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