleep and eat the right diet, and those who do not. Sufficient sleep helps virtuoso to relax and focus on ones studies. Students who do have enough sleep tend to feel lazy and always procrastinates activities, leading to head for the hills load and depression. Sleeping problems are a significant hurdle to learning and cognition, and have an adverse effect on behaviour and the gaining of social competence (Gibson, Powles and Thabane, 116). Furthermore, corking nutrition helps in cognitive functioning. Children who have a deficiency of calcium are likely to suffer from anaemia, which heavily impacts on their school performance. On the homogeneous note, most students consume meals that are high on sugar, fat and sodium, and which may lead to obesity and chronic ailments. Additionally, since most parents are now in the workforce, whatever students end up skipping nutritious meals and opting for junk foods. Consequently, poor nutrition increases the risks of high blood pressure, obesity, cancer, osteoporosis, high cholesterol, heart disease and Type 2 diabetes (Edlin and Golanty, 93-94). This brings the need for teachers and parents to support students in getting sufficient sleep and proper nutrition to ensure they perform well in school. With all the partying, preference for television programmes, part time jobs, and studying, it is inevitable for student s to lack sufficient sleep and to consume poor diet. Research shows that approximately 20% of most college students suffer from insomnia. Those experiencing sleeping disorders suffer from anxiety, irritability, and weight gain, aspects that instantly affecting their performance in school. Additionally, research has revealed that poor nutrition contributes immensely to diseases like cancer, diabetes, obesity, among others, hence, adversely affecting the academic performance of most students (Edlin and Golanty, 93-94). Students should think holistically on how health behaviours are related to their attainment of success (Carter et al., 8-9). Other adverse impacts of lack of sleep and poor nutrition extend to seizure, gaining of weight, and stroke. Consequently, students result in fetching unpleasant measures in order to combat the effects of lack of sleep. Such measures include a high consumption of sodas, coffee, and energy drinks which end up deterioration the problem. Various sc holars agree that students who are sleep deprived tend to score lower marks as compared those who sleep sufficiently. The scholars further add that students should get sextuplet to about eight hours sleep in order to perform well in their tasks. People who fail to get ample rest end up having low productivity and for the students they end up registering poor scores in their academics (Gibson, Powles and Thabane, 116). Most people do not perceive lack

Final exam 2 Essay Example | Topics and Well Written Essays - 500 words

Final exam 2 - Essay ExampleThe information provided by the book with regard to the topic is one that shows that President Kennedy did non jock people or rather workers during his tenure in that he did not push to the civil rights movements. It is particular to understand that a president is very critical towards initiating change and the fact that President Kennedy did nothing to see to changes shows how much of a poor leader he was.This information is important in comprehending the issue of a just nightclub. A just society is one that involves people receiving similar treatment and not having one group showing superiority to the other. According to the book, flush toilet F. Kennedy Struggle for Black Equality, there is the sagaciousness that the Black community did not have as much respect as it has today (Bryant 78). The reason pot the unfairness shown to this community is the fact that it was condescended upon by many other groups.There was a poll carried out in the United States between the year 1960 and 1961 that was to undo the views of the people on what had to be done for America to advance in society (Bryant 93). This factor adds value to the entire project in that there is the understanding that earlier presidents in the United States did not support the black community as they were supposed to. The reason for this is the fact that they were all white. This proves that the American society has not always been just throughout the years.The information provided by the book is important to college students and history enthusiastic people. The fact that the students get to understand the history of the United States and the society makes them appreciate the current environment. In modern times, there are very few issues revolving around civil issues such as racism and social segregation. The changes witnessed in contemporary days are a product of the increased activism by different people in society.The Bystander John F. Kennedy and the Struggle for Black

Pinocchio and the Liar Liar Movies Essay Example | Topics and Well Written Essays - 1500 words

Pinocchio and the Liar Liar Movies - Essay ExampleFletcher spends ample time with his news and the ex-wife though all(prenominal) promise he makes to the son, Max, happens without being fulfilled. This portrays the theme of thieving(prenominal)y, in this movie. Fletcher has adopted the habit of giving superiority to his job while giving false statements on his declining constitution to take good care of his son after his divorce with the wife. This research paper compares and contrasts the Pinocchio and Liar Liar movies in relation to their dishonesty thematic settings. wholeness of the significant themes that are portrayed, in these films, is dishonesty. Both Pinocchio and Liar Liar movies portray their characters to be of an ever-lying nature thus making these movies inappropriate for children without parental guidance. Lastly, this paper explores the thematic differences in these two movies and their impacts on the viewers. Pinocchios kidnapping, being caged and threats for d estructions leave him with no option, but to lie in order to be rescued in any case his parents refuse to turn up. The Liar Liar movie, on the other hand, portrays Fletcher as an ever-lying parent who even misses his sons fifth birthday party. The son makes an ironical wish that, on his fifth birthday party, his father would non lie for the whole day. The father finally turned him down by not attending the birthday party. Pinocchio and Fletcher seem to have neglected their parenting responsibility by leaving the whole upbringing aspect of the socialization process to the mothers. This is evident in Fletcher and Audrey case where they even got divorced as a result of his irresponsible character. In the Pinocchio movie, Pinocchios friend, Lampwick, introduced him to cigar smoking, but he denies it. He is dishonest of the drug malignment they carry out together, and when their parents find this out, they are severely punished. The punishment should be carried out in the dishonest ca ses especially to bring back the norms into the existence within the dishonest individuals. This becomes one of the reasons why Lampwick and Pinocchio are punished for them to comply with social norms. Morality, in these two movies, becomes the key point of view in dishonesty as a thematic setting in both films. Gambling and smoking are the order of the day between Pinocchio, Lampwick and the other boys they find on their manner to Geppettos house. This brings closely the relationship between dishonesty and morality in the Pinocchio dismay pictures (Pinocchio). These characters, in addition, get drunk and vandalized Jiminys dismay because of deviance and dishonest behaviors, which are exhibited by Pinocchio and his friends. This is due to the lack of rules and authority to deter them from these dishonest behaviors. In the Liar Liar movie, on the other hand, moral issues are as well pictured where Fletcher indulges in the extramarital sex before and even after he divorced his wife (Liar Liar). Fletcher is immoral, and he finally confesses this through a series of embarrassing moments. He says to his wife that he just had better sex with Miranda, his boss than he did with her, which makes him unable to tell a lie (Liar Liar).

The Life of workers Essay Example | Topics and Well Written Essays - 750 words

The Life of trifleers - Essay ExampleEven during the good times the wages provided were extremely low and the working conditions were hazardous. Very runty portion of the wealth earned actually went to the workers. Periodic economic crises hit the nation and further increased the problems of the industrial wages leading to high levels of unemployment. On the other hand the technological improvements added to the productivity of the nation and hence increased the demands of the skilled labors. Yet the pools of the unskilled labors were constantly growing, just like the number of the immigrants. The capitalist capitalism actually dominated the latter half of the nineteenth century and increased huge concentrations of power and wealth. This was actually backed by certain elements of the judicatory system that ruled against any one that challenged the system. Many philosophers actually tagged this as Social Darwinism. The cost of such indifferences to the victims of the capitalism wa s high. The working conditions of the labors were poor and the chances of defeating need was very little. In the 1900s the United States of America had high job related fatalities. Most of the industrial workers worked for almost ten hours per day. In the steel industries the working hours went up to twelve hours sometimes. Still these people earned at least thirty to fifty percent less minimum deemed for a decent life. Here it postulate to be mentioned that the first major effort to organize the worker on a national basis became apparent in the year 1869. This was organized by the Philadelphia garments workers and the group called the Noble Order of the Knights of Labor was open to all the workers including Afro Americans, farmers and women also. The knights started to grow slowly but soon started to face decline as the place was taken up by the American federation of Labor (Ashton, 1964). Women coalminers It has been already discussed that the life of a 19th century labor was extremely tough as the workers had to work for long hours in extremely hazardous conditions and yet the workers employ to struggle to maintain a healthy standard of living due to the low wages. The stead was worse for women in particular who actually made up of a high percentage of the work force in some of the industries and yet used to receive a mere fraction of the wages a male worker can earn. Various women workers have reported that the sometimes they had to make 7 shillings a week and work from six oclock in the morning till six oclock in the night. The women had to put knock around the waist and chains passed through the legs. Here it needs to be mentioned that these statements were recorded before 1874 when the city of Massachusetts passed the first legislation of the nation to leap the number of the hours for women and also children (Winstanley, 1998). Sanitary Conditions The health and sanitation was a major concern. As industrial revolutions developed the health and w elfare of the workers went down. In USA the industrial revolutions and the bad effects on the health of the workers were first experienced. This lead to a movement towards the sanitation reforms leading the establishment of various public health institutions. Specifications The 19th century workers were mainly victims of poor social and legislative structures that saw the rich get richer and the poor becoming poorer. Also the workers did not have any organized unions that could stand up for the works. Also the industrial

Document Analysis of Julius Caesar's The Gallic War Essay

Document Analysis of Julius Caesars The Gallic War - Essay ExampleThe onslaught of Britain The year 55 BC was Caesars set glum attempt at invading Britain. It cannot be considered a complete success in the sense that after the excursion, the legions went back to Gaul and Britain was not occupied. But from the Roman position, most assuredly from Caesars point of view, the invasion was a resounding especially when he already received the homage of British tribal chiefs and kings. This, undoubtedly, was the needed evidence to show how the territory has already been conquered as utmost as the campaign is concerned. This first foray, however, has provided Caesar a fleeting glimpse of the Britain and its societies. When they arrived, they instal societies made up of large tribes and clans. Leaders of these groups were not averse to calling themselves kings even when all their constituents were an amalgamation of families and clans. In Caesars eyes we are provided some details about ho w the early Britons conducted their affairs. For instance, he found this out for himself when he noted that the Cantii (people of Kent) have several kings from various kingdoms found in the region. Military Strategy The first campaign involved several skirmishes with the Britons. The Romans had achieved a certain degree of success. And there were several accounts that provided a clear root about the Roman military strategy in Gaul. The Britons like their distant Gaul cousins are also tribal in the way they wage their war. They adoptive the guerilla tactic, which, of course, proved ineffective in the long run. Caesars legions were equipped and experienced in fighting in this condition. The soldiers had the benefit of Roman training, which produced the worlds first truly professional soldiers, those that considered their work as duty and responsibility, obeying the chain of command and are immune to external influence. Additionally, Caesars soldiers were already used to fighting sta ndardised strategies in their war with Gallic tribes. The long campaign in Gaul has equipped them with better understanding in regard to the most effective get on in dealing with their British opponents. Essentially, the strategy adopted in Britain was composed of two major components the scorch earth strategy and the show of force. The former was adopted in response to the large British force. In addition, based from Caesars commentaries, the Britons also proved adept in stealth and treachery. So the strategy entailed the burning and destruction of fields and property and the plunder of supplies in order to deprive the opposition the resources to sustain their operations and weaken them in an effort to resolve skirmish the soonest possible time. After a year passed, Caesar decided to lead another invasion and the campaign this time became a bigger conflict. The Romans and the Britons faced off in several bloody battles. The latter, of course, sustained the most damage since the training and discipline of the Roman force were unmatched. The poorly equipped British though far superior in number were still technically savages, too untrained, wielding rudimentary tools. The show of force was crucial in this campaign as demonstrated in the sheer number of Roman soldiers mobilized and the use of war machines and implements such as war elephants, which, of course, deterred much of the local populace. It is important to note

The American Pursuit of Happiness Beyond US Borders Essay Example for Free

The Ameri cornerst whizz Pursuit of Happiness Beyond US Borders EssayIn recent times, more and more Americans are immigrating to countries homogeneous Canada and Australia in a spirited search of the American dream. Catalysts for this recent trend are tied largely to the American frugal crisis which has been afflicting Americans for quite some time. The improbably high levels of crime in the coupled States have also influenced Americans to pursue happiness beyond U. S. borders. Countries like Canada and Australia demonst straddle lower rates of crime than the united States and that seems to resonate with most Americans. Another convincing factor towards emigration is the high cost of healthcare in the United States compared to some of the politics-funded healthcare systems around the world. every of these dynamics are deeply valued in American society and are seen as worth chasing. I believe emigration towards countries that promote economic stability, low crime rates and socialized healthcare is the ideal thing to do for U. S. citizens in search of these pursuits.America is experiencing a high unemployment rate, large income gaps and an translucent lack of growth for the working middle row due to the modern economic crisis and this is swaying Americans to search for jobs in foreign countries. According to Trading scotchs and the chest of Labor Statistics, the percentage of unemployed Americans is 8. 3% as of January, 2012. This fares out higher than the Canadian unemployment rate which is at 7. 6% and especially elevated compared to the Australian unemployment rate which is 5. 1% (Trading Economics).Also, the latest studies show that mobility between classes in the United States is less apparent than in other countries due to the large American poor class and the tall demand U. S. employers place on the need for college degrees from prospective employees (DeParle). It has become clear to me that the opportunities needed to develop into a success ful and effective worker can be found, with less effort, in a foreign country. The United States has a ghastly reputation of having some of the highest crime rates in the world including capacious quantities of violent offenses.As indicated by the Disaster Center and the F. B. I. Uniform Crimes Report, in 2010 the United States had over ten one million million reported criminal offenses and over one million of them were violent crimes. This measures up much higher than Canadas crime rates which in 2009 were reported at just over two million criminal offenses (Rodriguez). What is dumbfounding is the significant difference in violent offenses which was under four-hundred and fifty thousand (Rodriguez).That is less than the amount of aggravated assaults in the United States in 2010 which totaled over seven-hundred and seventy-five thousand (Disaster Center). The pursuit of happiness certainly entails residing in a safe and sound country and the evidence points towards the land beyond U. S. borders. There is very little the American people treasure more than their health, but with healthcare prices soaring to astronomical heights, it has become difficult to acquire the prerequisite coverage that Americans need.Statistics show that Americans pay over fifty percent more on premiums per capita for health care over other countries in the Organization for Economic Cooperation and Development (OECD) which includes, among others, Canada and Australia (Med Health Insurance). Canadian citizens benefit from publicly funded healthcare coverage without the need to consider their income or medical history (Canadian Health Care). In Australia, the government is primarily responsible for healthcare funding by covering roughly seventy percent of medical costs (Australian Law Reform Commission).The peace of see gained by having a socialized government funded health care plan is invaluable and a worthy basis for emigration from the United States. The American Dream is sought af ter by all Americans and comprises of several key principles. A primary principle is social and financial stability through employment and mobility. The imprimatur standard is the sense of security brought on by reduced crime rates and a reduced amount of violent crimes in particular.A lowest and yet crucial ideal for those in pursuit of happiness is the sense of tranquility acquired through a government-financed healthcare plan. All of these standards cannot be met within the United States, but they can be attained in countries like Canada and Australia. I consider it imperative for Americans to search for these ideals across American boundaries through the act of emigration. I encourage U. S. citizens to think outside this country.

Dialysis Experience Essay Example for Free

Dialysis Experience EssayHemodialysis (HD) is one of several renal replacement therapies used for the discussion of end stage kidney disease (ESKD) and kidney failure. Dialysis removes excess fluids and waste products and restores chemical and electrolyte balance. HD involves passing the patients blood through an artificial semipermeable tissue layer to put to death the filtering and excretion functions of the kidney. One important step before starting regular hemodialysis sessions is preparing the vascular access ideally, a vascular access should be laid weeks or months before you start dialysis. The early placement of the vascular access will allow sufficient time for the access to heal and mature. The three underlying kinds of vascular access for hemodialysis are an arteriovenous (AV) fistula, an arteriovenous (AV) graft, and a venous catheter. Peritoneal dialysis (PD) occurs though diffusion and osmosis across the semipermeable peritoneal membrane and capillaries. The pe ritoneal membrane is large and porous. It allows solutes and water to move from an area of higher concentration in the blood to an area of lower concentration in the dialyzing fluid (diffusion).The fluid and waste products dialyzed from the patient move through the blood vessel walls, the interstitial tissues, and the peritoneal membrane and are removed when the dialyzing fluid is drained from the consistency through a siliconized rubber (Silastic) catheter that is surgically placed into the abdominal cavity. PD is slower than hemodialysis (HD), however, and more time is needed to achieve the same effect. As far as treatment options, both have complications. Hemodialysis includes Disequilibrium syndrome, musclebuilder cramps, bleed, air embolus, cardiac dysrhythmia, and Hemodynamic changes such as hypotension and anemia.Peritoneal dialysis complications include protein loss, peritonitis, hyperglycemia, respiratory distress, and bowel perforation. Hemodialysis Nursing care and ro les are to monitor the patient immediately and for several hours after dialysis for any side effects from the treatment. Common problems include hypotension, headache, nausea, malaise, and vomiting, dizziness, and muscle cramps. The reserve must obtain vital signs and weight for comparison with pre-dialysis measurements. Blood pressure and weight are expected to be reduced as a result of fluid removal.Hypotension may require rehydration with IV fluids, such as normal saline. The patients temperature may also be elevated because the dialysis railroad car warms the blood slightly. If a fever results, sepsis may be present and a blood sample is needed for culture and sensitivity. The heparin required during hemodialysis increases the coagulation time and thus the risk for excessive bleeding. All invasive procedures must be avoided for 4 to 6 hours after dialysis. Continually monitor the patient for hemorrhage during dialysis and for one hour after.Peritoneal dialysis nursing care and roles are to start and monitor during PD. Before treatment, assess baseline vital signs including blood pressure, apical and radial pulse rates, temperature, quality of respirations, and breath sounds. Weigh the patient, always on the same scale, before the procedure and at least 24 hours while receiving treatment. Weight should be checked after a drain and before the next fill to monitor the patients dry weight. Baseline laboratory tests, such as electrolyte and glucose levels, are obtained before starting PD and are repeated at least daily during the treatment.Vital signs need to be recorded every 15-30 minutes. prise for signs of respiratory distress, pain, discomfort. Dressing around the catheter site must be checked every 30 minutes for wetness during procedure. Maintain accurate inflow and outflow records. The nurse monitors the treatment to make sure the client is getting the right amount of hemodialysis to remove enough wastes from the blood. About once a month, the client s blood will be tested by using one of two formulas urea reduction ratio (URR) or total urea dynamic headroom (Kt/V).The physician may adjust the hemodialysis intensity and frequency based on the test results. These labs are crucial and must be checked periodical while being on dialysis. Mr. L was the gentleman I chose to assess, he was very friendly and talkative has been a dialysis client for the past three years. He has dialysis treatments three times a week, and treatments are approximately 3 to 4 hours long depending on his level that day. I asked Mr. L how he felt some being on dialysis and his response was In the early days of dialysis, I would not even drive myself home. I would just collapse on the vomit up in he living room and be there until morning. besides all that has changed. I now drive myself to and from dialysis, and I feel just fine after. I even have a part time job now. I tend to be very hungry after dialysis so I try eating something as soon as I get home. Just one evening recently it was like old times. It was because the nurse took hit more than I wanted and my body really reacted to it. I just went home and collapsed. I was not even able to work the next day. But that is very rare for me. I enjoyed our conversation and my experience at the dialysis center.

Molluscs and Natural Selection Essay Example for Free

Molluscs and Natural Selection EssayThe process of natural selection is one of the most cited reasons for the evolution of a species, and it was made famous by Charles Darwins famous observations of finches in the Galapagos Islands. It is believed to work by way of random mutations random mutations occur, as it indicates, randomly and spontaneously in a population for a multitude of genetic reasons. Mutations help to create variation of different traits within a species, and they can be expressed with different phenotypes. In times where a mutation has no negative effect on the individual organism, this trait could be advantageous in a new habitat or predacious situation, etc. With an advantage in survival, and thus reproduction, these organisms are often selected for over other members of the species, creating a change in variation of a species over generations. Molluscs, although a very large and diverse group of animals, often share certain features a mantle, radula, lambas te, and foot. The mantle is a thin and fleshy layer which secretes the hard shell of a mollusc. The radula is a grate-like building in the m extincth used to scrape surfaces and drill holes.The foot is a muscle which assists in locomotion and movement of the molluscs. It is hypothesized that each(prenominal) current-day molluscs share a common ancestor, called the hypothetical ancestral mollusc or HAM, because of the similar characteristics and body plans that drop been modified in diverse ways over time to adapt to different environments. Two members of the mollusc family include the clam, of the class bivalvia, and the calamari, of the class cephalopoda, and these are an example of variation from the HAM that helped them adapt for their particular environment, victuals behavior, and movement (Sigwart, 2007).The squid species has infragone many adaptations. The squids radula resembles a beak-like structure that it uses to devour its food, very different from the chiton-like H AM which probably had a small radula. oer time, the radulas shape has been mutated and then selected for as the squid changed its eating habits if it provided quicker eating time, then it would be selected for. The squid lacks an outer shell (its intragroupized), so the mantle of the squid has also been modified into muscular flaps that it uses to propel itself quickly through the water, nd thus capture prey or keep off predators, a necessary function due to the squids lack of a hard protective barrier (Sigwart, 2007) A large shell would be unnecessary for the squid since it can propel quickly away from predators, and may even hinder its ability to swim this would lead one to believe that the squid developed a muscular mantle from HAM and then a mutation for loss of the shell was selected for following the muscular body.Also, the foot of the squid has vary from the single foot of the HAM to become tentacles and arms, used to quickly capture and bring prey closer to its beak-like radula to eat, which is buried behind its many arms. This modified transformation of its foot is an extremely effective feeding method that, coupled with the squids speed, en commensurates it to catch and hold prey that otherwise might be able to escape (Sutton, 2007). The clam is a sedentary mollusc that uses its foot to burrow into the sand.The clam is a filter feeder, straining food particles from the water. The clam doesnt have a radula, probably the result of a random mutation that caused some clam ancestors to lack the structure, or it may have been modified into another structure that aided in the filter feeding process. The filter feeding process is environmentally selected for because it enables the animal to take in food particles while buried under the sand. The mantle of the clam is found inside of its hard, hinged shell.The strong shell of the clam was environmentally selected for since it prevents predators from easily eating the clam, allows it to bury safely into t he sand without affecting its internal organs, and improves the clams ability to survive and reproduce. The foot of the clam has adapted so that the species can dig into the sand with this muscle which can be moved out of the shell, a very different type of foot than the HAMs muscular, positioned foot which allows for scavenging (Sutton, 2007). The HAM, very similar to the chiton, served as a good base moulding for this very diverse phylum of animals. Lots of spontaneous and random mutations must have occurred for such diversity to have sedentary, burrowing animals and predatory, jet-propelling animals in the same phylum of animals is quite a feat.

Nurse Strategies to Prevent Elderly Suicide Attempts

Nurse Strategies to Prevent Elderly Suicide AttemptsInvestigation into shield strategies to prevent or denigrate act self-destruction in patients get ond 65 and over.AbstractThis dissertation considers the rationale for positive nurse- idead hindrance in consideration of issues relating to self-annihilation in the decrepit. The introduction sets the context, including the historical context, of the issues and discusses the negative issues of ageism on issues relating to suicide in the remote.The books review considers selected texts which have been chosen for their specific relevance to the issue and specificly those that adopt the view that ageism is counter productive to a satis itemory quality of life outcome for the elderly person.Conclusions be drawn and discussed with specific emphasis on those measures that argon of particular relevance to the c atomic number 18 for profession whether it is in a inessential care facility, a residential home setting or in the original healthcare team and the community.We stinker observe, from a recent theme (OConnell H et al. cc4), the comments that, although thither is no doubt that the elderly present a eminent hazard of completed suicide than any other(a) age group, this position receives comparatively little attention with movers such as media interest, aesculapian research and universal health measures cosmos disproportionately focused on the immatureer age groups (Uncapher H et al. 2000).Perhaps we should not be surprised at the fact that two unsafe feelings and thoughts of hope littleness have been considered part of the social context of growing old and becoming progressively less cap qualified. This is not a phenomenon that is just contain to our society. We know that the Ancient Greeks tolerated these feelings in their society and actively cond unityd the option of assisted suicide if the person involved had come to the conclusion that they had no over oftentimes reclaimabl e role to play in society (Carrick P 2000). Society largely took the view that once an individual had reached old age they no longer had a purpose in life and would be better off dead. In a more modern context, we note the writings of Sigmund Freud who observed (while he was low-down from an incurable malignancy of the palateIt may be that the gods are merciful when they make our lives more unpleasant as we grow old. In the end, finale seems less intolerable than the many burdens we have to bear.(cited in McClain et al. 2003)We would suggest that one of the explanations of this apparent phenomenon of comparative indifference to the plight of the elderly in this regard is due to the fact that the social burden of suicide is often refered to in purely scotch cost, specifically relating to neediness of social contribution and loss of productivity. (Brechin A et al. 2000).This purely economic assessment would have to observe that the young are much more likely to be in employment and less likely to be a burden on the economic status of the country whereas with the elderly exactly the converse is likely to be true. This outgrowths in economic prominence being lend to the death of a younger person in many reviews. (Alcock P, 2003). There is also the fact that, despite the fact that we have al dealy cotton uped the increase in relative frequency of suicide in the elderly, because of the demographic distributions of the nation in the UK, the absolute itemizes of both move suicides and actual suicides are smashinger in the younger age ranges and wherefore more readily apparent and obvious.The elderly are a especially vulnerable group from the risk of suicide. In the modify world males over the age of 75 represent the single largest demographic group in terms of suicide attempts. Interestingly (and for reasons that we shall shortly discuss) although on that point is a general campaign of increasing suicide rate with age the excess pass judgment associa ted with the elderly are slowly declining in the recent past (Cattell 2000).We can quantify this statement by considering the statistics. If we consider the dot 1983 to 1995 in the UK then we can show thatThe suicide rates for men reduced by mingled with 30% and 40% in the age groups 5564, 6574 and 7584The rates for the most elderly men (males over 85 social classs) remained fairly static, this group still having the highest rates of any groupBy way of contrast, the 25- to 34-year-old male group exhibited a 30% increase in suicide rate during the same period, this group are becoming the group with the second highest rate, while the 15- to 24-year-old male group demonstrated a 55% increase in suicide rates. (WHO 2001)Female suicide rates have shown a similar overall lessening, reducing by between 45 and 60% in the 4584 age group.Elderly women, however, retain the highest rates throughout the life span (Cattell 2000)The ratio of male to female elderly suicide deaths remains appro ximately 31 (Fischer L R et al. 2003)We can suggest that these trends in decline of suicide, particularly in the elderly are likely to be due, amongst other things, toThe improved spotting of those at risk together with the advent of vulturine treatment policies relating to mental illness in the elderly. (Waern M et al. 2003)One of the main reasons, we would suggest, for this seemingly changing pattern and the discrepancies in the suicide rates between the age ranges, is the fact that, in direct consideration of the context of our topic, the elderly are more likely to be both amenable to professional help and also, by virtue that a higher proportion are likely to be in direct contact with healthcare professionals either through failing health or nursing homes and hospitals, (Suominen K et al. 2003), have the warning signs of impending suicide appreciate and acted upon more promptly than the younger, arguably more independent age group.In specific consideration of the elderly gr oup we should also note that attempted suicide is more likely to be a failed suicide attempt rather than a parasuicide. (Rubenowitz E et al. 2001).There is considerable prove that the incidence of effect is change magnitude in the presence of a concurrent physical illness (Conwell Y et al. 2002) and clearly this is going to be more likely in the elderly age group. Some sources have cited association rates of between 60-70% of major stamp with physical illness in the over 70yr olds. (Conwell Y et al. 2000).Another significant factor in is that it is commonly accepted that an attempted suicide is a strong independent risk factor in the aetiology of further suicide attempts. (Conwell Y et al. 1996) This trend is much more marked in the elderly group with a ratio of close 41 which compares very badly with the ratios in the younger age groups of between 81 and 2001 (depending on age range, definition and test). (Hepple J et al. 1997)In this dissertation it is intended to gain be ar witness based knowledge of the scope and significance of the phenomenon of attempted suicide in the elderly. In addition it is intended to gain say based knowledge in the use of strategies to ameliorate attempted suicide in the elderly to highlight gaps in the literature available and to suggest recommendations for change in nursing formula It is hoped to be able to suggest subjects for research into the phenomenon of attempted suicide in the elderly.The initial strategy was to under pee a library search at the topical anaesthetic post graduate library and the local university library (Client you might like to personalise this) on the key words suicide, elderly, prevention strategies, industrialised societies. This presented a great many papers. About 40 were selected and read to provide an overview of the literature in this area. During this phase, references were noted and followed up and key literary works were assimilated. The bulk of the papers accessed and read were pub lished within the last decade, however a number of significant older references were also accessed if they had a specific bearing on a particular issue. The most significant references were accessed and digested. The dissertation was written referencing a selected sub-set of these works.To increase nurses knowledge and understanding of attempted suicide in the older age group and to highlight through the literature review, evidence based strategies that an be employed to ameliorate attempted suicide amongst the elderly.Literature reviewBefore commencing the literature review, it is acknowledged that the literature on this subject is huge. The parameters of the initial search have been defined above. In addition it should be noted that there is a considerable literature on the subject of assisted suicide which has been specifically excluded from these considerationsThe literature base for suicide in the elderly is quite extensive and provides a good evidence base for understanding, a ppropriate action and treatment. (Berwick D 2005)One of the landmark papers in this area is by Hepple and Quinton (Hepple J et al. 1997) which provided a benchmark, not only on the aetiology of the subject, but also in the long term outcomes, which, in terms of potential nursing care in personate, is super important. The paper points to the fact that there is a good understanding of the absolute risk factors for suicide in the elderly but a comparative lack of good quality follow up studies in the area. It set out to identify 100 cases of attempted suicide in the elderly and then follow them up over a period of years. The employment was a retrospective examination of 100 consecutive cases of attempted suicide that were referred to the psychiatric services over a four year period. The authors were able to make a detailed investigation (including an interview of many of the survivors), about(predicate) four years later. Their findings have been widely quoted in the literature.Of pa rticular relevance to our considerations here we note that they found that of the 100 cases identified, 42 were dead at the time of follow up. Of these, 12 were suspected suicides and fiver more had died as a result of complications of their initial attempt. There were 17 further attempts at suicide in the remaining group. Significantly, the twelve women in the group all made non-lethal attempts whereas all five of the men made successful attempts. The authors were able to establish that the risk of further attempts at suicide (having made one attempt) was in excess of 5% per year and the success rate was 1.5% per year in this group. From this fill we can also conclude that the risk of successful repeat attempted suicide is very much greater if the subject is male. The authors were also able to establish that, because of their initial attempt, those at risk of self harm were likely to be in contact with the psychiatrical services and also suffering from persistent severe depressi on.We can examine the paper by Dennis (M et al. 2005) for a further insight into the risk factors that are bunsable in the at risk groups. This paper is not so detailed as the Hepple paper, but it differs in its construction as it is a control matched study which specifically considered the non-fatal self harm scenario. The study compared two groups of age matched elderly people both groups had a history of depression but the active study group had, in addition, a history of self harm. The significant differences highlighted by this study were that those in the self harm group were characterised by a poorly(predicate) integrated social network and had a significantly more hopeless ideation. This clearly has implications for intervention as, in the context of a care home or warden assisted setting, there is scope for improving the social desegregation of the isolated elderly, and in the domestic setting community support can provide a number of options to remove factors that miti gate towards social isolation. This would appear to be a positive step towards reducing the risk of further self harm.The OConnell paper (OConnell et al. 2004) is effectively a tour de force on the pertinent issues. It is a review paper that cherry-picks the important information from other, quite disparate, studies and combines them into a coherent whole. It is extremely well written, very detailed, quite long and extremely informative. While it is not appropriate to consider the paper in its entirety, there are a number of factors that are directly relevant to our considerations here and we shall restrict our comments to this aspect of the paper.In terms of the identification of the risk factors associated with attempted suicide in the elderly, it highlights psychiatric illnesses, most notably depression, and certain personality traits, together with physical factors which entangle neurological illnesses and malignancies. The social risk factors identified in the Dennis paper are expanded to include social isolation, being divorced, widowed, or long term single.The authors point to the fact that many of the papers refered to tend to treat the fact of suicide in reductionist terms, analysing it to its basic fundamentals. They suggest that the actual burden of suicide should also be considered in more human terms with consideration of the consequences for the family and community being understood and assessed. (Mason T et al. 2003)In terms of nursing intervention for suicide prevention, we note that the authors express the hypothesis that suicidality exists along a continuum from suicidal ideation, through attempted suicide, to completed suicide. It follows from this that a nurse, picking up the possibility of suicidal ideation, should consider and act on this as a significant warning sign of contingent impending action on the part of the patient.The authors point to the fact that the estimation of the actual significance of the various prevalences of suicid e varies depending on the study (and and so the definition) (Kirby M et al. 1997). In this context we should note that the findings do not support the ageist assumptions expounded earlier, on the grounds that the prevalence of either hopelessness or suicidal ideation in the elderly is reported as up to 17% (Kirby M et al. 1997), and there was a universal association with psychiatric illness, especially depressive illness.If we consider the prevalence of suicidal feelings in those elderly people who have no evidence of mental disturb, then it is as low as 4%. It therefore seems clear that hopelessness and suicidality are not the natural and understandable consequences of the ageing process as Freud and others would have us believe. This has obvious repercussions as far as nursing (and other healthcare) professionals are concerned, as it appears to be clearly inappropriate to assume that suicidality is, in most cases, anything other than one of many manifestations of a mental illnes s. It also follows from this, and this again has different nursing implications, that suicidal ideation and intent is only the tip of the iceberg when one considers the weight of psychological, physical and social health problems for the older person. (Waern M et al. 2002)If one considers evidence from studies that involve psychological autopsies, there is further evidence that psychopathology is involved. Depressive disorders were found in 95% in one study. (Duberstein P R et al. 1994) Psychotic disorders and apprehension states were found to be poorly correlated with suicidal completion.Further evidence for this vantage point comes from the only study to date which is a prospective cohort study in which completed suicide was the outcome measure. (Ross R K et al. 1990). This shows that the most reliable predictor of suicide was the self-rated severity of depressive symptoms. This particular study showed that those clients with the highest ratings were 23 quantify more likely to die as the result of suicide than those with the lowest ratings. It also noted that other independent risk factors (although not as strong), were drinking more than 3 units of alcohol per day and sleeping more than 9 hours a night.One further relevant point that comes from the OConnell paper is the fact that expression of suicidal intent should never be taken lightly in the older age group. The authors cite evidence to show that this has a entirely different pattern in the elderly when compared to the younger age groups. (Beautrais A L 2002).The figures quoted show that if an elderly person undertakes a suicide attempt they are very much more likely to be successful than a younger one. The ratio of parasuicides to completed suicides in the adolescent age range is 2001, in the general population it is between 81 and 331 and in the elderly it is about 41. (Waern M et al. 2003). It follows that suicidal demeanor in the elderly carries a much higher degree of intent. This finding co rrelates with other findings of preferential methods of suicide in the elderly that have a much higher degree of lethality such as firearms and the use of hanging. (Jorm A F et al. 1995).The paper by Cornwell (Y et al. 2001) considers preventative measures that can be put in place and suggests that independent risk factors commonly associated with suicide in the elderly can be expanded to include psychiatric and physical illnesses, functional impairment, personality traits of neuroticism and low openness to experience, and social isolation. And of these, t is affective illness that has the strongest correlation with suicide attempts. We have discussed (elsewhere) the correlation between impending suicide and contact with the primary care providers. Cornwell cites the fact that 70% of elderly suicides have seen a member of the primary healthcare team within 30 days of their death and therefore proposes that the primary healthcare setting is an important venue for screening and inter vention. It is suggested that mood disorders are commonplace in primary healthcare practice but, because they are comparatively common, are underdiagnosed and often inadequately treated (ageism again).The authors suggest that this fact alone points to the fact that one of the suicide prevention strategies that can be adopted by the primary healthcare team. they suggest that clinicians, whether they are medically qualified or nursing qualified, should be trained to identify this group and mobilise appropriate intervention accordingly. Obviously the community nurses can help in this regard as they are ideally placed to maximise their contact with vulnerable and high risk groups.We have identified the role of a major depressive illness in the aetiology of suicide in the elderly. Bruce (M L et al. 2002) considered the role of both reactive and idiopathic major depression in the population of the elderly in a nursing home setting. This has particular relevance to our considerations as fi rstly, on an intuitive level, one can possibly empathise with the reactive depressive elements of the elderly person finding themselves without independence in a residential or nursing home and secondly, this is maybe the prime setting where the nurse is optimally placed to monitor the mood and other risk factors of the patient and continual close quarters. The salient facts that we can take from this study are that there was a substantial burden of major depressive symptomatology in this study group (13.5%). The majority (84%) were experiencing their first major depressive episode and therefore were at greatest risk of suicide. The depression was associated with comorbidity in the majority of cases including medical morbidity, instrumental activities of daily living disability, reported pain, and a past history of depression but not with cognitive function or sociodemographic factors. All of these positive associations which could have been recognised as significant risk factors o f suicide in the elderly.Significantly, in this study, only 22% of all of the seriously depressed patients were receiving antidepressant therapy and none were receiving any sort of psychotherapy. In addition to this the authors point to the fact that 31% of the patients who were put on antidepressants were taking a subtherapeutic dose (18% because they were purposely not complying with the dosage instructions). The conclusions that the authors were able to draw from this study were that major depression in the elderly was double as common in the residential setting as opposed to those elderly patients still in the community. The majority of these depressed patients were effectively left untreated and therefore at significant risk of suicide. There was the obvious conclusion that a great deal more could be done for this study population in terms of relieving their social isolation and depressive illnesses. And, by extrapolation, for their risk of suicide.Ethical considerations.In con sideration of the issue of suicide in the elderly we note that there are a number of ethical considerations but these are primarily in the field of assisted suicide which we have specifically excluded from this study. (Pabst Battin, M 1996)Having set up the evidence base in the literature that defines the risk factors that are known to be particularly associated with suicide in the elderly, we take it as read that this allow form part of the knowledge base for the nurse to be alert to, and to identify those patients who are at particular risk of suicide. It is equally important to be aware of those factors that appear to confer a degree of protection against suicide. This will clearly also help to inform strategies of intervention for the nurse.Studies such as that by Gunnell (D et al. 1994) point to the fact that religiosity and life satisfaction were independent protective factors against suicidal ideation, and this factor was particularly noted in another study involving the te rminally ill elderly where the authors noted that higher degrees of spiritual well-being and life satisfaction scores both independently predicted lower suicidal feelings. (McClain et al. 2003).The presence of a spouse or significant friend is a major protective factor against suicide. Although clearly it may not be an appropriate intervention for nursing care to facilitate the presence of a spouse () it may well be appropriate, particularly in residential settings, to facilitate social interactions and the setting up of possible friendships within that setting (Bertolote J M et al. 2003)This Dissertation has considered the rationale behind the evidence base for nursing intervention and strategies to prevent or minimise suicide attempts in the elderly age group. We have outlined the literature which is directed at identification of the greatest at risk groups and this highlights the importance of the detection and treatment of both psychiatric disorders (especially major depression) , and physical disorders (especially Diabetes Mellitus and gastric ulceration). (Thomas A J et al. 2004)Although we have been at pains to point out the relatively high and disproportionate incidence of suicide in the elderly, we should not loose sight of the fact that it is not a common event. One should not take the comments and evidence presented in this dissertation as being of sufficient severity to merit screening the entire elderly population. (Erlangsen A et al. 2003) The thrust of the findings in this dissertation are that the screening should be entirely timeserving. The evidence base that we have defined should be utilised to identify those who are in high risk groups, for example, those with overt depressive illnesses, significant psychological and social factors, especially those who have a history of previous attempted suicide. The healthcare professional should not necessarily expect the elderly person to volunteer such information and if the person concerned is natur ally withdrawn or reserved, minor degrees of depressive symptoms may not be immediately obvious. (Callahan C M et al. 1996).In terms of direct nursing intervention, this must translate into the need to be aware of such eventualities and the need to enquire directly about them. The nurse should also be aware that the presence of suicidal feelings in a patient with any degree of depression is associated with a lower reply rate to treatment and also an increase in the need for augmentation strategies. The nurse should also be aware of the fact that these factors may indicate the need for secondary referral. (Gunnell D et al. 1994).If we accept the findings of Conwell (Y et al. 1991), then the estimated population at risk from significant mood disorder and therefore the possibility of attempted suicide in the elderly, is 74%. This can be extrapolated to suggest that if mood disorders were eliminated from the population then 74% of suicides would be prevented in the elderly age group. C learly this is a theoretical viewpoint and has to be weighed against the facts that firstly elimination of mood disorders (even if it were possible), would only be achieved by treatment of all existing cases as well as prevention of new-fashioned cases, and the secondary prevention of sub-clinical cases.We know, from other work, that the detection and treatment of depression in all age ranges is low, and even so only 52% of cases that reach medical attention make a significant response to treatment (Bertolote J M et al. 2003). These statistics reflect findings from the whole population and the detection rates and response rates are likely to lower in the elderly. (Wei F et al. 2003).It follows that although treatment of depressive illness is still the mainstay of treatment intervention as far as suicide prevention is concerned, preventative measures and vigilance at an individual level are also essential. Nursing interventions can include measures aimed at improving physical and s tirred health together with improved social integration. Sometimes modification of lifestyle can also promote successful ageing and lead to an overall decrease in the likelihood of suicidal feelings. (Fischer L R et al. 2003)On a population level, public health measures designed to promote social contact, support where necessary, and integration into the community are likely to help reduce the incidence of suicide in the elderly, particularly if we consider the study by Cornwell (Y et al. 1991) which estimated the independent risk factor for low levels of social contact in the elderly population as being 27%. Some communities have provided telephone lines and this has been associated with a significant reduction in the completed suicide in the elderly (Fischer L R et al. 2003)To return to specific nursing interventions, one can also suggest measures aimed at reducing access to, or availability of the means for suicide such as restricting access to over the counter medicines. (Skoog I et al. 1996),Some sources (Cattell H 2000) point to the possibility of introducing opportunistic screening in the primary healthcare setting. The rationale behind this suggestion is the realisation that there is a high level of contact between the suicidal elderly person and their primary healthcare team in the week onward suicide (20-50%) and in the month before suicide (40-70% make contact). This is particularly appropriate to our considerations here because of the progressively increasing significance of the role of the nurse within the primary healthcare team particularly at the first point of contact. (Hogston, R et al. 2002)The evidence base for this point of view is strengthened by reference to the landmark Gotland study (Rutz W et al. 1989) which examined the effect of specific prep in suicide awareness and prevention in the primary healthcare team by providing extensive suicide awareness training and measures to increase the facilitation of opportunistic screening of th e population. Prior to the intervention, the authors noted that, when compared to young adults, the elderly were only 6% as likely to be asked about suicide and 20% as likely to be asked if they felt depressed and 25% as likely to be refered to a mental health specialist. This balance was restored almost to newton after the intervention.Suicide in the elderly is a multifaceted and complex phenomenon. It appears to be the case that the elderly tend to be treated with different guidelines from the young suicidal patient insofar as the increased risk is not met with increased assistance. (Lykouras L et al. 2002). We have presented evidence that the factors included in this discrepancy may include the higher overall number of young suicides, the higher economic burden that society appears to carry for each young suicide together with ageist beliefs about the factors concerning suicide in the elderly.From the point of view of nursing intervention, both in a hospital and in a community s etting, there should be greater emphasis placed on measures such as screening and prevention programmes targeted at the at risk elderly. There is equally a need for aggressive intervention if depression or suicidal feelings are overtly expressed, particularly in the relevant subgroups where additional risk factors may be active, for example those with comorbid medical conditions or social isolation or recent bereavement. (Harwood D et al. 2001),Many of the elderly spend their last years in some form of supply accommodation, whether this is a nursing home, a hospital, warden assisted housing or being cared for by the family. (Haupt B J et al. 1999) In the vast majority of cases this is associated with a loss of independence, increasing frailty and an increasing predisposition to illness that comes with increasing age. (Juurlink D N et al. 2004). This loss of independence and increasing predisposition to illness is also associated with depressive illnesses of variable degrees. (Bruc e M L et al. 2002). These patients are arguably, by a large, more likely to come into contact with the nurses in the community. (Munson M L 1999) The comments that we have made elsewhere relating to the nurses role in being aware of the implications for the depressed elderly patient are particularly appropriate in this demographic subgroup. As a general rule, it may be easier to keep a watchful eye on patients who are exhibiting early signs of depressive illness or mood disorder in this situation by making arrangements to visit on a regular basis or on significant anniversaries such as the death of a spouse or a wedding anniversary. (Nagatomo I et al. 1998) when the risk factors for suicide increase dramatically (Schulberg H C et al. 1998)The literature in this area is quite extensive and covers many of the aspects of suicide in the elderly. It is noticeable however, that there is a great deal of literature on the subject of risk factors and associations of suicide together with ple nty of papers which quote statistics that relate the various trends and incidences. There are, by comparison, only a few papers which emphasise and reflect on the positive aspects of nursing care. The positive steps that can be taken by the nursing profession specifically to help to minimise the burden of suicidal morbidity. There is clearly scope for studies in areas such as the impact that a dedicated community nurse might have on the levels of depression in the community if regular visits were timetabled. It is fair to observe that the community mental health nurses fulfil this role to a degree, but are severely hampered in most cases by sheer weight of numbers in the caseload. (Mason T et al. 2003)Having made these observations, we must conclude that there appears to be an overwhelming case for opportunistic screening of the at risk elderly at any point of contact with a healthcare professional. It is part of the professional remit of any nurse to disseminate their specific prof essional learning with others. (Yura H et al. 1998). This can either be done on an informal professional basis in terms of mentorship or, if appropriate in a lecture or seminar situation. (Hogston, R et al. 2002). There clearly is little merit in critically evalua